Elsevier

Public Health

Volume 119, Issue 6, June 2005, Pages 509-517
Public Health

Poor health is associated with episodic heavy alcohol use: evidence from a National Survey

https://doi.org/10.1016/j.puhe.2004.08.016Get rights and content

Summary

Objectives

The objective of this study was to examine the relationship between self-rated health and episodic heavy drinking in a representative sample of American adults. We also sought to determine ethnic and gender differences in the association between self-rated health and episodic heavy drinking.

Methods

Data (n=4649) from the Third US National Health and Nutrition Examination Survey were utilized for this investigation. Episodic heavy drinking was defined as the consumption of five or more and four or more alcoholic beverages on one occasion for men and women, respectively. Poor health was defined as answering fair or poor to the question: ‘Would you say your health in general is excellent, very good, good, fair or poor?’ Odds ratio from the logistic linear regression analysis was used to estimate the risk for poor health that was associated with episodic heavy drinking. Statistical adjustments were made for age, hypertension, diabetes, current smoking, body mass index and race/ethnicity.

Results

Overall, episodic heavy drinking was associated with increased odds of poor self-rated health in men and women. In men, episodic heavy drinking was independently associated with 1.28 (95% CI: 1.07–1.82) increased odds of poor health. The corresponding value in women was 1.86 (95% CI: 1.05–2.28). In men, being Black was associated with ∼two-fold (OR=1.96; 95% CI: 1.33, 2.89), and being Hispanic was associated with ∼four-fold (OR=3.59; 95% CI: 2.50, 5.14) increased odds of poor self-rated health relative to being White. The corresponding odds ratios in women were 2.97 (95% CI: 1.90, 4.64) and 5.18 (95% CI: 3.23, 8.30). Associations were greater among blacks (adjusted OR=2.41; 95% CI: 1.81–3.22) and Hispanics (adjusted OR=4.15; 95% CI: 3.12–5.52) than among whites.

Conclusions

Poor health is associated with episodic heavy alcohol consumption. Public health strategies to curb alcohol abuse may improve self-reported health status in these at-risk populations.

Introduction

Alcohol abuse is an adverse health behavior that is associated with increased risk for many chronic diseases.1, 2, 3 Alcohol abuse is a marker for sociobehavioral disintegration, and is significantly associated with increased mortality in different populations.4, 5, 6, 7 In the USA, alcohol abuse is associated with approximately 100,000 deaths annually, and it is the third leading preventable cause of death.7 Alcohol abuse is associated with development of cancers of the liver and esophagus.8, 9 Recent data on the prevalence of alcohol use among US adults demonstrated that alcohol abuse is more prevalent among low socio-economic groups.10

A classical form of alcohol abuse that is often associated with acute impairment and a substantial portion of all alcohol-related deaths is episodic heavy drinking (sometimes called binge drinking). Episodic heavy drinking is generally defined as the consumption of five or more alcoholic beverages on a single occasion.11 Adverse health effects of episodic heavy drinking include falls, burns, drowning, hypothermia and motor vehicle injuries.12, 13, 14 Other consequences of episodic heavy drinking are suicide, alcohol poisoning, hypertension, diabetes, coronary heart disease, gastritis and sexually transmitted diseases.15 Social and economic burdens of episodic heavy drinking are often described in terms of violence, unintended pregnancy, child neglect, fetal alcohol syndrome and lost productivity.15 In the USA, social burdens of episodic heavy drinking are more prevalent among adolescents.16

While much of the association between episodic heavy drinking is described in the literature in terms of specific diseases, only a few studies exist linking episodic heavy drinking with a broad measure of overall health (self-rated health). The reported association between overall health and alcohol consumption in these studies is inconsistent. Investigating university students from Sweden, Vaez and Laflamme observed an association between poor self-rated health and alcohol use.17 An association between poor health and alcohol use was also observed by Powles et al.18 in a population from Melbourne, Australia. However, in Russia, Carlson19 did not observe any association between poor health and episodic heavy drinking.

Self-rated health is a summary measure of different domains of health that includes the psychosocial domain.20, 21 Self-rated health reflects a complex process of internalization that takes into account both disease exposure experiences and knowledge of disease causes and consequences.20, 21 Self-rated health is an important indicator of health that is associated with a wide range of outcomes, from wellbeing to health service utilization,20, 21 and even overall mortality.22, 23

Despite gender differences in the perception of overall health and episodic heavy drinking,24, 25, 26 there is little data to date concerning the relationship between overall health and episodic heavy drinking. Hence, in this study, we examined the relationship between self-rated health and episodic heavy drinking in a representative sample of American adults. We also sought to determine gender differences in the association between episodic heavy drinking and self-rated health.

Section snippets

Data source

Data from the Third US National Health and Nutrition Examination Survey (NHANES III) as provided by the National Center for Health Statistics were used in this investigation. The sampling and measurement procedures have been described in detail previously by other investigators.27, 28, 29 Briefly, NHANES III is a multistage probability sampling that was conducted in non-institutionalized US population groups between 1988 and 1994. Only subjects identified as non-Hispanic whites, non-Hispanic

Results

Fig. 1 shows the distribution of eligible men (n=2244) and women (n=2405) by self-rated health status. There was a statistically significant gender difference with respect to perceived health (P<0.05). The proportion of subjects reporting poor health (defined as fair or poor in the self-rating five-point Likert-type scale) was significantly higher in women (26.3%) compared with men (23.7%).

The basic characteristics of subjects reporting poor health and good health are shown in Table 1. There

Discussion

Episodic heavy drinking, which may be defined as the consumption of four or more drinks on one occasion, is increasingly becoming a common pattern of alcohol abuse in the USA. A reduction in episodic heavy drinking is one of the leading health initiatives described in US Healthy People 2010.34 Although many studies associating alcohol abuse such as alcohol dependence and binge drinking are often described in relation to well-established diseases, to our knowledge, only a few studies have

Conclusion

Episodic heavy drinking is an adverse health behavior that has consequences for public health. The result of this study indicating an association between episodic heavy drinking and increased risk for poor self-rated health provides a framework to communicate ill effects of this form of alcohol abuse to the general public. There is a need to educate the public about the risk to overall health that is attributable to episodic heavy drinking.

Acknowledgements

We thank the US National Center for Health Statistics for providing data that were used in this study.

References (58)

  • J. Rehm et al.

    Alcohol as a risk factor for global burden of disease

    Eur Addict Res

    (2003)
  • C. Power et al.

    The role of family formation and dissolution in shaping drinking behaviour in early adulthood

    Br J Addict

    (1990)
  • M. Ramstedt

    Alcohol consumption and alcohol-related mortality in Canada, 1950–2000

    Can J Public Health

    (2004)
  • A.H. Mokdad et al.

    Actual causes of death in the United States, 2000

    JAMA

    (2004)
  • M.J. Thun et al.

    Alcohol consumption and mortality among middle-aged and elderly US adults

    N Engl J Med

    (1997)
  • G.K. Singh et al.

    Social epidemiology of chronic liver disease and cirrhosis mortality in the United States, 1935–1997: trends and differentials by ethnicity, socioeconomic status, and alcohol consumption

    Hum Biol

    (2000)
  • A. Yokoyama et al.

    Alcohol and oropharyngolaryngeal and digestive tract cancer

    Nihon Arukoru Yakubutsu Igakkai Zasshi

    (2001)
  • G.M. Curran et al.

    Gender differences in the relationships among SES, family history of alcohol disorders and alcohol dependence

    J Stud Alcohol

    (1999)
  • H. Wechsler et al.

    Binge drinking: the five/four measure

    J Stud Alcohol

    (1998)
  • J. Kauhanen et al.

    Beer binging and mortality: results from the Kuopio ischaemic heart disease risk factor study, a prospective population based study

    BMJ

    (1997)
  • A.J. McDonald et al.

    US emergency department visits for alcohol-related diseases and injuries between 1992 and 2000

    Arch Intern Med

    (2004)
  • Tenth Special Report to the US Congress on Alcohol and Health

    (2000)
  • J.M. Shultz et al.

    Quantifying the disease impact of alcohol with ARDI software

    Public Health Rep

    (1991)
  • J. Rehm et al.

    The relationship of average volume of alcohol consumption and patterns of drinking to burden of disease: an overview

    Addiction

    (2003)
  • M. Vaez et al.

    Health behaviors, self-rated health, quality of life: a study among first year Swedish university students

    J Am Com Health

    (2003)
  • W. Powles et al.

    Differences in drinking patterns associated with migration from Greek island to Melbourne, Australia a study of sibships

    J Stud Alcohol

    (1991)
  • P. Carlson

    Risk behaviors and self-rated health in Russia

    J Epidemiol Community Health

    (2001)
  • N.M. Krause et al.

    What do global self-rated health items measure?

    Med Care

    (1994)
  • E.L. Idler et al.

    The meaning of self-rated health: a qualitative and quantitative approach

    Res Aging

    (1999)
  • Cited by (41)

    • Alcohol and other substance use during the COVID-19 pandemic: A systematic review

      2021, Drug and Alcohol Dependence
      Citation Excerpt :

      Some people in isolation may turn to alcohol to alleviate feelings of fear or boredom (Krotava and Todman, 2014) while others may do so because they do not have social pressures or answerability that is more likely when drinking in public and/or with friends. Other identified risk factors for increased alcohol consumption have also been found in previous studies; male gender (Nolen-Hoeksema, 2004); income loss or unemployment (Khan et al., 2002); education (Crum et al., 1993), poor physical health (Okosun et al., 2005), impulsivity (Simons et al., 2004), and fear and distress (Holzhauer et al., 2017). One perhaps surprising risk factor in the included studies was parental status (those with children were more likely to increase their alcohol use during the pandemic).

    • Cautionary tails of grip strength in health inequality studies: An analysis from the Canadian longitudinal study on aging

      2020, Social Science and Medicine
      Citation Excerpt :

      Health is a multidimensional concept, and a growing number of studies examining determinants of grip strength reveal a potentially unique health measurement construct for grip strength (Isen et al., 2014; Frederiksen et al., 2002; Dodds et al., 2012). For example, while associations between health damaging behaviours and lower self-rated health are consistently shown (Shields and Shooshtari, 2001; Abu-Omar et al., 2004; Okosun et al., 2005; Galán et al., 2010; Shankar et al., 2011; Kim et al., 2013; Abuladze et al., 2017), such associations are inconsistently reported for grip strength (Cooper et al., 2010; Strand et al., 2011a, 2011b). In addition, Cesari et al. (2008) show potentially different pathways between mortality and grip strength and between mortality and self-rated health (Cesari et al., 2008).

    • Patterns of alcohol use and associated characteristics and HIV-related outcomes among a sample of African-American women living with HIV

      2020, Drug and Alcohol Dependence
      Citation Excerpt :

      Three sets of participant characteristics (demographic, social, and clinical) were evaluated based on a review of the alcohol and HIV literature and measures available in the Unity Study (Williams et al., 2016a). Demographic characteristics hypothesized to be associated with patterns of alcohol use in this sample included participant age (continuous), educational level (less than high school, high school or equivalent, or greater than high school), Latina/Hispanic identity (Latina/Hispanic or other), and marital status (married/partnered or other) (Chavez et al., 2015; Curran et al., 1998; Darrow et al., 1992; Epstein et al., 2007; Klein et al., 2016; Okosun et al., 2005; Volk et al., 1996; Williams et al., 2014a). Social characteristics included characteristics hypothesized to be negatively (HIV-related stigma) or positively (religiosity, social support, and attachment and belonging to one’s ethnic identity) associated with patterns of alcohol use (Brome et al., 2000; Cotton et al., 2006; Lehavot et al., 2011; Liao et al., 2014; Mannes et al., 2016; Martin et al., 2003; Mulia et al., 2008; Peirce et al., 2000; Serovich et al., 2001; Vyavaharkar et al., 2010).

    • Defining binge drinking: young drinkers’ perceptions of risky alcohol consumption

      2017, Public Health
      Citation Excerpt :

      However, further work is needed to explicate the range of relevant beliefs that are brought to the drinking occasion and the implications of these for health promotion efforts targeting this high-risk population segment. Behavioural theories document the role of pre-existing beliefs in determining behavioural outcomes, highlighting the importance of addressing these beliefs in health promotion campaigns.7 Accordingly, the aim of the present study was to provide insight into (i) how young Australian drinkers understand and use the term ‘binge drinking’ and (ii) implications for the development of interventions to reduce heavy episodic drinking in this age group.

    • Substance-use coping and self-rated health among US middle-aged and older adults

      2015, Addictive Behaviors
      Citation Excerpt :

      Self-rated health is correlated with health-related outcomes and physician ratings of health (LaRue, Bank, Jarvik, & Hetland, 1972), offering a quick and inexpensive means of assessing the effect of substance use on overall health. Prescription drug use, alcohol consumption, and smoking have been associated with lower self-rated health (Darviri, Artemiadis, Tigani, & Alexopoulos, 2011; Hor, 2008; Lim, Ma, Heng, Bhalla, & Chew, 2007; Okosun, Seale, Daniel, & Eriksen, 2005; Schulz, Mittelmark, Kronmal, et al., 1994). Studies of the association between self-rated health and either alcohol use or alcohol use disorders among older adults have shown mixed results (Darviri et al., 2011; Girón, 2012; Lin, Karno, Grella, et al., 2011; Valencia-Martin, Galan, & Rodriguez-Artalejo, 2009).

    • Longitudinal changes in drug use severity and physical health-related quality of life among untreated stimulant users

      2009, Addictive Behaviors
      Citation Excerpt :

      Thus, the impact of treatment on HRQL might be indirect through improvements in mental health functioning. We were surprised to find that higher ASI-alcohol use scores were concurrently associated with better SF-8 PCS scores because a number of population-based studies have shown that heavy alcohol consumption is associated with poorer physical HRQL (Okoro et al., 2004; Okosun, Seale, Daniel, & Eriksen, 2005; Stranges et al., 2006). On the other hand, moderate alcohol consumption has been shown to be associated with better SF-36 PCS scores (Stranges et al., 2006).

    View all citing articles on Scopus
    View full text