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Israel 2000: immigration and gender differences in alcohol consumption.

The present study addresses the association between immigration from the former Soviet Union (FSU) and gender and alcohol consumption among a representative sample of young adults in Israel 2000. Previous studies that were conducted on FSU immigrants to Israel indicate higher consumption than that of resident Israelis and immigrants of earlier periods. The current study aims to assess alcohol consumption among FSU and resident Israelis five years later to determine whether the discrepancy in alcohol consumption stays consistent or reduces. In addition, gender differences in alcohol consumption among the Israeli society were examined as well, as a special case of socio-culture differences. The data came from the 2000 national survey of drinking in Israel. Of 5,004 Jewish Israelis, 532 were immigrants from the FSU who arrived since 1989, and 4,472 were resident Israelis. The FSU group was compared with resident Israelis, and males were compared to females on several drinking variables. Logistic regression was the principal method of analysis. Demographics and cultural variables as main effects or in interaction with FSU and gender were controlled. The FSU group was significantly more likely to report drinking in the last twelve months plus drinking in the last thirty days than resident Israelis. Women's reported drinking in the last twelve months was one fourth of men's and during the past thirty days was one fifth of men's. Further investigation on the associations between the success of FSU acculturation in the Israeli society and drinking patterns as well as attitudes toward women and gender differences in alcohol consumption may provide explanations for gender and immigration gaps in alcohol consumption.

Acculturation↗

Alcohol consumption and psychological distress in recently widowed older men.

OBJECTIVE: The relationship between severe adverse life events and subsequent health-related behaviour is not well established for older people. To address this issue, we studied self-reported alcohol consumption in recently widowed older men and matched married men. METHOD: We carried out a double cohort study in community-residing men aged 65 years and over. Recently widowed men (n = 57; mean age = 74.5 years) were identified from the death records of their wives and assessed at 6 weeks, 6 months and 13 months post-bereavement. Matched married men (n = 57; mean age = 75.4 years) were identified from the electoral roll and assessed at similar intervals. Self-report measures of alcohol consumption, grief and state anxiety were employed. RESULTS: Similar proportions of older widowers and married men reported that they consumed some alcohol, although recently widowed older men reported significantly greater frequency (chi2 = 4.64, df = 1, p = 0.031) and quantity (chi2 = 7.75, df = 1, p = 0.005) of alcohol consumption than matched married men. A significant minority of subjects reported hazardous levels of alcohol consumption with 18.9% of widowers and 8.3% of married men reporting that they drank five or more standard drinks per drinking day. However, among widowers, self-reported alcohol consumption was not significantly correlated with levels of either self-reported grief or state anxiety. CONCLUSIONS: Hazardous alcohol consumption occurs commonly among recently widowed older men, but is not related to their levels of self-reported grief or psychological distress. Loss of spousal care and control may be an alternative explanation for this drinking behaviour. Older widowers should be regarded as a high-risk group for hazardous alcohol consumption and would be a suitable target group for preventive interventions.

Aged↗

Alcohol consumption and risk of lung cancer: a pooled analysis of cohort studies.

BACKGROUND: Although smoking is the primary cause of lung cancer, much is unknown about lung cancer etiology, including risk determinants for nonsmokers and modifying factors for smokers. OBJECTIVE: We hypothesized that alcohol consumption contributes to lung cancer risk. DESIGN: We conducted a pooled analysis using standardized exposure and covariate data from 7 prospective studies with 399,767 participants and 3137 lung cancer cases. Study-specific relative risks (RRs) and CIs were estimated and then combined to calculate pooled multivariate RRs by using a random-effects model. RESULTS: We found a slightly greater risk for the consumption of > or = 30 g alcohol/d than for that of 0 g alcohol/d in men (RR: 1.21; 95% CI: 0.91, 1.61; P for trend = 0.03) and in women (RR: 1.16; 95% CI: 0.94, 1.43; P for trend = 0.03). In male never smokers, the RR for consumption of > or = 15 g alcohol/d rather than 0 g alcohol/d was 6.38 (95% CI: 2.74, 14.9; P for trend < 0.001). In women, there were few never-smoking cases and no evidence of greater risk (RR: 1.35; 95% CI: 0.64, 2.87). Because of possible residual confounding by smoking, we performed sensitivity analyses by reclassifying the never smokers in the highest drinking category as former smokers. Resulting associations for alcohol consumption were somewhat attenuated, but P for trend = 0.05 for men, which was near the original P = 0.03. CONCLUSIONS: A slightly greater risk of lung cancer was associated with the consumption of > or = 30 g alcohol/d than with no alcohol consumption. Alcohol consumption was strongly associated with greater risk in male never smokers. Residual confounding by smoking may explain part of the observed relation.

Alcohol Drinking↗

Nut consumption, vegetarian diets, ischemic heart disease risk, and all-cause mortality: evidence from epidemiologic studies.

Perhaps one of the most unexpected and novel findings in nutritional epidemiology in the past 5 y has been that nut consumption seems to protect against ischemic heart disease (IHD). Frequency and quantity of nut consumption have been documented to be higher in vegetarian than in nonvegetarian populations. Nuts also constitute an important part of other plant-based diets, such as Mediterranean and Asian diets. In a large, prospective epidemiologic study of Seventh-day Adventists in California, we found that frequency of nut consumption had a substantial and highly significant inverse association with risk of myocardial infarction and death from IHD. The Iowa Women's Health Study also documented an association between nut consumption and decreased risk of IHD. The protective effect of nuts on IHD has been found in men and women and in the elderly. Importantly, nuts have similar associations in both vegetarians and nonvegetarians. The protective effect of nut consumption on IHD is not offset by increased mortality from other causes. Moreover, frequency of nut consumption has been found to be inversely related to all-cause mortality in several population groups such as whites, blacks, and the elderly. Thus, nut consumption may not only offer protection against IHD, but also increase longevity.

Aged↗

Relation between homocysteine concentrations and the consumption of different types of alcoholic beverages: the French Supplementation with Antioxidant Vitamins and Minerals Study.

BACKGROUND: Previous studies on the effects of alcohol consumption on total plasma homocysteine (tHcy) concentrations showed contradictory results. The conflicting results may derive in part from confounding by the type of alcoholic beverage consumed. OBJECTIVE: The objective of the study was to evaluate in a predominantly wine-drinking French population whether the relation between alcohol consumption and homocysteine concentrations is dependent on the type of alcoholic beverage consumed. DESIGN: In 1996, a cross-sectional study measuring tHcy and red blood cell folate concentrations was conducted in 1196 middle-aged women and men from the French Supplementation with Antioxidant Vitamins and Minerals Study. Intakes of alcohol, energy, coffee, and B vitamins were assessed by 6 separate 24-h dietary records from the previous year. RESULTS: tHcy concentrations were positively associated with wine intake (P = 0.01) in the women and with beer intake in the men (P = 0.002). No association with the consumption of spirits was observed. The association between beer consumption and tHcy concentrations in the men was modified by the consumption of wine; the association was positive in wine drinkers, whereas an inverse trend was seen in those who drank no wine. CONCLUSION: Wine consumption may increase tHcy concentrations, whereas beer consumption seems to have no effect (or even an inverse effect) on tHcy.

Adult↗

Frequent nut consumption and decreased risk of cholecystectomy in women.

BACKGROUND: Gallstone disease is a major source of morbidity in the developed countries. Nuts are rich in several compounds that may protect against gallstone disease. OBJECTIVE: The association between nut intake and cholecystectomy was examined in a large cohort of women. DESIGN: We prospectively studied nut (peanuts, other nuts, and peanut butter) consumption in relation to the risk of cholecystectomy in a cohort of 80,718 women from the Nurses' Health Study who were 30-55 y old in 1980 and had no history of gallstone disease. As part of the Nurses' Health Study, the women reported on questionnaires mailed to them every 2 y both their consumption of nuts and whether they had undergone cholecystectomy. The women were followed through 2000. RESULTS: During 1,393,256 person-years of follow-up from 1980 to 2000, we documented 7831 cholecystectomies. After adjustment for age and other known or suspected risk factors, women who consumed > or =5 units of nuts (1 unit = 1 oz or 28.6 g nuts)/wk (frequent consumption) had a significantly lower risk of cholecystectomy (relative risk: 0.75; 95% CI: 0.66, 0.85; P for trend < 0.0001) than did women who never ate nuts or who ate <1 unit/mo (rare consumption). Further adjustment for fat consumption (saturated fat, trans fat, polyunsaturated fat, and monounsaturated fat) did not materially alter the relation. In analyses examining consumption of peanuts and other nuts separately, both were associated with a lower risk of cholecystectomy. CONCLUSION: In women, frequent nut consumption is associated with a reduced risk of cholecystectomy.

Adult↗

Chronic coffee consumption has a detrimental effect on aortic stiffness and wave reflections.

BACKGROUND: The effect of coffee consumption on the cardiovascular system is still an unresolved issue. Aortic stiffness and wave reflections are important prognosticators of cardiovascular disease risk. We have shown that caffeine acutely increases aortic stiffness and wave reflections. OBJECTIVE: The objective was to investigate the effect of chronic coffee consumption on aortic stiffness and wave reflections. DESIGN: This was a cross-sectional study of 228 healthy subjects: 141 men (x +/- SD: 41 +/- 8 y old) and 87 women (41 +/- 9 y old). Aortic stiffness was evaluated with carotid-femoral pulse wave velocity (PWV). Wave reflections were evaluated with augmentation index (AIx) and augmented pressure (AP) of the aortic pressure waveform with the use of high-fidelity pulse wave analysis. Coffee consumption was ascertained over 1 y with a food-frequency questionnaire. RESULTS: A linear relation between coffee consumption and PWV, AIx, and AP was observed (P for trend < 0.05). Compared with the nonconsumption group, PWV was on average 13% higher, AIx was 2-fold higher, and AP was 2.4-fold higher (P < 0.01 for all) in the high-consumption group (>450 mL/d). The findings remained significant after control for confounders such as age, sex, smoking habits, body mass index, total and LDL cholesterol, triacylglycerols, blood glucose, mean blood pressure, and heart rate. The linear relation (P for trend < 0.05) observed between coffee consumption and arterial pressures was largely explained when the covariates were entered in the model. CONCLUSIONS: Chronic coffee consumption exerts a detrimental effect on aortic stiffness and wave reflections, which may increase the risk of cardiovascular disease.

Adult↗

Differential associations of fast food and restaurant food consumption with 3-y change in body mass index: the Coronary Artery Risk Development in Young Adults Study.

BACKGROUND: Away-from-home food consumption has rapidly increased, though little is known about the independent associations of restaurant food and fast food intake with body mass index (BMI) and BMI change. OBJECTIVE: The aim was to compare the associations of restaurant food and fast food consumption with current and 3-y changes in BMI. DESIGN: Multivariate linear regression models, with control for demographic and lifestyle factors, were used to examine cross-sectional and longitudinal associations of away-from-home eating with BMI by using data from subjects of the Coronary Artery Risk Development in Young Adults Study (n = 3394) obtained at exam years 7 (1992-1993) and 10 (1995-1996). RESULTS: Forty percent of the sample increased their weekly consumption of restaurant or fast food, though mean (+/-SD) changes were -0.16 +/- 2.39 times/wk (P = 0.0001) and -0.56 +/- 3.04 times/wk (P < 0.0001), respectively. Cross-sectionally, fast food, but not restaurant food, consumption was positively associated with BMI. Similarly, higher consumption of fast food at year 7 was associated with a 0.16-unit higher BMI at year 10. After adjustment for baseline away-from-home eating, increased consumption of fast food only (beta: 0.20; 95% CI: 0.01, 0.39) and of both restaurant food and fast food (beta: 0.29; 95% CI: 0.06, 0.51) were positively associated with BMI change, though the estimates were not significantly different (P = 0.47). Increased consumption of restaurant food only was unrelated to BMI change (beta: -0.01; 95% CI: -0.21, 0.19), which differed significantly (P = 0.014) from the estimate for an increase in both restaurant food and fast food intake. CONCLUSIONS: We found differential effects of restaurant food and fast food intakes on BMI, although the observed differences were not always statistically significant. More research is needed to determine whether the differential effects are related to consumer characteristics or the food itself.

Adult↗

Alcohol consumption and risk of peripheral arterial disease: the Rotterdam study.

Moderate alcohol consumption is associated with a reduced risk of cardiovascular disease. Data on alcohol consumption and atherosclerosis are scarce. To determine the association between alcohol consumption and risk of peripheral arterial disease, the authors carried out a cross-sectional study (1990-1993) in the population-based Rotterdam Study among men and women aged 55 years or over. Data on alcohol consumption and peripheral arterial disease, as measured by the ankle/brachial blood pressure index, were available for 3,975 participants without symptomatic cardiovascular disease. Male drinkers consumed beer, wine, and liquor, while female drinkers consumed predominantly wine and fortified wine types. An inverse relation between moderate alcohol consumption and peripheral arterial disease was found in women but not in men. Because of residual confounding by smoking, analyses were repeated in nonsmokers. In nonsmoking men, odds ratios were 0.86 (95% confidence interval (CI): 0.46, 1.63) for daily alcohol consumption up to and including 10 g, 0.75 (95% CI: 0.37, 1.55) for 11-20 g, and 0.68 (95% CI: 0.35, 1.34) for more than 20 g, compared with nondrinking. In nonsmoking women, corresponding odds ratios were 0.65 (95% CI: 0.48, 0.87), 0.66 (95% CI: 0.42, 1.05), and 0.41 (95% CI: 0.21, 0.77), respectively. In conclusion, an inverse association between alcohol consumption and peripheral arterial disease was found in nonsmoking men and women.

Aged↗

A prospective cohort study of nut consumption and the risk of gallstone disease in men.

Gallstone disease is a major source of morbidity in Western countries. Nuts are rich in several compounds that may be protective against gallstones. The objective of the study was to examine the relation between nut consumption and gallstone disease in the Health Professionals Follow-up Study. The consumption of nuts was assessed starting in 1986 as part of a 131-item semiquantitative food frequency questionnaire. The main outcome measure was newly diagnosed symptomatic gallstones. During 457,305 person-years of follow-up, 1,833 participants reported gallstone disease. After adjustment for age and other known or suspected risk factors, men consuming 5 or more units of nuts per week (frequent consumption) had a significantly lower risk of gallstone disease (relative risk = 0.70, 95% confidence interval: 0.60, 0.86; p(trend) < 0.001) than did men who never ate or who ate less than 1 unit per month (rare consumption) (1 unit = 1 ounce (0.028 kg) of nuts). Further adjustment for fat consumption (saturated fat, trans-fat, polyunsaturated fat, and monounsaturated fat) did not materially alter the relation. In analyses examining consumption of peanuts and other nuts separately, both were significantly associated with a lower risk of gallstone disease in the age-adjusted and multivariate models. Our findings suggest that frequent nut consumption is associated with a reduced risk of gallstone disease in men.

Adult↗

Nut and seed consumption and inflammatory markers in the multi-ethnic study of atherosclerosis.

Nuts and seeds are rich in unsaturated fat and other nutrients that may reduce inflammation. Frequent nut consumption is associated with lower risk of cardiovascular disease and type 2 diabetes. The authors examined associations between nut and seed consumption and C-reactive protein, interleukin-6, and fibrinogen in the Multi-Ethnic Study of Atherosclerosis. This 2000 cross-sectional analysis included 6,080 US participants aged 45-84 years with adequate information on diet and biomarkers. Nut and seed consumption was categorized as never/rare, less than once/week, 1-4 times/week, and five or more times/week. After adjustment for age, gender, race/ethnicity, site, education, income, smoking, physical activity, use of fish oil supplements, and other dietary factors, mean biomarker levels in categories of increasing consumption were as follows: C-reactive protein-1.98, 1.97, 1.80, and 1.72 mg/liter; interleukin-6-1.25, 1.24, 1.21, and 1.15 pg/ml; and fibrinogen-343, 338, 338, and 331 mg/dl (all p's for trend < 0.01). Further adjustment for hypertension, diabetes, medication use, and lipid levels yielded similar results. Additional adjustment for body mass index moderately attenuated the magnitude of the associations, yielding borderline statistical significance. Associations of nut and seed consumption with these biomarkers were not modified by body mass index, waist:hip ratio, or race/ethnicity. Frequent nut and seed consumption was associated with lower levels of inflammatory markers, which may partially explain the inverse association of nut consumption with cardiovascular disease and diabetes risk.

Aged↗

Smoking, hypertension, alcohol consumption, and risk of abdominal aortic aneurysm in men.

Despite the known protective association between moderate alcohol consumption and ischemic heart disease, little is known about the effects of alcohol consumption on abdominal aortic aneurysms (AAA). The authors analyzed prospective, biennially updated data for a cohort of 39,352 US men from 1986 to 2002. The association of incident AAA diagnosis with alcohol consumption in grams per day was assessed at baseline and by using alcohol consumption data updated every 4 years, controlling for previously reported cardiovascular risk factors. During 576,374 person-years of follow-up, 376 newly diagnosed cases of AAA were demonstrated. After adjustment for other risk factors for AAA, including smoking, hypertension, and body mass index, alcohol consumption at baseline was independently associated with AAA diagnosis (p for trend = 0.03), with a maximum hazard ratio of 1.21 (95% confidence interval: 0.78, 1.87) for > or =30.0 g (approximately > or =2 standard drinks) of daily alcohol consumption. This association was stronger when the updated alcohol consumption data were assessed rather than simply baseline exposure (p for trend = 0.02); the hazard ratio for the highest level of intake (> or =30.0 g/day) was 1.65 (95% confidence interval: 1.03, 2.64). Small numbers limited analyses by beverage type, but liquor demonstrated the strongest positive association with AAA.

Adult↗

Chronic ethanol consumption modulates myocardial ischaemia-reperfusion injury in murine AIDS.

AIMS: The severity of cardiovascular complications in acquired immune deficiency syndrome (AIDS) patients may be associated with acute ischaemia-reperfusion injury. Epidemiological studies suggest that moderate ethanol consumption has myocardial protective effects. However, it is unknown if chronic ethanol consumption benefits acute myocardial ischaemia-reperfusion injury in AIDS. The aim of this study was to determine if chronic ethanol consumption modulates myocardial ischaemia-reperfusion injury in murine AIDS. METHODS: Four groups were studied: control, murine AIDS, ethanol, and ethanol plus murine AIDS. All mice were subjected to 30 min of left anterior descending branch (LAD) occlusion and 120 min of reperfusion. RESULTS: We found that the survival from an acute myocardial infarction was reduced in advanced-stage murine AIDS mice. Although early-stage murine AIDS hearts did survive in acute myocardial infarction, the infarct size was significantly larger. Chronic ethanol consumption significantly decreased infarct size compared to the control group. Chronic ethanol consumption also improved the survival of murine AIDS mice from an acute myocardial infarction. However, chronic ethanol consumption did not significantly reduce infarct size in murine AIDS. CONCLUSIONS: Our results indicate that multiple deleterious effects may enhance acute ischaemia-reperfusion injury in murine AIDS. The beneficial effects of chronic ethanol consumption in myocardial ischaemia-reperfusion injury may be due to modulation of neutrophil adhesion molecule expression and cytokine secretion.

Alcohol Drinking↗

Alcohol consumption among school adolescents in Palma de Mallorca.

AIMS: To describe alcohol consumption of adolescent boys and girls in Palma de Mallorca, and its relationship with physical activity and socio-demographic factors. METHODS: Four hundred and forty five adolescents (171 boys, 274 girls; 14-18 years old) selected from the school census (participation 96%), using two-stage probability sampling were studied. A semi-quantitative food frequency questionnaire was administered and alcohol intake was analysed. Physical activity was computed as a ratio of energy expended in basal metabolic rate. Socio-demographic data were collected, and categorized as gender, mother's level of education, parental occupational status, and mother's region of origin. RESULTS: About 60% of adolescents, 53% of boys and 65% of girls, reported alcohol consumption, which increased with age in boys (91% when they were 18 years old), but remained constant in girls. The adolescents consumed alcohol mainly on weekends; average consumption was four drinks per drinking day, and the most consumed drinks were mild distilled spirits. The mother's educational level and adolescents' physical activity were negatively and significantly related to alcohol consumption, whereas the adolescents from occupational upper-class parents and non Majorcan/Balearic mothers were positively and significantly related to alcohol consumption. CONCLUSIONS: The increased penetration of alcohol into the adolescents' environment may result in misuse of consumption. To give more information to parents and adolescents on considering alcohol to be a drug, and to promote physical activity among adolescents may be contributing factors towards decreased alcohol consumption among the latter age group.

Adolescent↗

Social capital, the miniaturization of community and high alcohol consumption: a population-based study.

AIMS: To study the impact of social participation, trust, and the miniaturization of community, i.e. high social participation/low trust, on the risk of high alcohol consumption. METHODS: The Scania 2000 public health survey is a cross-sectional, postal questionnaire study. A total of 13 604 persons aged 18-80 years were included. A logistic regression model was used to investigate the association between the social capital variables and high alcohol consumption (168.0 g/week or more for men and 108.0 g/week or more for women). The multivariate analyses analysed the importance of confounders (age, country of origin, education, and economic stress) on the risk of high alcohol consumption according to the social capital variables. RESULTS: A 14.0% proportion of all men and 7.8% of all women had an alcohol consumption above recommended levels. High alcohol consumption above recommended levels was not associated with social participation but negatively associated with trust among men. The miniaturization of community category, i.e. high social participation/low trust, had significantly higher risks of high alcohol consumption compared to the high social capital (high social participation/high trust) category among men. CONCLUSION: High social participation combined with low trust, i.e. the miniaturization of community, is positively associated high alcohol consumption among men. A structural/social factor which may affect the amount of alcohol consumed has thus been identified in this study.

Adolescent↗

Arteriographically documented coronary artery disease and alcohol consumption in French men. The CORALI Study.

The relationship between alcohol consumption and angiographically documented coronary artery disease was examined among 484 men who underwent coronary arteriography. Severity of coronary artery disease was assessed by the number of arteries, or the number of segments, with at least one in which the luminal diameter is reduced by > or = 50%. Alcohol and tobacco consumption were assessed by a technician according to a standardized questionnaire, and an estimate of the average consumption level prior to the onset of the clinical symptoms was used for analysis. A decrease in the average coronary artery disease scores was observed with increasing alcohol consumption until a mean consumption of about 100 ml.day-1. After adjustment for age, town, clinical group and tobacco consumption, the same pattern of association was obtained. Similar trends were also present with alcohol consumption restricted to wine, beer and other alcoholic beverages. Taking into account classical risk factors of the disease and blood lipid levels at the time of angiography, did not modify these trends but less significant differences were observed. These findings provide additional evidence that the reduction of the clinical coronary risk observed in moderate alcohol consumers might be secondary, at least partly, to an anatomically less extensive disease. This, however, does not justify the recommendation of alcohol for prevention purposes.

Adult↗

Social capital, the miniaturisation of community and consumption of homemade liquor and smuggled liquor during the past year. A population-based study.

BACKGROUND: To study the impact of social participation, trust and the miniaturisation of community, i.e. high social participation/low trust, on consumption of homemade liquor and smuggled liquor during the past year. METHODS: The Scania 2000 public health survey is a cross-sectional, postal questionnaire study. A total of 13,604 persons aged 18-80 years were included. A logistic regression model was used to investigate the association between the social capital variables and illegal alcohol consumption. The multivariate analyses analysed the importance of confounders (age, country of origin, education and economic stress) on the differences in consumption of homemade and smuggled liquor according to the social capital variables. RESULTS: A 28.2% proportion of all men and 14.9% of all women had consumed homemade liquor during the past year. The proportions who had consumed smuggled liquor during the past year were even higher, 40.1% among men and 21.4% among women. Both forms of illegal alcohol consumption were significantly positively associated with social participation and negatively associated with trust. The miniaturisation of community category, i.e. high social participation/low trust, had significantly higher risks of consumption during the past year of the consumption of both forms of illegally provided alcohol compared to the high social capital (high social participation/high trust) category, while the low social participation/high trust category had significantly lower risks. CONCLUSION: High social participation combined with low trust is positively associated with consumption of illegally provided alcohol. The results have implications for alcohol prevention programs, because structural/social factors that may hinder information and norms concerning illegal alcohol have been identified in this study.

Adolescent↗

The effects of negative life events on alcohol consumption among older men and women.

We examined the effect of selected negative life events on changes in alcohol consumption in a prospective cohort study of community-dwelling persons 65 years of age and older. Using the Tension Reduction Hypothesis (TRH) as a framework, we tested the hypothesis that exposure to negative life events leads to increased alcohol consumption at follow-up (1985) after controlling for baseline alcohol consumption (1982) and covariates found to be associated with alcohol use. In addition, we modeled the interaction between exposure to events and baseline alcohol consumption. Among men, four of the eleven events tested were associated with higher alcohol consumption but only as interaction effects. Another two events were associated with decreased alcohol consumption. Among women, four significant interaction effects and two main effects were found in the expected direction. Two additional events were found to be associated with decreased drinking at follow-up. In general, alcohol consumption declined in the aggregate over the three-year period. Implications for the TRH are discussed.

Adaptation, Psychological↗