Relationship Between Age and Drinking Patterns and Drinking Problems Among Japanese, Japanese-Americans, and Caucasians

Comparing alcohol consumption patterns by age and gender among Japanese in Japan and Japanese-Americans and Caucasians in the United States, this study examined the associations between age and both heavy drinking and social problems using logistic regression for each ethnic group of male current drinkers. As reported in previous studies of Caucasians, men drink more alcohol than women, older respondents are more likely than younger ones to be abstainers, and the percentages of heavier drinkers and problem drinkers are higher among the young than among older people. Although Japanese-Americans reported consuming less alcohol than Caucasians, their drinking patterns by age were similar:among both United States populations, younger respondents are at higher risk for drinking problems than older respondents, even when alcohol consumption and sociodemographic variables are controlled by logistic regression. However, this association of age and drinking patterns and drinking problems is not universal. Japanese men consumed more alcohol and had a higher proportion of heavier drinkers in the middle age groups; the association between age and drinking problems also varied in this group. In addition to aging, sociocultural factors such as drinking norms probably account for the differences in drinking behavior among different age groups. This study may stimulate further cross-cultural comparison of drinking patterns and problems.     

Sociodemographic Predictors of Pattern and Volume of Alcohol Consumption Across Hispanics,Blacks, and Whites: 10‐Year Trend (1992–2002)

Background: There have been limited trend studies examining variations on the patterns of alcohol consumption among Whites, Blacks, and Hispanics in the United States. The current paper reports national trends in drinking patterns, volume of drinking (number of drinks per month), binge drinking, and drinking to intoxication among Blacks, Whites, and Hispanics over a period of 10 years and identifies sociodemographic predictors of these behaviors across the 3 ethnic groups. Methods: Data are from the 1991 to 1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES; n = 42,862) and the 2001 to 2002 National Epidemiologic Study on Alcohol and Related Conditions (NESARC; n = 43,093). Both surveys used multistage cluster sample procedures to select respondents 18 years of age and older from the U.S. household population. Results: Trends varied across different dimensions of drinking and ethnic groups. There were no statistically significant differences in the mean number of drinks consumed per month among men and women in any of the 3 ethnic groups between 1992 and 2002, but there was a significant rise in the proportion of current drinkers in both genders and in all 3 ethnic groups. Multivariate analysis indicated that, compared to Whites in 1992, Blacks and Hispanics did not increase their volume of drinking, but Whites did. Drinking 5 or more drinks in day at all did not increase between 1992 and 2002, but drinking 5 or more drinks at least once a month was more likely for all groups in 2002 compared to Whites in 1992. Drinking to intoxication at all was more likely among Whites in 2002 than 1992, but drinking to intoxication at least once a month was more likely among Whites and Blacks in 2002 than 1992. Conclusion: The only common trend between 1992 and 2002 across both genders and 3 ethnic groups was a rise in the proportion of drinkers. There was also a rise in drinking 5 or more drinks in a day (Whites, Blacks, and Hispanics) and drinking to intoxication (Whites and Blacks), but this was limited to those reporting such drinking at least once a month. The reasons for these changes are many and may involve complex sociodemographic changes in the population. It is important for the field to closely monitor these cross‐ethnic trends in alcohol consumption.     

The use of drinking places by gender, age and ethnic groups: an analysis of routine drinking activities

Aims. This paper extends a prior analysis of drinking patterns to consider the influence of non-economic variables on the selection of drinking locations. Design. Using data from a general population telephone survey conducted as a part of the Community Trials Project, Tobit models are estimated to determine the influence of background demographic characteristics upon the selection of drinking locations net of other model control variables. Participants and setting. 24 778 current drinkers from four California and two South Carolina communities. Findings. Distinct patterns of premise utilization are found to be associated with age, gender and ethnic subgroups. Additionally these patterns of utilization are differentially linked to drinking and driving, suggesting that patterns of outlet utilization are differentially linked to acute drinking problems (e.g. drunken driving and alcohol-related car crashes). Conclusions. Observed differences in outlet utilization patterns between age, gender and ethnic subgroups imply that preventive interventions should take into account the manner in which these subpopulations make use of drinking venues.     

Alcohol consumption and problems: the relevance of drinking patterns

BACKGROUND: Data on risks and benefits associated with drinking patterns provide the scientific basis for moderate, low-risk drinking guidelines. Illustrated are methods to investigate and adjust for heterogeneity in relations between three-dimensional drinking patterns and 41 alcohol problems assessed among current regular drinkers in the 1988 National Health Interview Survey. METHODS: Three dimensions of mean drinking patterns, (i.e., usual quantities, heavy drinking rates (days of 5+ drinks/drinking days x 100), and drinking frequencies) were estimated in overlapping subsets of the population reporting each of the 41 problems, and mean usual quantities and heavy drinking rates were plotted against frequencies. Respondents were categorized into drinking problem groups associated with comparable mean drinking patterns; and main and interactive effects of age and sex on drinking patterns were examined by conducting three regression analyses within each group, with quantity, frequency, and heavy drinking rates as dependent variables, respectively. RESULTS: Analyses revealed substantial heterogeneity in relations between drinking patterns and alcohol problems. Respondents having only minor problems drank on average two days a week, usually had 2.6 drinks, and drank heavily 12-13 days a year. Whereas, those having minor and severe problems drank an average of 3.5 days a week, usually had 4.7 drinks, and drank heavily 58 days a year. Within each problem group, usual quantity and frequency were higher among males than females, but the greatest gender differences were seen in heavy-drinking rates. Age-related differences in drinking patterns were striking. Usual quantity and heavy-drinking rates associated with problems decreased with age, whereas drinking frequency increased. CONCLUSIONS: Findings demonstrated the importance of assessing and adjusting for heterogeneity in relations between drinking patterns and alcohol problems when aggregating and interpreting such data, (e.g., when assessing alcohol dependence criteria or evaluating guidelines for moderate drinking), and illustrated new methods for doing so.     

Ethnic differences in driving after drinking and riding with drinking drivers among adolescents

BACKGROUND: This study examined the relationship between ethnicity and driving after drinking (DD) and riding with drinking drivers (RWDD) while controlling for drinking patterns, driving practices, and background demographic characteristics including age and gender. METHODS: Using random-digit dialing procedures, 1534 young adults ranging from 15- to 20-years of age(mean = 17.6) living in California were recruited to participate in a telephone survey. Latinos, African Americans, and Asian Americans were oversampled to allow cross-group comparisons. RESULTS: Rates of DD were lower for females than for males and were also lower for African Americans and Asian Americans than for whites. However, after we controlled for drinking patterns and driving practices, the results showed Latinos at greater risk for DD than white adolescents. Compared with whites and males, Asian American and female adolescents were less likely to report RWDD. When drinking patterns and driving practices were taken into account, Latino adolescents were nearly twice as more likely to ride with drinking drivers than whites. CONCLUSIONS: These findings indicate a greater need for directing prevention efforts to target Latino youth and youth at risk. Moreover, research aimed at elucidating the social and environmental factors involved in the low prevalence rates of DD and RWDD among Asian American youth may indicate possible protective factors to DD and RWDD operating within the Asian American community.     

The risk of harm to oneself from drinking, Canada 1989

In a national sample of 11 634 Canadians aged IS years and above, risk curves for harm to six life-areas from one's own drinking and for assault by another drinker rose steadily with the respondent's volume of alcohol consumption. While drinking five or more drinks on an occasion at least once a month substantially raised the risk at a given volume of drinking, the risk rose with volume even among those not regularly drinking Jive or more drinks. These relationships remained in logistic regressions which controlled for gender, age and educational level. Younger respondents, those without higher education and men reported more harm for a given level of their own drinking although differences by gender disappeared above one-third of one drink per day. Three sets of guidelines for low-risk drinking—two from Canada, and one generally used in Britain—were compared in terms of the proportions of respondents reporting harm from their own drinking among those who had kept within the guideline in the previous 7 days' drinking. More restrictiveness in the guidelines was associated with substantial reductions in reported drinking-related harm     

Gender differences in the relationships between multiple measures of alcohol consumption and physical and mental health

BACKGROUND: Epidemiological research examining health consequences of alcohol consumption generally relies on average volume consumed, yet examinations of drinking patterns show different dimensions of use associated with different health outcomes. Gender differences in metabolism and body composition may lead to gender-specific consequences of drinking frequency, quantity consumed per occasion, average amount consumed, and drinking pattern. Inconsistent results suggest gender differences are not well understood. METHODS: Participants were 3069 male and 2600 female health maintenance organization survey respondents. Gender differences in relationships between alcohol consumption and health were examined using analyses of covariance adjusting for age alone and for age, ethnicity, marital status, body water index, and smoking. Past-year alcohol consumption (frequency, quantity per occasion, average drinks per month, and drinking pattern) and health measures (Short Form-36 general health, physical functioning, mental health subscales) were examined. RESULTS: Gender x drinking frequency and drinking quantity interactions were significant in age-adjusted and fully adjusted models of general health and physical functioning. Gender interactions for drinking pattern were significant in the age-adjusted model and marginally significant in the fully adjusted model. No gender x drinking measure interactions were found for mental health. Fully adjusted models attenuated but did not eliminate gender differences for health and magnified relationships for functioning, the latter after adjusting for body water. For both genders, light to moderate consumption and more frequent drinking were associated with better health and functioning; relationships were stronger among women than men. CONCLUSIONS: Gender x drinking measure interactions in health outcomes suggest analyses should include such interactions except, possibly, for mental health. Adjusting for potential confounders can attenuate (general health) or magnify (physical functioning) gender differences. Functional status appears a sensitive measure for evaluating gender differences in alcohol's health effects, adjusting for body water. Women's health may benefit proportionally more from moderate drinking than men's.     

Spouse abuse and alcohol problems among white, African American, and Hispanic U.S. Army soldiers

BACKGROUND: Prior studies suggest racial/ethnic differences in the associations between alcohol misuse and spouse abuse. Some studies indicate that drinking patterns are a stronger predictor of spouse abuse for African Americans but not whites or Hispanics, while others report that drinking patterns are a stronger predictor for whites than African Americans or Hispanics. This study extends prior work by exploring associations between heavy drinking, alcohol-related problems, and risk for spouse abuse within racial/ethnic groups as well as variations associated with whether the perpetrator is drinking during the spouse abuse incident. METHODS: Cases (N=7,996) were all active-duty male, enlisted Army spouse abusers identified in the Army's Central Registry (ACR) who had also completed an Army Health Risk Appraisal (HRA) Survey between 1991 and 1998. Controls (N=17,821) were matched on gender, rank, and marital and HRA status. RESULTS: We found 3 different patterns of association between alcohol use and domestic violence depending upon both the race/ethnicity of the perpetrator and whether or not alcohol was involved in the spouse abuse event. First, after adjusting for demographic and psychosocial factors, weekly heavy drinking (>14 drinks per week) and alcohol-related problems (yes to 2 or more of 6 alcohol-related problem questions, including the CAGE) were significant predictors of domestic violence among whites and Hispanics only. Also for the white soldiers, the presence of family problems mediated the effect of alcohol-related problems on spouse abuse. Second, alcohol-related problems predicted drinking during a spouse abuse incident for all 3 race groups, but this relation was moderated by typical alcohol consumption patterns in Hispanics and whites only. Finally, alcohol-related problems predicted drinking during a spouse abuse incident, but this was a complex association moderated by different psychosocial or behavioral variables within each race/ethnic group. CONCLUSION: These findings suggest important cultural/social influences that interact with drinking patterns.     

Early adult outcomes of adolescent binge drinking: person- and variable-centered analyses of binge drinking trajectories

BACKGROUND: Many studies of the consequences of binge drinking take a variable-centered approach that may mask developmentally different trajectories. Recent studies have reported qualitatively different binge drinking trajectories in young adulthood. However, analyses of developmental trajectories of binge drinking have not been examined for an important period of drinking development: adolescence. The purpose of this study was to examine young adult outcomes of adolescent binge drinking using an approach that combines person-centered and variable-centered methods. METHODS: Data were from the Seattle Social Development Project, an ethnically diverse, gender balanced sample (n = 808) followed prospectively from age 10 to age 21. Semiparametric group-based modeling was used to determine groups of binge drinking trajectories in adolescence. Logistic regression was used to examine how well the trajectory groups predicted young adult outcomes after demographics, childhood measures, and adolescent drug use were considered. RESULTS: Four distinct trajectories of binge drinking during adolescence were identified: Early Highs, Increasers, Late Onsetters, and Nonbingers. These trajectories significantly predicted positive and negative outcomes in adulthood after controlling for demographic characteristics, early proxy measures of the outcome, and adolescent drug use. CONCLUSIONS: This integrated person- and variable-centered approach provides more information about the effects of specific patterns of binge drinking than studies that employ variable-centered methods alone.     

Differences in the measured alcohol content of drinks between black, white and Hispanic men and women in a US national sample

Aims   To measure and describe drink alcohol content differences between Hispanic, non-Hispanic white and non-Hispanic black men and women in the United States.
Design   A telephone survey re-interview of 397 respondents who participated originally in the 2005 National Alcohol Survey, of whom 306 provided complete information on home drinks.
Setting   United States.
Participants   Adults aged 18 years and older from across the United States.
Measurements   Direct measurement by respondents of simulated drink pours in respondents' own glassware using a provided beaker and reported beverage brands were used to calculate drink alcohol content.
Findings   Black men were found to have the largest overall mean drink alcohol content at 0.79 oz (23 ml) of alcohol. This was significantly larger than the mean for white men or for black women and added 30% to black men's monthly alcohol intake when applied to their reported number of drinks. Spirits drinks were found to be particularly large for men. Multivariate models indicated that drink alcohol content differences are attributable more to income and family structure differences than to unmeasured cultural factors tied to race or ethnicity per se . Models predicting alcohol-related consequences and dependence indicate that adjusting drink alcohol content improves model fit and reduces differences between race/ethnicity defined groups.
Conclusions   Differences in drink alcohol content by gender, race/ethnicity and beverage type choice should be considered in comparisons of drinking patterns and alcohol-related outcomes. Observed differences can be explained partially by measured characteristics regarding family structure and income.     

Risk functions for alcohol-related problems in a 1988 US national sample

To assess the relationship of alcohol use and three types of alcohol-related problems (ICD-10 dependence syndrome, work problems and drunk driving), risk curves were developed for average number of drinks per day during last year (volume) and number of days drinking five or more drinks during one day (5 +). Using data from the I98S National Health Interview Alcohol Supplement, risk curves were derived from data on 22 102 current drinkers who consumed at least 12 drinks in the last year. The emphasis in this analysis was on the proportion of drinkers at lower levels reporting different types of problems. The results indicate that even at lower levels of drinking (volume averaging one or fewer drinks/day) there is considerable risk for drunk driving and less risk for work problems and alcohol dependence. The risk for all types of problems at lower and moderate levels of drinking was significantly higher for respondents who had five or more drinks during one day in the last year. These findings underscore the importance of examining risk (physical and social) at lower levels of drinking and for using both overall volume and heavier quantity per occasion drinking measures when assessing risk for any alcohol-related problem.     

Beliefs about the cardiovascular benefits of drinking wine in the adult population of Ontario

AIMS: to explore beliefs about the cardiovascular benefits of drinking wine in the Ontario population. DESIGN: secondary analysis of data from a provincial survey of adults. PARTICIPANTS: Ontarians aged 18 or older (n = 606) from Ontario living in households and participating in a telephone survey. MEASURES: responses to questions concerning beliefs that wine drinking may reduce the risk of heart disease. Self-reports of age, gender, quantity and frequency of wine drinking, drinking problems, and existence of a diagnosis of heart disease. Findings: a majority of respondents believed that wine drinking reduces heart disease. Almost all (87.6%) said that drinking one or two drinks a day would reduce heart disease. Belief in the health benefits of wine drinking was more common among men, more frequent drinkers, and wine drinkers. CONCLUSIONS: beliefs in the health benefits of wine drinking is common amongst Ontario adults and is consistent with many recommendations by health authorities. The study should be replicated with larger samples in a variety of countries with different drinking patterns.     

Comparison of Screening Instruments for Alcohol Problems Between Black and White Emergency Room Patients from Two Regions of the Country

A number of brief screening instruments to identify alcohol dependence exist, but the validity of these instruments across ethnic groups or regions of the country is not well established. The sensitivity and specificity of a number of standard screening instruments (CAGE, brief MAST, AUDIT, TWEAK, and RAPS), as well as other measures (History of Trauma Scale, breathalyzer reading, self-reported drinking before the event, and consuming five or more drinks at a sitting at least monthly) are compared against ICD-10 and DSM-IV criteria for alcohol dependence between probability samples of Black and White emergency room patients in Santa Clara County, CA (n= 716) and in Jackson, MS (n= 1330). Variability in the sensitivity of screening instruments among current drinkers was found to be greater between samples for both Blacks and Whites, than for Blacks compared with Whites within the same sample. The AUDIT, TWEAK, and RAPS seemed to perform well by gender and injury status for both Blacks and Whites in the two samples, and no significant differences were found in the performance of these instruments across sample sites. To evaluate the influence of regional differences in alcohol dependence on differences found in the performance of screening instruments, using logistic regression with the simultaneous entry of demographic variables (age, gender, ethnicity, injury status, and site) and drinking variables (breathalyzer reading, serf-reported drinking before the event, and drinking five or more drinks at a sitting at least monthly) to predict alcohol dependence in a merged sample of these patients (Jackson vs. Santa Clara) site was not found to be significant Data suggest that, whereas region of the country may not be important in predicting alcohol dependence in emergency room populations, regional differences in the performance of screening instruments for alcohol dependence may exist, even when ethnicity is taken into account Given distinct regional differences in drinking patterns and problems in the U.S., further research on commonly used screening instruments is needed to determine those screeners most efficient for identifying problem drinking.     

Variations in drinking patterns in the rural South: joint effects of race, gender, and rural residence

OBJECTIVES: To understand the relative contribution of gender, race (African-American vs. Caucasian), and rural residence on variations in drinking patterns, including past year abstinence, at-risk drinking, and recent drinking quantity and frequency for drinkers only. METHODS: A brief health survey was administered by telephone to a probability sample of 11,529 residents of six southern states, over-sampling rural inhabitants. RESULTS: Drinking patterns varied by gender, race, and rural residence in bivariate analysis. Gender effects were independent of rural residence, but race effects on abstinence and at-risk drinking were found only in urban residents and race differences in drinking quantity only in rural residents. Multivariate analysis, controlling for age and education, found gender and rural residence to be the strongest predictors, as well as being an African-American female. CONCLUSIONS: Female gender, African-American race, and rural residence appear protective for at-risk drinking but rural residence dominates racial differences.     

Ethnic differences and heritability of heart rate variability in African- and European American youth

This study investigated whether heart rate variability (HRV) in young African-Americans differed from that in young European Americans. It further examined the genetic and/or environmental sources of HRV variance and to what extent they depend on ethnicity or gender in young twins. Subjects were available from 1 data set including 166 subjects (mean age 16 +/- 2 years; 63 African-Americans) and another including 219 twins (11 singletons [4 African-Americans] and 104 pairs [42 African-Americans]; mean age 15 +/- 2 years). HRV was measured over 256 RR intervals in a supine position. Two time-domain variables, the SD of normal RR intervals (SDNN) and the root-mean-square of successive differences (RMSSD) of normal RR intervals, and 3 frequency-domain variables, high-frequency (HF) power, low-frequency (LF) power, and the LF power/HF power ratio, were used. African-Americans had higher RMSSDs (p <0.01) and HF power (p = 0.047) and lower LF power/HF power ratios (p <0.01) than European Americans. These differences remained significant after adjusting for covariates. All HRV parameters were heritable; estimated heritability ranged from 32% to 71%. Model fitting showed no ethnic or gender differences for any measure. SDNN, RMSSD, and HF power were strongly correlated (r values >0.8). One factor explaining >90% of the variance for all 3 measures was identified. The heritability of this combined HRV score was 70%. In conclusion, this study suggests that ethnic differences in HRV already exist in youth, with African-Americans having greater HRV than European Americans. High heritability estimates for HRV measures were observed, and no differences in HRV heritability estimates were noted for ethnicity or gender.     

Alcohol consumption among low-income pregnant Latinas

BACKGROUND: Due to changing cultural norms, Latinas of childbearing age residing in the U.S. may be at increasing risk of drinking harmful levels of alcohol during pregnancy, and may also be unaware of the risks for Fetal Alcohol Spectrum Disorders associated with this behavior. We assessed the prevalence of alcohol consumption in a sample of low-income pregnant Latinas and examined risk factors for alcohol use in the periconceptional period. METHODS: As part of a larger intervention trial, a cross-sectional in-home interview study was conducted among a sample of 100 pregnant low-income Latinas receiving services from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in San Diego County, California. RESULTS: Fifty-seven percent of respondents indicated they were either life-time abstainers or had not consumed any alcohol in the periconceptional period. Forty-three percent reported some alcohol use in the three months prior to recognition of the current pregnancy, and 20% reported at least one binge episode of four or more standard drinks during that time frame. Five percent reported drinking seven or more drinks per week, and 8% continued drinking alcohol after recognition of pregnancy. Significant predictors of any alcohol use in the periconceptional period included English language/higher level of acculturation, younger maternal age, lower parity, higher level of education, younger age at first drink, and having ever smoked. Women who were aware of alcohol warning messages and /or had more knowledge of the Fetal Alcohol Syndrome (FAS) were significantly more likely to have consumed alcohol in the periconceptional period. Frequency of periconceptional use of alcohol did not differ between women who planned or did not plan the pregnancy. CONCLUSION: The prevalence and pattern of early pregnancy alcohol consumption in this sample of Latinas is similar to patterns noted in other race/ethnic groups in the U.S. Level of knowledge about FAS and awareness of warning messages was not protective for early pregnancy alcohol consumption, suggesting that specific knowledge was insufficient to prevent exposure or that other factors reinforce maintenance of alcohol consumption in early pregnancy. Selective interventions in low-income Latinas are warranted, and should be focused on women of reproductive age who are binge or frequent drinkers and who are at risk of becoming pregnant.     

Alcohol and the economic crisis in Argentina: recent findings

AIMS: In 2002 Argentina participated in the GENACIS project (Gender, Alcohol, and Culture: An International Study) as one of the countries funded by the World Health Organization. Four questions about the current economic crisis in Argentina were added to the original GENACIS questionnaire in order to find out the opinions of the general population in relation to alcohol and the economic crisis. METHODS: Gender differences in the answers to these questions were examined. Logistic regression was used to identify demographic, drinking pattern and drinking problems variables related significantly to responses to the economic crisis questions. FINDINGS: During the economic crisis people stopped or reduced going to bars and instead drank at home or at friends' homes. A large number of respondents also reported that people had changed to cheaper or lower-quality alcoholic drinks. Women were more likely to agree with statements that the economic crisis had increased 'escape' drinking and required reductions in money spent on alcohol; men were more likely to agree that the crisis had led to less drinking in bars and to the purchase of cheaper or lower-quality alcoholic beverages. Respondents who reported having significant others with drinking-related problems were more likely to endorse all four statements about effects of the economic crisis on drinking behaviour. A qualitative approach was used to discuss themes in the general comments that were recorded by the interviewers while collecting data. A strongly moralistic attitude towards alcohol was present in these comments, especially among women. CONCLUSION: The findings suggest that the economic crisis in Argentina led to major changes in patterns of drinking that differed according to gender roles and other demographic variables. The long-term effects of these changes remain to be determined as economic circumstances improve.     

Variations in Drinking Patterns in the Rural South: Joint Effects of Race,Gender, and Rural Residence

Objectives: To understand the relative contribution of gender, race (African-American vs. Caucasian), and rural residence on variations in drinking patterns, including past year abstinence, at-risk drinking, and recent drinking quantity and frequency for drinkers only. Methods: A brief health survey was administered by telephone to a probability sample of 11,529 residents of six southern states, over-sampling rural inhabitants. Results: Drinking patterns varied by gender, race, and rural residence in bivariate analysis. Gender effects were independent of rural residence, but race effects on abstinence and at-risk drinking were found only in urban residents and race differences in drinking quantity only in rural residents. Multivariate analysis, controlling for age and education, found gender and rural residence to be the strongest predictors, as well as being an African-American female. Conclusions: Female gender, African-American race, and rural residence appear protective for at-risk drinking but rural residence dominates racial differences.     

Longitudinal trajectories of heavy drinking in adults in the United States of America

AIMS: To estimate age, period, cohort and other demographic influences on heavy alcohol consumption and trajectories of heavy drinking in American adults. DESIGN: Prospective cohort of 14 127 participants, aged 25-74 years at baseline. Generalized estimating equations to model longitudinal change in the probability of heavy drinking and its association with demographic factors. Setting National, population-based sample of non-institutionalized civilians. MEASUREMENTS: Heavy alcohol consumption (usual number of drinks per occasion >or= five for men; >or= four for women) at baseline (1971-74) and three follow-ups until 1992. FINDINGS: Heavy alcohol consumption declined with increasing age (age effect) and tracked national average consumption (period effect). There was no cohort effect. Higher probability of heavy drinking was associated with male gender (relative risk: RR = 2.4), being not married (RR = 1.4), having less than high school education (RR = 1.7), having annual income below the median (RR = 1.5), not living in the South-east (RR = 1.7), and smoking (RR = 3.4). Getting married and quitting smoking during the study were each associated with reduction in heavy drinking (RR = 0.55 and 0.61, respectively). Slower age-related decline in the probability of heavy drinking was seen in men (P < 0.0001), married individuals (P = 0.03), and smokers (P = 0.05). CONCLUSIONS: Demographic predictors of trends in heavy drinking are different from those for trends in average alcohol consumption. The likelihood of heavy drinking declined more slowly with increasing age in men and smokers, suggesting that the negative health effects of alcohol in older ages may be greatest in these groups.