Critique 121: Differences between wine and other alcoholic beverages in terms of adverse consequences of alcohol consumption – 22 August 2013
Dey M, Gmel G, Studer J, Dermota P, Mohler-Kuo M. Beverage preferences and associated drinking patterns, consequences and other substance use behaviours. European Journal of Public Health 2013; advance access; doi:10.1093/eurpub/ckt109
Background: Studies about beverage preferences in a country in which wine drinking is relatively widespread (like Switzerland) are scarce. Therefore, the main aims of the present study were to examine the associations between beverage preferences and drinking patterns, alcohol-related consequences and the use of other substances among Swiss young men.
Methods: The analytical sample consisted of 5399 Swiss men who participated in the Cohort Study on Substance Use Risk Factors (C-SURF) and had been drinking alcohol over the preceding 12 months. Logistic regression analyses were conducted to study the associations between preference for a particular beverage and (i) drinking patterns, (ii) negative alcohol-related consequences and (iii) the (at-risk) use of cigarettes, cannabis and other illicit drugs.
Results: Preference for beer was associated with risky drinking patterns and, comparable with a preference for strong alcohol, with the use of illicit substances (cannabis and other illicit drugs). In contrast, a preference for wine was associated with low-risk alcohol consumption and a reduced likelihood of experiencing at least four negative alcohol-related consequences or of daily cigarette smoking. Furthermore, the likelihood of negative outcomes (alcohol-related consequences; use of other substances) increased among people with risky drinking behaviours, independent of beverage preference.
Conclusions: In our survey, beer preference was associated with risky drinking patterns and illicit drug use. Alcohol polices to prevent large quantities of alcohol consumption, especially of cheaper spirits like beer, should be considered to reduce total alcohol consumption and the negative consequences associated with these beverage types.
The present study was based on questionnaire data related to alcohol intake that were obtained from just over one half of military conscripts from the general population who were invited to participate. Their average age was just over 19 years. “Risky single occasion drinking” (RSOD) was defined as consuming at least six standard drinks (10-12 g of alcohol/drink), and “At risk RSOD” was defined as risky drinking episodes at least once a month. Beverage preference was based on reporting that 2/3rds or more of the total intake of a subject came from one type of beverage. The intake of apertifs, alcopops, beer pops, wine pops, chillers, and coolers were all classified as “other preferences.” Overall, 31.7% preferred beer, 5.4% preferred wine, and 11.5% had “other preferences.”
Only 0.3% of subjects reported an average intake of > 21 drinks/week. Hence, these young subjects were primarily light drinkers or “binge” drinkers.
Many previous studies have shown healthier outcomes associated with the consumption of wine than of other alcoholic beverages. Such beneficial effects are generally attributed both to the polyphenols and other constituents of wine, other than alcohol, as well as to the drinking pattern and more moderate other lifestyle factors of wine consumers.
To some extent, the present study supports such findings, as the risk of most adverse alcohol-related consequences (e.g., blackouts, accidents, unprotected sex, encounters with police) were much less likely among men in whom two-thirds or more of their total alcohol consumption was from wine than from other beverages. Beer drinkers were more frequently binge drinkers. Smoking (both cigarettes and cannabis) and the use of illicit drugs were much less common among wine drinkers than either beer drinkers or those with other preferences. However, more frequent binge drinking, of any beverage, strongly related to an increase in adverse alcohol-related consequences.
Reviewer Finkel commented: “Nothing new here: young men, especially in the company of other young people, engage in risky behavior more than us more boring beings. Ever shall it be. I agree that the support of this study may help enable more sensible programs and legislation, but it will be difficult to persuade the rule makers that wine should be treated differently from other beverages. (Probably we should focus on treating young brains.)”
Forum member Skovenborg agreed: “Not much to learn from this study with cross-sectional data from a Swiss cohort study. As the authors acknowledge, men with a preference for beer and strong alcohol belong to a particular subculture that demonstrates problematic substance use due to personal characteristics. No causal inferences may be drawn due to lack of longitudinal data.” Skovenborg continued: “I am not sure why the authors suggest an attempt to reduce total alcohol intake in this group of young men, where consumption of more than 21 drinks per week occurred rarely. The essential problem is at risk binge drinking. To curb the binge drinking pattern of this group of young men with a price increase might work, however, even the illegal status of cannabis and other illicit drugs has not been able to stop such drug use.”
Implications of the results of this study for setting alcohol policy: Forum reviewer Ursini had some interesting observations: “The authors suggest that in order to decrease the ‘negative consequences’ of alcohol intake (the reference to the use of cannabis and illicit drugs is straightforward), alcohol policy must aim to prevent, with highest priority, the consumption of the beer just because it is ‘cheap.’ As a matter of fact the same results could be obtained by increasing the price of either beer (possibly welcome in terms of Governmental taxes) or of illicit drugs (but this would be inappropriate and definitely out of the Governmental control). The other option (the most desirable) would be increasing the richness of young people that in this way would be “protected” from the use of illicit drugs, while drinking –in moderation- the most expensive wines and spirits.”
The authors suggest that the data from this study may be useful when planning programs for reducing alcohol misuse. They state specifically that while preventive strategies should attempt to reduce excessive drinking of all types of beverages, “to lessen the additional negative effects of beer and strong alcohol, which are particularly cheap in Switzerland, targeted strategies such as minimum pricing policies for these beverage types should be considered.” In the opinion of Forum members, it is yet to be shown the extent to which such price restructuring would decrease unhealthy drinking practic0es among young people.
Questionnaire-based data on alcohol consumption were collected from more than 5,000 military recruits in Switzerland, who had a mean age of just over 19 years. There were very few drinkers who averaged more than 21 drinks/week, so the emphasis was on the effects of what is usually referred to as “binge drinking,” defined in this study as the consumption of 6 or more typical drinks (a drink containing 10-12 g of alcohol) on a single occasion. The “preference” of one particular type of beverage was based on the subject indicating that it made up more than two-thirds of his total alcohol consumption. The specific type of beverage preferred — beer, wine, or “other beverages” (the latter including apertifs, “pops,” chillers, and coolers) — was related to the pattern of drinking (frequency of binge drinking) and to the reported occurrence of adverse alcohol-related consequences (e.g., blackouts, driving after heavy drinking, missing work due to drinking, accidents, unprotected sex, encounters with police).
The authors report: “Preference for beer was associated with risky drinking patterns and, comparable with a preference for strong alcohol, with the use of illicit substances (cannabis and other illicit drugs). In contrast, a preference for wine was associated with low-risk alcohol consumption and a reduced likelihood of experiencing at least four negative alcohol-related consequences or of daily cigarette smoking.” More frequent binge drinking of any beverage was strongly associated with an increase in adverse alcohol-related consequences.
Forum reviewers thought that the adverse outcomes, especially those related to heavy beer intake, tend to characterize a particular subculture that demonstrates problematic substance use due to personal characteristics of the subjects. The unhealthy outcomes may be a feature more of the cultural habits of the subjects rather than just due to the type of beverage they consume most frequently.
The authors conclude that strategies for preventing problems with alcohol abuse should attempt to reduce excessive drinking of all types of beverages. However, they add: “to lessen the additional negative effects of beer and strong alcohol, which are particularly cheap in Switzerland, targeted strategies such as minimum pricing policies for these beverage types should be considered.” Forum members think that the extent to which such beverage-specific price restructuring would decrease unhealthy drinking practices among young people remains unclear.
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Comments on the critique of this paper were provided by the following members of the International Scientific Forum on Alcohol Research:
Harvey Finkel, MD, Hematology/Oncology, Boston University Medical Center, Boston, MA, USA
Erik Skovenborg, MD, Scandinavian Medical Alcohol Board, Practitioner,
Fulvio Ursini, MD, Dept. of Biological Chemistry, University of Padova, Padova, Italy
Arduino A. Mangoni, PhD, Strategic Professor of Clinical Pharmacology and Senior Consultant in Clinical Pharmacology and Internal Medicine, Department of Clinical Pharmacology, Flinders University, Bedford Park, SA; Australia
R. Curtis Ellison, MD, Section of Preventive Medicine & Epidemiology, Boston University School of Medicine, Boston, MA, USA