Alcohol Abstainers versus Drinkers: Changes in Health Outcomes after 20 Years Kelly S. Marczynski, Ph.D. Center for Health and Social Research Institute for Community Health Promotion Buffalo State College, CLAS A203 marczyks@buffalostate.edu (716)878-6137

Overview What is the j-shaped curve, and what do abstainers have to do with it? The Buffalo Longitudinal Study – Drinking and Delinquency among Young Men Some findings Controversies surrounding the j-shaped curve Results and significance

The J-shaped Curve “There are more old wine drinkers than old doctors.” - German proverb

Alcohol Abstainers Abstainers are rarely the focus of research It appears that abstainers suffer from some of the same negative outcomes as do drinkers Alcohol is therefore not an independent predictor of health problems

The Study Sample “Drinking and Delinquency Among Young Men” ● 625 young men aged 16-19 selected from Buffalo, NY by RDD in 1992-93; interviewed three times initially, and then did Wave 4 12-15 years later ● Over-sampled high crime areas ● Data collected: Demographics, drinking and drug use, degree of family stability, physical health problems, and personality characteristics and psychiatric symptoms.

Abstainers Lifetime abstainers: ● Defined by the question, “Have you ever had a drink of beer, malt liquor, wine cooler, fortified wine, wine, liquor, or any other beverage containing alcohol, not counting small tastes?” “Current” abstainers/former drinkers: ● If answered yes to above, repeated the question for the past 12 months.

Further Delineation of Abstainers Lifetime abstainers Long-term abstainers Former drinkers as a group Former light drinkers Former moderate drinkers Former heavy drinkers Former problem drinkers Former alcoholic drinkers

Mental Health Brief Symptom Inventory (BSI) ● Depression ● Anxiety ● Obsessive-compulsive disorder ● Psychoticism

Strict Abstainers Former Drinkers F Sig. Mental Health of Strict Abstainers vs Former Drinkers as a Group: Wave 1 Strict Abstainers Former Drinkers F Sig. BSI (mean+SD) (mean+SD) Dimension Anxiety 0.81+0.8 0.92+0.7 0.6 ns Psychoticism 0.79+0.7 1.00+0.8 2.3 ns OCD 1.08+0.7 1.34+0.8 3.5 .06 Depression 0.68+0.7 0.85+0.8 1.7 ns Total 0.84+0.7 1.02+0.7 2.4 ns n=156

Strict Abstainers Former Drinkers F Sig. Mental Health of Strict Abstainers vs Former Drinkers as a Group: Wave 4 Strict Abstainers Former Drinkers F Sig. BSI (mean+SD) (mean+SD) Dimension Anxiety 1.62+0.6 1.63+0.8 .001 ns Psychoticism 1.58+0.9 1.88+0.8 1.0 ns OCD 1.84+0.7 2.13+0.9 1.1 ns Depression 1.52+0.7 1.75+0.9 0.7 ns Total 1.64+0.7 1.85+0.8 0.7 ns n=35

Controversies Surrounding the j-shaped Curve Well-documented by Jayasekara et al (AJE, Vol 179(9), May 2014): Quality of the epidemiologic evidence Choice of reference group Most cohort studies measure alcohol consumption only at baseline, but it’s likely to vary over life Misclassification of intake Consumption over prolonged time correlates more with biological processes with chronic health effect, compared with current drinking, which correlates more with acute alcohol effects Does not address whether low-dose drinking in young adulthood renders a benefit when you’re older

Results and Significance Abstainers should not be analyzed as a group, but rather broken down into lifetime and various categories of former drinking Infrequent drinkers (less than 12 drinks in any year of life) should not be aggregated with strict abstainers or with other drinkers, but analyzed as a separate group Significance: Represents a first step in leading to a better understanding of why certain people choose not to drink alcohol, and how this may impact their overall well-being as measured by other (non-alcohol) constructs in the data This understanding is imperative in light of recent literature suggesting a positive association between some alcohol and better physical health