hol consumption (NCHS, 1998a). Generally, heavy drinking tends to decrease with education, and moderate alcohol use increases with education (NCHS, 1998a; Substance Abuse and Mental Health Services Administration, 1993). In 1994–1996, African American men and women with less than a high school education were almost twice as likely to report heavy alcohol use as were those who had more than a high school education (NCHS, 1998a). White men with high school diplomas were 20% more likely to report heavy alcohol use than were those with more education. White women with less than a high school diploma were 40% more likely to report heavy drinking than were women with more education.

Negative Health Effects

As early as 1926, a U-shaped relationship was described between mortality and consumption of alcohol (Pearl, 1926). The wide range of alcohol-induced illnesses and injuries is primarily attributable to differences in the amount, duration, and patterns of alcohol consumption as well as to differences in genetic vulnerability to particular alcohol-related consequences (USDHHS, 1997a; 2000). Long-term excessive drinking increases risk for high blood pressure, irregularities of heart rhythm (i.e., arrhythmias), disorders of the heart muscle (i.e., cardiomyopathy), and stroke (USDHHS, 2000). Long-term, heavy drinking also increases the risk of developing cancer of the esophagus, mouth, throat, and voice box and of the colon and rectum (NIAAA, 1993; USDHHS, 2000). Alcohol consumption appears to increase the risk of breast cancer in women (Smith-Warner et al., 1998); consumption of two or more drinks per day has been shown to slightly increase women’s risk of developing breast cancer (Reichman, 1994; USDHHS, 2000).4 The Dietary Guidelines for Americans (USDA, 1995a) advises women to consume no more than 1 drink per day; while men are advised to consume no more than two per day. Because men and women have less body water as they age, older persons can lower their risk of alcohol problems by drinking no more than one drink per day (Dufour et al., 1992; USDHHS, 2000). Heavy and chronic alcohol use is a cause of poor pregnancy outcomes (NCHS, 1998a; USDHHS, 1993), including fetal alcohol syndrome, a major nongenetic


A drink is defined as 0.54 ounces of ethanol, which is the approximately the amount of alcohol in 12 ounces of regular beer, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits.

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