Health Risk Factors Associated with Lifetime Abstinence from Alcohol in the 1979 National Longitudinal Survey of Youth Cohort

Abstract

Background The choice and definition of a comparison group in alcohol-related health studies remains a prominent issue in alcohol epidemiology due to potential biases in the risk estimates. The most commonly used comparison group has been current abstainers, however, this includes former drinkers who may have quit drinking due to health problems. Lifetime abstention could be the best option but measurement issues, selection biases due to health and other risk factors, and small numbers in populations are important concerns. This study examines characteristics of lifetime abstention and occasional drinking that are relevant for alcohol-related health studies. Methods This study used data from the National Longitudinal Survey of Youth 1979 cohort of 14-21 year olds followed through 2012 (n=7,515). Definitions of abstinence and occasional drinking were constructed based on multiple measurements. Descriptive analyses were used to compare the definitions, and in further analysis, lifetime abstainers (n=718) and lifetime minimal drinkers (n=1,027) were compared with drinkers across demographics and early-life characteristics (i.e., religion, poverty, parental education and family alcohol problems) in logistic regression models. Results Using a strict measurement of zero drinks from adolescence to the fifties, only 1.7% of the sample was defined as lifetime abstainer compared to a broader definition allowing a total of one drink over the lifetime that included 9.5% and to lifetime minimal drinking (a total of three drinks or less a month), which accounted for 13.7%. Factors significantly associated with lifetime abstention and lifetime minimal drinking included religion, poverty, having no family alcohol problems, Hispanic ethnicity, foreign-born and female gender. Importantly, work-related health limitations in early life were significantly associated, but not childhood physical and mental health problems. Conclusion Alcohol-related health studies should utilize lifetime classifications of drinkers and abstainers, and in doing so, should account for early-life socioeconomic adversity and childhood health factors or consider these as unmeasured confounders.

Commentary on Kerr and Colleagues (): More Evidence that Social and Health Limitations in Childhood Increase the Risk of Lifetime Abstention from Alcohol

“…Several studies have found a social gradient in non-drinking (Jefferis et al, 2007;Ng Fat and Shelton, 2012), with the more socially and economically disadvantaged being less likely to drink alcohol. In terms of health, Kerr et al's (2017) findings are consistent with a different prospective study in the UK, which found limiting longstanding illness from an early age and persistent limiting longstanding illness from childhood to be associated with lifetime abstention (Ng Fat et al, 2014). Since this relationship was found early on in life, it suggests that poor health may be causing lifetime abstention, rather than the reverse, as has been implicated in later-life in comparison with moderate drinkers.…”

“…Findings from Kerr et al (2017) (Kerr et al, 2017), add to the growing body of literature on lifetime abstention and abstention more generally. Several studies have found a social gradient in non-drinking (Jefferis et al, 2007;Ng Fat and Shelton, 2012), with the more socially and economically disadvantaged being less likely to drink alcohol.…”

“…Since this relationship was found early on in life, it suggests that poor health may be causing lifetime abstention, rather than the reverse, as has been implicated in later-life in comparison with moderate drinkers. More specifically Kerr et al (2017) found health related work limitations reported at age 14 to 21 to be associated with lifetime abstention. This may highlight a potential mechanism through which poor health may influence lifetime abstention, via the non-participation in the work-force.…”

“…However, a concurrent body of literature is now emerging on risk factors for lifetime abstention from alcohol. Early life poverty and limiting illness, has been found to be related to lifetime abstention in two British Cohorts (Ng Fat et al, 2014) and now in the US (Kerr et al, 2017).…”

“…Childhood poverty and work-related health limitations were found to increase the risk of being a lifetime abstainer from alcohol, according to a new study by Kerr and colleagues (Kerr et al, 2017). Findings were based on analyses of the 1979 National Longitudinal Survey of Youth Cohort, a nationally representative prospective study following 6,111 youths aged 14 to 21 in private residences in the US.…”