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The impact of region and urbanization on African American drinking patterns: results from a national survey.

Regional migration has been a central aspect of black American social life throughout the present century. Beginning in the early l900s, thousands of blacks began to flock to Northern cities in one of the early waves of the "Great Migration." The outpouring of blacks from the South came in response to aggressive campaigns for laborers in the North, as well as to crop failures and racial oppression in the South. Reflecting these shifts, the 1920 census indicated that the proportion of blacks in selected Northern cities had increased by at least half and often by several times in the 10-year span between 1910 and 1920 (Gwinnell, 1928).

After 1940, the migration of blacks from the South increased even more dramatically. The South lost close to 1.5 million blacks in each of the three decades from 1940 to 1970. Initially the North was the destination of most blacks; however, substantial numbers also migrated to the West Coast, primarily to California (U.S. Department of Commerce, 1983). Since the 1970s, the outflow of blacks from the South has declined, while the immigration of blacks to this region has become more common (ibid.).

Black migration in the U.S. signaled not only changes in the regional distribution of this group, but also its rapid urbanization. In 1890, four-fifths of the black population resided in rural areas. Eighty years later, the situation was completely reversed, and the vast majority of blacks lived in urban areas. Most of the urbanization occurred in the years after 1940, fed by the large influx of blacks to Northern cities from Southern rural areas.

The continuous migration and rapid urbanization of black Americans have been linked to major changes in social attitudes and behavior regarding alcoholic beverages. Blacks left small farm and village settings, where social life was dominated by rural churches, to urban areas with an extensive tavern and nightclub culture. As blacks became a focus of this wet cultural milieu, particularly under national prohibition, alcohol use and alcohol-related problems appeared to increase substantially (Herd, 1985b).

The geographical distribution of many alcohol-related problems among blacks appears to reflect the path of relocation from the Deep South to Northern and Southern coastal cities. For example, an analysis of cirrhosis mortality (Herd, 1985a) showed that between 1949 and 1971, rates for blacks in the Northeast and South Atlantic regions rose dramatically, while they remained very low in the South Central regions. In 1971, blacks residing in Northern or South Atlantic regions were from two to four times more likely to die of cirrhosis than blacks in the Deep South. Similarly, in a cohort analysis of mortality from esophageal cancer between 1930 and 1967 (Schoenberg et al., 1971), rates for non-whites had increased greatly and were particularly high among those living in the North and South Atlantic regions. The increases in mortality in the non-white population were attributed to migration from rural to urban areas, which might result in a larger proportion of heavier smokers.

A classic study of racial differences in mental diseases (Malzberg, 1944) showed that elevated rates for blacks in New York were largely due to excessive rates among migrants from other states. For example, in 1931 overall hospital admission rates were 40.0 per 100,000 for blacks born in New York and 186.2 for those born in other areas; the rates for alcoholic psychoses were nearly eight times higher for those born out of state compared with native New Yorkers. When migration status of the population was controlled for, many of the considerable differences between blacks and whites were minimized.

More recent data on the utilization of alcohol treatment facilities also indicate that blacks are greatly overrepresented in states traditionally associated with the heaviest influx of out-of-state migrants. The proportion of blacks in treatment was two to three times higher among blacks in the general population in the Estern Seaboard states (New York, Connecticut, New Jersey, Pennsylvania), while in the South, treatment rates were roughly equal to the percentage of blacks in each state's population (Herd, 1989).

The historical experience of migration and skewed geographical distribution of many indicators of alcohol-related problems suggests that they may reflect underlying shifts in the regional distribution of heavier drinking. Although the limited base on black drinking patterns has made it difficult to explore this question directly, data from existing studies do suggest that there might be a heavier concentration of high-risk drinking among blacks in the urban North compared with the South. General population studies of New York state (Barnes and Russell, 1977) and the Boston area (Wechsler et al., 1978) showed that blacks as well as whites exhibited considerably higher rates of heavier drinking than blacks in national samples (Cahalan et al., 1969) or blacks in the South (Globetti, 1967; Windham and Aldridge, 1965; Warheit et al., 1976). Community epidemiological surveys of blacks in New York (Bailey et al., 1965; Haberman and Sheinberg, 1967) and in Connecticut (Weissman et al., 1980) illustrated that rates of "alcoholism" were disproportionately high among blacks, particularly women. Studies of black men in the St. Louis area (Robins et al., 1968) revealed that heavy drinking was twice as common among blacks as whites, and that problems from drinking were more than three times as common.

The purpose of the present paper is to directly explore the issues raised in previous studies surrounding region, migration and black drinking patterns in a large national probability sample. The analyses focus on several central research questions suggested in previous analyses:

1. Do regional differences in black drinking patterns mirror the geographical distribution of reported statistics on alcoholism and other alcohol-related problems? Based on prior research, it is expected that rates of heavier drinking would be considerably higher for blacks in northeastern and southern coastal states as opposed to the Deep South.

2. Does regional migration (particularly from drier areas) increase the risk of heavier drinking compared with the pat terns of non-migrants in the "sending" areas (e.g., Southern states) or "receiving" areas (e.g., Northern and Western states)?

3. Are regional differences in drinking behavior mediated by differences in urbanization? That is, is the effect of region or migration status mainly attributable to the effect of differences in levels of urbanization?

4. Do region, migration and urbanization influence black drinking patterns by influencing norms and social contexts related to drinking?

Methods

Sample

Data for this study come from a nationwide general population survey of alcohol use conducted in 1984 by the Alcohol Research Group under a grant from the National Institute on Alcohol Abuse and Alcoholism.(1) A total of 5,221 respondents were sampled from the adult population (18 years and older) residing in U.S. households (excluding Alaska and Hawaii). Probability methods were used at each stage of the sampling process (i.e., in the selection of primary sampling units, neighborhoods or census tracts, listing areas, households and eligible respondents) to ensure a generalizable sample.(2) Respondents were personally interviewed in their homes by trained interviewers from the Institute of Survey Research at Temple University. They were administered a standardized interview schedule that took approximately 60-75 minutes to complete.

The following analysis is based on subsamples of 1947 black3 men and women. Detailed profiles of the sample are available in Clark and Hilton (1991).

Drinking patterns

Three measures of drinking patterns are used in the study. The first is used in the descriptive analyses and consists of a two-dimensional typology on the frequency of drinking any alcoholic beverages and the frequency of drinking five or more drinks per occasion or in a single day during the previous 12 months (Cahalan et al., 1976; Wallack and Barrows, 1981) (see the appendix for a more detailed description of the typology). The index was constructed from a series of items on drinking frequency and on the amounts of usual consumption of wine, beer, and liquor (see the appendix).

The second measure is a quantity-frequency drinking scale designed for use in the multivariate analyses. The scale was also created from a series of items measuring drinking frequency and on the amounts of usual consumption of wine, beer, and liquor (see the appendix). The response categories to each item on the frequency of drinking of wine, beer or liquor and on how often respondents consumed 1-2, 3-4, or 5-6 drinks of wine, beer, or liquor were assigned numerical values corresponding to category midpoints. Average scores of drinking frequency and quantity across beverage types were obtained, and these were multiplied to create a scale measuring the combined quantity-frequency of drinking for each respondent.

Finally, a scale of heavier drinking was created for use in the multivariate analyses. This measure is based on two questionnaire items that ask the respondent, "During the past year, how often did you have 12 or more drinks of any kind of alcoholic beverage in a single day?" and "During the past year, how often did you have at leas eight but less than 12 drinks of any kind of alcoholic beverage in a single day?" The responses to these two items were assigned numerical values and then summed to give a measure of the frequency of drinking eight or more drinks in a single day. This indicator of heavy drinking was selected because preliminary analysis showed that it accounts for more variance in alcohol-related problems than an alternate measure based on consuming five or more drinks at a sitting. Knupfer (1984) confirms the usefulness of using this measure; she states that "the best index for risk [of negative consequences of drinking] seems to be eight or more drinks once a week or more" (p. 195).

Region, urbanization and migration

Information on the respondent's current region of residence and level of urbanization was obtained from data used to design and select household samples. The information was individually coded for each respondent's interview. Data on the respondent's birthplace and the birthplace of the respondent's mother were obtained by asking respondents, "In what state, territory, or country were you born?" and "In what state, territory, or country was your mother born?" In addition, information on the degree of urbanization and the region where the respondent lived as a child (until age 16) were elicited through the following two questions: "Which of the following best describes where you lived most of the time before you were 16: (1) In the country on a farm; (2) in the country, but not on a farm; (3) in a town of less than 5,000, including the suburbs; (4) in a city between 5,001 to 25,000; (5) in a city between 25,001 to 100,000; (6) in a city between 100,001 to 500,000; or (7) in a city of more than 500,000?" and "What state, territory, or country was that in?"

In the multivariate analyses, regional variables were dichotomized into "wet" or "dry" regions based on the classification approach developed by Cahalan and Room (1974). Historically, sentiment about drinking in the U.S., as reflected in voting patterns on prohibition and alcohol control laws, and drinking patterns has been divided on regional lines. "Drier" areas in the U.S. were traditionally found in the South and Midwest, while the Northeastern and Pacific Coast regions were described as "wet" regions, with social mores and policies favorable to drinking (Cahalan and Room, 1974). The different orientations to alcohol use in dry and wet areas probably stem from broader ethnic, religious, economic, and social differences as well as from specific factors related to the availability of alcoholic beverages, prevalence of drinking settings, and alcohol control policies (Room, 1983). In the present analysis, "wetter" regions include the Northeast, East North Central and Pacific areas, while "drier" regions include the South and the Mountain and West North Central states (cf. Cahalan and Room, 1974).

Drinking norms and social contexts

A scale of drinking norms was developed from a series of items on respondents, perceptions of how much drinking is appropriate in various social situations. The settings included drinking at lunch with co-workers; during working hours not just at lunch; when with friends at home; when getting together with friends after work; when getting together with people at sports events or recreation; when going to drive a car; as a parent spending time with small children; a husband and wife having dinner out together; and a man or a woman at a bar with friends. The responses ranged from one (no drinking) to four (getting drunk is sometimes all right) and were averaged to form an overall measure of drinking norms. The alpha reliability score for this scale was .90.

The respondents were also asked whether they agreed or disagreed with two items regarding the use of alcohol in the home: "In our household, we usually serve alcoholic beverages when friends come over" and "I keep a supply of alcoholic beverages at home." The responses to these items were summed. Finally, the level of participation in drinking-related environments was ascertained by asking respondents how often they had visited bars, taverns and cocktail lounges in the past year.

Results: descriptive analyses of region, urbanization, migration and drinking behavior

Region

For male respondents, rates of heavier drinking deviated considerably from expected patterns. It was assumed that the proportion of heavier drinkers would be lower in states in the Deep South (South Central region) and higher in northern and southern coastal regions (Northeast and South Atlantic regions, respectively).

However, there was little variation in rates of heavier drinking in different areas. In fact, the proportion of frequent heavier drinkers was as high in the South Central region as in the North or the West. It was also expected that rates of abstaining would be much higher in the South than in other areas. However, abstention rates in the Northeast were identical to or similar to those in the South Atlantic and South Central regions. Considerably lower rates of non-drinking were reported by respondents in the North Central region and in the West.

Among black women, differences in rates of abstention did follow expected patterns--they were considerably higher in the South Atlantic and South Central regions than in the other areas. However, rates of frequent high maximum drinking and heavier drinking did not differ greatly by region.

Urbanization

Urbanization is generally associated with higher rates of drinking in the U.S. (Room, 1983) because of higher levels of alcohol availability and liberal social norms.

However, results on the drinking patterns of black men deviated from the expected urban/rural division. The abstention rate for men living in rural areas was similar to rates among men residing in large cities and suburban areas. The highest proportion of abstainers actually occurred among men in medium-sized cities. In addition, rural black men were more likely to engage in frequent high maximum drinking than were men living in either small or large cities. However, rates of frequent heavier drinking were highest for men living in large metropolitan cities and were substantially lower among residents in cities of fewer than 50,000 inhabitants or in nonmetropolitan areas.

Among women, there was a stronger relationship between urbanization and drinking rates. Women living in rural areas were the least likely to be drinkers; those living in suburban and medium-sized cities showed about a 10% increase in the proportion of drinkers; and women living in large cities were the most likely to be drinkers. However, there were no dramatic differences in the level of frequent or heavy drinking among women according to the level of urbanization. Instead, the rise in drinking rates along the rural-urban continuum appeared to be the result of increases in infrequent and less frequent drinking.

Migration

The historical exodus of blacks from Southern states to Northern and Western states is mirrored in the background characteristics of the respondents.

Whereas more than 90% of men and women in the sample indicated that their mothers were born in drier regions (South Central, South Atlantic, Midwest, and Mountain regions), only about 60% of these respondents lived in these areas at the time of the survey. The percentage of respondents born or living in the wetter regions (Northeast, West North Central and Pacific regions) has expanded proportionately. Although highly prevalent, migration does not appear to increase the risk of heavier drinking among respondents.

If this were the case, we would expect that rates of heavier drinking would be higher among migrants from dry to wet regions than for non-migrants living in either type of region. In contrast, the results show that men who moved from one region to another were no more likely to drink heavily than other men and were in fact less likely to be frequent high maximum drinkers than non-migrants. Migration from wet to dry regions appears to result in increases in infrequent or moderate drinking levels rather than in abrupt shifts to heavy drinking.

Among women, some of the same patterns emerged. Women who migrated from drier regions were somewhat less likely to be abstainers and more likely to be infrequent drinkers than those reared and currently living in drier regions. Among migrant women, rates of heavy drinking were lower than those of non-migrants. In contrast to patterns observed among men, women who were reared in drier regions (whether they migrated or not) were considerably less likely to be drinkers and to drink frequently than women reared and living in wetter regions. This finding mirrors previous results showing that there are stronger regional differences in women's drinking than in men's and suggests that the transition to frequent drinking occurs very slowly among women reared in drier areas.

Changes in urbanization status

The process of urbanization has been an integral part of the migration experience of blacks and may have affected drinking behavior as much as or more than migrating from dry to wet geographical regions. As a review by Room (1983) illustrates, since the 1930s indicators of heavy drinking have shown much higher rates in city populations than in farm populations.

Urbanization has occurred among a large proportion of black Americans. About a third of the sample (34%) indicated that they grew up in a rural area. However, at the time of the present survey, only 12% of the men and 8% of the women lived in rural areas.

Among men, moving from rural to urban locations did not show a clear association with drinking behavior. For example, the proportion of abstainers did not decline incrementally with the intensity of urbanization, nor did rates of heavier or frequent drinking show steady increases for those with greater exposure to urban settings. In contrast, men born in rural areas who moved to cities are considerably more likely to be abstainers and are less likely to drink five or more drinks at a sitting than the other groups of men.

Among women, there was a clear urban/rural split in drinking patterns based on the kind of setting where they grew up. Women reared in urban areas were considerably more likely to be drinkers and to drink heavily than women who grew up in rural settings, whether they remained in these areas or moved to cities. Both groups of women born in rural areas (even those living in cities at the time of the survey) reported very high rates of abstaining and negligible rates of heavier drinking. These findings suggest that among women, heavier drinking patterns are acquired only after living for a substantial time in urban settings.

In sum, the above findings illustrate that the influence of region and urbanization on black male drinking patterns deviated considerably from the expected wet/dry, urban/rural split in abstention and heavier drinking. Regional differences in drinking behavior were not statistically significant for men, with rates of abstention and heavier drinking similar in the Northeast and South Central areas. Furthermore, increasing urbanization was associated with higher rates of abstention and lower rates of frequent high maximum drinking. In contrast, drinking patterns, especially abstention rates, among women generally reflected the traditional divide along wet and dry regions or urban/rural settings. However, for both men and women, regional migration was not associated with sharp increases in heavier drinking. In each gender group, moving from a dry to a wet area decreased abstention rates and increased the frequency of infrequent or low maximum drinking. And among men, migration lowered rates of frequent high maximum drinking.

Results: multivariate analysis of region and urbanization as predictors of drinking problems

The previous sections showed that region and urbanization appear to affect the drinking behavior of black men and of black women in different ways. A multiple group structural equation model was used to determine if these differences would persist after taking into account socio-demographic factors and to ascertain whether region, urbanization and migration independently influence drinking behavior through norms and social contexts.

The structural equation model was tested using EQS (Bentler, 1989). Regional migration and urban-rural migration status,4 as well as other demographic variables (age, income, education, religious affiliation, and gender), were included as predictors of intervening variables (drinking-related norms, bar attendance, and home use of alcohol), which in turn predicted drinking patterns (the quantity-frequency of drinking scale and a scale measuring the frequency of consuming eight or more drinks per day). The quantity-frequency scale was selected as one of the dependent variables to provide insight into the predictors of general consumption levels, since one of the issues explored in the study is whether geographic variables affect overall drinking behavior. A scale on heavier drinking was also included, because the literature suggests that migration may increase vulnerability to alcoholism and alcohol-related problems (cf. Knupfer, 1984).

In the first stage of analysis, separate models were solved for men and women using all of the variables. Although the original model specified only indirect effects of demographic variables on drinking, all of the variables were tested as potential direct predictors of the respondents, drinking behavior. Any variables that were significant for either gender group were retained, and a multiple group comparison procedure was used to compare differences in effects for men and for women. The initial multiple group analysis specified that all parameter effects were equal for the two groups. Then Lagrange multiplier tests were used to determine for which parameters the hypothesis of equal effects was not reasonable. Based on the theoretical hypotheses and results of the Lagrange multiplier tests, specific parameters were freed one at a time. The model was then reanalyzed in an iterative fashion and reassessed by examining the diagnostic information. The entire sequence of freeing individual parameters and reanalyzing the model was repeated until a model that fit the data well was attained. The structural coefficients for the final model are presented in Table 6. These coefficients are interpreted in the same manner as regression coefficients.

The chi-square for the final model is 89, df=83, p < .31, which represents a significant decrease from the chi-square of 160.76, df=88, p < .001 observed for the fully constrained baseline model. The final model showed a reasonably good fit with the data, as indicated by values obtained for the Bentler-Bonett Normed and Nonnormed Fit Indices (.98 and 1.00, respectively) and the Comparative Fit Index (1.00).

The results (Table 6) show that most of the effects of region or urbanization on drinking patterns occurred through their influence on norms, the home environment, and bar attendance.

Living in a wet area (whether the respondent grew up in a wet or a dry region) and being reared in and currently living in an urban area increased the liberalness of drinking norms and of the home drinking environment. Both norms and the home drinking environment were highly significant predictors of the drinking quantity-frequency scale and of heavier drinking. In addition, growing up in and currently living in a wet area raised the level of bar attendance, which in turn predicted drinking patterns. Coefficients for the indirect effects of geographic variables on drinking are presented in Table 7 and confirm the relationships described above.

Living in a wet area, and having been reared in and currently living in an urban area, had significant indirect influences for both men and women on the quantity-frequency scale and on the frequency of consuming eight or more drinks. Although type of region and urbanization indirectly influenced drinking through norms and social context, only migrating from a rural to an urban environment had a direct effect on drinking patterns, and this influence was negative.

The findings indicate that although geographic setting influenced drinking behavior, regional migration (e.g., moving from a dry to wet area) did not appear to do so. A respondent whose current residence was in a wet area, whether he or she grew up in a wet or a dry region, was more likely to endorse liberal drinking norms and to keep or serve alcohol at home than was a respondent who resided in a dry area at the time of the survey. Similarly, migration from a dry to a wet region did not specifically predict bar attendance. Respondents growing up and living in wet regions were more likely to go to bars than were respondents who grew up in dry areas regardless of what type of region they lived in at the time of the survey. In contrast, migration from a rural to an urban environment did have an impact on drinking quantity-frequency, but not in the expected direction. Respondents migrating from rural to urban environments were less likely than those who stayed in rural areas or those reared and currently living in urban areas to score high on the quantity-frequency scale of drinking.

There were no gender differences in the direct effects of region or urbanization on drinking or on norms, the home drinking environment, or bar attendance. However, the indirect effects of these variables differed between the sexes because of the greater influence of norms and bar attendance on men's drinking patterns. Region and urbanization had a stronger effect on men's drinking behavior, primarily through the impact of drinking norms. In addition, the indirect effect of region on men's drinking was slightly enhanced through the greater influence of bar attendance on heavier drinking.

The influence of age on men's and on women's drinking patterns also differed. Age was negatively correlated with the quantity and frequency of men's drinking, but not that of women. In contrast, age predicted the home drinking environment of women, but had no effect on home drinking among men.

Finally, there were gender differences in the R2 for models predicting drinking and intervening factors. The models predicting drinking accounted for a substantially larger proportion of the variance in men's drinking than in women's, while those predicting the intervening variables were better predictors for women.

Conclusion

The previous sections illustrate that although there are considerable gender differences in the geographical distribution of drinking behavior, region, urbanization and migration shape the drinking patterns of men and of women in very similar ways. Among both genders, current or lifetime residence in a wet region and/or lifetime residence in an urban area increase drinking rates through influencing respondents, norms, home use of alcohol, and bar attendance. Conversely, migration from a rural to an urban environment reduces the quantity and frequency of drinking.

The findings of the impact of wet and urban residence on drinking norms and social context of drinking are consistent with previous explanations of how environmental differences influence drinking patterns (Room, 1983; Hilton, 1991). They support the notion that the liberalness of the drinking environment as reflected in norms, use of alcohol in the home, and availability of drinking establishments affects drinking patterns.

In addition, the finding that both migrants to wet areas and non-migrants living in these areas had more liberal drinking norms than those in drier regions lends support to Smith's observation (1982) that "the drinking patterns of migrants tend to conform to those in a new residence" (p. 33). This finding is consistent with the idea that changes in the social context of drinking associated with migration from a dry to a wet area, rather than the process of migration itself, result in increased drinking rates.

The results showing that growing up in an urban area predicts liberal drinking norms and home use of alcohol echo Cahalan and Room's (1974) conclusion that size of place of upbringing affects drinking patterns more than the degree of urbanization where one lives. However, the finding that rural to urban migration among black men and women decreases drinking quantity-frequency contradicts the findings and assumptions of most research on urbanization and drinking. Further research into the lifestyle and social conditions of contemporary rural life among African Americans and of the life circumstances of urbanizing migrants will be necessary to explain this anomaly. In addition, it will be necessary to rule out methodological problems such as sampling biases that could result in artifactual findings.

At another level, the above results illustrate that although regional setting and urbanization can influence drinking in similar ways, the two factors have independent and sometimes different effects on alcohol consumption. Further research should examine these distinctions more and explore whether region and urbanization have an interactive influence on drinking behavior.

Although the direct influence of geographical variables on men's and on women's drinking and drinking-related factors is very similar, the two groups differed in the indirect effect of these variables, primarily through the greater impact of norms (and to some extent of bar attendance) on men's drinking. These patterns suggest that male-female differences in drinking norms and tavern patronage can affect the relationships between gender, drinking behavior, and environment. For example, the greater role of bar drinking in black male than in black female drinking cultures might lead to sharper regional differences in drinking between the sexes because the distribution of bars and taverns differs substantially along regional lines.

In general, the above findings suggest that complex social differences, rather than differences in how the ecological setting affects drinking per se, contribute to the stark gender contrasts in the geographical distribution of drinking. Thus high rates of heavier drinking among black males in the Deep South, as opposed to the very low rates among black women, may be the outcome of concrete sociodemographic differences (e.g., difference in age or income distribution) and of differences in how sociodemographic factors, norms or social context affect moderate drinking in the sexes. Further research is needed to clarify demographic and sex-role differences that interact with the ecological context of alcohol consumption to produce such differences in the portraits of male and of female drinking.

Notes

(1.) Detailed methods are reported in a monograph edited by Clark and Hilton, 1991. (2.) It should be noted that although the sample was especially designed to yield a good probability sample of African Americans nationwide, the respondents in it are fairly heavily clustered. To minimize the effects of oversampling and clustering, unweighted data are used in the analyses. However, since standard errors could be biased, statistical significance tests should be interpreted conservatively. (3.) Blacks are respondents who classified themselves as "black, not of Hispanic origin." (4.) Regional migration status was measured through an index categorizing respondents on region where he or she lived until age 16 and region of current residence. The categories include: grew up in dry region/lives in dry region; grew up in dry region/lives in wet region; grew up in wet region/lives in wet region. In the EQS model, grew up in dry region/lives in dry region served as the contrast category with which others were compared. Urban migration status was measured with an index with the following categories: grew up in rural area/lives in rural area; grew up in rural area/lives in urban area; grew up in urban area/lives in urban area. Grew up in rural area/lives in rural area served as the contrast category with which others were compared.

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Appendix

I. Drinking patterns: quantity-frequency typology

A. "Infrequent": Drinks 1-11 times a year (less than monthly) and seldom drinks as much as five drinks at a sitting. B. "Less frequent, low maximum": Drinks 1-3 times a month, but never drinks as much as five drinks at a sitting. C. "Less frequent, high maximum": Drinks 1-3 times a month, and sometimes drinks five or more drinks at a sitting. D. "Frequent low maximum": Drinks once a week or more often, but never drinks as many as five drinks at a sitting. E. "Frequent high maximum": Drinks once a week or more often and occasionally drinks five or more drinks. F. "Frequent heavier": Drinks at least five drinks at a sitting, once a week or more often.

II. Drinking patterns: intake items

A. How often do you usually have wine (or a punch containing wine)? B. How often do you usually have beer? C. How often do you usually have drinks containing whiskey or any other liquor, including scotch, bourbon, gin, vodka, rum, etc.? D. How often do you usually have any kind of beverage containing alcohol, whether it is wine, beer, or whiskey, or any other drink?

Response choices for Questions A through D:

Two or more times a day

Two times a day

Once a day

Nearly every day

Three or four times a week

Once or twice a week

Two or three times a month

About once a month

Less than once a month but at least once a year

Less than once a year

I have never had wine (beer or liquor) E. When you drink wine, how often do you have as many as five or six glasses? F. When you drink wine, how often do you have three or four glasses? G. When you drink wine, how often do you have one to two glasses? H. When you drink beer, how often do you have as many as five or six glasses or cans? I. When you drink beer, how often do you have three or four glasses or cans? J. When you drink beer, how often do you have one to two glasses or cans? K. When you drink whiskey or liquor, how often do you have as many as five or six drinks? L. When you drink whiskey or liquor, how often do you have as many as three or four drinks? M. When you drink whiskey or liquor, how often do you have one or two drinks?

Response choices for Questions E through M:

Nearly every time

More than half the time

Once in a while

Never

N. During the past year, how often did you have 12 or more drinks of any kind of alcoholic beverage in a single day--that is, any combination of cans of beer, glasses of wine, drinks containing liquor of any kind?

O. During the past year, how often did you have at least eight but less than 12 drinks of any kind of alcoholic beverage in a single day--that is, any combination of cans of beer, glasses of wine, drinks containing liquor of any kind?

Response choices for Questions N and O:

Every day or nearly every day

Three to four times a week

Once or twice a week

One to three times a month

Seven to eleven times in the past year

Three to six times in the past year

Once in the past year

Never in the past year

Professor Herd is on the faculty of the School of Public Health, University of California (Berkeley, CA 94720). In addition to her survey analyses, the author has published ethnographic, cultural, historical and epidemiological studies of African American drinking now and in the past.

AUTHOR'S NOTE: Research for this paper was supported by grant AA09002-02 from the National Institute on Alcohol Abuse and Alcoholism. The author wishes to acknowledge the invaluable assistance of Joel Grube for computer programming and statistical consultation and of Karolyn Tyson for computer programming and manuscript preparation.
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Author:Herd, Denise
Publication:Contemporary Drug Problems
Date:Sep 22, 1995
Words:6657
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