Graduate School of Public Health, Yonsei University, 134 Shinchon-dong, Seodaemun-gu, Seoul 120752, Korea
Correspondence: Graduate School of Public Health, Yonsei University, 134 Shinchon-dong, Seodaemun-gu, Seoul 120752, Korea. Tel.: +82 2 361 5094; Fax: +82 2 392 7734; E-mail: wchung{at}yumc.yonsei.ac.kr
(Received 21 July 2003; first review notified 3 September 2003; in revised form 9 October 2003; accepted 24 October 2003)
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ABSTRACT |
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INTRODUCTION |
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SUBJECTS AND METHODS |
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Before including type of beverage in our analyses, we took into consideration two country-specific characteristics related to drinking in Korea. First, two types of alcoholic beverages are traditionally popular in Korea: soju and makkolli. Soju, the most widely used traditional beverage, is a distilled liquor made from fermented potatoes and its alcohol content, 25%, is between that of wine (1014%) and spirits (more than 35%). Makkolli is the oldest liquor in Korea, made by fermenting non-glutinous and glutinous rice together. The constituents of soju are not similar to those of wine and spirits. Wine is not common in Korea; in terms of alcohol content, wine is more close to makkolli (about 7%) than to beer or soju. On the basis of this information, we first classified a beverage into one of five types (beer, soju, spirits, makkolli, wine). In contrast, for multivariate analyses, we tied makkolli and wine into one category, makkolli or wine. At the time of the survey, beer strength varied between products, but was beginning to be standardized at 4% following guidelines from the Korea Alcohol and Liquor Industry Association and Korea's National Tax Service.
Second, the survey revealed that some respondents drank two or more types of beverage in the last month. Some Korean drinkers consume more than one type of beverage in a day. If we include two or more types of beverage for those respondents, findings in a logistic regression analysis will not be independent. To avoid this problem, we selected only one type of beverage from among two or more alcoholic beverages that they drank, in the following way. We first categorized respondents into two groups, drinkers (someone who consumed at least one drink in the past month) and non-drinkers. For each drinker (n = 530), beverage-specific quantity-frequency scores were computed by multiplying the frequency of drinking of each beverage by the usual amount consumed (Kilty, 1990; Smart and Walsh, 1995
). After assigning alcohol contents of beverage types [beer 4% (by volume), soju 25%, spirits 40%, makkolli 7% and wine 12%] to the computed quantity-frequency score and assuming that 1 ml consumed alcohol includes 0.79 g of pure alcohol (World Health Organization, 2000
), we calculated pure alcohol content which each drinker had consumed in a session through each type of beverage. Finally, we selected the single beverage of which each drinker had consumed the most pure alcohol in the last month, and then finally included that type of beverage in our analyses.
Various socio-demographic characteristics previously shown to be related to individual alcohol intake and consumption were assessed as confounding factors. Age was divided by the mean age, 46.37 years. Respondents were classified into male and female. They were grouped according to whether they lived with a partner or not. Respondents reported their level of education, and we categorized them on whether they completed their high school education. They were also grouped according to their employment status. Considering their residential areas, we divided them according to whether they lived in large cities or not. With regard to smoking, respondents were grouped according to whether they had ever smoked in the last month. Body mass index (BMI) was categorized on the basis of whether the index was greater than or equal to 25. Concerning stress level and subjective health status, respondents were grouped according to whether a respondent had felt often stressed (Have you ever felt stressed to a degree to which you could not bear it?) in the last month or not and whether a respondent evaluated his or her health status as worse or not compared to others.
On the basis of information on the usual consumption of pure alcohol for each chosen beverage, three levels of risk from drinking were categorized according to the guidelines from the World Health Organization (2000) on high risk drinking for short-term or acute harm, in particular, alcohol-related acute diseases such as acute gastritis and pancreatitis, road crashes, violent incidents, suicide, and other causes of injury. These levels of risk from drinking are: (1) low or medium risk drinking (women who drank less than or equal to 40 g pure alcohol per drinking day and men who drank less than or equal to 60 g per drinking day); (2) high-risk drinking (women who drank more than 40 g and less than or equal to 60 g per drinking day and men who drank more than 60 g and less than or equal to 100 g per drinking day; and (3) very high-risk drinking (women who drank more than 60 g per drinking day and men who drank more than 100 g per drinking day).
Our analyses were two-fold. First, the significance of the associations between different levels of risk from drinking and selected variables were tested through chi-squared tests. Second, we used multivariate logistic regression controlling for various confounding factors to detect OR for risky drinking (with 95%CI limits). The data were weighted to account for non-response, census projection counts, and age and sex of the population. All statistical analyses were conducted by using SAS 8 software package.
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RESULTS |
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DISCUSSION |
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Study limitations
In the data we employed for this study, respondents were asked questions about beverage types that they consumed in the last month and their usual consumption of these types per drinking day (Kilty, 1990; Smart and Walsh, 1995
; Theobald et al., 2000
). Unfortunately, these type of data often disregard a potential measurement error incurred by the possibility of two or more types of beverage being consumed in a drinking day. For improved analyses, either the last 7 days or the graduated quantity-frequency approaches are recommended (Lemmens et al., 1992
; Rehm et al., 1999
).
This study used cross-sectional data, not longitudinal data, so our results may suffer from the inadequacy of causal inference and recall bias (Jensen et al., 2002). In addition, in order to investigate confounders more precisely, we need more information than we had available about the social group to which respondents belonged (Ennett et al., 1999
; Engels and ter Bogt, 2001
). In Asian countries such as China, Japan and Korea, the role and influence of social group on drinking behaviour may be stronger than in Western countries (Hwang and Akers, 2002
).
Role of price
Price may have been a factor limiting high sessional beer drinking at the time of the study. The Korea's National Tax Service levies tax on alcoholic beverages. In 1997, the ad valorem tax rates were 130% for beer, 35% for soju, 100% for spirits, 5% for makkolli and 30% for wine. Tax rate per gram of pure ethanol (%/gram) was thus 41.14% for beer, 1.77% for soju, 3.16% for spirits, 0.90% for makkolli and 3.16% for wine. In 2001, new tax rates were introduced: 100% for beer and 72% for soju and spirits, lowering the tax rate per gram of pure ethanol (%/g) to 31.65% for beer and raising that for soju to 3.65%. Thus, there is still apparent protection of widely consumed traditional alcoholic beverages. It will be important to measure whether this slight price change will alter relations between risky drinking and beverage type.
Implications
In order for a country to reduce the economic and social cost associated with alcohol consumption, government policy needs to be targeted at the specific type of beverage for which the highest costs are incurred, and toward the specific population group that usually consumes this particular beverage. In some western countries, beer has been regarded as the beverage most likely to lead to a variety of alcohol problems. However, currently in Korea, it is soju, rather than beer, that has the higher association with risk from drinking for acute harm. Soju is also the most widely consumed beverage across all levels of population. In this regard, in Korea, soju, rather than beer, ought to be targeted. Therefore, we think this study has policy implications for Korea, and perhaps for other countries as well.
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ACKNOWLEDGEMENTS |
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REFERENCES |
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