AN ANALYSIS BY BIRTH COHORT OF ALCOHOL CONSUMPTION BY ADULTS IN GREAT BRITAIN 1978–1998

John Kemm

Department of Public Health and Epidemiology, University of Birmingham, Birmingham B15 2TT, UK

Received 3 May 2002; in revised form 14 September 2002; accepted 8 October 2002


    ABSTRACT
 TOP
 ABSTRACT
 INTRODUCTION
 SUBJECTS AND METHODS
 RESULTS
 DISCUSSION
 DISCLAIMER
 APPENDIX 1: DATA SOURCES
 REFERENCES
 
Aims and Methods: The General Household Survey for Great Britain has, since 1978, in even numbered years, included questions on alcohol consumption. A cohort analysis was applied to these sequential cross-sectional data. Results and Conclusions: Analysis confirms that, after about age 20 years, both men and women, as they grow older, become more likely to be non- or very light drinkers. Men are also less likely to be heavy drinkers as they grow older, but for women the picture is less clear-cut. Cohort effects can also be discerned, but are much less obvious than for smoking. There is a general trend for members of later cohorts at any age to be less likely to be non- or very light drinkers and more likely to be heavy drinkers, than members of earlier cohorts. However, for men, this trend seems to have ended with those born from about 1927 to 1931, while for women the trend has continued and possibly become stronger in cohorts born after 1927–1931.


    INTRODUCTION
 TOP
 ABSTRACT
 INTRODUCTION
 SUBJECTS AND METHODS
 RESULTS
 DISCUSSION
 DISCLAIMER
 APPENDIX 1: DATA SOURCES
 REFERENCES
 
Trends in alcohol consumption in the UK may be studied using excise data (British Beer and Pub Association, 2001Go) or data from serial cross-sectional surveys (Bridgwood et al., 2000Go). Estimates of consumption based on surveys give much lower results than estimates based on excise data, and this is generally explained by non-response of heavy drinkers and under-reporting by those who do respond [Office of Population Censuses and Surveys (OPCS), 1980Go]. Cross-sectional studies show major differences between drinking behaviour of different age groups, but longitudinal studies or serial cross-sectional studies are required to identify whether these are due to cohort or ageing effects. In Great Britain, the General Household Survey has included questions about consumption of alcoholic drinks in alternate years since 1978 and so provides an extensive series of cross-sectional data on drinking behaviour from which cohorts can be constructed. Use of these data sets allows cohort and age effects in a population to be explored in much greater detail than in any previously published study.


    SUBJECTS AND METHODS
 TOP
 ABSTRACT
 INTRODUCTION
 SUBJECTS AND METHODS
 RESULTS
 DISCUSSION
 DISCLAIMER
 APPENDIX 1: DATA SOURCES
 REFERENCES
 
The General Household Survey
The General Household Survey is a continuous multipurpose national survey of people living in private households conducted by the Social Survey Division of the Office for National Statistics (before 1996 by the OPCS). A representative sample of all private households is drawn from the postal address file (before 1982 from the electoral roll), using a multi-stage cluster sampling procedure (OPCS, 1986Go). These households are then visited and data are collected on a wide range of matters for all residents in that household aged 16 years and over. Typically, about 13 000 households are sampled, yielding data on about 20 000 individuals. Since 1978, questions on consumption of alcoholic beverages have been included in even numbered years. The section on alcohol is one of many sections in an extensive interview schedule. It comes towards the end of the schedule and follows a section on smoking. Prior to 1988, questions on alcohol consumption were only asked of those aged 18 years or over, but from 1988 onwards those aged 16 and 17 years were asked to answer these questions by filling in a self-completion form.

In 1978, the first two alcohol questions established if respondents drank at all. Those who had drunk even occasionally in the last year were then asked about their consumption of five types of drink: ‘shandy’, ‘beer/lager/stout/cider’, ‘spirits (e.g. gin/whisky/rum/brandy/vodka) or liqueurs’, ‘port/sherry/vermouth/martini’ and ‘wine’. First, for each drink type they were asked ‘How often have you had a drink of (...) during the last 12 months?’ with the response categories: most days, three to four times a week, once or twice a week, once or twice a month, once or twice in 6 months, once or twice in the year and not at all in the last 12 months. After asking about frequency of consumption for all drink types, they were then asked for those drink types that they had drunk in the past 12 months ‘How much (...) have you usually drunk on any one occasion during the last 12 months?’ and responses were recorded in usual measures: pints for shandy and beer group, singles for spirits group and glasses for port group and wine group.

These same questions have been used in subsequent surveys, though there have been minor changes over the years. In 1990, the frequency categories were changed to almost every day, 5 or 6 days a week, 3 or 4 days a week, once or twice a week, once or twice a month, once every couple of months, once or twice a year and not at all in the last 12 months. At the same time, the quantity question was changed to ‘How much (...) have you usually drunk on any one day?’. The measures in which quantities of the beer group could be reported were expanded to include other measures such as large and small cans. In 1998, two extra categories of drink were added: strong beer and alcopops. The case for believing that these minor changes in question did not have any substantial effect on consumption estimates is argued in the Discussion.

The responses to the quantity questions were coded as units (one unit equals 8 g of alcohol). Up to 1984, the drinking questions were used to derive quantity frequency (QF) ratings, that grouped drinkers into five categories based on the frequency of drinking their main drink and the quantity consumed (occasional, infrequent light, frequent light, modest, heavier). From 1986, drinkers were categorized on the basis of estimated total number of units of alcohol consumed per week into alcohol consumption (AC) ratings. For 1984 and 1986, tables were published showing both QF and AC ratings to allow comparison (Green, 1989Go). The estimates of weekly alcohol consumption were calculated by converting each frequency category into its median value, multiplying by number of units of that drink consumed on a typical drinking day and then summing consumption of all drink types.

Data on estimated units of alcohol consumed, sex and age for the surveys in even numbered years from 1978 to 1998 were extracted from computer files held by the data archive at the University of Essex (data sources are listed in Appendix 1). So far as the author is aware, no analysis of AC groups for the 1978–1982 surveys has previously been published. The estimated units consumed per week were grouped into non- or very light drinkers, light, medium and heavy. For males, these groups drank less than 1, 1–9.95, 10–21, and more than 21 units per week, and for females less than 1, 1–6.95, 7–14, and more than 14 units per week, respectively.

Birth cohort analysis
The sample was divided into 5-year birth cohorts for males and females (1977–1981, 1972–1976, 1967–1971 and so on). Each cohort was then followed through the series, for example, the 1952–1956 cohort consisted of the 22–26-year-olds in 1978, the 24–28-year-olds in 1980, the 26–30-year-olds in 1982 and so on. Cohorts were followed up to 1998 or until they reached age 83–87 years. Most cohorts could be followed for 11 observations spanning 20 years. This method of analysis was analogous to that used for smoking data from the General Household Survey (Kemm, 2001Go). Linear regression of prevalence of different drinking states on age was calculated by the least-squares method (Excel regression tool) separately for each cohort.

Most 5-year age sex bands contained 500 or more subjects. Only age bands that included over 80-year-olds contained less than 300. The only male age band to contain less than 100 was that aged 83–87 years in 1984, with 88 subjects. The only female age bands to contain less than 200 were that aged 83–87 years in 1984, with 172 subjects and that aged 82–86 years in 1998, with 183 subjects. The largest band was that aged 27–31 years in 1978, with 1034 male and 1064 female subjects.


    RESULTS
 TOP
 ABSTRACT
 INTRODUCTION
 SUBJECTS AND METHODS
 RESULTS
 DISCUSSION
 DISCLAIMER
 APPENDIX 1: DATA SOURCES
 REFERENCES
 
Age and sex differences
Figure 1Go shows the percentage of non- or very light (less than one unit per week) drinkers for males and females in different birth cohorts. Half the cohorts (1972–1976, 1962–1966, 1952–1956, etc.) have, for clarity, been omitted from Figs 1Go and 3Go. At all ages in all cohorts, the percentage of non- or very light drinkers was higher in females than males. Initially, the percentages of non- or very light drinkers fell with age, reaching a minimum around age 20 years, when about 10% of males and about 20% of females were non- or very light drinkers. After the age of 20 years, the percentage of non- or very light drinkers rose to reach at age 80 years about 40% in males and about 65% in females. The trends are made clearer in Fig. 2Go, which shows the regression line for percentages of nonor very light drinkers on age for each cohort. The slopes are positive and significantly different from zero in most of the male cohorts and in some of the older female cohorts. It can also be seen that the slope tends to be steeper in earlier (older) cohorts.



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Fig. 1. Percentage of non- or very light drinkers by age and cohort. The percentage of non- or very light drinkers is plotted against age. Each cohort is represented by a different symbol as shown in the key. Males are shown with a solid line and females with a broken line. For clarity, alternate cohorts have been omitted.

 


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Fig. 3. Percentage of heavy drinkers by age and cohort. The percentage of heavy drinkers (male >21 units per week, female >14 units per week) is plotted against age. The symbols and conventions used are the same as for Fig. 1Go.

 


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Fig. 2. Regression lines for percentage of non- or very light drinkers on age by cohort. The regression lines on age are shown for each cohort. The symbols used for each cohort are the same as for Fig. 1Go. The symbols after each date in the key indicate for male (first) and for females (second) the significance of the correlation coefficient for each line. (**Significant at the P < 0.001 level; *significant at the P < 0.05 level; –, not significant.)

 
The changes in heavy drinkers for men (more than 21 units per week) and women (more than 14 units per week) are shown in Fig. 3Go and the regression lines for these cohorts in Fig. 4Go. In cross-sectional analysis, the percentage of heavy drinkers fell with age in both men and women. At the age of 25 years, about 35% of men and 15% of women were heavy drinkers, but by age 80 years, only about 10% of men and 2% of women were heavy drinkers. In all the male cohorts, except the first, the slope was negative and, in many cases, significantly less than zero. In contrast, among younger female cohorts, the slope tended to be positive, although usually not significantly different from zero (95% confidence limits included zero). This suggests that, in these cohorts, over the period covered by the data, females did not become less likely to be heavy drinkers as they got older.



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Fig. 4. Regression lines for percentage of heavy drinkers on age by cohort. The regression lines on age are shown for each cohort. The symbols and conventions used are the same as for Fig. 2Go.

 
The distribution of light or moderate drinkers was also examined (data not shown). At age 25 years, about 10% of men were non- or very light drinkers, 30% were light (1 to <10 units per week) drinkers, about 25% moderate (10–21 units per week) drinkers and about 35% heavy (more than 21 units per week) drinkers. With increasing age, there were slow rises in the percentage of non- and very light drinkers (to about 40% at age 80 years) and light drinkers (to about 40% at age 80 years). There were corresponding falls in the percentages of moderate drinkers (to about 10% at age 80 years) and of heavy drinkers (to about 10% at age 80 years).

Females were not only less likely to drink, but also less likely to drink at higher levels, than males. At age 25 years, about 25% of females were non- or very light drinkers, about 40% were light (1–<7 units per week) drinkers, about 20% moderate (7–14 units per week) drinkers and about 15% heavy (more than 14 units per week) drinkers. With increasing age, women tended to shift into lower drinking categories. By age 80 years, the percentage of non- and very light drinkers has risen to about 65%, the percentage of light drinkers has fallen slightly to about 25% and the percentage of moderate and heavy drinkers has fallen sharply (moderate drinkers to about 5%, heavy drinkers to about 2%).

In summary, women at all ages were more likely to be non- or very light drinkers and less likely to be heavy drinkers than men. Above the age of 20 years in both men and women, the level of drinking tended to decrease with age.

Cohort effects
The plots for each cohort in Figs 1Go and 3Go tend to overlap, indicating that, at any given age, the cohorts were behaving fairly similarly, but closer inspection and regression analysis revealed some differences. In earlier (older) cohorts for men (cohorts born before 1917–1921) and less clearly earlier cohorts for women (cohorts born before 1942–1946), the percentages of non- or very light drinkers (Figs 1Go and 2Go) in each cohort showed a tendency to separate. Cohort differences were also discernible in the percentages of light drinkers (data not shown). For men born before 1927–1932 and for women born after 1927–1932, those in earlier cohorts were more likely to be light drinkers at any age, than those in later cohorts. In females, earlier cohorts were less likely than later cohorts to be heavy drinkers at any age (Figs 3Go and 4Go). This effect was particularly marked in the most recent cohorts (1977–1981, 1972–1976, 1967–1971). For men, the same trend was apparent only for cohorts born before 1937–1941.

In summary, earlier (older) cohorts of both men and women drank less at any age than cohorts born later.


    DISCUSSION
 TOP
 ABSTRACT
 INTRODUCTION
 SUBJECTS AND METHODS
 RESULTS
 DISCUSSION
 DISCLAIMER
 APPENDIX 1: DATA SOURCES
 REFERENCES
 
This analysis confirms the impression from cross-sectional analysis that, as they grow older, both men and women are more likely to be non- or very light drinkers. Men are also less likely to be heavy drinkers as they grow older. For women, the picture is less clear, with cross-sectional analysis suggesting that older women are less likely to be heavy drinkers, but examination of individual cohorts showed no fall with age and in some cases a rise.

This study also reveals cohort effects, but these are strikingly less obvious than those found when the same data source was analysed for cohort effects in smoking using a similar method (Kemm, 2001Go). In this latter study, the plots of prevalence of never smoking and current smoking against age were clearly separate for different cohorts. A general tendency can be discerned for members of each cohort to be less likely to be non- or very light drinkers, less likely to be light drinkers and more likely to be heavy drinkers at any age, than members of earlier cohorts. However, for men this trend seems to have ended with those born from about 1927 to 1931, with no clear cohort effect thereafter. For women, the trend has continued and possibly becomes stronger in cohorts born after 1927–1931.

Concern that younger women are drinking more is reinforced by the finding in this paper that the cohort of females born from 1977 to 1981 stands out as having a much higher percentage of heavy drinkers (Fig. 3Go) than earlier cohorts. Other reports show that the percentage of heavy drinkers among women aged 18–24 years has risen from 18% in 1996 to 33% in 2000 (Walker et al., 2001Go). However, the data set and the analytical approach used in the present paper are not well suited to examine the lower extreme of the age range.

The wide confidence intervals around some points, particularly those for older ages, could have masked some cohort differences. The data covered a period when alcohol consumption, as estimated from excise data, has been relatively constant. Mean consumption in litres of absolute alcohol per year per head aged over 15 years was 9.4 in 1978 and 9.7 in 1998 (British Beer and Pub Association, 2001Go). Cohort effects might have been more apparent if overall consumption by the population had been changing rapidly, as smoking levels have.

As there have been changes in the sampling procedure, the precise questions asked and the precise method of estimating alcohol consumption used in the General Household Survey over the period described, one must question the comparability of the samples. However, the sampling procedure has always been robust and any differences arising from changes in the sampling procedure are likely to be small. Similarly, the changes in questions and estimation process, described in the Methods, have been minor. They have not produced obvious discontinuities in the trends published [for example, see tables 9.14 and 9.15 on AC groups in the report of the General Household Survey 1998 (Bridgwood et al., 2000Go) or table 11.1 on QF groups in General Household Survey 1984 (OPCS, 1986Go)].

Surveys of alcohol consumption are liable to numerous errors, including incomplete sampling frames, differential non-response, under- or over-reporting of frequency, under- or over-reporting of quantity, recall bias and social acceptability bias (DeVries et al., 1999Go; Feunekes et al., 1999). There is particular concern that heavy drinkers may be disproportionately lost to the sample and, when included, may under-report their consumption. The General Household Survey is not immune to these problems, but they are minimized by detailed interviewing protocols, trained interviewers and quality control systems. It may thus be expected to produce high quality data.

There are appreciable regional differences in drinking behaviour in Great Britain, which is the area covered by the General Household Survey. The analytical approach used in this paper cannot explore these. Breaking the data into a large number of cells produced some small numbers especially for the extreme groups (non-drinkers and heavy drinkers) and the oldest age bands. In consequence, the confidence intervals are quite wide for some groups. For example, the 95% confidence intervals around an estimated prevalence of 30% would be 25.5–34.5% with a sample size of 400 and 21.0–39.0% with a sample size of 100, while around an estimated prevalence of 10% the corresponding intervals would be 7.1–12.9% and 4.1–15.9%, respectively.

There are limited longitudinal studies and sequential cross-sectional studies with which these findings may be compared. The General Household Survey data analysed in this paper covers a longer period, with more consistent data collection methods, more frequent observations, more cohorts and a wider age range, than most reported studies.

In a complex meta-analysis of several longitudinal studies, Johnstone et al. (1996)Go found evidence of age, cohort (cultural) and period effects. A study in The Netherlands took advantage of a series of four cross-sectional surveys to compare six cohorts of men and women from 1958 to 1989 (Neve et al., 1993Go). These latter authors concluded that, in men and women, the percentage of abstainers increased with age, but considered differences between cohorts were due to period, rather than cohort, effects. The normative ageing study in the USA, which collected data on three cohorts in 1973, 1982 and 1991 (Levenson et al., 1998Go), found that consumption declined with age in some, but not all, cohorts and that there were significant differences between cohorts. A study of two cohorts of women in Gothenburg first seen in 1968 and followed after 12 and 24 years (Bengtsson et al., 1998Go) showed increases in the percentages consuming wine and spirit, but no clear differences between the cohorts.

Several studies, which followed single cohorts, gave information on age effects, but, of course, allowed no comparison between cohorts. Examples of such studies are a study of 40-year-old Danish men and women from 1976 to 1987 (Saelan et al., 1992Go) and a study of Czech men from 1983 to 1993 (Kubicka et al., 1998Go), neither of which showed a simple decrease of consumption with age.

It should be noted that, although analysed as a cohort, this study is a multiple cross-sectional one based on repeated samples of each birth cohort, rather than the whole cohort. Studies such as this indicate changes in percentages in different categories, but give no information on the percentages moving between categories. For example, the situation in which no abstainer starts to drink cannot be distinguished from the situation in which a percentage of abstainers start to drink but are replaced by a corresponding number of drinkers who stop. The data on drinking are less satisfactory in this respect, than data on smoking, which included a category of ex-smoker.

Only longitudinal studies appropriately analysed can give information on percentages changing drinking categories. Two studies from Finland over 5 years (Seppa et al., 1999Go) and 10 years (Kivela et al., 1988Go) showed appreciable numbers moving between drinking categories. A study of French electricity workers (Zins et al., 1999Go) suggested that, even over a period as short as 2 years, 30% of heavy drinkers reduced their consumption but were partly replaced by a smaller number who increased their consumption. A study of a cohort of Dutch men and women showed relatively few becoming frequent drinkers, but many ceasing to be frequent drinkers over a 10-year period (Hajema et al., 1997Go).

In conclusion, cohort analysis of data from Great Britain confirms that, in this population, at all ages, men are more likely to be drinkers and more likely to consume alcohol heavily, than women. In both men and women after the age of 20 years, younger people are more likely to drink and more likely to drink heavily, than older ones. Cohort effects are also apparent with members of earlier (older) cohorts likely to have drunk less at any age than members of later cohorts.


    DISCLAIMER
 TOP
 ABSTRACT
 INTRODUCTION
 SUBJECTS AND METHODS
 RESULTS
 DISCUSSION
 DISCLAIMER
 APPENDIX 1: DATA SOURCES
 REFERENCES
 
The General Household Survey data are Crown Copyright. Neither the Office for National Statistics, Social Survey Division, nor the Data Archive, University of Essex bears any responsibility for the analysis or interpretation of the data described in this paper.


    APPENDIX 1: DATA SOURCES
 TOP
 ABSTRACT
 INTRODUCTION
 SUBJECTS AND METHODS
 RESULTS
 DISCUSSION
 DISCLAIMER
 APPENDIX 1: DATA SOURCES
 REFERENCES
 
Office of Population Censuses and Surveys, Social Survey Division, General Household Survey, 1978 (GHS) [computer file]. Colchester Essex, The Data Archive [distributor]. 1980, SN 1465.

GHS, 1980 [computer file]. The Data Archive [distributor]. 1982, SN 1766.

GHS, 1982 [computer file]. The Data Archive [distributor]. 1985, SN 2034.

GHS, 1984 [computer file]. The Data Archive [distributor]. 2 December 1986, SN 2154.

GHS, 1986 [computer file]. The Data Archive [distributor]. 20 February 1989, SN 2569.

GHS, 1988–1989 [computer file]. The Data Archive [distributor]. 20 November 1990, SN 2724.

GHS, 1990–1991 [computer file]. The Data Archive [distributor]. 6 October 1992, SN 2937.

GHS, 1992–1993 [computer file]. The Data Archive [distributor]. 19 January 1994, SN 3166.

GHS, 1994–1995 [computer file]. The Data Archive [distributor]. 13 May 1996, SN 3538.

Office for National Statistics, Social Survey Division, General Household Survey, 1996–7 [computer file], 2nd edn. Colchester, Essex; The Data Archive [distributor]. 5 October 1998, SN 3804.

GHS 1998–9 [computer file]. The Data Archive [distributor]. 3 August 2000, SN 4134.


    REFERENCES
 TOP
 ABSTRACT
 INTRODUCTION
 SUBJECTS AND METHODS
 RESULTS
 DISCUSSION
 DISCLAIMER
 APPENDIX 1: DATA SOURCES
 REFERENCES
 
Bengtsson, C., Allebeck, P., Lissner, L., Bjorkelund, C., Hallstrom, T. and Sigurdsson, J. (1998) Alcohol habits in Swedish women; observations from the population study of women in Gothenburg, Sweden 1968–1983. Alcohol and Alcoholism 33, 533–540.[Abstract]

Bridgwood, A., Lilley, R., Thomas, M., Bacon, J., Sykes, W. and Morris, S. (2000) Living in Britain: Results for the 1998 General Household Survey. The Stationery Office, London.

British Beer and Pub Association (2001) Statistical Handbook. Brewing Publications, London.

De Vries, J. H. M., Lemmens, P. H. H. M., Pietinen, P. and Kok, F. J. (1999) Assessment of alcohol consumption. Chapter 2. In Health Issues Related to Alcohol Consumption, 2nd edn, MacDonald, I., ed., pp. 27–62. ILSI Europe and Blackwell Science, Oxford.

Fuenekes, G. L., Van’t Veer, P., VanStaveren, W. A. and Kok, F. J. (1999) Alcohol intake assessment: the sober facts. American Journal of Epidemiology 150, 105–112.[Abstract]

Green, H. (1989) General Household Survey 1986. Drinking Report. HMSO, London.

Hajema, K.-J., Knibbe, R. A. and Drop, M. J. (1997) Changes in alcohol consumption in a general population in the Netherlands: a 9-year follow up study. Addiction 92, 49–60.[CrossRef][ISI][Medline]

Johnstone, B. M., Leino, E. V., Ager, C. R., Ferrer, H. and Fillmore, K. M. (1996) Determinants of life course variation in the frequency of alcohol consumption: meta-analysis of studies from the collaborative alcohol related longitudinal project. Journal of Studies on Alcohol 57, 494–506.[ISI][Medline]

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Kivela, S., Nissinen, A., Ketola, A., Punsar, S., Puska, P. and Karvonen, M. (1988) Changes in alcohol consumption during a ten year follow up among Finnish men aged 55 to 74 years. Functional Neurology 3, 167–178.[Medline]

Kubicka, L., Csemy, L, Duplinsky, J. and Kozeny, J. (1998) Czech men’s drinking in changing political climates 1983–93: a three wave longitudinal study. Addiction 93, 1219–1230.[CrossRef][ISI][Medline]

Levenson, M. R., Aldwin, C. M. and Spiro, A. (1998) Age, cohort and period effects on alcohol consumption and problem drinking: findings from the Normative Ageing Study. Journal of Studies on Alcohol 59, 712–722.[ISI][Medline]

Neve, R. J. M., Diederiks, J. P. M., Knibbe, R. A. and Drop, M. J. (1993) Developments in drinking behaviour in the Netherlands from 1958–1989, a cohort analysis. Addiction 88, 611–621.[ISI][Medline]

OPCS (Office of Population Censuses and Surveys) Social Survey Division (1980) Drinking. Chapter 8. In General Household Survey 1978, pp. 134–139. HMSO, London.

OPCS (Office of Population Censuses and Surveys) Social Service Division (1986) General Household Survey 1984. HMSO, London.

Saelan, H., Moleer, L. and Koster, A. (1992) Alcohol consumption in a Danish cohort during 11 years. Scandinavian Journal of Social Medicine 20, 87–93.[ISI][Medline]

Seppa, K., Pitkajarvi, T. and Sillanaukee, P. (1999) Alcohol consumption profile by time in middle aged men: a longitudinal study based on three different diagnostic instruments. Alcohol and Alcoholism 34, 65–70.[Abstract]

Walker, A., Maher, J., Coulthard, M., Goddard, E. and Thomas, M. (2001) Living in Britain: Results from the 2000/01 General Household Survey. The Stationery Office, London.

Zins, M., Carle, F., Bugel, I., LeClerc, A., DiOrio, F. and Goldberg, M. (1999) Predictors of change in alcohol consumption among Frenchmen of the GAZEL study cohort. Addiction 94, 385–395.[CrossRef][ISI][Medline]





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