Utilizing culture and behaviour in epidemiological models of alcohol consumption and consequences for Western nations.

Cultural differences in alcohol consumption are inescapable, but have been difficult to establish as predictor variables in epidemiological models. With respect to dependent variables, the behavioural outcomes of alcohol use have not been operationalized as successfully as the health outcomes. This study examined cultural differences in drinking by employing Levine's distinction between Temperance and non-Temperance cultures, along with other cultural, consumption, and policy predictor variables, among 21 Western countries. Dependent variables included the prevalence of Alcoholics Anonymous (AA) groups (as a measure of behavioural and social problems) and a range of alcohol consumption and health measures. Level of consumption was an important determinant of the health consequences of drinking among Western nations, but not so important in determining behavioural outcomes. Culture, on the other hand, is largely determinative of behavioural outcomes and also quite critical for some health outcomes. An inverse relationship between alcohol consumption and AA membership strongly indicated that consumption is modified by cultural styles in producing drinking behaviours. Temperance cultures, which are largely Protestant, have far more AA groups and higher rates of coronary heart disease mortality, but lower cirrhosis mortality. Overall mortality does not vary according to national alcohol consumption or cultural distinctions. The percentage of alcohol consumed as wine is a strong inverse predictor of mortality in the 55-64 year age group, but the change in absolute national wine consumption is directly associated with overall all-age mortality. In conclusion, religious and cultural distinctions among Western nations strongly predict behavioural drinking problems and also enhance the prediction of death rates from diseases related to alcohol consumption. Social engineering techniques which attempt to modify well-established cultural drinking practices can have counter-productive results.