Alcohol drinking in Jerusalem

Ah'ohol, Vol. 1, pp. 435-439, 1984. ©Ankho International Inc. Printed in the U.S.A.

0741-8329/84 $3.00 + .00

Alcohol Drinking in Jerusalem M. B A R A S , * S. H A R L A P * A N D S. E I S E N B E R G ?

*Department of Medical Ecology, Hebrew University Hadassah School of Public Health and Community Medicine P.O.B. 1172, Jerusalem 91010, Israel ?Jerusalem Lipid Research Clinic, Department of Medicine B Hadassah University Hospital, Jerusalem, Israel R e c e i v e d 24 M a y 1984 BARAS, M., S. HARLAP AND S. EISENBERG. Ah'ohol drinking in Jerusalem. ALCOHOL 1(6) 435--439, 1984.Alcohol use was assessed in a random sample of middle aged Jewish parents (1043 men and 591 women) who were interviewed at Visit 2 of the Lipid Research Clinics Prevalence Study in Jerusalem in 1976--80. A standard questionnaire probed drinking frequency (times per week) and quantity (number of drinks per week). Only 15.7% of men and 3.8% of women drank more than twice weekly, the mean number of drinks being 3.5 and 1.3 for men and women respectively. Teetotalism was rare and most subjects (61.9% of men and 55.1% of women) drank once or twice weekly, reflecting the high proportion of the Jews who use wine for sacramental purposes. Immigrants from North Africa drank more than native born Israelis or immigrants from Asia or Europe. Drinking was most frequent among men in lower status occupations, though the opposite was true of their wives. Season had a marked impact on the quantity and type of drinking, the mean number of drinks per week reaching a maximum in late winter and a minimum in summer. More beer was consumed in summer and more spirits in winter. Alcohol

Jews

Season

Origin groups

The questionnaire was a Hebrew translation of the standard protocol used in 13 centers in the North-American LRC. Two variables measuring different quantitative aspects of alcohol consumption were constructed. The first was the " f r e q u e n c y " variable, based on the two closed questions: (1) "During the past year, have you had at least one drink of beer, wine or liquor?" and (2) " A b o u t how often do you drink some kind of alcoholic beverage?" with categories ranging from "less often than once a month" to "daily or almost every d a y " . The second was the " n u m b e r of drinks" variable calculated as the sum of the answers to 4 questions: "During this past week about how many (a) bottles or cans of beer, (b) glasses of wine, (c) highballs, cocktails or mixed drinks, (d) drinks of liqueurs or other alcoholic drinks did you drink?" Alcohol use was explored in relation to the following variables: sex, age, origin, social class, smoking and season. The majority of the adult population of Jerusalem consists of immigrants from various countries and we classified these into four broad origin groups depending on the place of birth: Israel, Asia (mainly the Near East), North Africa, and Europe (including also the Americas, Southern Africa, Australia and New Zealand). Social class consisted of a classification into 3 groups (high, medium and low), based on the occupation of the head of the family [13]. Smoking was studied both as a dichotomy (current and non-smokers) and as the number of cigarettes smoked per day. Season refers to the month of examination.

A L C O H O L use has important effects on physical and social health. It is a major contributor to road accidents, liver disease, and crime [3, 6, 7, 16, 17] and may have a protective effect in cardiovascular disease [1]. Jews in general [9,14] and Israelis in particular, [8] have always been regarded as infrequent abusers of alcohol and drugs. Recently, however, there have been reports that alcoholism is increasing rapidly in Israel [12] and this parallels reports from North America of a noticeable rise in alcoholism among Jews there [15]. Accurate statistics on patterns of alcohol use in Israeli adults have been difficult to obtain. Most reports are anecdotal or based on numerator data from psychiatric hospitals [12,11]. The present study makes use of data collected on a random sample of Jerusalem adults during the course of the Lipid Research Clinics Prevalence Study [13]. A standard protocol was used in Jerusalem and 13 other clinics in North America so that direct cross-cultural comparisons can be made. METHOD Data were gathered from a random sample of parents of 17-year-old Jerusalem males and females who attended a medical examination prior to induction into the army, in 1976-1980. The study design and sampling procedure of the Jerusalem LRC program have been described in detail elsewhere [13]: A random sample drawn from all parent participants of the initial examination (Visit 1)---constituting 21Y~ of all mothers, 20% of all fathers in the first year, and 50% of all fathers in the remaining y e a r s - - w e r e invited for more extensive examinations (Visit 2). The final sample size was 1634, 1043 fathers and 591 mothers.

RESULTS The data concerning frequency of drinking and number of drinks and their relationships to sex, origin, age, social class and smoking are presented in Tables 1 to 3.

435

436

BARAS, HARI,AP AND EISENBERG TABLE 1

DISTRIBUTION (%) OF DRINKING FREQUENCY FOR EACH ORIGIN GROUP, SOCIAL CLASS, AGE GROUPS AND SMOKING CATEGORY

Males

Females

never (abstainer)

1,2/week

3+/week

(including less than once a week)

1,2/week

3+week

l including less than once a week)

6.3 8.7 12.5 4.9

61.0 59.7 64.6 62.8

13.3 14.4 14.1 24.0

315 263 263 183

26.5 19.0 30.3 21.4

52.4 51.2 54.2 65.0

2.6 5.0 2.6 6.0

189 12 ! t 55 117

9.2 8.1 6.7

56.8 64.9 63.0

13.5 13.4 21.1

303 359 327

20.1 24.9 28.9

51.8 56.5 55.0

5.5 2.8 3.8

164 t 77 21 i

Males 35-44 Females 35-39

7.1

62.6

14.7

238

27.1

5L 1

4.2

96

Males 45-49 Females 40-44

6.8

62.7

16.0

324

19.1

58.9

4.3

209

Males 50-54 Females 45-49

10.0

58.8

16.9

260

25.9

54.9

1.2

162

9.9

63.9

14.9

202

31.6

50.9

6.1

114

never (abstainer)

Origin Israel Europe Asia N. Africa Social Class High Medium Low Age

Males 55+ Females 50+ Smoking Non-Smokers Cigts. per day 1-19 20+

8.8

64.8

11.8

628

25.6

57~3

3. I

445

8.2 7,1

61.2 54.4

21.8 22.1

170 226

21.1 27.1

52,2 39.6

4.4 8,3

40 48

All Smokers

7.6

57.3

22.0

396

23.2

47.8

5.8

138

8.3 85

61.9 634

15.7 161

1024

25.0 146

55.1 321

3.8 22

583

Percentage n

T h e use o f alcohol by J e r u s a l e m J e w s was low. Only 15.7% of the men and 3.8% o f the w o m e n drank more than twice a week. The m e a n n u m b e r o f drinks per w e e k was 3.5 for males and 1.3 for females. Only I5.3% o f m e n drank more than 5 drinks per w e e k and 4.2% o f the w o m e n drank more than 3 drinks per week. A m o n g the males w h o t o o k alcohol at m o s t t w i c e a w e e k only 7. I% t o o k m o r e than 5 drinks per week. F o r w o m e n this was 3.1. On the o t h e r hand, rates o f teetotalism w e r e low: 8,3% of m e n and 25% of w o m e n had not drunk during the past year. T h e majority o f the sample (61.9% o f the males and 55.1% of the females) drank o n c e o r t w i c e a w e e k and this probably reflects the high p e r c e n t a g e of the J e w i s h population w h o take wine regularly for Sabbath benedictions. Table 3 s h o w s a cross tabulation of drinking f r e q u e n c y by n u m b e r of drinks r e p o r t e d in the past week, for the sexes separately. In the following analyses we apply the t e r m " d r i n k e r " to

those w h o drank more than twice a w e e k ; the term " h e a v y d r i n k e r " to the m e n taking more than 10 drinks per w e e k and to the w o m e n taking m o r e than 3 drinks per week: the term "light d r i n k e r " to the men taking 4 to 10 drinks per w e e k and to the w o m e n taking 2-3 drinks per w e e k : and the term " a b s t i n e n t " to those w h o did not take a single drink in the last year.

Origin N o r t h Africans drank conspicuously more than o t h e r origin groups, the p e r c e n t a g e o f drinkers, light drinkers and h e a v y drinkers a m o n g t h e m being almost twice those in each o f the o t h e r groups (Tables 1 and 2). The average n u m b e r of drinks per w e e k was 5.8 for N o r t h African men, c o m p a r e d with 3 . 3 . 2 . 9 and 2.8 for Asians, E u r o p e a n s , and the Israeli born groups respectively ( O n e - w a y A n o v a , p < 0 . 0 0 t ) . O f all h e a v y drinkers 35% w e r e N o r t h Africans although this origin

A L C O H O L D R I N K I N G IN J E R U S A L E M

437

TABLE 2 DISTRIBUTON (%) AND MEANS VALUES OF THE NUMBER OF DRINKS PER WEEK FOR EACH ORIGIN GROUP, SOCIAL CLASS, AGE GROUPS AND SMOKING CATEGORY Males 0

1

2

3

17.0 20.9 18.0 10.8

30.3 29.1 24.7 17.8

20.1 18.3 17.6 16.8

20.1 17.8 12.9

30.8 26.6 21.9

Males 35-44 Females 35-39

17.8

Males 45-49 Females 40--44

Females

4-5

6--10

11+

Mean

11.8 9.3 14.6 11.9

8.4 10.4 12.0 14.1

7.7 6.7 6.0 14.6

4.6 5.2 7.1 14.1

2.8 2.9 3.3 5.8

20.1 18.4 17.1

9.7 12.1 13.5

9.7 9.9 13.2

4.5 9.3 11.1

4.9 6.0 10.5

26.6

19.1

13.3

9.5

6.6

16.5

24.6

18.3

10.2

12.9

Males 50-54 Females 45-49

17.0

24.9

18.5

13.2

Males 55+ Females 50+

17.6

30.9

17.6

Non-Smokers

17.2

29.1

Cigts. per day 1-19 20+

17.5 16.7

n

0

1

2

3

323 268 267 185

41.7 32.0 44.5 32.2

38.5 40.0 40.0 32.2

14.6 19.2 9.0 21.2

3.1 3.2 2.6 7.6

2.5 3.3 4.7

308 365 334

36.3 35.4 43.0

40.5 39.9 34.1

14.9 18.5 13.1

7.1

3.2

241

36.7

40.8

10.5

6.9

3.9

333

36.9

9.4

8.3

8.7

3.6

265

11.3

10.8

6.4

5.4

2.8

20.8

11.7

10.2

6.6

4.4

22.6 21.6

13.0 15.9

10.7 13.2

17.0 7.9

11.3 10.6

4+

Mean

n

2.1 5,6 3.9 6.8

1.2 1.2 1.1 1.6

192 125 155 118

3.0 3.4 5.1

5.4 2.8 4.7

1.4 1.0 1.3

168 178 214

17.3

4.1

1.0

0.9

98

38.8

15.4

4.7

4.2

1.4

214

41.1

36.2

15.3

1.8

5.5

1.3

163

204

38.6

36.8

14.0

5.3

5.3

1.2

114

2.7

639

38.2

40.6

15.0

3.5

2.6

1.0

453

7.9 14.1

3.7 5.5

177 227

36.7 45.8

28.9 29.2

21.1 8.3

5.5 4.2

7.8 12.5

1.7 2.8

90 48

Origin Israel Europe Asia N. Africa Social Class High Medium Low Age

Smoking

All Smokers

17.1

22.0

14.6

12.1

11.9

10.9

11.4

4.7

404

39.9

29.0

16.7

5.1

9.4

2.1

138

Total

17.2

26.4

18.4

11.9

10.8

8.2

7.1

3.5

1043

38.6

37.9

15.4

3.9

4.2

1.3

591

g r o u p c o m p r i s e d only 18% o f o u r sample. A s i a n m e n were the m o s t a b s t i n e n t . In w o m e n , N o r t h A f r i c a n again t e n d e d to lead in drinking a n d h e a v y drinking. A s i a n w o m e n w e r e also the m o s t abstin e n t . E r u o p e a n w o m e n r a n k e d differently from the E u r o p e a n m e n . T h e p e r c e n t a g e o f w o m e n d r i n k i n g 3 or m o r e t i m e s w e e k l y w e r e 6.0% for N o r t h A f r i c a n s , 5.0% for E u r o p e a n s a n d 2.6% for b o t h A s i a n a n d Israeli b o r n w o m e n (Table 1). T h e p e r c e n t a g e s of h e a v y d r i n k e r s (4 o r m o r e weekly) w e r e 6.8, 5.6, 3.9 a n d 2.1 in the s a m e groups. Differences in m e a n n u m b e r o f drinlzs, h o w e v e r were quite small (Table 2).

Age In m e n , alcohol use i n c r e a s e d s o m e w h a t with age f r o m the y o u n g e s t age group, 35-44, to the middle age g r o u p s , 45--49, a n d 50-54, a n d t h e n d e c r e a s e d in t h e 5 5 + age group. In w o m e n , the y o u n g e s t g r o u p s studied d r a n k the least: only

1% o f the 35-39 y e a r old g r o u p r e p o r t e d h e a v y drinking. All o t h e r age g r o u p s o f w o m e n s h o w e d similar m e a n n u m b e r s of drinks ( a b o u t 1.3 p e r week) a n d t h e r e was n o o b v i o u s age t r e n d in the p e r c e n t a g e s o f d r i n k e r s or o f h e a v y d r i n k e r s . A b s t i n e n c e o n the o t h e r h a n d , i n c r e a s e d with age, f r o m 19.1% in w o m e n aged 4 0 - 4 4 to 31.6% in t h o s e aged 5 0 + .

Social Class In m e n t h e r e was a s t r o n g a s s o c i a t i o n b e t w e e n s o c i o e c o n o m i c s t a t u s a n d drinking. T h e m e a n n u m b e r o f d r i n k s p e r w e e k r a n g e d f r o m 4.9 for t h e l o w e s t s t a t u s g r o u p t h r o u g h 3.3 to 2.5 in the middle a n d h i g h e s t g r o u p s ( O n e - w a y A n o v a , p <0.001). T h e p e r c e n t a g e s o f h e a v y d r i n k e r s were 10.5, 6.0, 4.0 r e s p e c t i v e l y . R e g a r d i n g the f r e q u e n c y o f drinking, the p e r c e n t a g e o f d r i n k e r s w a s similar for high a n d middle socioe c o n o m i c g r o u p s a n d n o t i c e a b l y h i g h e r in the l o w e s t social g r o u p (Table 2). A b s t i n e n c e s h o w e d a r e v e r s e p a t t e r n .

438

BARAS, HARLAP AND EISENBERG TABLE 3 DISTRIBUTION (%) OF NUMBER OF DRINKS LAST WEEK FOR EACH DRINKING FREQUENCY AND SEX Frequency

0

1

"2

3

4-5

6-10

il f

u

100.0

0 38.2 32.2 6.2

0 16.0 24.4 75

0 4.2 16.2 8.1

{) 4.2 13.7 11.8

0 1.4 6.0 28.6

4)

36.1 5.0 1.2

U 2.4 36.6

85 144 634 161

17.2

26.4

18.4

I 1.9

10.8

.8.2

7~t

~124

0

1

2

3

4

100.0 52.1 7.5 13.6

0 38.3 57.3 13.6

0 7.4 24.9 13.6

0 I. I 6.5 4.5

0 I. 1 37 545

]46 94 321 22

38.6

37.9

IS.4

39

4.2

~83

Males Never - 2/month 1,2/week 3+ Total Frequency Females Never - 2/month 1,2/week 3+/week Total

In females, on the other hand, the higher socioeconomic group had the greater percentage of heavy drinkers and the greater mean number of drinks. The middle classes drank the least.

4.00

Smoking As expected, there was a positive association between smoking and drinking. In males, the proportion of drinkers among smokers (22.0%) was almost twice that among nonsmokers (11.8%) and the percentages of heavy drinkers were 11.4 and 4.4% in smokers and non-smokers respectively. Smokers drank 4.7 drinks per week, on the average, compared with 2.7 for non-smokers. Heavier smokers tended to be heavier drinkers (data not shown). In females, the same positive association between smoking and drinking was noted; 12.5% of the females smoking 20 or more cigarettes per day drank 4 or more drinks weekly compared with only 2.6% for non-smokers. The remaining analyses was carried out for males only because the low alcohol intake of females resulted in very small numbers of female drinkers available for analysis.

"-'/\.-"x,._,:'.:.1----"

3.00

tn t•r 2.00 ~0

A j .....

,.~ w i n e t~ Cocktails+ l i q u e u r s

0--~0

Beer

"6 L00 13

E Z

~0 /

~ i l ~ ~l~r'"

\c,

0~0~

0

I

I

I

I

I

I

2

3

Z.

5

_L____L_-

6

7

I

i

I_~

I

8

9

10

11

L --

12

M o n l h

FIG. 1. Seasonality in drinking: Numbers of drinks by month 1moving averages) (non-abstainer males).

SdasOtl

There was a strong impact of season on drinking (Fig. 1). Three-month sliding averages of drinks per week were maximum in March. They followed a sinusoidal curve falling to a minimum in September. Wine use paralleled that of total alcohol consumption, while beer and liquor showed a different seasonal pattern. The men reported using more beer in the summer and more liquor in the winter. The seasonal patterns of beer and liquor use are almost a perfect mirror image of one another, and the consumption of these two types of drink added together varied very little with season. The averages plotted in Fig. 1 were computed for nonabstainers only. For all months of the year, the percentages of abstainers were similar.

DISCUSSION

This study was conducted using interviews with volunteers, and was not designed specifically for research into alcohol use. There is likely to be a degree of underreporting of alcohol intake and there was considerable ambiguity in interpreting the translation of the North-American-designed questionnaire for use in Israel. with items such as "Spritz'" (wine and water mix) and arak having virtually no parallel in America. For this reason we have not attempted to analyse absolute alcohol consumption. Our findings do confirm the view that Jews are infrequent drinkers [8, 9. 12, 14]. In Israel the purchase of alcoholic beverages is legally unrestricted, for all ages. This

ALCOHOL

DRINKING IN JERUSALEM

439

s t r e n g t h e n s the s u p p o r t g i v e n b y o u r d a t a to t h e c h a r a c terization o f the J e w s as a s o c i o c u l t u r a l g r o u p s w i t h low rates o f a l c o h o l i s m . S e v e r a l r e p o r t s h a v e i n d i c a t e d t h a t N o r t h - A m e r i c a n J e w s d r i n k less t h a n gentiles [4,5]. B a s e d o n the N o r t h - A m e r i c a n L i p i d s R e s e a r c h Clinics d a t a E r n s t et al. [2], r e p o r t e d t h a t w h i t e m a l e s aged 4 0 - 4 9 in the N o r t h - A m e r i c a n s c e n t e r s d r a n k 17.8 ml a b s o l u t e alcohol daily, w h i c h is roughly e q u i v a l e n t to a n a v e r a g e w e e k l y cons u m p t i o n o f 10 b e e r s or 11 glasses o f wine or 7 m i x e d drinks. This is 2 to 3 times the c o n s u m p t i o n of J e r u s a l e m m e n . A m o n g d r i n k e r s the d i f f e r e n c e s are e v e n g r e a t e r if we take into a c c o u n t the k n o w l e d g e that t e e t o t a l i s m is less f r e q u e n t in o u r s a m p l e t h a n in N o r t h - A m e r i c a .

It w o u l d b e useful to c o n d u c t a s t u d y d e s i g n e d for inquiry into a t t i t u d e s , v a l u e s , r e a s o n s for drinking, d r i n k r e l a t e d p r o b l e m s , alcohol a b u s e s y m p t o m s , a n d o t h e r socio cultural f a c t o r s in this low risk p o p u l a t i o n .

ACKNOWLEDGEMENT The authors are grateful to Dr. Israel Adler and the referees for helpful comments. This research was supported in part by an NIH contract, No. HV-5-3015-L.

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