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Better Psychological Functioning and Higher Social Status May Largely Explain the Apparent Health Benefits of Wine
A Study of Wine and Beer Drinking in Young Danish Adults
Erik L. Mortensen, PhD;
Hans H. Jensen, PhD;
Stephanie A. Sanders, PhD;
June M. Reinisch, PhD
Arch Intern Med. 2001;161:1844-1848.
ABSTRACT
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Background Findings from a recent series of Danish studies suggest that moderate
wine drinkers are healthier than those who drink other alcoholic beverages
or those who abstain.
Objective To identify possible explanatory factors associated with the health
benefits of wine consumption through the examination of a wide spectrum of
social, cognitive, and personality characteristics related to both beverage
choice and health in young Danish adults.
Subjects and Methods Descriptive cross-sectional study of characteristics associated with
beverage choice in a sample of 363 men and 330 women between the ages of 29
and 34 years, selected from the Copenhagen Perinatal Cohort on the basis of
perinatal records.
Main Outcome Measures Socioeconomic status, education, IQ, personality, psychiatric symptoms,
and health-related behaviors, including alcohol consumption, were analyzed.
The outcome variables were subjected to linear and logistic regression analyses
with 2 factors (beer and wine), each with 2 levels (drinking or not drinking
a certain beverage type).
Results Wine drinking was significantly associated with higher IQ, higher parental
educational level, and higher socioeconomic status. Beer drinking was significantly
associated with lower scores on the same variables. On scales concerning personality,
psychiatric symptoms, and health-related behaviors, wine drinking was associated
with optimal functioning and beer drinking with suboptimal functioning.
Conclusions Our data demonstrate that wine drinking is a general indicator of optimal
social, cognitive, and personality development in Denmark. Similar social,
cognitive, and personality factors have also been associated with better health
in many populations. Consequently, the association between drinking habits
and social and psychological characteristics, in large part, may explain the
apparent health benefits of wine.
INTRODUCTION
DANISH epidemiological studies of beverage choice and health have revealed
many apparent health benefits related to drinking wine. In this series of
studies light to moderate wine consumption was related to good self-perceived
health1; lower risks for stroke,2
upper digestive tract cancer,3 lung cancer,4 and hip fracture5;
and, perhaps more remarkably, to a lower rate of all-cause mortality as compared
with abstaining, or beer or liquor drinking.6
However, all the Danish studies based their analysis of the beneficial
health effects of wine on observational data collected between 1976 and 1982.
At that time, only a small proportion of the Danish population regularly drank
wine. This raises the question as to whether the apparent health benefits
of wine reflected the direct physiologic effects of this beverage or other
health-related individual differences between wine drinkers and nonwine drinkers.
In this study, we examined the association between beverage choice and a broad
spectrum of social, cognitive, and personality characteristics in a large
sample of Danish adults evaluated between November 26, 1990, and October 5,
1994.
SUBJECTS AND METHODS
SUBJECTS
The Copenhagen Perinatal Cohort consists of 9125 individuals born at
the Copenhagen University Hospital from September 22, 1959, to December 20,
1961. As part of a study addressing the effects of prenatal exposure to prescribed
maternal medications, a sample was selected on the basis of perinatal records
for detailed evaluation of physical, psychological, and social development.7 (Preliminary analyses revealed very few significant
interactions between beverage choice and prenatal medication exposure.) The
sample consisted of 693 subjects (363 men and 330 women) between the ages
of 29 and 34 years (mean age, 32.0 years). The mean number of school years
attended for the total sample was about 10 months above the average reported
for this Danish generation (ie, 10 years).8
DATA COLLECTION
The assessment procedures included the following standardized tests
and questionnaires: Wechsler Adult Intelligence Scale,9
Eysenck Personality Questionnaire,10 Zuckerman's
Sensation Seeking Scale,11 and Millon Clinical
Multiaxial Inventory12 (data will only be presented
for the clinical symptom scales). Detailed information was also collected
on health and health behaviors and on social status and educational level,
including parental educational level and social status (recorded at the subjects'
1-year birthday). An Alcohol Usage Questionnaire included detailed information
about alcohol consumption during the last week (or the last typical week,
if consumption in the most recent week was atypical).
ALCOHOL CONSUMPTION
Cross-tabulation of beer and wine drinking resulted in the following
4 groups based on beverage preference during the last week: no beer/no wine
drinkers, beer drinkers, wine drinkers, and beer and wine drinkers. The distribution
of men and women within these groups is listed in Table 1. Consumption of liquor was rare, the median consumption
being 0 to 1 drinks per week, irrespective of beer- and wine-drinking pattern.
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Table 1. Number of Subjects in Each Beverage Group
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The number of drinks during the last week is given in Table 2. For the total sample, the mean number of drinks per week
and the percentage of abstainers was close to results for the same age group
in a 1995 Copenhagen Health Survey.13
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Table 2. Number of Drinks Last Week*
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DATA ANALYSIS
Beer and wine are conceptualized as 2 factors with 2 levels (drinking
or not drinking). A linear regression program (SPSS Inc, Chicago, Ill) was
used to test the main effects of these 2 factors and their possible interactions.
Statistically significant interactions between beer and wine were disclosed
for only women's parental educational level (Table 3). Thus, the characteristics associated with the 2 beverage
types may be interpreted independently. The differences between wine drinkers
and no wine drinkers were not signficantly different in the beer-drinking
and no beer-drinking parts of the sample. Similarly the characteristics associated
with beer drinking did not depend on wine-drinking status. Preliminary analysis
revealed many interactions between sex and alcohol type, and consequently,
data for male and female subjects were analyzed separately.
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Table 3. Parental and Subject's Social Status and Educational Level*
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RESULTS
Table 3, Table 4, and Table 5
present data for the 4 subgroups resulting from cross-tabulation of beer and
wine drinking. As there was no interaction between beer and wine drinking,
the tables also give the estimates of the main effects associated with the
2 beverage types. In general, across all tables, the differences between the
pure beer and pure wine drinkers were close to the differences expected from
the main effects of beer and wine drinking, respectively.
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Table 4. IQ and Personality Test Results*
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Table 5. Millon Clinical Multiaxial Inventory12 (MCMI) Raw
Scores*
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SOCIAL AND EDUCATIONAL VARIABLES
The data in Table 3 show
that for men and women, wine drinking was consistently associated with higher
scores in parental social status, parental education, and subjects' years
in school and social status.
COGNITIVE TEST FINDINGS
Table 4 presents Verbal,
Performance, and Full-Scale Wechsler Adult Intelligence Scale IQs. Significant
main effects of beer and wine were obtained for all IQs except for Performance
IQ in women. For both sexes, beer drinking was consistently related to lower
scores on the IQ scales; wine drinking consistently related to higher scores
on the IQ scales. The IQ differences between male pure beer and pure wine
drinkers were dramatic (Full-Scale IQs, 95.2 and 113.2, respectively).
PERSONALITY MEASURES
For Sensation Seeking, Table 4
shows a significant effect of wine drinking for males only. With regard to
the Eysenck Personality Questionnaire, beer-drinking men showed higher Neuroticism
scores while for women, wine drinking was related to lower Neuroticism scores
and to higher Extroversion scores. Analysis of Millon Clinical Multiaxial
Inventory clinical symptoms revealed that wine drinking was consistently related
to lower scores and beer drinking to higher, more pathological scores for
both men and women (Table 5).
Moreover, pure wine drinkers obtained the lowest (healthiest) mean scores;
pure beer drinkers obtained the highest mean scores on 8 of 9 symptom scales,
with the largest differences in Anxiety and Alcohol Abuse.
HEALTH AND HEALTH BEHAVIOR
Beverage choice was unrelated to body mass index, height, and weight.
Beer drinking was statistically significantly associated with a higher prevalence
of risk drinking, smoking, and illicit drug use, while wine drinking was associated
with lower prevalence of smoking (data not shown).
ADDITIONAL ANALYSES
Data in Table 2 show that
total alcohol consumption is larger for beer drinkers (particularly in male
subjects). Since studies investigating health effects of beverage choice usually
attempt to control total alcohol consumption, all analyses were repeated with
total alcohol consumption as a covariate. As may be expected from the correlation
between beer drinking and total consumption, most effects associated with
beer drinking became smaller or insignificant. In contrast, the effects associated
with wine drinking remained significant and for some Wechsler Adult Intelligence
Scale IQs and Millon Clinical Multiaxial Inventory symptom scales became statistically
stronger.
COMMENT
The Copenhagen City Heart Study6 demonstrated
lower mortality associated with wine drinking based on measurement of drinking
habits 3 to 5 years after Denmark joined the European Community in 1973. Before
joining the European Community, Denmark was traditionally a beer-drinking
country. In the 1990s it is much more common for Danes to drink wine, and
consequently intellectual, social, and personality differences between wine
drinkers and no wine drinkers may be far less pronounced than in the 1970
population study by Grønbæk et al.6
Nevertheless, 20 years later, we found 2 sets of characteristics significantly
associated with beer and wine drinking in a Danish population. In support
of our conclusions, a 1999 study of the introduction of coffee into the traditionally
tea-drinking society of Scotland shows similar relationships to social status
and health risk factors.14
Social status gradients in health are one of the most consistent findings
of public health epidemiology.15-16
The present study demonstrates strong relationships among beverage choice
and intelligence and socioeconomic status (these results were corroborated
by a parallel analysis of a 20- to 26-year-old sample from the same cohort).
A substantial part of the variation in intelligence (and personality) is independent
of social status, and consequently, residual confounding is likely when a
single index of social status is used as a covariate in studies of the beneficial
health effects of wine.
Our results suggest that wine drinking is associated with optimal social,
intellectual, and personality functioning, while beer drinking is associated
with suboptimal characteristics. According to Bouchard,17
virtually any dimension of behavior scaled from the less valued to the more
valued correlates positively with IQ. The dramatic IQ differences and differences
in personality measures between wine drinkers and beer drinkers strongly suggest
that wine and beer drinking in Denmark is associated with many known and unknown
factors that may affect health, morbidity, and mortality.
AUTHOR INFORMATION
Accepted for publication January 11, 2001.
This study has been supported by US Health Service (USPHS) grant DA05056
from the National Institute on Drug Abuse (Drs Reinisch and Sanders), USPHS
grants HD17655 and HD20263 from the National Institue of Child Health and
Human Development (Dr Reinisch), Bethesda, Md, and grant 1400/2-4-1997 from
the Danish National Board of Health, Copenhagen (Dr Mortensen).
We thank Vibeke Munk, BA, for help with the manuscript and for critical
comments.
Corresponding author: Erik L. Mortensen, PhD, Institute of Preventive
Medicine, Kommunehospitalet, DK-1399 Copenhagen K, Denmark (e-mail: lykke{at}ipm.hosp.dk).
From the Danish Epidemiology Science Center, Institute of Preventive
Medicine (Drs Mortensen, Jensen, and Reinisch) and the Department of Health
Psychology, Institute of Public Health (Drs Mortensen and Jensen), University
of Copenhagen, Copenhagen, Denmark; and The Kinsey Institute for Research
in Sex, Gender, and Reproduction, Indiana University, Bloomington (Drs Sanders
and Reinisch).
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