DOES EDUCATION LEVEL EFFECT HOW KENT
STATE UNIVERSITY FEMALE FACULTY AND
STAFF PERCEIVE THE HEALTH ASPECTS OF WINE?
A thesis submitted to the
Kent State University College
of Education, Health, and Human Services
in partial fulfillment of the requirements
for the degree of Master of Science.
By:
Jenna Lynn Iannello
May 2012
Thesis written by
Jenna Lynn Iannello
B.S. Bowling Green State University, 2010
M.S. Kent State University, 2012
Approved by
__________________, Director, Master’s Thesis Committee
Natalie Caine-Bish
__________________, Member, Master’s Thesis Committee
Nancy Burzminski
__________________, Member, Master’s Thesis Committee
Kele Ding
Accepted by
_________________, Director, School of Health Sciences
Lynne Rowan
_________________, Dean, College of Education, Health and Human Services
Daniel Mahony
ii
IANNELLO, JENNA L., M.S., May 2012
Nutrition and Dietetics
DOES EDUCATION LEVEL EFFECT HOW KENT STATE UNIVERSITY
FEMALE FACULTY AND STAFF PERCEIVE THE HEALTH ASPECTS OF WINE?
(95 pp.)
Director of Thesis: Natalie Caine-Bish, Ph.D., R.D., L.D.
The purpose of this study was to measure if education level of female faculty and
staff at a Midwest university impacted the perception of the health effects of red wine
consumption. Secondly, to measure if the sample perceived health benefits or risks of
other types of alcohol. Female faculty and staff members (n=503, ages 22-76 years)
participated in an online questionnaire. The questionnaire included questions on the
perception of the health aspects of alcohol. Variables measured included the belief and
reasons for consumption, drinking characteristics, and health belief of alcohol types.
Independent t-tests were used to determine differences in perceptions of health benefits of
red and white wine, beer, and liquor between faculty and staff. The data were compiled
and analyzed using social sciences (SPSS) software (version 18.0.3). There was no
significant difference in perception of the possible cardiovascular health benefits of red
wine between faculty and staff. However, significant differences in perception were
found between faculty and staff on health benefits and consequences of beer, liquor, and
white wine (p ≤ 0.05). Both faculty and staff perceived that red wine may have positive
health benefits for cardiovascular disease, but did not perceive any other benefits to red
wine and had mixed perceptions of benefits and consequences of other alcohol types.
This disconnect suggests a need for more public education of wines impact on health, as
well as additional alcohol and health outcome research.
ACKNOWLEDGEMENTS
I would like to thank my thesis advisor, Dr. Natalie Caine-Bish, and my other
thesis committee members, Dr. Nancy Burzminski and Dr. Kele Ding for the invaluable
time, guidance, comments, reviews, and advice they provided to confirm that my thesis
was the finest it could possibly be. I would also like to express my thankfulness to all of
the Kent State University female faculty and staff members who took the time to
participate in my study, without whom this study would not be possible.
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TABLE OF CONTENTS
Page
ACKNOWLEDGEMENTS .......................................................................................iii
LIST OF TABLES .....................................................................................................vii
CHAPTER
I. INTRODUCTION ................................................................................................1
Problem Statement ...............................................................................................4
Purpose Statement ................................................................................................5
Hypothesis ............................................................................................................5
Operational Definitions ........................................................................................5
II. REVIEW OF LITERATURE ..............................................................................7
Types of Alcohol.................................................................................................7
Wine .................................................................................................................7
Beer ..................................................................................................................7
Liquor ...............................................................................................................7
Nutrient Content of Alcohol ...............................................................................8
Nutrient Composition.......................................................................................8
Effect of Alcohol on Energy Intake and Appetite .........................................11
Compounds in Alcohol ..................................................................................13
Phenolic and polyphenolic compounds ......................................................13
Congeners ...................................................................................................14
Current Intakes of Alcohol................................................................................15
Metabolism of Alcohol Consumption...............................................................16
Physiological Health Effects ..........................................................................16
Absorption...................................................................................................16
Metabolic pathways ....................................................................................17
Lipid composition and protein distribution.................................................18
Physical Health Effects .....................................................................................20
Recommendations of Alcohol Consumption ....................................................21
Women vs. Men .............................................................................................21
Who Should Not Drink ..................................................................................22
Reasons for Consumption .................................................................................22
Physiological Benefits ...................................................................................22
Health .............................................................................................................23
Reasons for Health Belief .................................................................................24
Socioeconomic Status ....................................................................................24
Culture............................................................................................................25
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Associated Health Risks ...................................................................................28
Injuries, Violence, and Addiction ..................................................................28
Associated Health Benefits and/or Complications of Alcohol .........................29
Alcohol Type and Health ...............................................................................29
Wine ............................................................................................................29
The french paradox ..................................................................................33
Beer and liquor ............................................................................................33
Alcohol and Disease Risk ..............................................................................34
Cardiovascular diseases ..............................................................................34
Alzheimer’s disease and dementia ..............................................................35
Liver disease ...............................................................................................37
Type 2 diabetes mellitus .............................................................................38
Cancer .........................................................................................................39
Head and neck ..........................................................................................40
Digestive tract and pancreas ....................................................................40
Breast .......................................................................................................42
III. METHODOLOGY ..........................................................................................45
Purpose ............................................................................................................45
Variables ..........................................................................................................45
Participants ......................................................................................................45
Survey Design .................................................................................................45
Part One ........................................................................................................46
Part Two .......................................................................................................46
Part Three .....................................................................................................47
Procedures .......................................................................................................47
IV. JOURNAL ARTICLE .....................................................................................49
Introduction .....................................................................................................49
Methodology ...................................................................................................52
Sample ..........................................................................................................52
Measures .......................................................................................................52
Perception of the health aspects of wine questionnaire .............................52
Procedure ......................................................................................................52
Statistical Analysis .......................................................................................53
Results .............................................................................................................54
Discussion .......................................................................................................66
Limitations....................................................................................................72
Applications..................................................................................................73
Conclusion .......................................................................................................74
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APPENDICES .....................................................................................................76
APPENDIX A. STUDY CONSENT FORM .................................................77
APPENDIX B. PERCEPTION OF THE HEALTH ASPECTS OF WINE
QUESTIONNIARE AND DEMOGRAPHIC QUESTIONS .....................80
APPENDIX C. E-MAIL TO PARTICIPANTS.............................................86
REFERENCES ....................................................................................................88
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LIST OF TABLES
Table
Page
1. U.S. Standard Drink Types Containing 0.6 Ounces of Pure Alcohol ..........................9
2. Calorie Content of Standard U.S. Alcoholic Beverages ............................................10
3. Demographic Data of Kent State University Female Faculty and Staff
(N=493) ......................................................................................................................55
4. Drinking Characteristics of Kent State University Female Faculty and Staff
(N= 493) .....................................................................................................................57
5. Comparison of Health Beliefs of Alcohol Between Faculty and Staff
(N=493) ......................................................................................................................58
6. Level of Agreement with the Role of Red Wine on Health Outcome Between
Faculty and Staff (N=493) .........................................................................................60
7. Level of Agreement with the Role of White Wine on Health Outcome Between
Faculty and Staff (N=493) .........................................................................................63
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CHAPTER I
INTRODUCTION
Wine has been produced since before recorded history in Asia Minor and the
Mediterranean basin (Wright, Bruhn, Heymann, & Bamforth, 2008). In the United States,
prior to regulations restricting the use of health claims, beer was described as a tonic,
health boosting beverage (Wright et al., 2008). Currently, most studies show that
moderate alcohol consumption, particularly wine, is associated with a lowered mortality
(Engs, 1996; Saliba & Moran, 2010; Szmitko & Verma, 2005; Bauer, 2008; Castelnuovo,
Rotondo, Iacoviello, Donati, & Gaetano, 2002; Gronbaek, Deis, Thorkild, Becker,
Schnorh, & Jensen, 1995; USDHHS, 2000; Gronbaek, 2001).
The Dietary Guidelines for Americans, published by the United States
Department of Agriculture (USDA), includes reliable information on what we should eat
to be healthy (USDA, 1997). The guidelines are developed with advice from leading
nutrition experts, stating “If you do drink alcohol, do so in moderation.” It is not
recommend that those who do not consume alcohol to begin drinking (USDA, 1997). As
a whole, women in the U. S., and other cultures, are more likely to abstain, drink less, and
drink less frequently compared to men (Engs, 1996).
Epidemiologic evidence has shown that those who drink high quantities of
alcohol are at an increased risk for health problems (NIH, 2000; USDHHS, 2000; USDA,
1997; USDA, 2010). Other studies have suggested that individuals who abstain from
1
2
using alcohol may be at greater risk for a variety of conditions, than those who consume
small to moderate amounts of alcohol (NIH, 2000; Shaper, 1990). Moderate alcohol
consumers tend to have better health and live longer lives than heavy consumers and
abstainers (NIH, 2000, Gronbaek, 2001).
Intake of any alcoholic beverage appears to be beneficial to health, but some
studies suggest that red wine confers additional health benefits (Szmitko & Verma, 2005;
Saliba & Moran, 2010; Castelnuovo et al., 2002, Gronbaek et al., 1995). Regular
consumption of red wine has been suggested as the explanation for the “French Paradox.”
The “French Paradox” supports the idea that the low incidence of coronary
atherosclerosis in France, compared to Western countries, may be due to the red wine
consumption, despite the high intake of saturated fat in the French diet (Engs, 1996).
This benefit from red wine may be due to its chemical composition. Polyphenolic
compounds in red wine, such as flavonoids and resveratrol, may play a role in limiting
the initiation and progression of atherosclerosis (Szmitko & Verma, 2005). Flavonoids
and resveratrol have been associated as antioxidants, preventing molecules known as
“free radicals” from causing cellular damage in the body (Bauer, 2008; Gronbaek, 2001;
Luchsinger, Ming-Xin, Siddiqui, Shea, & Mayeux, 2004). Red wine provides a
significant amount more resveratrol compared to white, because the longer the skin is
kept on the grape, the greater amount of resveratrol (Bauer, 2008).
The Copenhagen City Heart Study provided the first support for a more
pronounced cardioprotective effect for red wine, compared to other alcohol beverages
3
(Szmitko & Verma, 2005). The study compared 13,285 men and women for 12 years,
suggesting that those who drank wine had half the risk of dying from coronary heart
disease (CHD) or stroke, opposed to those who never drank wine. Those who drank beer
and spirits did not experience the same health advantage (Szmitko & Verma, 2005).
There has been an increase of studies document an association between lower CHD risk
and alcohol consumption (USDHHS, 2000; Gronbaek, 2001).
Some studies have suggested that alcohol intake can also reduce risk of dementia
and Alzheimer’s disease (Luchsinger et al., 2004; Ruitenberg et al., 2002). Moderate
alcohol intake has been associated with a decreased risk of dementia, mostly in European
studies (Luchsinger et al., 2004). In a cohort of individuals aged 65 years and older, light
to moderate alcohol intake was associated with a lower risk of dementia and Alzheimer’s
disease (Luchsinger et al., 2004).
Some research on alcohol consumption and breast cancer supports an increased
risk of disease. One study, comparing breast cancer risk with beverage-specific alcohol
intake, found a positive association in alcohol consumption and the risk of invasive breast
cancer in women (Smith-Warner et al., 1998). Women who consumed 60 grams per day
or more of alcohol had a 31% higher risk of invasive breast cancer.
Some research shows how demographic characteristics can impact health belief
and consumption of alcohol. In a study by Minugh, Rice, and Young (1998),
demographic characteristics constituted the primary source for variation of quantity
alcohol consumed. The relationship between demographic variables and alcohol
4
consumption was the same for quantity and frequency, with the exception of education.
Women and men both drank more frequently as education increased, whereas quantity
consumed was inversely correlated with education. Perceived health status, in both sexes,
was related to how often and how much individuals reported drinking (Minugh et al.,
1998). More favorable health perceptions were related to frequent drinking, whereas
negative health perceptions were associated with greater alcohol consumption (Minugh et
al., 1998).
Problem Statement
The reasons that people consume wine vary largely, as it plays a role in social
activities, from the business lunch, to the special occasions (USDHHS, 2000). Reduced
stress, improved mood, increased sociability, and relaxation are the most commonly
reported psychosocial benefits of drinking alcohol (USDHHS, 2000). Drinking wine has
become one way that humans cope with feelings of anxiety, anger, and sadness when
faced with traumatic experiences (Beseler, Aharonovich, & Hasin, 2011).
Medical literature on wine is pointing to the health benefit outcomes with
consumption (Engs, 1996; Saliba & Moran, 2010; Szmitko & Verma, 2005; Bauer, 2008;
Castelnuovo et al., 2002; Gronbaek et al., 1995; USDHHS, 2000; Gronbaek, 2001). A
study by Minugh, Rice, and Young (1998), found that individuals drank more frequently
as education increased, whereas quantity consumed was inversely correlated with
education. There needs to be a focus on whether or not education level has an effect on
5
the perception of wine, as there is minimal research available that compares health belief
of wine and education level.
Purpose Statement
The purpose of this research is to determine whether education level plays a role
in the way that KSU female faculty and staff perceive the effects of red wine
consumption on health. Secondly, to measure if the sample perceived health benefits or
risks of other types of alcohol.
Hypothesis
KSU female faculty will perceive moderate red wine consumption as a benefit to
health and staff will not perceive moderate red wine consumption as a benefit to health.
Operational Definitions
Alcohol abuse: When drinking leads to problems, but not physical addiction.
Alcoholism: Having signs of physical addiction to alcohol and continues to drink,
despite problems with physical health, mental health, and social, family, or job
responsibilities.
Binge drinking: Four or more drinks during a single occasion for females, and five or
more drinks during a single occasion for men.
Faculty: An educator who works at a college or university.
6
Heavy drinking: More than one drink per day on average for females, and more than two
drinks per day on average for males.
Staff: An employee who is a member of a staff of workers.
The French Paradox: The substances present in wine, but not in beer and spirits, may be
responsible for the lower mortality amongst wine drinkers.
CHAPTER II
REVIEW OF LITERATURE
Types of Alcohol
Wine
Wines vary largely of 10-22% alcohol content (WHO, 2011). The most common
wines are produced from grapes. However, wines are also made from a variety of
different fruits, such peaches, plums, and apricots. A few key components affect the taste
and quality of the wine; such as, the soil that grapes and/or other fruits are grown and the
weather conditions in the growing season (WHO, 2011). When the fruits are ripe, they
are crushed and fermented in bins to create wine (WHO, 2011).
Beer
Beer is 4-8% alcohol content, and produced by the fermentation process (WHO,
2011). Wort, a liquid mix is prepared by combining yeast and malted cereal, such as corn,
rye, wheat, or barely (WHO, 2011). The fermentation of the wort mix is what produces
alcohol and carbon dioxide, promoting fermentation. Fermentation is stopped before it is
completed with beer in order to limit the alcohol content (WHO, 2011).
Liquor
Spirits include brandy, gin, rum, tequila, vodka, and whisky (WHO, 2011).
Brandy is distilled from fermented fruit juices. The color of brandy comes either from
casks or from caramel that is added, and is usually aged in ask casks. Brandy is typically
7
8
about 40-50% alcohol by volume (WHO, 2011). Gin is a distilled beverage that is a
combination of alcohol, water, and other various flavors. Gin does not improve with age
so it is not stored in wooden casks. Rum is a distilled beverage made from fermented
molasses or sugarcane juice and is aged for at least three years. Rum is typically 40-55%
alcohol by volume (WHO, 2011). Tequila is produced through the distillation of
fermented juices of the mescal plant, species of the agave plant (American Bartenders
School, 2011). Vodka is distilled from a fermented mash of grain, differing in whiskey
by being distilled at a high proof, 190 or above, then processed further to remove the
flavor (American Bartenders School, 2011). Whiskey is produced by distilling the
fermented juice of cereal grains (corn, rye, or barely). Whiskey is typically 40-55%
alcohol by volume (WHO, 2011).
Nutrient Content of Alcohol
Nutrient Composition
Alcohol is a fermentation product of carbohydrates, both sugars and starches,
supplying calories in beverages and in food (Duyoff, 2006). Although alcoholic
beverages tend to lack nutrients, they are the second highest source of energy of all the
micronutrients, as alcohol provides about seven calories per gram (Foster & Marriott,
2006). Carbohydrates and protein provide four calories per gram, and fat provides nine
calories per gram of fat. For example, a 1.5 ounce “shot” of vodka may be around 40%
alcohol, up to 0.6 ounces of alcohol, which contributes about 100 calories. In the United
States, a drink is considered to be half an ounce, or 15 grams of alcohol, which is
9
equivalent to 12 ounces or beer, five ounces of wine, or 1.5 ounces of 80-proof distilled
spirits (NIAAA, 2000).
Alcohol is a top calorie contributor in the diets of many American adults (USDA,
2010). The amount of calories in a drink is determined by how much alcohol is present,
and for mixed drinks, the other ingredients in the drink often a lot of calories (Duyoff,
2006). Since alcohol is often consumed in mixtures with other beverages, the calorie
content of additional mixers should be considered when calculating the calorie content of
alcoholic beverages (USDA, 2010).
In the U. S., a standard drink is any drink that contains 0.6 ounces (14 grams or
1.2 tablespoons) of pure alcohol (CDC, 2011). See Table 1 for standard drink types in
the U.S. that contain 0.6 ounces of pure alcohol. Although the calorie levels vary by
alcoholic drink, standard drink sizes usually supply about the same amount of alcohol
(Table 2).
Table 1. U.S. Standard Drink Types Containing 0.6 Ounces of Pure Alcohol
Drink Type
Amount
(Ounces)
Beer
12
Wine Cooler
12
Malt Liquor
8
Wine
5
80-Proof Distilled Spirits or
1.5
Liquor
*(Data from Centers for Disease Control and Prevention (CDC), 2011).
10
Table 2. Calorie Content of Standard U.S. Alcoholic Beverages
Drink Type
Amount (Ounces) Calories
Beer
12
150
Light Beer
12
100
Dry Wine
5
100
Wine Cooler
12
180
80-Proof Distilled
1.5
100
Spirits
Liquor or Cordial
1.5
160
*80-proof distilled spirits or liquor with an added mixer, such as a soft drink, adds more
calories.
*(Data from The American Dietetic Association (ADA); Complete Food and Nutrition
Guide, 2006).
The quantity of vitamins and minerals in beers and wines vary largely, depending
on a number of factors. For example, the micronutrient content in wine is affected by the
grape used, production method, harvest time, storage, yeast variety used during
fermentation, and the different additives that are added to the wine. Sometimes vitamin
C may be added to wine in order to stabilize it. Yeast contains high levels of B vitamins,
as the variation in different yeasts makes a difference in the nutrient content. Liqueurs
may also contain protein and fat owing to the addition of egg or cream (Foster & Marriott,
2006). Beers contain small amounts of some micronutrients, including B vitamins and
some minerals, and wines contain several trace elements, including iron, potassium,
copper, and sodium (Foster & Marriott, 2006).
The alcohol content of one drink depends on the serving size and type of alcoholic
beverage. When restaurants advertise “special” alcoholic drinks on menus, they tend to
contain more alcohol because they’re bigger serving sizes. The average percentage of
alcohol by volume (ABV) varies largely among different alcoholic drinks. Beer is 4-6%
11
ABV, low alcohol beer is 0-2% ABV, wine coolers are 4-5.5% ABV, wines are 9-13%
ABV, distilled spirits (37-45% ABV, and liquors are 20-40% ABV (Foster & Marriott,
2006).
Additionally, there are products on store shelves that may be confused by their
title. These products vary in their alcohol content, as consumers may not understand
what they are consuming when reading the titles of the beverages. “Near beer” is a malt
beverage that has alcohol content below 0.5%. “Low-alcohol or reduced-alcohol beer” is
a malt beverage with less than 2.5% alcohol and an “alcohol-free malt beverage” contains
0.0% alcohol. A “flavored malt beverage” (beer, lager, ale, porter, stout) is flavored after
fermentation, possibly with juice, juice concentrate, or fruit. “Aperitif wine,” often made
from a grape wine and brandy, has an alcohol content of 15-24%. “Fortified wine”
(dessert wine) has brandy or distilled spirits added to it, and is 14-24% alcohol. “Table
wine” (red wine, white wine, and sweet table wine) contains about 7-14% alcohol.
“Low-alcohol wine” is a wine or fermented fruit beverage, containing less than 7%
alcohol and may consist of more sugars than other wines. A “wine cooler” is less than
7% alcohol, and is a diluted wine product by adding sugar, water, and/or fruit juice
(Duyoff, 2006).
Effect of Alcohol on Energy Intake and Appetite
Alcohol consumption has been known to have an effect on an individuals’ energy
intake, as alcohol can impact one’s food intake (Foster & Marriott, 2006). Pathways for
appetitive drive states in the limbic cortex appear responsible for the craving of alcohol
12
and drugs (Miller & Goldsmith, 2001). Also, some studies have found that alcohol
exposure can produce a robust increase in actual alcohol craving (Reid, Flammino,
Starosta, Palamar, & Franck, 2006).
The effects of alcohol on food intake have been studied in laboratory-based
studies and observational studies (Foster & Marriott, 2006). Laboratory studies have
been used to measure physiological indicators associated with food intake, such as
appetite hunger or satiation. Observational studies have found trends in energy intake
according to levels of alcohol consumption. Generally, both of these studies
demonstrated that individuals are unlikely to decrease their food intake to compensate for
the energy from alcohol during the day (Westerterp-Plantenga & Verwegen, 1999).
Previous studies have indicated that alcohol can act as an appetite stimulant,
resulting in a greater overall intake of energy from a test meal after alcohol consumption
(Westerterp-Plantenga & Verwegen, 1999). The mechanism of how alcohol stimulates
appetite is not known, but it is known that alcohol affects neurotransmitters and certain
hormones, such as leptin. Changes to any of these components in the body could affect
an individuals’ food intake (Foster & Marriott, 2006).
An additional study by Yeomans found that significantly more energy was
consumed following alcohol than no alcohol (Yeomans, 2010). This effect was
demonstrated in the study, as a less amount of food was eaten after the alcohol – free
juice drink, and more was consumed after the same juice drink with added alcohol
(Yeomans, 2010). Additionally, there was no evidence that the effect of alcohol on
13
intake was due to restrained eating, nor did alcohol increase liking for the test foods.
Alcohol consumption was found to increase appetite once food had been tasted,
suggesting alcohol may increase food-related reward. Data suggests that the effects of
alcoholic drinks represent a complex interaction between physiological effects of alcohol
and expectations and associations generated by past experience of alcoholic drinks
(Yeomans, 2010).
Compounds in Alcohol
Phenolic and polyphenolic compounds. Some alcoholic beverages contain
plant-derived bioactive phenolic compounds, known as flavonoids. Plants produce
phenolic and polyphenolic compounds as secondary metabolites, which have a diverse
range of effects in vitro that are suggestive of a putative role in the prevention of chronic
diseases (Foster & Marriott, 2006).
Red wines, and to a much less extent, white wines, are a rich source of a variety
of phenolic and polyphenolic compounds. In red wine production, with lengthy
extraction, the fermented wine must contain up to 40% of the phenolics that were
originally present in the whole grapes. White wine contains lower levels or an absence of
skin and seed-derived phenolics, making the phenolics much lower than that found in red
wine. The geographic origin of the grapes also plays a role in the range of concentrations
of phenolic and polyphenolic compounds available (Foster & Marriott, 2006).
14
Whisky contains phenolic compounds also; quercetin, vanillin, and ellagic, gallic
and syringic acids, which are extracted from the wooden casks during maturation. The
phenolic profile depends on how long the spirit has been matured.
Beer contains phenolic and polyphenolic compounds produced from barely and
hops used in the production of beer. The amount of polyphenolic compounds in beer is
comparable to those that are found in white wine, and even some red wines. There is also
some evidence supporting that there is a decent amount of antioxidants in beer, resulting
in increases in antioxidant capacity of plasma after consumption. The idea of
antioxidants in beer is still unclear, but there is some supporting evidence (Foster &
Marriott, 2006). Wine, beer, and whiskies contain phenolic and polyphenolic compounds
in a variety of quantities. These compounds may have health-promoting effects; however
their precise roles remain largely unclear (Foster & Marriott, 2006).
Congeners. The fermentation of alcohol produces bioactive compounds, known
as congeners, and distil over with the alcohol. The fermentation process produces around
95% alcohol, 5% fusel oil, higher alcohols, aldehydes and esters, and a mixture of
organic acids (Foster & Marriott, 2006).
The maturation of the liquor changes fusel oil and allows the special flavor to the
spirit, as congeners contribute to the taste, smell, and appearance of alcoholic beverages.
The side effects of a hangover are attributed to congeners in the alcoholic beverages
(Foster & Marriott, 2006).
15
Current Intakes of Alcohol
Overall, Europe has the highest alcohol consumption worldwide. This trend is
said to be associated with the increased alcohol consumption among the younger
European population (Health Promotion Agency, 2011).
Wine-producing countries have been known to have the highest per capita alcohol
intake; however, this is now stabilizing compared with non-wine producing countries.
This trend is said to be due to increased accessibility and lower costs (Foster & Marriott,
2006).
In 2000, it was found that 44% of the U.S. adult population is current drinkers
who have consumed at least 12 drinks in the preceding year (NIAAA, 2000). According
to the Centers for Disease Control and Prevention, over half of the adult population drank
alcohol in the past 30 days. Approximately 5% of the total population drank heavily,
while 15% binge drank (CDC, 2011). Binge drinking is defined as four or more drinks
during a single occasion for females, and five or more drinks during a single occasion for
men. Heavy drinking is defined as more than one drink per day on average for females,
and more than two drinks per day on average for males (CDC, 2011). It has also been
found that about 14 million Americans, or 7.4% of the population, meet the diagnostic
criteria of alcohol abuse or alcoholism (NIAAA, 2000).
16
Metabolism of Alcohol Consumption
Physiological Health Effects
Absorption. Alcohol has been studied at length for more than a century, yet its
mechanism of action still remains controversial (Ingólfsson & Andersen, 2011). Alcohol
is a water-soluble molecule that is absorbed throughout the gastrointestinal tract,
controlled mostly by gastric emptying (Foster & Marriott, 2006). Through a process
called diffusion, alcohol circulates in the blood and is distributed through the water in the
body after absorbed. It will diffuse more quickly into organs with a rich blood supply,
such as the lungs, but little alcohol enters body fat, due to its solubility in fat (Foster &
Marriott, 2006). The liver is where the most exposure to alcohol occurs, as blood is
received directly from the stomach and small bowel through the hepatic portal vein.
Absorption occurs most rapidly when drinks are consumed on an empty stomach.
The type of alcohol will have an effect on rate of absorption, and the amount absorbed
can be measured by the blood alcohol concentration (Foster & Marriott, 2006). The rate
of absorption will vary between individuals, depending on the speed the drink was
consumed, and whether food was eaten while drinking. Certain drugs may also interfere
with gastric emptying, either slowing down or increasing the rate of absorption, and
affecting the concentration of alcohol in the blood (Foster & Marriott, 2006). Like other
drugs of abuse, alcohol, acts on multiple targets in brain and body to produce a complex
array of effects (Roma et al., 2008). Gender and body size, also have an impact on the
rate of alcohol absorption. For example, an average woman drinking the same amount of
17
an average man of the same size will become intoxicated more quickly, due to her higher
percentage of body fat. Also, women tend to have smaller statures, having smaller
volumes of blood, and resulting in a higher concentration of alcohol in the blood (Foster
& Marriott, 2006).
Metabolic pathways. After alcohol is absorbed, it is metabolized immediately.
This is due to the body having no capacity to store alcohol, in contrast to other
macronutrients, and its toxic properties. The liver is the primary site where metabolism
occurs, but some is immediately metabolized in the stomach by an enzyme responsible
for breaking down alcohol, called alcohol dehydrogenase (Foster & Marriott, 2006).
Only about 2-5% of alcohol is excreted unchanged in the breath, urine, or sweat.
In an individual who is healthy, most of the alcohol consumed is metabolized and
removed from the blood at a constant rate of about six grams per hour. However, this
rate varies largely amongst individuals depending on many factors, including drug intake,
frequency of alcohol intake, age, bodyweight, and genetics, and liver size (Foster &
Marriott, 2006). Gender has also been found to play a role in the speed of alcohol
metabolism, as females have less alcohol dehydrogenase. The decreased activity of this
enzyme in the females’ gastric mucosa forces them to metabolize alcohol more slowly,
with a steeper rise in blood alcohol concentration when drinking (Foster & Marriott,
2006).
Alcohol is metabolized in three different stages. In the first stage, alcohol is
oxidized to acetaldehyde, with the most common route is through the Nicotinamide
18
adenine dinucleotide (NAD)-linked enzyme alcohol dehydrogenase (AHD).
Acetaldehyde is more toxic than alcohol; therefore, it is quickly oxidized to acetate
through the enzyme acetaldehyde dehydrogenase (ALDH). Acetyl CoA synthetase
converts a large proportion of acetate to acetyl co-enzyme A (acetyl CoA), where it is
further oxidized to provide energy, via the Krebs cycle. Due to a genetic polymorphism,
some individuals are unable to oxidize acetaldehyde efficiently. Therefore, when alcohol
is consumed, they are exposed to high acetaldehyde levels, causing side effects that
include headaches and facial flushing. This problem is most commonly found in the
Asian population (Foster & Marriott, 2006).
Lipid composition and protein distribution. Alcohols are known modulators of
lipid bilayers, and membrane protein function (Ingólfsson & Andersen, 2011). There
have been a variety of terms to describe the changes in bilayer properties that occur,
reflecting different experimental methods. The biological efficacy of alcohols of various
chain lengths often displays a cutoff effect. For shorter alcohols, the potency increases
with increasing chain length (Ingólfsson & Andersen, 2011). Beyond a certain chain
length, further increases in length have less effect on potency, and may reduce it. The
cutoff effect is found in a variety of systems: Alcohols with chain lengths less than or
equal to six, which increase the formation of the photo activated form of rhodopsin in 1palmitoyl-2-oleylphosphatidylcholine lipid vesicles, whereas longer alcohols decrease its
formation (Ingólfsson & Andersen, 2011). In Xenopus oocytes, ethanol through 1butanol potentiate nicotinic acetylcholine receptor currents, and longer alcohols inhibit
19
them. The cutoff effect could be related to steric hindrances in alcohol-protein relations
(Ingólfsson & Andersen, 2011). However, this could also reflect alcohol-bilayer
interactions that are more multifaceted than estimated from a partition model. The
interaction between an alcohol’s affinity for a protein and limited solubility can also lead
to a cutoff effect. It has been found that short-chain alcohols cause increases in volume
when dividing into dimyristoylphosphatidycholine bilayers, where longer alcohols cause
decreases in volume (Ingólfsson & Andersen, 2011). These cutoff effects tend to occur
when the chain length of the alcohol is equal to half the acyl chain length of the bilayerforming lipids.
There is also evidence for direct alcohol interactions with membrane proteins.
Membrane proteins’ alcohol sensitivity has been related to specific protein regions, as
some responses can be modulated by amino acid substitutions (Ingólfsson & Andersen,
2011). In a recent study, in order to determine the bilayer-modifying potencies of
alcohols, gramicidin (gA)-based fluorescence assay was used. The gA channels are
formed by the transbilayer dimerization to two non-conducting subunits. The channel’s
hydrophobic length is usually less than the bilayer’s hydrophobic thickness, due to the
adaptation to accommodate the channel (Ingólfsson & Andersen, 2011). This adaptation
is related to the deformation of the bilayer, as the gA channels serve as molecular force
probes to assess changes in the lipid bilayer properties. The data suggests that the
biological actions of alcohol arise from a combination of specific membrane protein-
20
alcohol interactions, as well as alcohol induced changes in membrane proteins
(Ingólfsson & Andersen, 2011).
Physical Health Effects
Most data supports that heavy alcohol intake (greater than 30 grams or greater
than three drinks per day) is associated with increased risk of weight gain/obesity, while
light to moderate drinking is not (Foster & Marriott, 2006). However, not all studies
have been consistent with findings, with the exception that very heavy drinkers (greater
than 49 grams of alcohol per day) have a low BMI. These inconsistent findings may be
related to various methodology problems linked to studies measuring alcohol (Foster &
Marriott, 2006).
It has been found that alcohol intake contributes to over 10% of the total calorie
intake of adult drinkers in the U. S. (Williamson et al., 1987). In females, body mass
index (BMI) is found to be inversely related to alcohol intake at intakes less than or equal
to 50 grams per day. However, at higher intakes of alcohol, BMI has been found to
increase with alcohol consumption in females. In men, there is no such relation in BMI
and alcohol intake (Westerterp-Plantenga & Verwegen, 1999).
Additionally, epidemiologic studies of alcohol intake have found that moderate
alcohol consumers total energy intake increases when alcohol is introduced to the diet
(Westerterp-Plantenga & Verwegen, 1999). This idea suggests that alcohol-derived
energy is additive and not recognized or regulated by the body.
21
In a study done in 1987, it was found that alcohol had a substantial association
with lower body weight in women, and the association was similar to the effect of
smoking (Williamson et al., 1987). For women who drank less than 14 times per week,
there was evidence of a dose-response of alcohol on body weight. However, the weightlowering effect of alcohol in women was diminished at the highest level of drinking
(Williamson et al., 1987).
Recommendations of Alcohol Consumption
Women vs. Men
In the U.S., the latest consensus states that men should consume no more than one
to two drinks per day, and women should consume no more than one drink per day (CDC,
2011). Women are recommended a less amount of alcohol than males because women
have less activity of an enzyme that helps metabolize alcohol (USDA, 1997). One drink
counts as 12 ounces of regular beer, five ounces of wine, and 1.5 ounces of 80-proof
distilled spirits.
The recommendations are defined by moderate drinking, used by the U.S.
Department of Agriculture and the Dietary Guidelines for Americans (USDA, 1997).
Since alcohol carries the risk of dependency and excess consumption, which can lead to
serious health problems. Therefore, the Dietary Guidelines (DG) recommend that those
who do drink alcoholic beverages do so in moderation (USDA, 1997). The DG do not
recommend that those who do not consume alcohol begin drinking. Virtually, the same
22
advice has been given has been given from the USDA on alcohol consumption since
1980 (USDA, 1997).
Who Should Not Drink
The DG also caution that certain individuals should not drink alcohol. Individuals
who should not drink include children and adolescents, women who are pregnant or
trying to conceive, those who cannot restrict their drinking to moderate levels, individuals
who are planning to drive or take part in activities that require attention, and those using
certain prescriptions or over-the-counter medications (USDA, 1997). If alcohol is
consumed by a mother when pregnant, major birth defects, including fetal alcohol
syndrome, can occur (USDA, 1997).
Reasons for Consumption
Physiological Benefits
Alcohol plays a role in many social activities, from the business related lunch, to
the parties, and to the special occasions (USDHHS, 2000). Factors that have an influence
on drinking include, but are not limited to, culture, the setting, and people’s expectations
about alcohol’s effects (USDHHS, 2000). However, there is little research on the extent
to which these factors may be associated with drinking behaviors (Shaw, Krause, Liang,
& McGeever, 2011).
Reduced stress, improved mood, increased sociability, and relaxation are the most
commonly reported psychosocial benefits of drinking alcohol (USDHHS, 2000).
23
Drinking alcohol is one way that humans cope with feelings of anxiety, anger, and
sadness when faced with traumatic experiences (Beseler et al., 2011).
Terrorism, a fateful trauma, provides a natural experiment in which factors
affecting subsequent alcohol consumption can be investigated. After the fateful trauma
to the World Trade Center (WTC) on September 11, 2001, there was an increase in
alcohol consumption among Manhattan adults (Adams & Boscarino, 2006). Further,
increases in drinking were still present two years after the WTC attack. Alcohol
consumption after September 11 was significantly higher in those who were within five
miles of the WTC, compared to those further away (Adams & Boscarino, 2006).
Health
Despite considerable research, relationships among gender, alcohol consumption,
and health remain controversial, due to potential confounding by health-related attitudes
and practices associated with drinking (Polen, Green, Perrin, Anderson, & Weisner,
2010).
In a study comparing drinking patterns with gender and health, more frequent
heavy drinkers was associated with worse health-related attitudes and values, worse
feelings about visiting the doctor, and worse health-related practices (Polen et al., 2010).
The most frequent heavy drinkers reported less collaborative relationships with their
doctors, disliked going to the doctors, less confident they could change health practices,
less likely to value the respect of others, and were attached less importance to
religious/spiritual beliefs. However, women, compared to men, were more concerned
24
about their doctor’s disapproval of their health practices, placed less value on an exciting
life, and attached more importance to religious/spiritual beliefs (Polen et al., 2010).
Women were more likely than men to cope with stress by smoking or drinking.
Relationships between health-related practices and alcohol was differed by gender, and
daily or almost daily heavy drinking was associated with significantly lower physical and
mental health for women compared to men (Polen et al., 2010).
The study suggested that drinking status is independently related to physical
health, mental health, and vitality, even after controlling for the health-related attitudes,
values, and practices expected to confound relationships. Among current drinkers,
women who engage in frequent heavy drinking had worse physical and mental health
than males (Polen et al., 2010).
Reason for Health Belief
Socioeconomic Status
In a study by Minugh et al. (1998), women and men both drank more frequently
as education increased, whereas quantity consumed was inversely correlated with
education. Also, men who were employed drank alcohol in greater quantities. Heavier
drinking occurred among never-married, divorced, and separated individuals, and being
divorced or separated as opposed to single, was associated with more frequent drinking
for women, but not for men (Minugh et al., 1998). Older age was associated with
frequent drinking, whereas being younger was found to have greater alcohol intake.
25
Perceived health status, in both sexes, was related to how often and how much
individuals reported drinking (Minugh et al., 1998). The findings showed that more
favorable subjective health perceptions were related to frequent drinking, whereas
negative health perceptions were associated with greater consumption. There was also a
significant association between alcohol intake and the individual belief that alcohol is a
risk factor for oral cancer (Minugh et al., 1998). This indicates that greater knowledge of
the risks of oral cancer was related to more frequent drinking and heavier alcohol
consumption.
Culture
The benefits to those who drink during social occasions are greatly influenced by
culture (USDHHS, 2000). A dominant theme has emerged in analyses of drinking
patterns among members of various ethnic minorities in the influence of stressors related
to social adjustment to the U.S. culture (Caetano, Clark, & Young, 1998). Between
acculturative stress, socioeconomic stress, and minority stress, they are distinct forces
that often require coping strategies. Acculturative stress is typically felt by immigrants
who are faced with the turmoil of leaving their homeland and adapting to a new society
(Caetano et al., 1998). Socioeconomic stress is often experienced by ethnic minorities
who feel disempowered because of inadequate financial resources and limited social class
standing. Minority stress can also be experienced do to the tensions that minorities may
encounter from racism (Caetano et al., 1998).
26
Linking social adjustment stressors to drinking patterns is partially based on the
Durkheim theory of anomic and Leighton’s theory of mental illness and social
disintegration (Caetano et al., 1998). Durkheim’s theory suggests that rapid cultural
change causes a condition called anomic. Anomic is “the absence within a society of
common social norms and controls.” In this condition, one may lack clear behavioral
guidelines, possibly resulting in self-destructive tendencies (i.e. alcohol abuse,
depression). Further, Leighton’s theory suggests that social disintegration and lack of
social unity, often precipitates psychological distress (Caetano et al., 1998). Similar to
Durkheim’s theory, this recommends that rapid social change can cause high stress levels
that result in deviant behaviors.
Specifically, Hispanic cultural norms promote male alcohol consumption and
female abstention (Caetano et al., 1998). One explanation for heavy drinking patterns
among Hispanic men, particularly Mexican-Americans, is related to something called
“exaggerated machismo.” This concept implies that Hispanic men strive to appear strong
and drink large amounts of alcohol. However, comparing machismo in a mixture of
white, black, and Mexican-American men, found that that machismo was related to
alcohol use among men regardless of ethnicity (Caetano et al., 1998).
Drinking patterns among blacks have been thought of as a result from social
disorganization (Caetano et al., 1998). Years ago, heavy drinking was a common
characteristic of blacks’, as research characterized the blacks’ attitudes toward alcohol as
more liberal than those of whites. The mass migration of blacks from the rural South to
27
the Northern areas of the U.S. in the 1900s appears to have resulted in increased alcohol
consumption. Other research has indicated that the attitudes of blacks toward drinking
tend to be more conservative than those of whites (Caetano et al., 1998).
Asian-Americans have been considered a “model minority,” with high rates of
abstention and low rates of heavy alcohol use. Researchers suggest that this may be due
to the flushing of the skin response that many Asians experience with alcohol. Flushing
is associated with reduced drinking for “fast flushers”, of Asians with liberal attitudes on
the Korean culture (Caetano et al., 1998). Cultural values, such as the ancient Confucian
and Taoist philosophies in the Chinese and Japanese, may also have an impact on lower
consumption. The emphasis on conformity and harmony in those philosophies is
believed to promote a moderate drinking style, reinforcing moderate drinking and
sanctions against drunkenness (Caetano et al., 1998). Similarly, traditional Japanese
culture focuses on interdependence, restraint, and group achievement, possibly
contributing to more controlled drinking. Additionally, most drinking in Asian cultures
takes place in prescribed social situations, possibly limiting the likelihood of alcohol
abuse.
The “Firewater Myth” has been associated with Native Americans, suggesting
they have a predisposed heavy alcohol consumption, being unable to control their
drinking when intoxicated (Caetano et al., 1998). This myth dates back to the late 1600s,
when British settlers, French trappers, and other colonial observers in North America
noted the presumed insistence of Native Americans on drinking to the point of
28
intoxication and the resulting alcohol induced debauchery. However, the Firewater Myth
is insufficient to explain drinking among Native Americans, as there is no evidence
existing to demonstrate increased reactivity to alcohol among Native Americans,
compared to other ethnic groups (Caetano et al., 1998). Also, alcohol use varies widely
among the different Native American tribes. For example, the Navajo tend to view social
drinking as acceptable, whereas the Hopi consider drinking irresponsible.
Associated Health Risks
Injuries, Violence, and Addiction
Alcohol consumption has been linked to illness and injury, disruption of family
and social relationships, impact on perceived health, emotional problems, violence
aggression, and legal problems. The risk of these consequences varies widely, depending
on the situation (NIAAA, 2000). Research has found a trend in the increased risk of
adverse effects on society as the average alcohol intake among individuals increases
(USDHHS, 2000).
Alcohol intake and increased risk of injury are associated, specifically including
automobile crashes, falls, and fires. The increased risk of injury is likely due to the
reduced cognitive function, impaired physical coordination and performance, and
increased risk-taking behavior (USDHHS, 2000). Evidence has shown a dose-response
relationship between intake and injury risk, as the more a person drank, the greater the
risk, with no level of drinking to be without risk.
29
Alcohol addiction, or problem drinking, touches drinkers’ families, friends, and
communities (Harvard School of Public Health, 2011). According to the National
Epidemiologic Survey on Alcohol and Related Conditions (NESARC), 8.5% of adults in
the U. S. meet the criteria for an alcohol use disorder, 2% meet the criteria for a drug use
disorder, and 1.1% meets the criteria for both. Research has established that some of the
risk for addiction to both alcohol and drugs is inherited (NIAAA, 2008). Children of
alcoholics are 50-60% more likely to develop alcohol use disorders than people in the
general population (NIAAA, 2008).
Patterns of alcohol consumption also increase the risk of violence and the
likelihood that aggressive behavior will accelerate. As alcohol interacts with personality
characteristics, including impulsiveness and other factors related to a personal tendency
for violence (USDHHS, 2000).
Associated Health Benefits and/or Complications of Alcohol
Alcohol Type and Health
Wine. Studies suggest that there may be different effects on health of different
types of alcohol beverages (Gronbaek, 2001). Currently, most studies appear to show
that moderate alcohol consumption, wine in particular, is associated with a lowered
mortality (Engs, 1996; Saliba & Moran, 2010; Szmitko & Verma, 2005; Bauer, 2008;
Castelnuovo et al., 2002; Gronbaek et al., 1995; USDHHS, 2000; Gronbaek, 2001).
It has been suggested that those who preferred wine were at lower risk of death
from cardiovascular disease (CVD) than beer and spirit drinks. The substances present in
30
wine, but not in beer and spirits, may be responsible for the lower mortality amongst
wine drinkers (Gronbaek, 2001). Wine contains several components of possible
anticarcinogenic effects, some common in fruits and vegetables, known as antioxidants
which may inhibit carcinogenesis (Gronbaek, 2001). It has been suggested that beer and
spirits, but not wine, contain nitrosamines, which are thought to possess carcinogenic
properties (Gronbaek, 2001).
The Copenhagen City Heart Study provided the first support for a more
pronounced cardio protective effect for red wine, compared to other alcohol beverages
(Szmitko & Verma, 2005). The study compared 13,285 men and women for 12 years,
suggesting that those who drank wine had half the risk of dying from CHD or stroke,
opposed to those who never drank wine. Interestingly enough, those who drank beer and
spirits did not experience the health advantage (Szmitko & Verma, 2005).
The benefit of red wine has been supported further by an analysis of 13 studies
involving 209,418 participants (Szmitko & Verma, 2005). A 32% risk reduction of
atherosclerotic disease was found with red wine intake, as opposed to a 22% risk
reduction with beer consumption. This benefit from red wine may be due to its chemical
composition. Red wine provides a significant amount more resveratrol compared to white,
because the longer the skin is kept on the grape during wine making, the greater
concentration of resveratrol (Bauer, 2008). During white wine production, the skin is
removed before fermentation, giving white wines a lower concentration in resveratrol
compared to red.
31
It is generally believed that the French paradox is related to the consumption of
red wine and not white wine or champagne (Dudley et al., 2008). However, recent
evidence supporting that white wine could be as cardio protective as red wine (Dudley et
al., 2008). Initial studies focused on cardio protection with red wines because white wine
contains little to no resveratrol. Red wines are produced from the grapes that include
their skins, which contain resveratrol, whereas white wines are made from grapes without
their skins (Dudley et al., 2008).
Direct evidence supported that grapes without skin could possess cardio
protective properties, and hence the cardio protective abilities could be translated into
white wines (Dudley et al., 2008). Although white wines contain little to no resveratrol,
they have other protective antioxidants such as cinnamics acid, tyrosol, and
hydroxytyrosol. Tyrosol and hydroxytyrosol are phenolic compounds that are also found
in olive oil, which are present in olives either as free or conjugated forms as steroids or
aglycones (Dudley et al., 2008). This suggests that white wines may possess cardio
protective ability comparable to that of red wines if the wines are rich in tyrosol and/or
hydroxytyrosol (Dudley et al., 2008).
A study completed in 2011, (Schufelt et al., 2011) compared red to white wine
consumption with risk of breast cancer in healthy postmenopausal women. Results
showed that red wine was associated with significantly higher free testosterone and lower
sex hormone binding globulin, as well as significantly higher luteinizing hormone level
versus white wine in postmenopausal women (Schufelt et al., 2011). Red versus white
32
wine treatment is associated with changes in serum hormones consistent with an
aromatase inhibitor (AI) in healthy premenopausal women. Outcomes suggest that red
wine may serve as a nutritional AI, as it does not appear to increase breast cancer risk,
while white wine may increase risk as it did not serve as a nutritional AI (Schufelt et al.,
2011).
Another study, comparing red to white wine, found that red wine was more
efficient than white wine in inhibiting cholesterol oxidation (Tian, Wang, Abdallah,
Prinyawiwatkul, & Xu, 2011). However, the two red (Chenin blanc and Sauvignon
blanc) or two white wines (Merlot and Cabernet Sauvignon) compared had similar
antioxidant activities in inhibiting cholesterol oxidation. The difference among inhibiting
cholesterol oxidation showed that red wine had 50 times higher capability in inhibiting
cholesterol oxidation, compared to white wine (Tian et al., 2011). White wines are
generally made from free running juice without grape mash, having no contact with the
grape skin. The lower antioxidant activity of the white wines compared with red wines
could be due to the lower antioxidant activity polyphenolics content (Tian et al., 2011).
In a 12 year study, it was found that risk of dying steadily decreased with an
increasing intake of wine for both men and women for all causes of mortality (Engs,
1996). The relative risk of dying was 1.00 for the subjects who never drank wine,
compared to 0.5 for those who drank three to five glasses a day. This statistic suggests
that drinking three to five glasses of wine a day decreases ones risk of mortality by half,
compared to those who are non drinkers.
33
The french paradox. When looking at the “French paradox”, it has been
suggested that wine may have beneficial health effects (Gronbaek, 2001). The “French
Paradox” supports the idea that the low incidence of coronary atherosclerosis in France,
compared to Western countries, may be due to the red wine consumption, despite the
high intake of saturated fat in the French diet. Additionally, “folk wisdom” through
proverbs, has suggested that “wine builds the blood” and “wine is the milk of the elderly”
(Engs, 1996). Drinking small amounts of wine with meals in Southern Europe may have
developed an antiquity based upon folk observations that moderate drinking is associated
with longevity and health among women and men (Engs, 1996).
Beer and liquor. A meta-analysis of 26 studies on the relationship between wine
or beer consumption and CVD risk as completed in 2002 (Castelnuovo et al., 2002). The
analysis found a 32% reduction of overall vascular risk associated with drinking wine.
Not only were nonfatal vascular end points significantly reduced in wine drinkers, but so
was CVD mortality. Further, beer drinking was also associated with a reduced risk of
vascular events, but at a lower extent than that observed with wine (Castelnuovo et al.,
2002). However, a study in 1995 found that low to moderate consumption of wine was
associated with lower mortality from cardiovascular and CVD and other causes
(Gronbaek et al., 1995). Similar intakes of spirits implied an increased risk, while beer
consumption did not affect mortality. Furthermore, results implied that the increasing
mortality among heavy drinkers may be explained primarily by the effect of drinking
spirits (Gronbaek et al., 1995).
34
Alcohol and Disease Risk
Cardiovascular diseases. CVD accounts for more deaths among Americans than
any other group of diseases. Of all causes of death, CHD is first (USDHHS, 2000).
Alcohol can serve as both a risk factor and a potential protective factor for CVD, and the
cardiovascular system (NIAAA, 2000; USDHHS, 2000; Gronbaek, 2001).
Studies have reported a reduced risk of death from CHD across a wide range of
alcohol consumption levels (NIAAA, 2000). More specifically, studies have found that
low to moderate levels of alcohol intake is most associated a protective effect against
CHD. Mortality from CHD was lower in countries where wine was the predominant type
of alcohol, as opposed to countries where beer or spirits were the beverages mainly
consumed (Gronbaek, 2001). In addition to a decreased risk of CVD, incidence of
ischemic stroke, and lung and upper digestive tract cancer were lower as well, compared
to non-wine drinkers.
However, an association between moderate drinking and lower risk of CHD does
not necessarily mean that alcohol itself is the cause of the lower risk. For example,
higher mortality risk among abstainers may be attributable to mental health,
socioeconomic employment status, overall health, and health habits such as smoking,
rather than the participants’ nonuse of alcohol (Fillmore et al., 1998). Additionally, it is
important to understand that the seeming benefits of moderate drinking on CHD are
offset at higher alcohol intakes by increased risk of death from other types of heart
disease, trauma, cancer, and liver cirrhosis (NIAAA, 2000).
35
The relationship between alcohol consumption and stroke has been studied
comparing risk of ischemic and hemorrhagic strokes. An ischemic stroke is the
predominant type of stroke, resulting from blockage of a blood vessel, whereas
hemorrhagic stroke is due to is due to rupture of a blood vessel (NIAAA, 2000). No
differences have been found in risk patterns for the two strokes, but clear evidence has
been found that heavy drinking is associated with increased stroke risk, especially in
women (NIAAA, 2000).
The Cancer Prevention Study II found that in men, all levels of drinking were
associated with a decreased risk of stroke death. However, in women, the decreased risk
was significantly only among those consuming one drink or less per day (Thun et al.,
1997). The relationship between alcohol intake and blood pressure is important because
hypertension is a major risk factor for stroke as well as for CHD. Studies comparing
lower levels of alcohol use with abstention, findings are mixed. Some studies have found
low alcohol consumption to have no effect on blood pressure or to result in a small
reduction, while in other studies blood pressure increased when alcohol intake increased
(USDHHS, 2000).
Alzheimer’s disease and dementia. Alzheimer’s disease affects nearly 50% of
those older than 85 years. With some treatments to Alzheimer’s disease having reserved
success, preventative measures of the disease are needed (Luchsinger et al., 2003). The
prevalence of dementia is expected to increase significantly with the aging of the
population. Moderate intake of alcohol has been associated with a decreased risk of
36
dementia, mostly in European studies (Luchsinger et al., 2004). There is a scarcity of
data on the relationship between alcohol intake and the incidence of dementia in the
elderly in the U.S.
In a cohort of individuals aged 65 years and older, light to moderate alcohol
consumption was associated with lower risk of dementia and Alzheimer’s disease, while
intake of liquor and beer was not associated with incidence of dementia (Luchsinger et al.,
2004). Data also suggested that light to moderate alcohol consumption was not
associated with a lower risk of dementia or Alzheimer’s disease. Results of the study
summarized that intake of up to three daily servings of wine was associated with a lower
risk of Alzheimer’s disease (Luchsinger et al., 2004).
One reason why alcohol would be expected to decrease the risk of Alzheimer’s
disease would be due to antioxidant mechanisms. Studies have shown that oxidation has
an important role in Alzheimer’s disease, and there is continuing research on the
prevention of Alzheimer’s disease with antioxidant vitamins. Alcohol has antioxidant
effects, and wine has been found to have important antioxidant effects (Luchsinger et al.,
2004).
The Rotterdam Study reported that higher dietary intakes of vitamins C and E
were associated with a lower risk of Alzheimer’s disease (Ruitenberg et al., 2002).
Another study comparing antioxidant vitamin intake and disease risk, found no
association between higher vitamin C and beta carotene intake, and incident dementia
(Luchsinger et al., 2003). It is possible that the conflicting results of the two studies
37
could be due to smaller the Rotterdam Study having a longer follow-up time, possibly
leading to more opportunity to finding an association.
Liver disease. The liver is the most important organ governing essential
biochemical activities in the human body (Baskaran, Periyasamy, & Rajagopalan, 2010).
It has great ability to detoxify and synthesize useful substances, and therefore damage to
the liver has severe consequences (Baskaran et al., 2010). Oxidative stress to the liver
that is ethanol-induced, is known to play a major role n causing liver damage. Oxidative
stress is the imbalance between the prooxidant and antioxidant status, from increased
production of reactive oxygen species or decreased levels of antioxidant defense in
several tissues and organs (Baskaran et al., 2010). Therefore, increased ingestion of
alcohol, mainly through its metabolism, produces injury of the liver.
There is absolutely no question that alcohol abuse contributes to liver-related
morbidity and mortality in the U.S. Excessive alcohol consumption is the main dietrelated risk factor for liver cancer in Western countries (Foster & Marriott, 2006). Ways
that alcohol affects the liver include inflammation and cirrhosis or progressive liver
scarring (NIAAA, 2000). Nearly 900,000 people in the U.S. suffer from cirrhosis, with a
40-90% of cases estimated to have a history of alcohol abuse (USDHHS, 2000).
The risk of liver disease is related to how much a person drinks, as the risk is low
at low levels of consumption, and significantly high with higher levels of consumption.
This relationship was shown in the Cancer Prevention Study II, in middle-aged and
38
elderly adults (Thun et al., 1997). Some evidence also suggests that women are more
susceptible to the negative effects of alcohol on the liver.
It is well established that alcohol intake is a cause of chronic liver disease (Allen
et al., 2009). Findings from the National Cancer Institute in 2009, found that moderate
alcohol intake in women is associated with increased risk of liver cancer (Allen et el.,
2009).
Type 2 diabetes mellitus. The prevalence of type 2 Diabetes Mellitus (DM) is
rising to epidemic proportions (Koppes, Dekker, Hendricks, Bouter, & Heine, 2005).
Between 2000 and 2030, a 37% increase in the worldwide prevalence of diabetes is
predicted. Obesity, related to lifestyle factors have been shown to be greatly responsible
for this problem. Alcohol consumption is a lifestyle factor that has been suggested to be
relevant with respect to the risk of type 2 DM (Koppes et al., 2005).
There is indication that moderate alcohol consumption of one to three drinks per
day is associated with a decreased risk of type 2 DM by 30-40%, when compared with
the lowest consumers (Koppes et al., 2005). However, heavy alcohol consumption
appears to be associated with an increased risk of type 2 DM (Carlsson et al., 2005).
In 2005, the first meta-analysis was conducted on the relationship between
alcohol consumption and the risk of type 2 DM (Koppes et al., 2005). There was about a
30% reduced risk of type 2 DM in alcohol consumers of 6-48 grams per day, compared
with heavier consumers or abstainers (Koppes et al., 2005). The lower type 2 DM risk in
moderate drinkers was consistent over most of the included studies. However, the risk
39
estimates differed more across studies than was expected from the sampling error within
studies (Koppes et al., 2005). It is noteworthy to remember that individuals with DM
should avoid heavy alcohol consumption because of its harmful effects on lipid
metabolism, blood pressure, and other cardiovascular risk factors (Foster & Marriott,
2006).
Cancer. Alcohol has been linked to multiple cancers, including cancers of the
head and neck, digestive tract, and breast (NIAAA, 2000). Alcohol is established as a
cause of cancer of various tissues in the airway and digestive tract, including the mouth,
pharynx, larynx, and esophagus. Research suggests that cancer risk of the upper
digestive tract is associated with both the concentration of alcohol in beverages and
quantity of drinks consumed (USDHHS, 2000). People who use mouthwash are also at
an increased risk of the oral cavity and pharynx cancers. Research suggests that there is a
dramatic increase in cancers of the oral cavity, pharynx, larynx, and esophagus, when
both tobacco and alcohol are being used by an individual (USDHHS, 2000).
Specifically in women, data suggests that low to moderate alcohol consumption is
known to increase the risk for of certain cancers also. However, little is known about the
effect of moderate intakes of alcohol, or of particular types of alcohol, on cancer risk,
except for breast cancer. The 2009 Million Women Study found that each additional
drink regularly consumed per day for women up to the age of 75, increased cancer rates
(Allen et al., 2009). Per 1,000 women in developed countries, there were about 11 for
breast cancer, one for cancers of the oral cavity and pharynx, one for cancer of the rectum,
40
and 0.7 each for cancers of the esophagus, larynx, and liver. This study summarized that
there is a possible excess of about 15 cancers per 1,000 women up to age 75 (Allen et al.,
2009). The amount of alcohol consumed in the female population was associated with a
significantly increased risk of cancers of the oral cavity and pharynx, esophagus, larynx,
rectum, liver, breast, and all cancers combined (Allen et al., 2009).
Head and neck. In a study done by the American Association for Cancer
Research, it was found that alcohol consumption has a role in laryngeal carcinogenesis in
women. However, an association was only found with those females who were heavy
alcohol drinkers (Gallus et al., 2003). It was also found that alcohol consumption is a
much weaker risk factor for laryngeal cancer than cigarette smoking in Italian women.
These outcomes are in line with the findings of studies conducted in men and women in
the U.S., Korea, and Turkey (Gallus et al., 2003). In terms of population attributable risk
for laryngeal cancer in women, tobacco smoking accounted for 78% on incidence,
alcohol consumption for 34%, and the combination of the two factors of tobacco and
alcohol for 82% (Gallus et al., 2003).
Digestive tract and pancreas. Incidence rates for adenocarcinomas of the
esophagus and gastric cardia have risen steeply in the U.S. and Europe over past decades
(Gammon et al., 1997). An increased risk of gastric cancer with alcohol drinkers has
been identified in some studies, but not in the majority of cohort studies. There are
reasonable mechanisms in which alcohol may play a role in gastric cancer, specifically in
the gastric cardia, the uppermost part of the stomach joining the esophagus (USDHHS,
41
2000). The connection between alcohol use and gastric inflammation is clear, but
progression to neoplasia is less understood and likely involves other factors in addition to
alcohol (Single, Ashley, Bondy, Rankin, & Rehm, 2000).
In a study including 261 cases of adenocarcinoma of the gastric cardia, found no
association with total alcohol intake, or for beer, wine, or spirits separately, after
controlling for smoking (Gammon et al., 1997). The interaction between alcohol intake
and smoking and the development of gastric cancers is not well understood, and the
likelihood of a correlated interaction of these risk factors cannot be dismissed (Single et
al., 2000).
Alcohol is a cause of chronic inflammation of the pancreas. A link between
alcohol intake and pancreatic cancer is conceivable, but is not proven (USDHHS, 2000).
Cancer of the pancreas is the 10th most common incident cancer among women in the
U.S. Prognosis with this disease is poor, with a one year survival rate of less than 20%,
making it the fourth leading cause of cancer death in women (Harnack, Anderson,
Folsom, Sellers, & Kushi, 1997). A number of studies have been done to determine
whether coffee, tea, and/or alcohol consumption increase the risk of pancreatic cancer,
but results are inconsistent. A study by the American Association for Cancer Research
found no evidence to support a relationship between alcohol or coffee consumption and
risk of pancreatic cancer (Harnack et al., 1997). In a particular cancer study done in Iowa
women, associations were found of both alcoholic beverage and coffee consumption with
pancreatic cancer incidence, independent of age and cigarette smoking. The relationship
42
of alcoholic beverages with pancreatic cancer incidence persisted among nonsmokers
(Harnack et al., 1997). The Iowa study found no clear mechanism to explain their finding
that alcohol consumption increases risk of pancreatic cancer.
However, it was found that alcohol consumption, together with a high-fat diet, is
believed to be a risk factor for chronic calcifying pancreatitis, which is associated with an
increased risk of pancreatic cancer (Lowenfels et al., 1993). Pancreatitis risk is increased
by about 3% in people with heavier drinking patterns, and alcohol abuse is the leading
cause of chronic pancreatitis, accounting for 70% of cases (Heuberger, 2009). The role
of low-dose alcohol intake in pancreatitis is unclear, but there is some research to support
that light-to-modest ethanol consumption accelerates the disease process, increasing
severity (Heuberger, 2009).
Breast. Women who drink about one alcoholic beverage daily have a 10-30%
higher risk of incident breast cancer than nondrinkers (Longnecker, 1994). Alcohol
consumption is associated with a linear increase in breast cancer incidence in women
over the range of consumption reported by most women. Among women who consume
alcohol regularly, reducing alcohol consumption is a potential means to reduce breast
cancer risk (Smith-Warner et al., 1998). However, the relationship between alcohol
intake and breast cancer risk is still controversial, even though over 50 epidemiologic
studies have examined the association (Longnecker, 1994).
A study completed in 2009, with few women who regularly drink more than three
alcoholic drinks per day, showed a significant increase risk of breast cancer, along with
43
other cancers including esophagus, larynx, oral cavity and pharynx, rectum, and liver
(Allen et al., 2009). The association of alcohol with breast cancer risk was similar among
women who drank wine exclusively and other drinkers, consistent with findings from a
meta-analysis of six cohort studies. Also, the findings indicated that breast cancer risk is
similar in women who drink white wine, red wine, or a mixture of both (Allen et al.,
2009).
Further, a study by the American Medical Association, in 1998, compared breast
cancer risk with beverage-specific alcohol intake. The study found a positive association
in alcohol consumption and the risk of invasive breast cancer in women (Smith-Warner et
al., 1998). Women who consumed 60 grams per day or more of alcohol had a 31%
higher risk of invasive breast cancer. When comparing alcohol types to risk, 2.8-5.6
glasses of wine, 2.3-4.5 bottles of beer, or 2.0-4.0 shots of liquor, continuous estimates of
alcohol intake from wine, beer, and liquor were each positively associated with breast
cancer risk in the multivariate analyses (Smith-Warner, 1998).
It has been suggested that increased breast cancer, associated with alcohol
consumption, may be reduced with adequate folate intake (Feigelson et al., 2003). Data
has also recommended that adequate folate levels may ease the risk of breast cancer
associated with alcohol consumption. The mechanism behind folate and breast cancer
emphasizes the interference of folate absorption, transport, metabolism, and influence of
tissue folate stores with alcohol intake (Feigelson et al., 2003). In a study conducted by
the American Association for Cancer Research, a positive association was found between
44
alcohol consumption and breast cancer. However, a relationship between folate and
alcohol consumption could not be identified (Feigelson et al., 2003).
Chapter III
METHODOLOGY
Purpose
The purpose of this research is to determine whether education level plays a role
in the way that KSU female faculty and staff perceive the effects of red wine
consumption on health. Secondly, to measure if the sample perceived health benefits or
risks of other types of alcohol.
Variables
This was a quantitative study, using convenience sampling. The independent
variables are faculty and staff, and the dependent variable is health belief.
Participants
Participants included KSU female faculty and staff members. Potential
participants were contacted through e-mail, which were obtained from the Human
Resources (HR) department at KSU. According to HR, there are 1,786 female faculty
and staff members. The e-mail with the survey link was offered to all female faculty and
staff, who are at least 21 years of age. The consent form stated that if they are not 21
years of age or older, they cannot proceed with the survey.
Survey Design
The survey was developed with the help of two surveys used in previous studies
(Saliba & Moran, 2010; Wright et al., 2008). Demographic questions were helped to be
established from Saliba & Moran’s study, while questions asking of health belief and
45
46
reasons for consumption were referenced from Wright et al., from a study of the health
aspects of alcoholic beverages.
When the participants received the e-mail with the survey link, there was a short
introduction introducing them to the research. Once they clicked on the link, the consent
form appeared first, further explaining the study, and asked for their consent prior to
beginning the survey. Once consent was given, the survey began, starting with question
one. Demographic questions were asked first, followed by questions about their belief of
the health effects of wine, and reasons for consumption.
Part One
The survey began with six demographic questions, asking their education level,
ethnicity, income level, age, whether or not they are a faculty or staff member, and
whether they are a full-time or part-time employee at KSU. Obtaining whether the
participant was a faculty or staff member was one of the most important demographic
questions, as this was the primary variable used to compare health belief of wine.
Part Two
Questions 7-34 asked if they agreed or disagreed with questions regarding the
health benefit of both red and white wine. There were additional questions asking on
their level of agreement of the health benefit of beer and liquor. Questions were also
asked on whether or not red and/or white wine can increase or decrease certain disease
risks. To verify their level of agreement, a five point Likert scale, including an "I don't
know" option, was used.
47
Part Three
Questions 35-40 also used the five point Likert scale, asking about their reasons
for consumption of wine. Questions 41-47 asked participants to answer with either a
“yes” or “no,” asking further questions about reasons for consumption.
Procedures
Electronic surveys, developed using Survey Monkey, were used to send the
survey link and collect responses from KSU female faculty and staff members. E-mails
were sent to 1,786 female faculty and staff members, two times. The first e-mail was
sent on Monday, January 16th, and the second reminder e-mail was sent on Tuesday,
January 24th, asking for participation from those who had not completed the survey.
There were seven batches of sent mail that included about 200 e-mail addresses each,
when e-mails were sent out. The first time e-mails were sent, potential participants could
see who received the e-mail; however, the second round of e-mails were sent as a blind
cc, so that recipients of the e-mail could not be identified.
Participants were fully informed about the study and told that the research study is
being conducted on level of education and health belief of wine consumption.
Participants were told electronically, before completing the survey, that they must be a
female faculty or staff member at KSU, and at least 21 years of age, to participate.
Participants gave their electronic, informed consent before beginning the survey (when
they clicked the link to begin the survey).
48
An incentive of ten, $10.00 grocery store gift cards were given to participants.
When the initial e-mail was sent, the first five participants to complete the survey, and
provided their e-mail address, were given a gift card. When the second reminder e-mail
was sent to participants, an additional five gift cards were given to the first five
participants who submitted the survey, and who provided their e-mail address, at that
time. Participants were not identifiable with their questionnaire results, as all surveys
were anonymous.
The data were compiled and analyzed using social sciences (SPSS) software
(version 18.0.3). Differences between health belief of wine consumption and
demographic variables between faculty and staff were compared using independent t-tests.
Frequencies were also calculated for demographics and drinking characteristics. The sum
scores for the health beliefs in red wine consumption were also analyzed. Comparison of
belief of both red and white wine between faculty and staff members were also evaluated
using frequencies and percent scores calculated from the survey. Significant differences
that were found have been established and reported, as analyses were considered
statistically significant at p ≤ 0.05.
CHAPTER IV
JOURNAL ARTICLE
Introduction
Wine has been produced since before recorded history in Asia Minor and the
Mediterranean basin (Wright et al., 2008). In the United States, prior to regulations
restricting the use of health claims, beer was described as a tonic, health boosting
beverage (Wright et al., 2008). Currently, most studies show that moderate alcohol
consumption, particularly wine, is associated with a lowered mortality (Engs, 1996;
Saliba & Moran, 2010; Szmitko & Verma, 2005; Bauer, 2008; Castelnuovo et al., 2002;
Gronbaek et al., 1995; USDHHS, 2000; Gronbaek, 2001).
The Dietary Guidelines for Americans, published by the United States
Department of Agriculture (USDA), includes reliable information on what we should eat
to be healthy (USDA, 1997). The guidelines are developed with advice from leading
nutrition experts, stating “If you do drink alcohol, do so in moderation” (USDA, 1997).
Epidemiologic evidence has shown that those who drink high quantities of alcohol are at
an increased risk for health problems (NIH, 2000; USDHHS, 2000; USDA, 1997; USDA,
2010). Other studies have suggested that individuals who abstain from using alcohol may
be at greater risk for a variety of conditions, than those who consume small to moderate
amounts of alcohol (NIH, 2000; Shaper, 1990). Moderate alcohol consumers tend to
have better health and live longer than heavy consumers and abstainers (NIH, 2000;
Gronbaek, 2001).
49
50
Some studies suggest that red wine confers additional health benefits, opposed to
other types of alcohol (Szmitko & Verma, 2005; Saliba & Moran, 2010; Castelnuovo et
al., 2002, Gronbaek et al., 1995). Regular consumption of red wine has been suggested
as the explanation for the “French Paradox.” The “French Paradox” supports the idea
that the low incidence of coronary atherosclerosis in France, compared to Western
countries, may be due to the red wine consumption, despite the high intake of saturated
fat in the French diet (Engs, 1996). This benefit from red wine may be due to its
chemical composition of polyphenolic compounds, such as flavonoids and resveratrol
(Szmitko & Verma, 2005). Red wine provides a significant amount more resveratrol
compared to white, because the longer the skin is kept on the grape, the greater amount of
resveratrol (Bauer, 2008).
The Copenhagen City Heart Study provided the first support for a more
pronounced cardioprotective effect for red wine, compared to other alcohol beverages
(Szmitko & Verma, 2005). Those who drank wine had half the risk of dying from CHD
or stroke, opposed to those who never drank wine. Those who drank beer and spirits did
not experience the same health advantage (Szmitko & Verma, 2005).
Some studies have suggested that alcohol intake can reduce risk of dementia and
Alzheimer’s disease (Luchsinger et al., 2004; Ruitenberg et al., 2002). Moderate alcohol
intake has been associated with a decreased risk of dementia, mostly in European studies
(Luchsinger et al., 2004). However, some research on alcohol consumption and breast
cancer supports an increased risk of disease. One study, comparing breast cancer risk
51
with beverage-specific alcohol intake, found a positive association in alcohol
consumption and the risk of invasive breast cancer in women (Smith-Warner et al., 1998).
Some research shows how demographic characteristics can impact health belief
and consumption of alcohol. In a study by Minugh et al. (1998), demographic
characteristics constituted the primary source for variation of quantity alcohol consumed.
The relationship between demographic variables and alcohol consumption was the same
for quantity and frequency, with the exception of education. Women and men both drank
more frequently as education increased, whereas quantity consumed was inversely
correlated with education. Perceived health status, in both sexes, was related to how
often and how much individuals reported drinking (Minugh et al., 1998). More favorable
health perceptions were related to frequent drinking, whereas negative health perceptions
were associated with greater alcohol consumption (Minugh et al., 1998). The purpose of
the present investigation is to determine whether education level plays a role in the way
that KSU female faculty and staff perceive the effects of red wine consumption on health.
Secondly, to measure if the sample perceived health benefits or risks of other types of
alcohol. The research hypothesis was KSU female faculty will perceive moderate red
wine consumption as a benefit to health and staff will not perceive moderate red wine
consumption as a benefit to health.
52
Methodology
Sample
Five hundred and three KSU female faculty and staff participated in the study, but
only 493 participants were included because 10 participants did not answer at least 50%
of the questionnaire and were not included in the study. Subjects qualified for the study
if they were a female faculty or staff member at KSU, and if they were 21 years of age or
older. The subjects for this study were recruited through the Human Resources
department at KSU, in order to obtain their e-mail addresses and send the questionnaire.
Measures
Perception of the health aspects of wine questionnaire. The study sample
completed an online questionnaire, consisting of 41 questions asking their belief and
reasons for consumption of red wine and other alcohol types. There were also six
demographic questions asking about education level, income, age, ethnicity, and position
at KSU. This questionnaire was developed with the help of two surveys used in previous
studies (Saliba & Moran, 2010; Wright et al., 2008).
Procedure
Electronic surveys, developed using Survey Monkey, were used to send the
survey link and collect responses from KSU female faculty and staff members. E-mails
were sent to 1,786 female faculty and staff members, two times. The first e-mail was
sent on Monday, January 16th, and the second reminder e-mail was sent on Tuesday,
January 24th, asking for participation from those who had not completed the survey.
53
There were seven batches of sent mail that included about 200 e-mail addresses each,
when e-mails were sent out. The first time e-mails were sent, potential participants could
see who received the e-mail; however, the second round of e-mails were sent as a blind
cc, so that recipients of the e-mail could not be identified.
Participants were fully informed about the study and told that the research study is
being conducted on level of education and health belief of wine consumption.
Participants were told electronically, before completing the survey, that they must be a
female faculty or staff member at KSU, and at least 21 years of age, to participate.
Participants gave their electronic, informed consent before beginning the survey (when
they clicked the link to begin the survey).
An incentive of ten, $10.00 grocery store gift cards were given to participants.
When the initial e-mail was sent, the first five participants to complete the survey, and
provided their e-mail address, were given a gift card. When the second reminder e-mail
was sent to participants, an additional five gift cards were given to the first five
participants who submitted the survey, and who provided their e-mail address, at that
time. Participants were not identifiable with their questionnaire results, as all surveys
were anonymous.
Statistical Analysis
The data were compiled and analyzed using social sciences (SPSS) software
(version 18.0.3). Differences between health belief of red wine consumption and
demographic variables between faculty and staff were compared using independent t-tests.
54
Frequencies were also calculated for demographics and drinking characteristics. The sum
scores for the health beliefs in red wine consumption were also analyzed. Comparison of
belief of both red and white wine between faculty and staff members were also evaluated
using frequencies and percent scores calculated from the survey. Significant differences
that were found have been established and reported, as analyses were considered
statistically significant at p ≤ 0.05.
Results
The purpose of this study was to measure if education level played a role in the
way that KSU female faculty and staff perceived the health effects of red wine
consumption. Secondly, to measure if the sample perceived health benefits or risks of
other types of alcohol. The study sample completed an online questionnaire, consisting
of 41 questions asking their belief and reasons for consumption of red wine and other
alcohol types. There were also six demographic questions asking about education level,
income, age, ethnicity, and position at KSU. Five hundred and three KSU faculty and
staff participated in the study, but only 493 participants were included because 10
participants did not answer at least 50% of the questionnaire and were excluded from the
study. The surveys response rate was 28.16% for those who participated in the study at
KSU.
The majority of participants were white (89%), as opposed to other ethnicities,
and a masters degree (34.5%) was the most common education level (Table 3).
Participants were mostly middle class, as 35.1% made $30,000-$50,000 a year. The
55
majority of the participants were staff members, with 65.3% being staff and 34.3% being
faculty members. Furthermore, 93.7% of participants were full-time. The mean age of
participants was 46.50 ± 11.27 years, with a range of 22 to 76 years.
Table 3. Demographic Data of Kent State University Female Faculty and Staff (N=493)
Demographic
N
%
High School
Certificate/Diploma
Bachelor Degree
Masters Degree
Doctoral
Other
57
24
93
170
128
21
11.6
4.9
18.9
34.5
26.0
4.3
White
American Indian
Alaska Native
Asian
Black/African American
Native Hawaiian and Other
Pacific
439
2
0
7
39
2
89.0
0.4
0.0
1.4
7.9
0.4
<$30,000
$30,000 - $50,000
$50,001 - $75,000
$75,001 - $100,000
$100,001 - $200,000
$>$200,000
76
173
145
58
36
1
15.4
35.1
29.4
11.8
7.3
0.2
Faculty
Staff
169
322
34.3
65.3
Full-Time
Part-Time
462
26
93.7
5.3
Education
Ethnicity
Income level
Position at KSU
Employment Status
56
Table 4 describes the alcohol drinking characteristics between KSU female
faculty and staff participants. Results showed that majority of the participants drink
alcohol (85.8% faculty, 88.2% staff). Further, it was reported that the most popular
alcoholic beverage consumed was wine, as 76.9% of faculty and 75.5% of staff drank red
wine, and 79.3% of faculty and 76.4% of staff drank white wine. Limiting the amount of
wine consumption due to religious or cultural beliefs was not found to be a characteristic
of participants. When looking at beer and liquor consumption, roughly half of both
faculty and staff reported drinking both beer and liquor.
Table 5 describes alcohol health beliefs between female faculty and staff
members. The faculty and staff members’ responses were analyzed by using an
independent t-test, with equal variances not assumed. Significant differences (p ≤ 0.05)
were demonstrated between faculty and staff on the possible health benefits of beer and
liquor, and harmful health consequences of red and white wine consumption. The other
questions about health belief of alcohol consumption demonstrated no significant
difference in faculty and staff on the level of agreement. Both faculty and staff believed
there may be benefits to red wine consumption, showing no significant difference
between the two groups.
57
Table 4. Drinking Characteristics of Kent State University Female Faculty and Staff (N=
493)
Characteristics
Position
Agreement
N
%
Due to my cultural beliefs, I limit the amount of wine
I consume.
Faculty
Yes
No
24
145
14.2
85.8
Staff
Yes
No
36
284
11.2
88.2
Faculty
Yes
No
12
156
7.1
92.3
Staff
Yes
No
35
443
10.9
89.9
Faculty
Yes
No
23
145
13.6
85.8
Staff
Yes
No
35
284
10.9
88.2
Faculty
Yes
No
130
39
76.9
23.1
Staff
Yes
No
243
78
75.5
24.2
Faculty
Yes
No
134
35
79.3
20.7
Staff
Yes
No
246
75
76.4
23.3
Faculty
Yes
No
82
84
48.5
49.7
Staff
Yes
No
165
156
51.2
48.4
Faculty
Yes
No
95
70
56.2
41.4
Staff
Yes
No
187
202
58.1
41.0
Due to my religious beliefs, I limit the amount of
wine I consume.
I do not drink alcoholic beverages.
I drink red wine.
I drink white wine.
I drink beer.
I drink liquor.
58
Table 5. Comparison of Health Beliefs of Alcohol Between Faculty and Staff1 (N=493)
Position
Mean
Std.
Deviation
There are possible health
benefits with red wine
consumption.
Faculty
4.35
0.789
Staff
4.40
0.807
There are possible health
benefits with white wine
consumption.
Faculty
3.53
1.35
Staff
3.67
1.23
There are possible health
benefits with beer
consumption.
Faculty
3.14
1.58
Staff
2.81
1.47
There are possible benefits
with liquor consumption.
Faculty
2.81
1.53
Staff
2.37
1.39
Red wine may have
harmful effects to your
health.
Faculty
3.53
1.25
Staff
3.20
1.38
White wine may have
harmful effects to your
health.
Faculty
3.63
1.24
Staff
3.40
1.33
Beer may have harmful
effects to your health.
Faculty
3.94
1.18
Staff
3.80
1.16
Faculty
4.11
1.14
Staff
3.94
1.21
Liquor may have harmful
effects to your health.
1
Significance
0.520
0.269
0.022*
0.002*
0.009*
0.049*
0.223
0.130
Means were calculated from the following Likert Scale: 1=Strongly Disagree;
2=Disagree; 3=Neutral; 4=Agree; 5=Strongly Agree; 6=I Don’t Know
*Values were considered significant at p ≤ 0.05.
59
When comparing the level of agreement of the health outcomes of both red and
white wine, most participants were unsure about the possible health outcomes, regarding
increased or decreased risk of diseases. Table 6 represents the difference in level of
agreement with the role of red wine on health outcome between faculty and staff. No
difference was found when comparing health outcome belief of red wine. Both faculty
and staff supported that risk of developing coronary heart disease can decrease with red
wine consumption (51.5% faculty, 54.0% staff). They also agreed that risk developing
liver disease can increase with red wine consumption (33.1% faculty, 25.8% staff), and
disagreed that liver disease can decrease with red wine consumption (37.3% faculty,
26.7% staff). Participants also displayed that they did not know the role that red wine
plays in the risk of developing dementia and Alzheimer’s disease, type 2 diabetes, and
cancer.
Table 7 represents the difference in level of agreement with the role of white wine
on health outcome between faculty and staff. A difference was found in the role white
wine can impact liver disease. Faculty (39.6%) strongly disagreed that white wine can
decrease risk of liver disease, while staff (30.4%) did not know the impact. When asked
if liver disease risk increases with white wine consumption, 27.8% of faculty agreed, and
27.8% faculty did not know, while majority of the staff (28.0%) staff did not know
(24.8% staff agreed). Participants also displayed that they do not know the role that
white wine plays in the risk of developing coronary heart disease, dementia and
Alzheimer’s disease, type 2 diabetes mellitus, and cancer.
60
Table 6. Level of Agreement with the Role of Red Wine on Health Outcome Between
Faculty and Staff (N=493)
n,
%
Risk of developing
Coronary Heart
Disease can
decrease with red
wine consumption.
Faculty
Staff
Risk of developing
dementia and
Alzheimer’s
Disease can
decrease with red
wine consumption.
Risk of developing
Type 2 Diabetes
Mellitus can
decrease with red
wine consumption.
Faculty
Staff
Faculty
Staff
Risk of developing
cancer can decrease
with red wine
consumption.
Faculty
Staff
Strongly
Disagree
Disagre
e
Neutral
Agree
Strongly
Agree
I
Don’t
Know
n
1
7
22
87
38
14
%
0.6
4.1
13.0
51.5
22.5
8.3
n
6
16
23
174
73
29
%
1.9
5.0
7.1
54.0
22.7
9.0
n
4
19
45
32
12
57
%
2.4
11.2
26.6
18.9
7.1
33.7
n
10
30
86
62
19
114
%
3.1
9.3
26.7
19.3
5.9
35.4
n
11
45
38
10
5
59
%
6.5
26.6
22.5
5.9
3.0
34.9
n
17
48
82
38
9
127
%
5.3
14.9
25.5
11.8
2.8
39.4
n
13
31
37
31
7
49
%
7.7
18.3
21.9
18.3
4.1
29.0
n
15
39
83
68
18
97
%
4.7
12.1
25.8
21.1
5.6
30.1
61
n,
%
Risk of developing
liver disease
decrease with red
wine consumption.
Faculty
Staff
Risk of developing
Coronary Heart
Disease can
increase with red
wine consumption.
Faculty
Staff
Risk of developing
dementia and
Alzheimer’s
Disease can
increase with red
wine consumption.
Risk of developing
Type 2 Diabetes
Mellitus can
increase with red
wine consumption.
Faculty
Staff
Faculty
Staff
Strongly
Disagree
Disagree
Neutral
Agree
Strongly
Agree
I
Don’t
Kno
w
n
32
63
25
7
1
38
%
18.9
37.3
14.8
4.1
0.6
22.5
n
47
86
71
21
8
85
%
14.6
26.7
22.0
6.5
2.5
26.4
n
20
73
29
13
7
26
%
11.8
43.2
17.2
7.7
4.1
15.4
n
40
139
48
24
11
56
%
12.4
43.2
14.9
7.5
3.4
17.4
n
13
51
40
5
5
54
%
7.7
30.2
23.7
3.0
3.0
32.0
n
34
82
76
16
6
106
%
10.6
25.5
23.6
5.0
1.9
32.9
n
8
31
37
23
13
57
%
4.7
18.3
21.9
13.6
7.7
33.7
n
17
66
78
34
12
110
%
5.3
20.5
24.2
10.6
3.7
34.2
62
Strongly
Disagree
Disagree
Neutral
Agree
Strongly
Agree
I
Don’t
Know
n
9
46
34
14
13
50
%
5.3
27.2
20.1
8.3
7.7
29.6
n
30
83
82
24
7
91
%
9.3
25.8
25.5
7.5
2.2
28.3
n
4
16
22
56
31
38
%
2.4
9.5
13.0
33.1
18.3
22.5
n
11
42
74
83
46
64
%
3.4
13.0
23.0
25.8
14.3
19.9
n,
%
Risk of developing
cancer can increase
with red wine
consumption.
Faculty
Staff
Risk of developing
liver disease can
increase with red
wine consumption.
Faculty
Staff
63
Table 7. Level of Agreement with the Role of White Wine on Health Outcome Between
Faculty and Staff (N=493)
n,
%
Risk of developing
Coronary Heart Disease
can decrease with white
wine consumption.
Faculty
Staff
Risk of developing
dementia and
Alzheimer’s Disease
can decrease with white
wine consumption.
Faculty
Staff
Risk of developing
Type 2 Diabetes
Mellitus can decrease
with white wine
consumption.
Faculty
Staff
Risk of developing
cancer can decrease
with white wine
consumption.
Faculty
Staff
Strongly
Disagree
Disagree
Neutral
Agree
Strongly
Agree
I
Don’t
Know
n
9
30
41
23
7
59
%
5.3
17.8
24.3
13.6
4.1
34.9
n
14
59
93
44
5
106
%
4.3
18.3
28.9
13.7
1.6
32.9
n
10
30
42
12
5
70
%
5.9
17.8
24.9
7.1
3.0
41.4
n
17
54
91
20
2
137
%
5.3
16.8
28.3
6.2
0.6
42.5
n
11
48
37
5
3
65
%
6.5
28.4
21.9
3.0
1.8
38.5
n
24
66
78
21
2
130
%
7.5
20.5
24.2
6.5
0.6
40.4
n
13
43
41
9
4
58
%
7.7
25.4
24.3
5.3
2.4
34.3
n
19
67
81
24
2
123
%
5.9
20.8
25.2
7.5
0.6
38.2
64
n,
%
Risk of developing liver
disease can decrease
with white wine
consumption.
Faculty
Staff
Risk of developing
Coronary Heart Disease
can increase with white
wine consumption.
Faculty
Staff
Risk of developing
dementia and
Alzheimer’s Disease
can increase with white
wine consumption.
Faculty
Staff
Risk of developing
Type 2 Diabetes
Mellitus can increase
with white wine
consumption.
Faculty
Staff
Strongly
Disagree
Disagree
Neutral
Agree
Strongly
Agree
I
Don’t
Know
n
25
67
24
1
2
50
%
14.8
39.6
14.2
0.6
1.2
29.6
n
41
90
66
23
3
98
%
12.7
28.0
20.5
7.1
0.9
30.4
n
7
42
41
14
8
57
%
4.1
24.9
24.3
8.3
4.7
33.7
n
20
80
82
20
5
113
%
6.2
24.8
25.5
6.2
1.6
35.1
n
8
37
45
5
4
70
%
4.7
21.9
26.6
3.0
2.4
41.4
n
19
54
88
22
4
133
%
5.9
16.8
27.3
6.8
1.2
41.3
n
6
21
34
33
12
60
%
3.6
12.4
20.1
19.5
7.1
35.5
n
14
46
81
45
9
125
%
4.3
14.3
25.2
14.0
2.8
38.8
65
n,
%
Risk of developing
cancer can increase with
white wine
consumption.
Faculty
Staff
Risk of developing liver
disease can increase
with white wine
consumption.
Faculty
Staff
Strongly
Disagree
Disagree
Neutral
Agree
Strongly
Agree
I
Don’t
Know
n
8
31
42
14
9
63
%
4.7
18.3
24.9
8.3
5.3
37.3
n
15
58
87
25
6
125
%
4.7
18.0
27.0
7.8
1.9
38.8
n
3
13
25
47
31
47
%
1.8
7.7
14.8
27.8
18.3
27.8
n
12
30
64
80
40
90
%
3.7
9.3
19.9
24.8
12.4
28.0
66
Discussion
The purpose of this study was to measure if education level played a role in the
way that KSU female faculty and staff perceived the effects of red wine consumption on
health, along with other types of alcohol. The study results indicated no significant
difference in education level and perception of the possible health benefits of red wine
consumption, therefore; the research hypothesis was rejected. However, significant
differences were found between faculty and staff members on the possible health benefits
with beer and liquor consumption, and that red and white wine may have harmful effects
to health.
The data demonstrated that majority of the participants indicated that they were
drinkers, as most responded no to the question “I do not drink alcoholic beverages.”
Participants were predominantly wine drinkers, as opposed to beer or liquor drinkers.
With majority of the participants being current drinkers in the present investigation, this
behavior could have impacted their responses by denying any health risk there could be
to drinking alcohol. Past research by Hansen, Raynor, & Wolkenstein (1990), suggested
that individuals who drink more tend to deny the potential harm that may result from
alcohol consumption. In the present investigation, this is not a problem if participants are
consuming the USDA guidelines for alcohol, but if they are exceeding guidelines, this is
a problem which requires more education on the health effects of alcohol. The USDA
guidelines are defined by moderate drinking since alcohol carries the risk of dependency
and excess consumption, which can lead to serious health problems. The guidelines
67
recommend that those who do drink alcoholic beverages do so in moderation and those
who do not consume alcohol, do not begin drinking (USDA, 1997).
The results showing no significant difference in education level and the
perception of the possible health benefits of red wine is conflicting with other research.
Past research has found that education level and income have a significant impact, and
are related to the variance in health knowledge (Beier & Ackerman, 2003; Mortensen,
Jensen, Sanders, & Reinisch, 2002; Saliba & Carmen, 2010; Palsdottir, 2008). Previous
research has found that wine drinking was significantly associated with higher
socioeconomic status (Mortensen et al., 2002), and that individuals with more education
are more likely to seek health information than those with lower education (Palsdottir,
2008; Bier & Ackerman, 2003).
In the present investigation, perhaps the reason there was not a difference in
education level and knowledge, could be that support staff at a university may be more
educated, opposed to support staff in other work environments. This higher level of
knowledge in university support staff may be due to knowledge sharing. According to
Lauring & Selmer (2011), knowledge sharing is the provision of information, know-how,
and feedback in the context. The process of knowledge sharing engagement requires that
work individuals engage in close interactions, allowing observing and learning from each
other. This idea of knowledge sharing was found in a previous study comparing social
climates at universities (Lauring & Selmer, 2011).
68
Futhermore, research on the health benefits of red wine is more accepted as a
society, and more readily available to the public. For example, sales of red wine
increased after there was positive media coverage reporting on two studies in November,
2006 supporting the health benefits issued from the Harvard Medical School and the
National Institute on Aging (Fielding, 2007).
Overall, most faculty and staff agreed that risk of developing CHD can decrease
with red wine consumption (51.5% faculty, 54.0% staff). Participants were also in
disagreement with the statement that risk of developing CHD can increase with red wine
consumption. Reasons for the agreement of the decreased risk of CHD and red wine may
be due to the abundance of research connecting decreased CHD with red wine (Gronbaek,
2001; Szmitko & Verma, 2005; Dudley et al., 2008; Bauer, 2008). The Copenhagen City
Heart Study (Szmitko & Verma, 2005) suggested that those who drank wine had half the
risk of dying from CHD or stroke, opposed to those who never drank wine.
The significant differences that were found between faculty and staff on the
possible health benefits with beer consumption, supports past research linking higher
education to greater health knowledge (Beier & Ackerman, 2003; Mortensen et al., 2002;
Saliba & Carmen, 2010; Palsdottir, 2008). As faculty were found to be neutral, with the
health benefits of beer consumption, and staff was in disagreement. A study by
Castelnuovo et al. (2002) found that beer drinking was associated with a reduced risk of
vascular events, but at a lower extent than that observed with wine. The difference in
response from the present investigation could be due to information regarding the
69
possible health benefits of beer is harder to find, as there is less research and media
supporting the information.
Faculty perceived red and white wine to have harmful effects significantly more
than staff. This is in agreement with research supporting greater health knowledge with
higher education (Beier & Ackerman, 2003; Mortensen et al., 2002; Saliba & Carmen,
2010; Palsdottir, 2008) The consumption requirements to achieve health benefits of red
wine is defined as 1-2 drinks per day, as one drink counts as five ounces of wine
(Szmitko & Verma, 2005). However, the USDA guidelines conclude that if moderate
consumption of 1-2 drinks per day, of any alcohol type, is exceeded, harmful health
effects can occur (USDA, 1997). Though there was a mathematical significance found
between faculty and staff with the harmful effects of wine, and benefits of beer, the mean
differences between groups were minute and there may not be a practical difference
between groups.
Neither faculty nor staff perceived that liquor had health benefits, but faculty
significantly perceived the lack of health benefits to be greater than staff. The present
investigation may have found this because those who consume liquor (56.2% faculty,
58.1% staff), may justify their habit by believing that liquor may not have negative health
outcomes. As stated previously, research by Hansen et al. (1999), those who drink more
tend to deny any potential harm that may result from alcohol consumption. Gronbaek et
al. (1995) found that moderate consumption of spirits did not show a benefit and was
associated with increased mortality from cardiovascular and CVD. The responses from
70
health belief of liquor prove that both faculty and staff understand the negative health
consequences that can occur from liquor consumption.
Majority of participants proved that they were unsure about the possible health
outcomes with wine consumption, as most responses included “I don’t know,” when
asked if consumption increased or decreased disease risk. However, even though
participants were unsure of the health effects of wine, responses showed they were
mostly drinkers, with wine being most popular. This suggests that drinkers are
consuming wine because of other reasons besides health (USDHHS, 2000). Previous
research suggests that the most common reasons for people to consume alcohol are to
reduce stress, improve mood, increase sociability, and to relax (USDHHS, 2000).
Few responses did however show that they were aware of the harmful effects of
alcohol consumption with some disease states. For example, most agreed that risk of
developing liver disease can increase with red wine consumption (33.1% faculty, 25.8%
staff). The responses agreeing with an increased risk of liver disease with red wine
consumption is supported by past research that there is no question that alcohol abuse
contributes to liver-related morbidity and mortality in the U.S. (Foster & Marriott, 2006).
However, it was not surprising to find that participants did not know the possible
benefits of red wine consumption in respect to dementia, Alzheimer’s disease, and type 2
DM. Reasons for this disconnect is likely due to there not being a lot of research
available to the public supporting benefits of red wine in these two diseases. Another
possible reason for this disconnect could be from the public focus on the “French
71
Paradox,” the decreased risk of CHD from red wine (Gronbaek, 2001), and there is less
research focusing on other health benefits from red wine. A previous study by
Luchsinger et al. (2004) summarized that intake of up to three daily servings of wine was
associated with a lower risk of Alzheimer’s disease (Luchsinger et al., 2004). Other
previous studies also found moderate alcohol consumption (one to three drinks per day)
is associated with a decreased risk of type 2 DM by 30-40%, compared with the lowest
consumers (Koppes et al., 2005).
When comparing level of agreement with white wine consumption, majority of
faculty and staff did not know the health effects, except for risk of liver disease. Faculty
(39.6%) strongly disagreed that white wine could decrease risk of liver disease, while
30.4% of staff did not know. With the question asking if white wine could increase risk
of liver disease, 27.8% of faculty did not know and 27.8% of faculty agreed. However,
majority of staff, 28.0% did not know if there was an increased risk of liver disease with
white wine, while 24.8% agreed there was increased risk.
The lack of understanding in the role of white wine on health outcome was
expected to be evident in the present investigation. The possible reason for this is
because although wine is highly associated with health benefits (Engs, 1996; Saliba &
Moran, 2010; Szmitko & Verma, 2005; Bauer, 2008; Castelnuovo et al., 2002; Gronbaek
et al., 1995; USDHHS, 2000; Gronbaek, 2001), majority of the research is supporting red
and not white wine. Past research suggests that the difference in red to white wine may
be due to the higher resveratrol contained in red wine compared to white (Bauer, 2008).
72
This scientific evidence is highly publicized in the media for the public to hear of.
However, even though it is generally believed that the “French Paradox” is related to the
consumption of red wine and not white wine or champagne, recent evidence has
supported that white wine could be as cardio protective as red wine (Dudley et al., 2008).
Since the role of white wine on health outcome is not yet certain, the public is unsure and
understandably so, and are likely to be forming their own health beliefs of white wine.
Limitations
This study does not come without limitations. In the present investigation, most
participants were white, as opposed to other ethnicities. Past studies have shown that
people’s beliefs about the effects of alcohol vary depending on their ethnicity (Johnstone,
1994). Various ethnic or racial groups also differ in the degree of people’s beliefs of
alcohol on health (Ellis, Zucker, & Fitzgerald, 1997). Therefore, since most of the
participants were white, the data to responses may not represent the population.
Also, the questionnaire process may not be reliable. Participants were not monitored
while taking the online questionnaire and therefore were free to research the correct
answer, instead of answering with their belief.
With most of the participants being drinkers, responses of the health outcomes
with alcohol may be skewed as past research has suggested that people who consume
alcohol can be in denial of the health outcomes. Furthermore, since the comparison of
education level was at a university, the staff members, as opposed to faculty, are likely to
have more knowledge with being in a higher educated environment. With the staff being
73
more educated at a university work place, this could be a considerable limitation the
study. Lastly, the middle class income level, which was most popular in the study, may
be another limitation as it is not representative of a diverse population.
Applications
Findings from the present investigation imply that KSU female faculty and staff
are knowledgeable about the benefits of red wine consumption. Participants proved that
they perceive the French Paradox to be true, and that red wine can decrease risk of CHD.
They are also aware of the USDA guidelines of alcohol consumption, and that exceeding
these can have harmful effects, likely to cause liver disease. However, it was evident that
their perception of alcohols effect was uncertain on the less mainstream diseases, such as
dementia, Alzheimer’s disease, and type 2 DM. Overall, the perception of KSU female
faculty and staff was in line with current research on the health effects of wine and
alcohol consumption.
A few factors that may impact ones perception of red wine consumption include
stress level and lifestyle. For example, faculty members at a university may have higher
stress levels, opposed to other professions. Teaching was once viewed as a low stress
occupation, with light workloads, flexibility, and conference trips (Iqbal, 2011).
However, recent studies suggest that university faculty is among the most stressed
occupational group, which may lead to greater overall alcohol consumption, possibly
impacting their perception of wine. As stated previously, individuals who drink more
may tend to deny the potential harm that may result from alcohol (Hansen et al., 1990).
74
Lifestyle differences may also impact perception, as increased workplace flexibility may
enforce more positive lifestyle behaviors (Grzywacz, 2008). Individuals who perceived
an increase in their flexibility were more likely to have overall healthy lifestyle behaviors
(Grzywacz, 2008). This study implies that faculty and staff who have workplace
flexibility, may be more health conscious than others, which could influence perception.
Whether an individual is highly educated, or of lower education, it is important to
make them aware of the health outcomes with alcohol consumption. Furthermore, it is
necessary for registered dietitians to understand the USDA guidelines for alcohol
consumption, serving sizes, nutritional facts, and impact to disease states in order to
provide accurate education to patients. Therefore, it is also important for professionals in
the dietetics field to expand the research realm on knowledge of alcohol on health, and
the effects of alcohol to health (Ciliska, Peirson, & Muresan, 2007).
Conclusion
The study demonstrated there was no difference in the perception of the possible
health benefits of red wine consumption and level of education, in KSU female faculty
and staff members. However, with most of the participants being drinkers, and in an
educated university environment, further research is needed in order to further compare
different populations. Results of the study suggest that individuals do understand there is
a health benefit with red wine consumption, however; they are unsure of the health
outcomes that can occur with consumption beyond cardiovascular benefits. This
75
disconnect suggests a need for more public education of wines impact on health, as well
as additional alcohol and health outcome research.
APPENDICES
APPENDIX A
STUDY CONSENT FORM
Appendix A
Study Consent Form
Informed Consent Form to Participate in Research Study
Welcome to “The Perception of the Health Aspects of Wine,” a web-based experiment
that examines the belief of wine consumption. Before taking part in this study, please
read the consent form below and click on the “Next” button at the bottom of the page if
you understand the statements and freely consent to participate in the study.
This study involves a web-based experiment designed to understand whether education
effects the way that Kent State University female faculty and staff perceive the health
aspects of wine. The study is being conducted by Jenna Iannello, student of Kent State
University, and it has been approved by the Kent State University Institutional Review
Board. No deception is involved, and the study involves no more than minimal risk to
participants (i.e., the level of risk encountered in daily life).
Participation in the study takes about 5 – 10 minutes and is strictly anonymous.
Participants begin by answering demographic questions, following with questions about
health belief of wine, and reasons for consumption.
All responses are treated as confidential, and in no case will responses from individual
participants be identified. Rather, all data will be pooled and published in an aggregate
form only. Participants should be aware, however, that the experiment is not being run
from a “secure” https server of the kind typically used to handle credit card transactions,
so there is a small possibility that responses could be viewed by unauthorized their parties
(e.g., computer hackers).
An incentive will be given to 10 participants, with a $10.00 grocery store gift card. The
first five participants who submit the survey, and provide their e-mail address, will be
given a gift card. When a reminder e-mail is sent to take the survey, an additional five
$10.00 gift cards will be given to the first five participants to submit the survey at that
time. Subjects will not be identifiable with their questionnaire results, as all surveys will
be anonymous. Participation is voluntary, refusal to take part in the study involves no
penalty or loss of benefits to which participants are otherwise entitled, and participants
may withdrawal from the study at any time without penalty or loss of benefits to which
they are otherwise entitled.
If participants have further questions about this study or their rights, or if they wish to
lodge a complaint or concern, they may contact the principal investigator, Jenna Iannello,
at [email protected]; or the Kent State University Institutional Review Board, at (330)
672-2704.
78
79
If you are 21 years of age or older, understand the statements above, and freely consent to
participate in the study, click on the “Next” button below to begin the survey.
APPENDIX B
PERCEPTION OF THE HEALTH ASPECTS OF WINE
QUESTIONNAIRE AND DEMOGRAPHIC QUESTIONS
Appendix B
Perception of the Health Aspects of Wine Questionnaire and Demographic Questions
Part One - Demographic Characteristics:
1) What is your education level?
a. High School
b. Certificate/diploma
c. Bachelor degree
d. Masters degree
e. Doctoral
f. Other
2) What is your ethnic background?
a. White
b. American Indian
c. Alaska Native
d. Asian
e. Black/African American
f. Native Hawaiian and Other Pacific
Islander
3) What is your individual income level (your income only)?
a. <$30,000
b. $30,000-$50,000
c. $50,001-$75,000
d. $75,001-$100,000
e. $100,001-$200,000
f. >$200,000
4) What is your Age? _______
5) Are you a faculty or staff member at Kent State University?
□Faculty Member □Staff Member
6) Are you full-time or part-time at Kent State University?
□Full-Time □Part-Time
81
82
Part Two - Health:
7) Please answer whether you agree or disagree with the following questions.
Strongly Disagree Neutral Agree Strongly
Question
Disagree
Agree
(1)
(2)
(3)
(4)
(5)
There are possible health
benefits with red wine
consumption.
There are possible health
benefits with white wine
consumption.
There are possible health
benefits with beer
consumption.
There are possible health
benefits with liquor
consumption.
Red wine may have
harmful effects to your
health.
White wine may have
harmful effects to your
health.
Beer may have harmful
effects to your health.
Liquor may have
harmful effects to your
health.
Don’t
Know
83
8) Please answer whether you agree or disagree with the following questions, on red wine
consumption.
Strongly Disagree Neutral Agree Strongly
Don’t
Question
Disagree
Agree
Know
(1)
(2)
(3)
(4)
(5)
Risk of developing
Coronary Heart Disease can
decrease with red wine
consumption.
Risk of developing dementia
and Alzheimer’s Disease
can decrease with red wine
consumption.
Risk of developing Type 2
Diabetes Mellitus can
decrease with red wine
consumption.
Risk of developing cancer
can decrease with red wine
consumption.
Risk of developing liver
disease decrease with red
wine consumption.
Risk of developing
Coronary Heart Disease can
increase with red wine
consumption.
Risk of developing dementia
and Alzheimer’s Disease
can increase with red wine
consumption.
Risk of developing Type 2
Diabetes Mellitus can
increase with red wine
consumption.
Risk of developing cancer
can increase with red wine
consumption.
Risk of developing liver
disease can increase with
red wine consumption.
84
9) Please answer whether you agree or disagree with the following questions, on white
wine consumption.
Strongly Disagree Neutral Agree Strongly
Don’t
Question
Disagree
Agree
Know
(1)
(2)
(3)
(4)
(5)
Risk of developing
Coronary Heart Disease
can decrease with white
wine consumption.
Risk of developing
dementia and Alzheimer’s
Disease can decrease with
white wine consumption.
Risk of developing Type 2
Diabetes Mellitus can
decrease with white wine
consumption.
Risk of developing cancer
can decrease with white
wine consumption.
Risk of developing liver
disease can decrease with
white wine consumption.
Risk of developing
Coronary Heart Disease
can increase with white
wine consumption.
Risk of developing
dementia and Alzheimer’s
Disease can increase with
white wine consumption.
Risk of developing Type 2
Diabetes Mellitus can
increase with white wine
consumption.
Risk of developing cancer
can increase with white
wine consumption.
Risk of developing liver
disease can increase with
white wine consumption.
85
Part Three-Reasons for Consumption:
10) Please answer whether you agree or disagree with the following questions, on reasons
for consumption.
Strongly Disagree Neutral Agree Strongly
Don’t
Question
Disagree
Agree
Know
(1)
(2)
(3)
(4)
(5)
I consume wine when I
am celebrating a special
occasion.
I consume wine when I
want to reduce stress
and/or improve my mood.
I consume wine because it
makes me more sociable.
I consume wine because I
believe there are health
benefits with
consumption.
I do not consume wine
because I believe the
negative health effects out
way the possible benefits.
I consume wine simply
because I like the taste,
and I do not consider
other factors.
11) Please answer the following with either “Yes” or “No.”
Due to my cultural beliefs, I limit the amount of wine I consume. ___
Due to my religious beliefs, I limit the amount of wine I consume. ___
I do not drink alcoholic beverages. ___
I drink red wine. ___
I drink white wine. ___
I drink beer. ___
I drink liquor. ___
12) If you would like to be eligible for a $10.00 grocery store gift card, please enter your
e-mail address below. The first five participants who submit the survey, and who provide
their e-mail address, will be given a gift card. _______________________
APPENDIX C
E-MAIL TO PARTICIPANTS
Appendix C
E-mail to Participants
Good Morning / Afternoon / Evening! My name is Jenna Iannello, a graduate student at
Kent State University (KSU) enrolled in the Masters of Nutrition/Dietetic Internship
Program. I am conducting a thesis on behalf of KSU female faculty and staff members,
on perception of the health beliefs of wine.
The purpose of this research is to determine
whether education level plays a role in the way that KSU female faculty and staff
perceive wine consumption on health.
The questionnaire takes 5-10 minutes to complete. Grocery stores gift cards of$10.00
each will be given to the first five participants who submit the survey. The survey is
completely confidential; your comments will not be identified. However, if you would
like to be eligible for the gift card, please send your e-mail with your completed survey.
Thank you in advance for your time!
If you would like to participate, please click on the URL below.
https://www.surveymonkey.com/s/BHT5VFK
Thank You,
Jenna Iannello
87
REFERENCES
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