Workshop on alcohol use and health disparities 2002: a call to arms

Abstract 

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) of the National Institutes of Health (NIH) sponsored a “Workshop on Alcohol Use and Health Disparities 2002: A Call to Arms,” on December 5, 2002, in Bethesda, Maryland, USA. This workshop was part of the NIAAA/NIH comprehensive strategic plan to reduce, and ultimately eliminate, health disparities. Eleven topics were addressed: (1) biomedical risk factors that may contribute to disparities in the toxic effects of alcohol; (2) alcohol and gene–environment interactions that affect the health of diverse groups; (3) alcohol pharmacogenetics in Mexican-Americans; (4) determinants of risk for alcoholism in minority populations; (5) consideration of population groups in linkage-disequilibrium studies to identify genes associated with alcohol dependence; (6) interaction between alcohol dependence and African-American ethnicity in disordered sleep, nocturnal cytokines, and immunity; (7) disparities of brain functional reserve capacity affecting brain morbidity related to substance abuse; (8) alcohol and pregnancy disparities; (9) role of alcohol in cancer risk disparities; (10) ethnic diversity in alcoholic cardiomyopathy; and (11) postmenopausal health disparities. On the basis of these presentations, seven conclusions emerged: (1) Genetic variations in alcohol-metabolizing enzymes exist in various populations. (2) These enzymes play a role in the variation in health effect outcomes seen in different populations, owing to alcohol consumption. (3) Differences between and among population groups can be critically important for the design and interpretation of studies in genetics. These include differences in expression of phenotype, in locus heterogeneity, in risk alleles, and in population structure. (4) Incidence rates for fetal alcohol syndrome and fetal alcohol spectrum disorders are greater in African-Americans and Native-Americans than in Caucasians. Genetic polymorphisms, nutrition, and other factors may account for these differences. (5) The highest mortality rate for cirrhosis has been found in white Hispanic men. (6) Mexican-Americans have a low frequency of the protective alleles ADH1B^∗2 and ALDH2^∗2 and a relatively high frequency of CYP2E1 c2, which is associated with early onset alcoholism. (7) The incidence rate for cancer is greater for African-Americans than for Caucasians, and part of the higher risk may be attributed to heavier drinking.

Keywords: Health disparities, Cirrhosis, Cardiomyopathy, Fetal alcohol spectrum disorders (FASD), Esophageal cancer, Ethanol