A recent study highlighting one of the lesser discussed aspects of living in China:

July 21, 2011 A unique drinking culture in China is a major contributor to a national epidemic of excessive binge drinking, particularly among middle-aged men, highlighting an urgent need to implement public health strategies to address the problem, a national study suggests.

The findings are in stark contrast to other countries, where alcohol consumption peaks when individuals are in their late teens and early 20s, the investigators note. This may be because alcohol is considered to be an important social tool in Chinese culture.

"It is accepted, or even encouraged, for older people to drink during social [interactions], accompanied by a meal, in order to enhance relationships with friends or business partners, and to establish a happy and congenial atmosphere," the investigators, led by Yichog Li, National Center for Chronic and Non-communicable Disease Control and Prevention in Beijing, China, and the Shanghai Center for Disease Control and Prevention, note.

On the other hand, young people are expected to concentrate on their education and to not "waste time" with drinking.

The study was published online July 19 in Addiction.

Binging Prevalent Even in 'Moderate' Drinkers

Although previous research has examined total drinking consumption in China, it has not assessed drinking patterns, including comparing binge drinking with regular moderate intake.

They note that drinking patterns have been associated with a higher risk for total mortality, cardiovascular outcomes, and unintentional and intentional injuries, even in those who are light to moderate drinkers.

Data were examined for 49,527 Chinese residents (53% female) between the ages of 15 and 69 years from the 2007 China Chronic Disease and Risk Factor Surveillance program. All participants were interviewed in person about sociodemographic information and current drinking behaviors.

Results showed that 17,736 of the subjects (35.7%) were current drinkers, defined as having had at least 1 alcoholic drink in the previous 12 months.

Male drinking prevalence was 55.6%, with an average of 47.8 grams of alcohol consumed a day. For females, 15% were current drinkers, with a per-day alcohol consumption average of 19.1 grams.

Excessive drinking was defined as more than 25 grams per day for men and 15 grams for women. Binge drinking was defined as more than 50 and 40 grams, respectively, in 1 day during the past year.

The median number of annual binge drinking episodes was 5.6 for male drinkers and 2.4 for females. Even among the moderate drinkers, 31.5% of the males and 16.1% of the females reported binge drinking in the previous 12 months.

Further, proportions of excessive drinking, frequent dinking, and binge drinking were 62.7%, 26.3%, 57.3% for men and 51.0%, 7.8%, and 26.6% for women, respectively.

In addition, binge drinking was strongly associated with drinking frequency, and drinking quantity increased with drinking frequency in males and females.

Media 'Awash' With Alcohol Ads

Excessive and binge drinking rates were highest for the men between the ages of 35 and 44 years, and the drinking frequency rate increased significantly as they got older. However, these behaviors did not differ significantly with age for the women.

The current drinking rate also increased with higher education and increasing household income.

"This might be due to the fact that generally, in China, people with higher educational achievement obtain...higher social status and are more likely to become involved in social intercourse," write the researchers.

They note that toasting at events and playing the drinking game "Wager" are also very prevalent in Chinese culture.

"Consequently, the more frequently people drink, the greater the chance of being urged to drink in excess of sensible quantities."

The study also showed that the preferred alcohol beverage was spirits for 33% of the drinkers, spirits and beer for 24.9%, beer only for 24.8%, and wine only for 3.5%.

Spirits have a much longer history than wine in China and are more accessible, especially in rural areas or undeveloped regions.

According to Dr. Li, the Chinese mass media is "awash with ads for alcoholic beverages. And there are no regulations for access, so people of any age can buy alcohol.

"The most effective interventions for China would be to limit alcohol commercials, increase alcohol taxes, restrict availability, and most importantly, change Chinese people's entrenched attitudes toward drinking by persistently informing current and future generations about healthy drinking habits," he said in a statement.

The Chinese government recently amended its Road Traffic Safety Law so that drunk drivers now face criminal punishment or a lifetime driving ban.

The study was funded by Ministry of Health of the People's Republic of China. The study authors have disclosed no relevant financial relationships.

Addiction. Published online July 19, 2011.

Deborah Brauser