• G E Vaillant, P P Schnurr, J A Baron, and P D Gerber.
• Department of Psychiatry, Dartmouth Medical School, Hannover, NH 03756.
• J Gen Intern Med. 1991 Jul 1; 6 (4): 299-304.

ObjectiveTo compare the relative risks of alcohol abuse and cigarette smoking.DesignCohort studies utilizing a 12-to-16-year follow-up of 47-to-52-year old men.Participants And Setting237 Caucasian college sophomores (COLLEGE sample) and 366 socially disadvantaged junior high school students (CORE-CITY sample) selected in 1940-43 for relative mental health and for interdisciplinary study.Main ResultsThe presence of many risk factors for death, including alcohol abuse and smoking, had been assessed prior to age 47 (CORE-CITY sample) and age 52 (COLLEGE sample). Over the next 12 years (CORE-CITY sample) and the next 16 years (COLLEGE sample), the men's mortality was monitored. Heavy use of cigarettes and alcohol abuse were highly correlated. When the effect of alcohol abuse was controlled, heavy smoking was associated with elevated mortality risks in both samples, although this was not statistically significant in the CORE-CITY sample. When smoking was controlled, the odds ratios for mortality from alcohol abuse were substantial in both samples.ConclusionsThese results and a literature review suggest that insufficient alcohol abuse histories may lead clinicians to underestimate the mortality risk of alcohol abuse.

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