liver damage at every level of alcohol consumption with the differences being largest at the highest level of alcohol use. This pattern persisted after adjustment for age, sex, education, BMI, and pack years of smoking. We are currently unaware of the extent to which these patterns reflect group variation in the specific types of substance used (compared to whites, blacks are more likely than whites to use menthol cigarettes and to use hard liquor), differential exposure to unmeasured physical and chemical agents in occupational and residential environments, or interactions between health practices and stressors that markedly exacerbate health risks.
