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August 28, 2003


Emergency Room Doctors Find Moonshine Drinkers in Downtown Atlanta

ATLANTA -- Moonshine consumption has often been considered a backwoods activity in small, southern towns, yet as Emory University School of Medicine researchers at Grady Memorial Hospital have recently discovered, moonshine use is surprisingly common in urban Atlanta as well. In a study conducted in the Grady Memorial Hospital emergency department and published in the September 2003 issue of the Annals of Emergency Medicine, lead author Brent W. Morgan, MD, assistant professor of Emergency Medicine at Emory and director of Emoryís Medical Toxicology Fellowship Program, reveals that a group of patients who admitted consuming moonshine were more likely to have elevated blood lead levels than patients who did not drink moonshine.

The paper is based on a study that began at Grady in April 2000, after four adult patients with potentially lethal lead poisoning arrived at Gradyís emergency care center. Of the four, three patients presented with seizures and one with abdominal pain. All four admitted to consuming moonshine, and had elevated blood lead levels well above the normal limits. The study, done in conjunction with the Georgia Department of Health and the Centers for Disease Control and Prevention (CDC), was designed to estimate the prevalence of moonshine consumption among the urban population at Grady; identify predictors of moonshine consumption; and measure the relationship between self-reported moonshine consumption and blood lead levels.

The study was conducted in two phases: a prevalence phase, in which Dr. Morgan and other researchers assessed the prevalence of moonshine use; and a nested phase, in which they studied a subset of patients in more detail to examine associations of moonshine use with risk factors and blood lead levels.

Dr. Morgan says the study was important because it documented the prevalence of moonshine consumption.

"Frequently, when we think of moonshine consumption we think of the middle of Appalachia, but we didnít know that this phenomenon was also here in the inner city of Atlanta," he says. "We also wanted to see how prevalent moonshine consumption is in this area, and how it affects blood levels of those who drink moonshine. What we found was that moonshine use is fairly common in Atlanta, especially among those who drank any alcoholic beverage five to six times per week. They were more likely to be the ones who used moonshine, as opposed to people who only drank once a week or less."

Of the 581 patients studied, 8.6 percent reported consuming moonshine within the past five years. Of the patients who admitted to consuming moonshine, 26 percent had consumed it within the previous week. Moonshine drinkers were more likely to be men between the ages of 40 and 59 and were heavy alcohol users. Moonshine consumption was highly associated with elevated blood lead levels, particularly among recent drinkers. Eighty-eight percent of the patients in the study were black; 11 percent were white; and 1 percent were of other races.

Patients were screened every other day on a 24-hour basis during a two-week period in the two major treatment areas of the Grady Emergency Care Center. All patients who came to the hospitalís emergency department were screened to determine eligibility for the study.

Moonshine is defined as any illicitly distilled liquor or whiskey. In the Atlanta area, it is termed "moonshine," "street gin," "corn liquor," "white lightning," or "unbranded whiskey." Some patients in the study received their moonshine from stills in the metro Atlanta area, while others obtained moonshine from north and south Georgia. Moonshine is manufactured by using corn along with a mixture of yeast. The yeast ferments the corn and produces alcohol. The mixture is then heated. Since alcohol boils at a lower temperature than water, the bootlegger will collect the steam that is produced at a temperature lower than the boiling point of water. Lead can be introduced into the moonshine as the steam is collected and condensed in either lead soldered pipes or an automobile radiator.

According to the paper, patients who said they had drunk any amount of moonshine in the past five years were deemed moonshine drinkers. They were questioned about potential past environmental and occupational lead exposures. Other potential sources of lead exposure included hobbies, history of gunshot wounds, and whether the bullet was removed. Blood samples were also collected to measure the relationship between moonshine use and elevated blood lead levels.

Dr. Morgan says that moonshine use is more prevalent than some may believe.

"To our knowledge, prevalence rates of moonshine consumption have never been characterized," he writes. "It is widely thought that moonshine use is rare particularly in urban communities. This misconception is simply due to a lack of news reports in recent years about moonshine-associated lead toxicity and other adverse health effects. Our findings confirm that moonshine consumption is still associated with elevated blood lead levels."

Since moonshine consumption is such a pervasive problem among the urban population that Grady serves, Dr. Morgan recommends that similar studies be done in other urban and rural communities to determine whether moonshine consumption and associated elevated blood lead levels are an isolated problem or more widespread than presently realized. He also recommends health care providers inquire about moonshine consumption in areas where it is manufactured; that patients who acknowledge drinking moonshine be evaluated for lead exposure and educated about the risks of moonshine consumption; and that both law enforcement and health care sectors be alerted when contaminated moonshine is discovered. He and other researchers conclude by recommending lead testing of all moonshine that is confiscated by law enforcement personnel.

"Our study shows that the days of lead toxicity and moonshine are not over," Dr. Morgan concludes. "We must therefore renew efforts to increase understanding of this issue, educate health care providers and the public, and work closely with law enforcement personnel to effectively address and prevent adverse effects of moonshine consumption."

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