Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: Dr Mokdad and colleagues1 reported that the leading cause of mortality in
the United States is tobacco use, followed by poor diet/inactivity and alcohol
use. I believe that the authors should also address the beneficial effects
on mortality, if any, of these modifiable factors. Some may be beneficial
in small quantities and may thus have a U-shaped relationship to mortality.
One example is the well-documented beneficial effect of low levels of alcohol
consumption on the health of populations with a high risk of cardiovascular
Anstadt G. Modifiable Behavioral Factors as Causes of Death. JAMA. 2004;291(24):2941. doi:10.1001/jama.291.24.2941-a