Ms Engs studies the cycles of Health Reform in the US from 1800 to the present day. The cycles are defined as 'periods of cultural revitalization that begin in a general crisis of beliefs and values and extend over a generation or more, resulting in a profound reorientation of beliefs and values. Each cycle lasts 80 to 100 years.

Clean living movements are identified as broad periods when concerns about alcohol, tobacco, sex, diet, fitness and disease were in precedence, leading to legislation. This is often followed by a backlash .Three such Clean Living Movements are described, the first covering 1830-60, the second 1890 to 1920 and the third 1970 to 2005?.

Single issues tend to spark the campaigns - temperance against 'ardent spirits'in the first case, a move against the corruption of saloons in the second case and smoking and drink-driving in the current movement - few would have suspected in the 'two martini long lunches of the 1970's that smoking would be banned in public places in the 1990's, or that the drinking age would be raised to 21. The cycle is historically broken by a public backlash to restrictions, leading to some repeal, over time the problems increase again, and so the cycle renews itself.

The first movement was directed against the drunkenness of immigrants and labourers in the Jacksonian era. Alcohol had been seen as medicine and food until 1812 'a good creature of God' (Rush 1812). Engs believes the change in attitude was sparked by the new industrialists who needed sober machine operators during the industrial revolution. The movement was not against fermented beverages, but against 'ardent spirits' and drinking sprees'Only in the 1830's was 'abstinence' preached and 13 Sates introduced legislation banning public drinking and the distribution and sale of liquor. A backlash occurred and by the Civil War most laws had been repealed.

'The movement is not so much against the consumption of whiskey and other alcoholic beverages as against saloons, rum shops, bars and the like'Edward Lissner, Harpers Weekly 1907

The second movement of 1880 to 1920 was spurred by rapid urbanisation , indus-trial expansion and immigration, which resulted in huge social pressures. Saloons were seen as responsible for vice, prostitution and the corruption of family values. The movement was started by the Womens Christian Temperance Union (the largest and most powerful womens movement assembled in US history) and then carried through to legislation by the politically motivated and powerful Anti-Saloon League, resulting in Prohibition on a National level in 1919/20. The backlash occurred in the form of 'roaring 20's, with drinking being driven underground resulting in the consumption of unregulated and untaxed liquor, the growth of organised crime and political corruption.

The third and current movement was sparked as a reaction to the 'flower power' generation as a crusade against sex, drugs, alcohol and finally AIDS. For the first time 'system' blame was manifest rather than self responsibility, characterised by litigation against manufacturers and smoking and drinking being categorised as 'diseases'. The concept of moderation was removed from government policy in the 1980's, with a goal to reduce overall consumption rather than target problem areas being set by the Office of Substance Abuse and Prevention. Health warning labels were introduced in 1989, and by 1988 all States had raised the minimum drinking age to 21.Engs belivesThe US is still in this phase with the CSPI calling for zero tolerance laws and server liability and .08 BAC levels being driven for through the pressure of federal highway funds. The end of the Movement is envisaged to be in 2005.

Engs believes the backlash began in 1993, sparked by the 60 minutes Morris Shafer exposure of the french paradox in 1991. The concept of responsible use has been reintroduced and the Dietary Guidelines for Americans recognise that a daily drink of 14g for women and 2 drinks of 14g for men is acceptable and in some circumstances can confer health benefits. Similarly back labels have been modified. Such a structured backlash would not have been passible without the wealth of scientific evidence which has amassed in the 1990's demonstrating that drinking sensibly in most cases decreases mortality from all causes and in particular coronary heart disease.

Clean Living Movements covers other issues in detail as well as alcohol, such as public health, disease, sexual liberation, womens' suffrage, drugs and tobacco. Ruth Engs approach is a fascinating one and puts many of the current issues we are facing in perspective.

Clean Living movements is published by Praeger Publishers, 88 Post Road West, Westport, CT 06881, USA. ISBN 0-275-95994-5.