Unravelling the alcohol harm paradox: a population-based study of social gradients across very heavy drinking thresholds | Research report

 

Who was involved?

Dan Lewer – Imperial College Healthcare NHS Trust, Charing Cross Hospital

Petra Meier – ScHARR, University of Sheffield

Emma Beard – Department of Epidemiology & Public Health and Department of Clinical, Educational and Health Psychology, University College London

Sadie Boniface – National Addications Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London

Eileen Kaner – Institute of Health and Society, Newcastle University

Background to the research:

There is consistent evidence that individuals in higher socioeconomic status groups are more likely to report exceeding recommended drinking limits, but those in lower socioeconomic status groups experience more alcohol-related harm. This has been called the ‘alcohol harm paradox’. Such studies typically use standard cut-offs to define heavy drinking, which are exceeded by a large proportion of adults. Our study pools data from six years (2008–2013) of the population-based Health Survey for England to test whether the socioeconomic distribution of more extreme levels of drinking could help explain the paradox.

Methods used:

The study included 51,498 adults from a representative sample of the adult population of England for a cross-sectional analysis of associations between socioeconomic status and self-reported drinking. Heavy weekly drinking was measured at four thresholds, ranging from 112 g+/168 g + (alcohol for women/men, or 14/21 UK standard units) to 680 g+/880 g + (or 85/110 UK standard units) per week. Heavy episodic drinking was also measured at four thresholds, from 48 g+/64 g + (or 6/8 UK standard units) to 192 g+/256 g + (or 24/32 UK standard units) in one day. Socioeconomic status indicators were equivalised household income, education, occupation and neighbourhood deprivation.

Results of the study:

Lower socioeconomic status was associated with lower likelihoods of exceeding recommended limits for weekly and episodic drinking, and higher likelihoods of exceeding more extreme thresholds. For example, participants in routine or manual occupations had 0.65 (95 % CI 0.57–0.74) times the odds of exceeding the recommended weekly limit compared to those in ‘higher managerial’ occupations, and 2.15 (95 % CI 1.06–4.36) times the odds of exceeding the highest threshold. Similarly, participants in the lowest income quintile had 0.60 (95 % CI 0.52–0.69) times the odds of exceeding the recommended weekly limit when compared to the highest quintile, and 2.30 (95 % CI 1.28–4.13) times the odds of exceeding the highest threshold.

Conclusions

Low socioeconomic status groups are more likely to drink at extreme levels, which may partially explain the alcohol harm paradox. Policies that address alcohol-related health inequalities need to consider extreme drinking levels in some sub-groups that may be associated with multiple markers of deprivation. This will require a more disaggregated understanding of drinking practices.

Read the full report here.

 

@SARG_ScHARR Research reveals surprising insight into British drinking culture #alcohol

  • Almost half of all drinking occasions are moderate, relaxed and take place in the home
  • Pre-drinking is now a common feature of nights out for both younger and older adults
  • Half of get-togethers with friends or family involve increased or higher risk drinking

New research into the UK’s alcohol consumption has revealed a surprising picture of Britain’s drinking culture.

alcohol consumption infographic by ScHARR

The study by the University of Sheffield’s Alcohol Research Group, funded by Alcohol Research UK, shows that while heavy drinking is still commonplace, much consumption is moderate and sociable.

Between 2009 and 2011, almost half (46 per cent) of drinking occasions in the UK involved moderate, relaxed drinking in the home. However, nine per cent involved drinking heavily at home with a partner.

The study, published online by the scientific journal Addiction, also confirmed that ‘pre-drinking’ is a typical feature of nights out for both young adults and older drinkers – and often involves heavy consumption.

A total of 10 per cent of all drinking occasions involved groups of friends moving between home and pub drinking and consuming on average 14 units of alcohol – the equivalent of seven pints of beer or one and a half bottles of wine. However, for many, going out with friends often involved drinking only low levels of alcohol.

In comparison, almost half of get-togethers with friends or family which take place exclusively at home, such as dinner parties, house parties and watching sport, involved increased or higher risk drinking*.

Dr John Holmes, a Senior Research Fellow in the University of Sheffield’s Alcohol Research Group, who led the study, said: “Far from the stereotypes of binge Britain or a nation of pub-drinkers, we find that British drinking culture mixes relaxed routine home drinking with elements of excess.

“Young people do binge drink on big nights out but we also see heavy drinking among middle-aged couples relaxing at home and among all ages at domestic get-togethers.”

The findings come from detailed drinking diaries completed by a representative sample of 90,000 adults as part of Kantar Worldpanel’s Alcovision study**. In addition to recording how much they drank, participants detailed where and when they consumed alcohol, who was there and why they were drinking.

The researchers based at the University of Sheffield’s School of Health and Related Research (ScHARR) used the diaries to identify eight main types of drinking occasion.

Most of these involved drinking in the home and included; drinking at home alone (14 per cent of occasions), light drinking at home with family (13 per cent), light drinking at home with a partner (20 per cent) and heavy drinking at home with a partner (nine per cent).

Consuming alcohol away from home was less common and included going out for a few drinks with friends (11 per cent of occasions) and going out for a meal as a couple or with family (nine per cent). The study found 10 per cent of occasions involved drinking heavily at both home and the pub – whether through pre- or post-drinking during a night out.

Dr James Nicholls, Director of Research and Policy Development at Alcohol Research UK, said “The idea that there is a single British drinking culture is wrong. Drinking behaviours have changed enormously over time, and there are wide variations within society.

“Rather than assuming society is neatly divided between ‘binge’, ‘heavy’ or ‘moderate’ drinkers we should think about the occasions on which people drink more or less heavily – and the fact we may be moderate in some contexts, and less so in others. If we want to address problems associated with drinking, we need to recognise the diversity of how we drink and understand the crucial role that cultures and contexts play in that.”

The study is published as an open access paper in the scientific journal Addiction and is available in the accepted articles section of Addiction’s website:

http://onlinelibrary.wiley.com/journal/10.1111/%28ISSN%291360-0443

The full citation is: Ally AK, Lovatt M, Meier PS, Brennan A, and Holmes J. (2016) Developing a social practice-based typology of British drinking culture in 2009-2011: Implications for alcohol policy analysis. Addiction doi: 10.1111/add.13397.

To find out more about the Sheffield Alcohol Research Group’s work, click here to visit their website.

Read more @ The Conversation 

Important new report on alcohol & emergency services published by @InstAlcStud #alcohol

Important new report on alcohol and the emergency services from UKCTAS collaborators at the Institute of Alcohol Studies!

Screen Shot 2015-10-26 at 11.20.35

Press coverage:

Police call for end to 24-hour licensing over alcohol-related violence – The Guardian

24-hour booze mayhem: A&E staff, paramedics and police spend a quarter of their time dealing with drunks – Daily Mail

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@SARG_ScHARR team present Research Rap at UKCTAS Early Career Researchers’ Day!

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**To the tune of Fresh Prince of Bel Air**

From South Yorkshire, born and raised

SARG members examined an alcohol craze

Minimum pricing, taxation galore,

Just a few of the things we like to explore…

We first formed in two thousand and ten

When the MRC gave us money to spend

The Sheffield Alcohol Model we built,

Based on those who were drinking, while wearing a kilt!

We’ve got 15 members in our research group…

But we still like to keep UKCTAS in the loop

We research policy and many other things

So here’s a big list of what we bring…

Policy appraisal and price modelling,

Treatment capacity for heavy drinking,

Understanding why Brits drink a lot

Examining elasticities of what they bought

Adapting our model for tons of nations,

Like Wales, Scotland, and other relations

Developing models to curb tobacco smoking

Preventing risky drinkers from prematurely croaking

Awareness of drinking and cancer risk,

Hearing focus groups shout nanny state, ‘tisk, tisk!’

Reviewing drink guidelines in South London

Improving survey measures of alcohol consumption

Adapting our model for local authorities

Examining harms to others, close families

Defining what is meant by a drinking occasion

Addressing court appeal for EU persuasion

So these are the things SARG is working on now

We hope you enjoyed, now it’s time for the bow

If you have final comments for any one of us,

Please come and shout, future collaborations are a plus!

View more: SARG News and Activities 2015