A will to health? Drinking,risk and social class

This article explores risk conceptions related to alcohol use among Danes who drink ‘too much’ (based on the National Health Board’s standards for safe drinking). It analyses drinking patterns and risk management strategies among interviewees from different socio-economic backgrounds, and explores the differences between the behaviours and conceptions of these individuals and the risk advice and definitions provided by health agencies. The article shows that people from different socio-economic backgrounds respond differently to the neo-liberal strategy of alcohol risk minimisation, with middle- and upper-class participants being more in tune with the public health ethos of alcohol consumer ‘autonomisation’ and ‘responsibilisation’. Cutting across socio-economic differences, though, are risk conceptions that clash with the public health model of risk prevention. While the risk communication of the health agencies builds on the logic of ‘a will to health’, drinkers at relatively high consumption levels tend to prefer other rationales, associating alcohol use with socialisation, pleasure and relaxation, and defining alcohol risks in terms of ‘addiction’ rather than detrimental health effects. The article contributes to the discussion of the ‘prevention paradox’, showing that rational initiatives at a general population level are not always comprehended as such at the individual level.     

Social capital, the miniaturization of community and high alcohol consumption: a population-based study

AIMS: To study the impact of social participation, trust, and the miniaturization of community, i.e. high social participation/low trust, on the risk of high alcohol consumption. METHODS: The Scania 2000 public health survey is a cross-sectional, postal questionnaire study. A total of 13 604 persons aged 18-80 years were included. A logistic regression model was used to investigate the association between the social capital variables and high alcohol consumption (168.0 g/week or more for men and 108.0 g/week or more for women). The multivariate analyses analysed the importance of confounders (age, country of origin, education, and economic stress) on the risk of high alcohol consumption according to the social capital variables. RESULTS: A 14.0% proportion of all men and 7.8% of all women had an alcohol consumption above recommended levels. High alcohol consumption above recommended levels was not associated with social participation but negatively associated with trust among men. The miniaturization of community category, i.e. high social participation/low trust, had significantly higher risks of high alcohol consumption compared to the high social capital (high social participation/high trust) category among men. CONCLUSION: High social participation combined with low trust, i.e. the miniaturization of community, is positively associated high alcohol consumption among men. A structural/social factor which may affect the amount of alcohol consumed has thus been identified in this study.     

Just how high-risk are ongoing smokers? Exploring clusters of health risk behaviours among current and ex-smokers

There is limited research about the patterns of multiple health risks among smokers, despite the associated increased risk of poor health. This study aimed to identify which risk behaviours were evident in a sample of smokers and ex-smokers who had previously been offered cessation support. A cross-sectional telephone interview in 2013 involved participants from New South Wales, Australia, from the control condition (self-help materials only) of a randomised smoking cessation trial conducted approximately five years earlier. The interview assessed smoking, weight, height, fruit and vegetable intake, physical activity, alcohol intake and depression. Of the 626 eligible participants, 321 were interviewed (consent rate = 85.6%, response rate = 51.3%); 62% were current smokers. Most participants (57%) reported four or five health risk behaviours. Three risk clusters were identified using latent class analysis: i) ‘high risk’ (42% of sample): smokers, overweight, inadequate intake of fruit and vegetables and low levels of physical activity; ii) ‘lower risk non-depressed’ (22% of sample): adequate physical activity and an absence of depression; and iii) ‘lower risk, low alcohol’ (36% of sample): low alcohol consumption, overweight and depressed. Males and current smokers were more likely to be ‘high risk’, while women and ex-smokers were more likely to be members of the ‘lower risk, low alcohol’ cluster. Those who continue to smoke have multiple additional health risks; as do ex-smokers in the ‘lower risk, low alcohol’ cluster. Achieving good health outcomes for these sizeable groups will require tailored, intensive or case-management approaches which can address multiple health risk behaviours.     

Creeping edgework: carnivalesque consumption and the social experience of health risk

This article contributes to an understanding of voluntary health risk based on the regular, excessive intake of food and alcohol in the micro‐cultural setting. By drawing on and extending edgework theory our aim is to conceptualise the riskiness of carnivalesque consumption as a medium for expression and performance in two separate community contexts. Using ethnographic research methods, we explore the consumption of calorie‐dense, low nutrient food for gamers and the use of alcohol for hipsters. Our findings are reported over four key themes. The first and last consider how carnivalesque consumption provides sensations for multi‐sensory loss of self and a shared emancipation from day‐to‐day moderation. The second and third explore how community members prepare and exercise control over their consumption to manage risks related to an ‘immediate edge’. We discuss how carnivalesque behaviour, when ritualised, establishes a trajectory that creeps towards a more ‘distant edge’ characterised by longer term health consequences. We argue that the transcendental experiences that are part and parcel of edgework can be enacted by products that are traditionally conceptualised as mundane and that the risks of consuming them are largely accumulative rather than instantaneous. Implications for health interventions are included.     

Social network perspective on alcohol consumption among African American women: a longitudinal analysis

Objective: The aim of the study was to examine alcohol use in African American women’s social networks.

Design: This was a longitudinal study of African American women and their social networks in Baltimore, MD. Data were collected through face-to-face interviews at a community-based research clinic. Alcohol consumption frequency was assessed by a single question ‘How often do you drink alcohol?’ with a four-point ordinal rating scale ‘never,’ ‘monthly or less,’ ‘2–4 times a month’ and ‘>2 times a week.’ A longitudinal ordinal logistic model was conducted to use 317 African American women’s alcohol consumption frequency as a predictor of their social networks’ alcohol consumption frequency.

Results: Results show that African American women’s alcohol consumption frequency was a statistically significant predictor of their social network members’ alcohol consumption frequency.

Conclusion: Findings suggest the merit of social network-based approaches to address alcohol use among urban minority populations.     

An improved aetiologic fraction for alcohol-caused mortality

Abstract: A method is proposed for estimation of alcohol-caused mortality in which the aetiologic fraction of deaths is derived from an exposure contrast between the ‘unsafe’ drinker and ‘safe’ drinker; not between the drinker and the nondrinker. The method is consistent with the objectives of public health intervention in the alcohol education field. The ‘safe’ drinker is the reference exposure category and aetiologic fractions are obtained for the single categories of a multiple-level exposure scale, using separate relative risks for the ‘unsafe’ drinker and the nondrinker. Preliminary application of the method to Australian data yields an estimate of the number of deaths caused by misuse of alcohol that is larger than those obtained under the old conceptual model. Thus, the public health importance of unsafe alcohol consumption has been underrepresented.     

Habitus of home and traditional drinking: a qualitative analysis of reported middle‐class alcohol use

There is evidence that alcohol consumption among those in middle‐class occupations consistently exceeds safe levels, yet there has been little research into why this occurs. This article explores the meanings associated with alcohol use among professional, managerial and clerical workers. Qualitative data were collected from five focus groups of male and female employees aged 21–55 (N =49: 32 male, 17 female). Each focus group was conducted on the premises of a medium‐scale or large‐scale employer, four public sector and one private sector, in the north‐east of England. Using Bourdieu's concepts of ‘habitus’, ‘capitals’ and ‘fields’ we found that, among these middle‐class occupational groups, alcohol use was associated with two habitus: a ‘home drinking’ habitus and a ‘traditional drinking’ habitus. Those of the home drinking habitus particularly used wine as a source of cultural capital and a means of distinction, whereas those in the traditional habitus consumed lager, beer and spirits to have fun in social settings. A small minority appeared to belong to a third, omnivorous, habitus where a wide range of alcoholic drinks were consumed in a variety of contexts. Existing public health initiatives to reduce alcohol consumption may require modification to accommodate a range of drinking cultures.     

SCREENING ALCOHOL & DRUG USE IN A GENERAL PRACTICE UNIT: COMPARISON OF COMPUTERISED AND TRADITIONAL METHODS

Systematic screening of patients for areas of health risk in their lifestyle has much potential for primary health care clinicians as a cost-effective and time saving means to identify ‘at risk’ individuals. In the area of alcohol and drug problems, such early identification increases the likelihood of successful intervention. The present study, conducted at a general practice unit, compared the use of a computer to screen for alcohol and drug use with the two more traditional assessment methods of face-to-face interview and paper and pencil questionnaire. It was found that levels of reported consumption were similar across assessment methods. Although the interview method was strongly preferred overall, patients' preference for the computer increased significantly after use. The computer was also found to be more acceptable to patients reporting non-medical drug use, a potentially threatening and sensitive issue. There was a low refusal rate and most patients were willing to allow their doctor to see the assessment results. This indicates that screening for alcohol and drug use is acceptable to general practice patients, and that the computer can play a useful role as a prevention aid.     

‘I’m not clear on what the risk is’: women’s reflexive negotiations of uncertainty about alcohol during pregnancy

Health guidelines in many countries advise women that not drinking alcohol during pregnancy is the safest option for their babies. This advice is based on a lack of evidence about what is a safe amount of alcohol and increasing concern about Foetal Alcohol Spectrum Disorders. While there is some knowledge of factors informing women’s views and practices in relation to alcohol consumption during pregnancy, there is little knowledge or understanding of the ways women interpret and respond to the abstinence public health advice in Australia and its bearing, if any, on their own practices. In this article, we examine women’s experiences of alcohol consumption during pregnancy and their views of the abstinence advice. We locate our analysis within the body of thinking that views pronouncements about risks during pregnancy as bound up with social and cultural values and ideas about what it means to be a ‘good’ or ‘bad’ mother, as much as they are about science. We draw on a study that we undertook in 2014 of 20 women, who were either pregnant, had recently had a child or who had young children, or who were planning for pregnancy, who took part in one-to-one qualitative interviews or participated in focus group discussions in Canberra, Australia. We found that the women in our study variously described receiving reassurance after drinking in early pregnancy; opting to abstain as the safest option in the face of uncertainty; and having an occasional drink if they felt like it. In response to the abstinence advice, we found that some women understood it as a responsible message, even if they had not necessarily adhered to it, while others criticised it as an example of policing pregnant women. Overall, the women in our study accepted that it was possible to drink responsibly during pregnancy and defended this view through strategies of normalising the occasional drink, emphasising a woman’s right to make her own decisions, and associating low-level consumption with low risk.     

Social engagement,setting and alcohol use among a sample of older Australians

The harms associated with risky alcohol consumption have long been researched and recognised in the health field. However, little available research has focused on older people or extended analysis of alcohol use by this segment of the population beyond a biomedical perspective. With the rapid ageing of the global population, research that investigates alcohol use among older people from a social perspective is important. This article reports on research with a group of older women and men, to identify and explain factors that influence alcohol consumption. In‐depth interviews were conducted in Perth, Western Australia with 20 men and 22 women aged 65–74 years who were living in either private residences or retirement villages. The study findings indicated that alcohol use was linked with social engagement in activities across both settings, and that moderate alcohol use appeared to serve an important function as a ‘social lubricant’. The major facilitating factors for alcohol use included the frequency of opportunities for social engagement and access to a ready‐made social group in retirement villages. The major constraining factor across both settings was driving. Interestingly, health was not viewed as a major facilitating or constraining factor for alcohol consumption. Conclusions from the research were that alcohol serves an important role in enhancing social engagement, and there appear to be important associations between residential setting and alcohol use.     

Acceptance and expectance: Cultural norms for alcohol use in Denmark

Alcohol consumption levels in Denmark are high with the risk of increased morbidity and mortality in the population. It is suggested that people''s views of “normal” use of alcohol must be the platform for formulating effective alcohol education and prevention strategies. However, little is known about the cultural norms for alcohol use. The aim of this article is to examine the perceptions of cultural norms for alcohol use in Denmark among different age groups and the similarities and differences between the groups, including examining how people construct and negotiate the cultural norms for drinking. Five focus group interviews were conducted with one group per the following age groups: 16–20; 21–34; 35–44; 45–64; and 65–82. These groups consisted of both men and women with five to six participants in each group (a total of 27). Thematic analysis was performed with the aim of developing themes that reflected the cultural norms for alcohol use. The unifying theme of this research was Danish people''s acceptance and expectance of social drinking. Alcohol is widely accepted and associated with mutual expectations to drink, leading to identification of cultural influences and facilitation to drink. The social drinking context plays an important role in people''s perceptions of the normality of drinking. This includes the selection of particular beverages, and regularly leads to consumption above the recommended levels for low risk to health. This calls for public health attention that promotes low risk drinking in the social context and aims to prevent and reduce serious alcohol-related harm and health problems across the population.     

Alcohol and burden of disease in Australia: the challenge in assessing consumption

Objective : Alcohol consumption is one of the major avoidable risk factors for disease, illness and injury in the Australian community. Population health scientists and economists use estimates of alcohol consumption in burden of disease frameworks to estimate the impact of alcohol on disease, illness and injury. This article highlights challenges associated with estimating alcohol consumption in these models and provides a series of recommendations to improve estimates. Methods : Key challenges in measuring alcohol consumption at the population level are identified and discussed with respect to how they apply to burden of disease frameworks. Results : Methodological advances and limitations in the estimation of alcohol consumption are presented with respect to use of survey data, population distributions of alcohol consumption, consideration of ‘patterns’ of alcohol use including ‘bingeing’, and capping exposure. Key recommendations for overcoming these limitations are provided. Implications and conclusion : Alcohol‐related burden has a significant impact on the health of the Australian population. Improving estimates of alcohol related consumption will enable more accurate estimates of this burden to be determined to inform future alcohol policy by legislators.     

Risk creating and risk reducing: Community perceptions of supervised consumption facilities for illicit drug use

Progressive public health authorities in high-income countries have advocated supervised consumption facilities, where people who use illicit drugs can consume them in a hygienic, supervised environment, as a way of reducing drug-related risks to both people who use drugs and communities. However, the planning of such facilities has often met with strong reactions from the local community. ‘Not in my backyard’ (NIMBY) type reactions are frequently encountered and public opinion polling is limited in its ability to provide detailed insights into the reasons why people support or oppose these facilities in Toronto and Ottawa. We explore perceptions of residents and business representatives to the proposed implementation of supervised consumption facilities, and examine their perceptions of risks from these facilities. We collected qualitative data from 2008–2010 using focus groups and interviews with 38 residents and 17 business representatives in these two large Canadian cities lacking supervised consumption facilities. We used thematic analysis to examine expressed benefits and risks regarding supervised consumption facilities amongst community members. These participants saw these facilities as potentially risk-reducing, but recognised that the facilities could also create risks for their communities. While community members accepted that facilities could have positive health effects, they expressed a level of concern regarding the risk of public nuisance associated with supervised consumption facilities that seemed unwarranted based on the existing evidence. Discussions on the risks involved in the establishment of supervised consumption facilities should move beyond a focus on the benefits to facility users, to exploring community-level benefits and risks, and integrate evidence regarding actual risk experiences from other locations. Similar approaches may apply to NIMBY concerns related to other contentious issues.     

“Women of my age tend to drink”: the social construction of alcohol use by Australian and Danish women aged 50–70 years

In Australia and Denmark, women aged 50–70 years are more likely than younger women to consume alcohol at levels that exceed national low risk drinking guidelines. To explore and possibly help explain this sociocultural shift in patterns of alcohol use, this research investigated the social construction of alcohol use amongst 49 women (25 in Northern Denmark, 24 in Western Australia) aged 50–69 years. The women viewed drinking as normal and acceptable. While some women reported reducing their drinking due to health concerns, others neutralised alcohol-related health risks through compensatory behaviours including exercise. Such constructions arguably serve to sustain at-risk drinking amongst some women. Our research highlights that interventions to minimise alcohol-related health risks amongst middle-aged and young-old women should acknowledge that women's social construction of their drinking practices may prioritise subjective experiences of “being in control” while drinking, over biomedical understandings of the health impacts of alcohol.     

‘I can tell when you’re staring at my glass …’: self- or co-surveillance? Couples’ management of risks related to alcohol use during pregnancy

Social researchers have largely used the framework of self-surveillance to describe the experience of pregnant women within a social context characterised by risk avoidance for the sake of their baby. However, men’s positions regarding the risk discourses surrounding alcohol use during pregnancy and their engagement in their partners’ regulation of abstinence remain unclear. Using a socio-cultural approach to risk perception, this study contributes to the understanding of the lay management of health-related risk as a relational issue by considering the couple relationship as a significant context that shapes responses to risk in everyday life. In this article, I explore the woman’s and her partner’s management of the risks surrounding alcohol consumption during pregnancy. This study draws on joint interviews with 30 first-time expectant couples conducted in 2014 in Switzerland. I found that all the women’s changes of their drinking had been their personal choice and had been seldom discussed with their partners. While women’s responses to risk discourses reflected their engagement in self-surveillance, most of the men were actively involved in their partners’ self-regulation, in terms of support for the transition to abstinence, endorsement of maternal responsibility, and monitoring the woman’s behaviour. I show that the management of the risks related to alcohol consumption was a matter of co-surveillance, rather than of self-surveillance. Although co-surveillance was most often experienced as shared responsibility, some couples experienced conflicts that emphasised the moral meaning of risk related to alcohol consumption during pregnancy.     

A grouped data regression approach to estimating economic and social influences on individual drinking behaviour

General Household Survey (GHS) data sets, covering the period 1978-1990, are pooled to investigate the relationship between the riskiness of individuals' self-reported drinking behaviour and a wide range of personal characteristics and economic factors. A grouped data regression approach is used to reduce problems with the inaccuracy of self-reports of alcohol consumption and clustering of observations in the consumption data. Results for males aged 18 to 24 years are presented, and possible methods for interpreting the results of grouped data regression are illustrated. Controlling for other factors, current smokers are estimated to be at a 75% higher risk of drinking over recommended levels than non-smokers. Particular attention is paid to the interactions between the price of alcohol, income and heavy drinking. At average levels of income, a 5% increase in the real price of alcohol is predicted to reduce the probability of 'at-risk' drinking by 1.5%. At lower initial levels of income, drinking patterns are found to be more responsive to both price and income changes. Grouped data regression is proposed as a way of focusing policy analysis on individual risks of alcohol-related health and social problems.     

Critical incidents and invulnerability to risk: Young people's experience of serious health-related incidents and their willingness to take health risks

Previous research has established that young people tend to operate with a sense of invulnerability when it comes to risk-taking behaviour. This paper initially investigates the possibility that this might be a product of their relative lack of exposure to situations or events which involve death or serious threats to health. It then considers the thesis that exposure to such ‘serious health-related incidents’ will act as’ critical incidents' affecting the health-related behaviour of young people. Findings are based on the ESRC-funded research project Critical Incidents and Risk-Taking Behaviour Among Schoolchildren (R000 22 1802) which has investigated perceptions of risk and the consumption of alcohol and tobacco by 15-to 16-year-olds in a central region of England. The research reveals a high level of exposure to ‘serious health-related incidents’ and the findings provide some modest support for this thesis that these act as ‘critical incidents’ shaping the willingness of the young people to take risks with their health. However, the findings also indicate signficant limitations to the thesis. These limitations are discussed and it is concluded that they stem from the use of ‘expert opinion’ and ‘medical models’ of health as the bases for identifying critical incidents.     

GPs and the social amplification of BSE-related risk: An empirical study

Social studies of risk have consistently shown that physicians and health professionals are viewed by the general public as a trustworthy source of information and communication regarding risks. However, few if any empirical investigations have focused on the role physicians, particularly general practitioners (GPs), may play as a ‘social station’ in the processes of amplification or attenuation of risks to health that Kasperson et al described in their framework. The purpose of the present study is to investigate whether French GPs acted as amplifiers or attenuators in the BSE (‘mad cow disease’) crisis. A sample of 602 general practitioners completed a questionnaire aimed at assessing in a variety of ways their cognitive, affective and behavioural responses to BSE. Results show that, (1) GPs expressed moderate concern about BSE-related risks: Mad cow disease only ranked tenth in averaged ratings of 14 current risks to health. (2) However, about 90% of respondents reported having recommended one or several modifications in their patients' food habits. Remarkably, only 44% did the same at home. (3) By far the most common recommendation was to avoid organ meats from cattle, even though specified risk materials (which included some of those cuts) had been withdrawn from the market as early as April 1996. Such results point to potentially complex—perhaps even contradictory—responses to BSE from the GPs, with a clear dichotomy between reported private and professional behaviour. Our data suggest that social agents may act simultaneously as risk amplifiers and risk attenuators depending on the public towards which their communication was directed.     

The reliability of personal alcohol consumption estimates in a working population

Health and safety problems related to alcohol consumption represent a major concern in many businesses and consequently pre-employment questionnaires and workplace health promotion packages frequently contain questions seeking basic estimates of alcohol consumption. Although individuals with very heavy drinking patterns often attract much attention, on a population basis most morbidity is likely to arise from drinkers consuming above the recommended limits but not sufficient to result in gross occupational or social effects. This study reviews the research on the reliability of questionnaire techniques used to quantify alcohol consumption and compares the most valid retrospective interview based estimate of consumption, the time line follow-back (TLFB), with a prospective daily diary (DD) method in a working population. The DD method was acceptable and produced significantly higher estimates of consumption and for 'normal' subjects gave consistent estimates of +/- 10 units/week over several weeks. Appropriate questionnaire design is discussed and the use of a DD method in health promotion activities recommended.