Academic journal article Perspectives in Public Health

The Enigma of 'Harmful' Alcohol Consumption: Evidence from a Mixed Methods Study Involving Female Drinkers in Scotland

Academic journal article Perspectives in Public Health

The Enigma of 'Harmful' Alcohol Consumption: Evidence from a Mixed Methods Study Involving Female Drinkers in Scotland

Article excerpt


Alcohol-related harm to health and wellbeing is well documented in international literature. Considerable reactive research has been directed at the characterisation of the drinking behaviours of population subgroups to develop tailored interventions. One consideration is gender. Given a similar dose of alcohol, physiological differences explain the increased female vulnerability to alcohol's toxic effects compared with males. Gender variance is acknowledged in establishing national consumption guidelines including the United Kingdom.1

Several recent reports emphasise aspects of concern relating specifically to the repercussions of women's alcohol consumption in the United Kingdom. in 2015, the report by the intergovernmental Organisation for economic Co-operation and Development (OeCD)2 singled out 'dangerous drinking among better-educated women' as a contributory factor to the rise in UK consumption since the 1980s and contrary to the trend recorded in other industrialised countries. in their review, Smith and Foxcroft3 also highlighted the important changes which have occurred in female drinking within the United Kingdom in recent decades, accentuating issues pertaining to older women - a theme informing the work of emslie et al.4 in relation to mortality, the female death rate attributable to alcohol in Scotland is lower than that of men at 14.4 per 100,000 population, but almost twice that of women in other UK regions (england and wales: 7.7 per 100,000) (eASr, european Age-Standardised rate).5,6 indeed, female alcohol-related death rates in Scotland resemble those of english males, comparing unfavourably with those of european Union counterparts.7 while recently within the United Kingdom there has been a modest fall in deaths overall, a rise in alcohol-related mortality in women born in the 1970s in deprived cities within the United Kingdom (including Glasgow) was reported by Shipton et al.8 who warned of the need for policy response.

UK female consumption is defined as 'hazardous' (exceeding weekly limits of 14 UK units) or 'harmful' (>35 units per week), where 1 UK alcohol unit equals 8 g of ethanol.5 Scottish Health Survey (SHeS) data suggest almost one in six Scottish women drink at harmful or hazardous levels.9 However, the UK prevalence of female 'harmful' drinking is likely underestimated for several reasons; drinkers may be omitted from population surveys because their lifestyle precludes their participation or they may selfexclude. Furthermore, within national surveys, under-reporting is commonplace.10 Beeston et al.11 estimated that self-reported Scottish adult consumption in 2012 equated to only 54% of that predicted by retail sales data. Our previous work demonstrated that the defined threshold for 'harmful consumption' is considerably below that at which women receive treatment; among Scottish women attending services or admitted to hospital for alcohol-related harm, median consumption (most recent or typical week) was 143.1 UK units (interquartile range (iQr) = 121.29)12 (approximately four times the accepted definition).

Another important factor which influences the relationship between female alcohol consumption and harm is deprivation. in 2013/2014, alcoholrelated hospital stays for women were 5.8 times greater in the most deprived decile than in the least13 (eASr, excludes obstetric and psychiatric). in 2011, alcohol-related mortality rates (both genders) in the most deprived decile were 7.7 times those of the least deprived.5 The precise detail of the interplay between alcohol intake, harm and deprivation is still debated.14,15 For example, the health gap, illustrated by the excess adult mortality now linked to alcohol, drugs, suicide and violence in Scotland when compared to england and wales, is not explained simply by deprivation and has been referred to as the 'Scottish' or 'Glasgow' effect.16

An interest in the price paid per drink, and associated harms, seems to have been a relatively recent topic in the public health discussion of alcoholrelated disease and social damage. …

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