The Nature of Prejudice

Objectives To examine the suitability of age specific limits for alcohol consumption and to explore the association between alcohol consumption and mortality in different age groups.

Design Population based data from Health Survey for England 1998-2008, linked to national mortality registration data and pooled for analysis using proportional hazards regression. Analyses were stratified by sex and age group (50-64 and ≥65 years).

Setting Up to 10 waves of the Health Survey for England, which samples the non-institutionalised general population resident in England.

Participants The derivation of two analytical samples was based on the availability of comparable alcohol consumption data, covariate data, and linked mortality data among adults aged 50 years or more. Two samples were used, each utilising a different variable for alcohol usage: self reported average weekly consumption over the past year and self reported consumption on the heaviest day in the past week. In fully adjusted analyses, the former sample comprised Health Survey for England years 1998-2002, 18 368 participants, and 4102 deaths over a median follow-up of 9.7 years, whereas the latter comprised Health Survey for England years 1999-2008, 34 523 participants, and 4220 deaths over a median follow-up of 6.5 years.

Main outcome measure All cause mortality, defined as any death recorded between the date of interview and the end of data linkage on 31 March 2011.

Results In unadjusted models, protective effects were identified across a broad range of alcohol usage in all age-sex groups. These effects were attenuated across most use categories on adjustment for a range of personal, socioeconomic, and lifestyle factors. After the exclusion of former drinkers, these effects were further attenuated. Compared with self reported never drinkers, significant protective associations were limited to younger men (50-64 years) and older women (≥65 years). Among younger men, the range of protective effects was minimal, with a significant reduction in hazards present only among those who reported consuming 15.1-20.0 units/average week (hazard ratio 0.49, 95% confidence interval 0.26 to 0.91) or 0.1-1.5 units on the heaviest day (0.43, 0.21 to 0.87). The range of protective effects was broader but lower among older women, with significant reductions in hazards present ≤10.0 units/average week and across all levels of heaviest day use. Supplementary analyses found that most protective effects disappeared where calculated in comparison with various definitions of occasional drinkers.

Conclusions Beneficial associations between low intensity alcohol consumption and all cause mortality may in part be attributable to inappropriate selection of a referent group and weak adjustment for confounders. Compared with never drinkers, age stratified analyses suggest that beneficial dose-response relations between alcohol consumption and all cause mortality may be largely specific to women drinkers aged 65 years or more, with little to no protection present in other age-sex groups. These protective associations may, however, be explained by the effect of selection biases across age-sex strata.

https://www.bmj.com/content/bmj/350/bmj.h384.full.pdf

All cause mortality and the case for age specific alcohol consumption guidelines: pooled analyses of up to 10 population based cohorts

Low immigrant mortality in England and Wales: a data artefact?

Recent research suggests that safer student alcohol consumption might be assisted by understanding how social occasions are managed by non-drinkers. In-depth, semi-structured interviews with five 19 – 22 year old non-drinking English undergraduates were subjected to interpretative phenomenological analysis. We present five inter-linked themes: ‘living with challenges to non-drinking’; ‘seeing what goes on in drinking environments’; ‘dealing with conversations about non-drinking (making excuses vs. coming out)’; ‘knowing which friends care about you’; and ‘the importance of minimising “legroom” for peer pressure’. Participants felt under persistent peer scrutiny (as a form of peer pressure) and could feel alienated in drinking environments. Talking about non-drinking was characterised by whether to ‘come out’ (as a non-drinker) or ‘fake it’ (e.g. ‘I’m on antibiotics’). Loyal friendships were reported as particularly important in this context. The decision not to drink was experienced as providing a successful buffer to peer pressure for former drinkers. Our findings unsettle traditional health promotion campaigns which advocate moderate drinking among students without always suggesting how it might be most successfully accomplished and offer tentative guidance on how non-drinking during specific social occasions might be managed more successfully. Findings are discussed in relation to extant literature and future research directions are suggested.

/pdf/being-a-non-drinking-student-an-interpretative-2fzi7o4gnt.pdf

Being a non-drinking student: an interpretative phenomenological analysis

Objectives. To assess the impact of a mental simulation intervention designed to reduce student alcohol consumption by asking participants to imagine potential positive outcomes of and/or strategic processes involved in not drinking during social occasions. Design. English university students aged 18-25 years (n = 211, M.Age = 20 years) were randomly allocated to one of four intervention conditions. The dependent variables were weekly alcohol consumption, heavy episodic drinking (HED) and frequency of social occasions at which participants did not drink alcohol when others were drinking alcohol ('episodic non-drinking'). Measures of alcohol-related prototypes (i.e., prototypical non-drinker, prototypical regular drinker) were used to compute sociability prototype difference scores as a potential mediator of any intervention effects. All measures were taken at baseline and at two- and four-week follow-up. Methods. Participants completed one of four exercises involving either: imagining positive outcomes of non-drinking during a social occasion (outcome condition); imagining strategies required for non-drinking during a social occasion (process condition); imagining both positive outcomes and required strategies (combined condition); or completing a drinks diary task (control condition). Results. Latent growth curve analyses revealed a more substantial rate of decrease in weekly unit consumption and HED frequency among outcome condition and process condition participants, relative to control condition participants. Non-significant differences were found between the combined condition and the control condition. Across the whole sample, an inverted U-shape trend indicated an initial increase in episodic non-drinking before it returned to baseline levels. Conclusion. This study provides preliminary evidence that mental simulation interventions focused on non-drinking can successfully promote behaviour change.

/pdf/efficacy-of-a-non-drinking-mental-simulation-intervention-3e8we1o3av.pdf

Efficacy of a non-drinking mental simulation intervention for reducing student alcohol consumption

Young people’s drinking is a matter of social, media, and political concern and the focus of much policy activity within the United Kingdom. Little consideration has been given to the fact that some young people choose to drink little or not all and our knowledge and understanding of their choices and how they manage not drinking is limited. Nor has much attention been paid to the possibility that the insights of young light and non-drinkers could be useful when thinking about how to change the prevailing drinking culture, but if we are to gauge and engage with the current culture of consumption then we need to understand all parts of it. This qualitative study of young people (aged 16–25) who drink little or no alcohol aimed to further understanding of their lives and choices. The results highlight that choosing not to drink or drink lightly is a positive choice made for diverse reasons with the strongest messages and influences coming from real-life observations. Young people develop strategies to manag...

/pdf/but-no-one-told-me-it-s-okay-to-not-drink-a-qualitative-5bib2qn3ni.pdf

“But no one told me it’s okay to not drink”: a qualitative study of young people who drink little or no alcohol

This literature review draws together recorded drinking patterns among minority ethnic groups in the UK over the last 15 years and considers the evidence for service provision and support. A recommendation in implementing the Government’s alcohol strategy, Safe. Sensible. Social. is to assess the need for and develop provision for black and minority ethnic groups. This need is heightened by the growing minority ethnic population and changes in consumption levels that may emerge over generations.
The review explores differences in drinking patterns by ethnicity and the cultural and social contexts around which the use of alcohol is established and maintained.
This review:
• describes drinking levels as reported in national surveys and local research;
• considers processes and infl uences that help to explain why drinking rates among ethnic groups in a new country may
change over time;
• examines help-seeking, support and service provision for
minority ethnic groups;
• examines the extent to which services are equipped to respond to the needs of minority ethnic groups.

/pdf/ethnicity-and-alcohol-a-review-of-the-uk-literature-42vxbjhe2m.pdf

Ethnicity and alcohol: a review of the UK literature

This paper reports drinking patterns among minority ethnic groups from the UK literature over the past 15 years, and considers the evidence for service provision and support. Findings show that drinking remains low among minority ethnic groups, though with evidence of increases in consumption, particularly among Indian women and Chinese men. South Asian men, particularly Sikh men, are over‐represented for liver cirrhosis, and some ethnic groups have higher than national average alcohol‐related deaths. People from black and minority ethnic backgrounds have similar rates of alcohol dependency as the white population; however services do not appear to be responsive enough to the needs of minority ethnic groups as they are under‐represented in seeking treatment and advice for drinking problems. Help‐seeking preferences vary for drinking problems between and within groups suggesting that drinking problems need to be addressed within both mainstream and specialist services. Greater understanding of cultural issues is needed in the development of alcohol services in mainstream and specialist settings.

Drinking patterns and alcohol service provision for different ethnic groups in the UK: A review of the literature

This study examined the lives and choices of young people (aged 16-25) living in the UK who drink little or no alcohol.
Current policy is directed at young people who drink alcohol with little attention paid to the insights of those who drink lightly or not at all. The influences that shape young people’s decisions and how their choices and patterns of consumption affect their lives were explored through interviews.
The report:
• examines current drinking patterns and identifies five ‘drinking types’;
• highlights that choosing not to drink alcohol or to drink lightly is a commonplace and positive choice;
• explores the influences and experiences that led young people to their choices and identifies three ‘narratives’ encapsulating their journeys;
• considers the strategies and responses young people employ to manage not drinking or drinking lightly; and 
• critically examines the widely held assumption that drinking is part of‘growing up’ and discusses how ‘not drinking’ could be supported as a valid choice.

A positive choice: young people who drink little or no alcohol

This report explores the links between young people’s interethnic friendships and their drinking patterns and behaviours.
Britain is a multicultural society, but little is currently known about if, and how, young people mix with friends from different ethnic backgrounds and the potential impact of this on drinking attitudes and behaviours. Research was undertaken to examine these links using quantitative and qualitative methods among a sample of 14-and 15-year-olds in diverse locations in London and Berkshire.
The report:
• explores the intra- and interethnic mix of young people’s
friendship groups as described by young people in
questionnaires and interviews;
• analyses how drinking patterns vary by ethnicity, religion and gender;
• investigates the links between young people’s background
characteristics, their friendship groups (including the ethnicity of friends) and their reported drinking rates; and
• looks at the implications of the findings, including
recommendations for harm reduction based on education and
peer support programmes.

/pdf/teenage-drinking-and-interethnic-friendships-4k6li6jxkt.pdf

Rachel Hurcombe

Papers

“But no one told me it’s okay to not drink”: a qualitative study of young people who drink little or no alcohol

Ethnicity and alcohol: a review of the UK literature

Drinking patterns and alcohol service provision for different ethnic groups in the UK: A review of the literature

A positive choice: young people who drink little or no alcohol

Teenage drinking and interethnic friendships.