The enigma of 'harmful' alcohol consumption: evidence from a mixed methods study involving female drinkers in Scotland.

BACKGROUND/AIMS: An appreciation of the drinking patterns of population subgroups may usefully inform tailored interventions. For this purpose, research has highlighted a need to better describe the drinking behaviour of UK women. This study aims to characterise the purchasing and consumption behaviour of female heavy, harmed, drinkers in contact with Scottish health services in two cities and to explore the factors that influence the link to harm. METHODS: Mixed methods study involving cross-sectional survey questionnaires and one-to-one interviews (5). The questionnaires documented (1) demographic data (including derived deprivation score), last week's (or 'typical' weekly) consumption (type, brand, volume, price, place of purchase), self-reported illnesses, and (2) Alcohol-Related Problem Questionnaire score. A total of 181 patients with serious health problems linked to alcohol were recruited within National Health Service (NHS) hospital clinics (in- and outpatient settings), in two Scottish cities during 2012. RESULTS: Median consumption was 157.6 UK units for the recorded week, with almost exclusive purchase from 'off-sale' retail outlets. Preferred drinks were white cider, vodka and white wine. Increasing problems was positively associated with drinking more in the week, being younger and belonging to Glasgow. CONCLUSION: For Scottish women, the current definition of 'harmful' consumption likely captures a fourfold variation in alcohol intake, with gender differences less apparent. While current alcohol-related harm is positively associated with dose and being younger, there is clear evidence of an influence of the less tangible 'Glasgow effect'. Future harm concerns are warranted by data relating to pattern, alcohol dose and cigarette use.

The total margin of exposure of ethanol and acetaldehyde for heavy drinkers consuming cider or vodka.

Heavy drinkers in Scotland may consume 1600 g ethanol per week. Due to its low price, cider may be preferred over other beverages. Anecdotal evidence has linked cider to specific health hazards beyond other alcoholic beverages. To examine this hypothesis, nine apple and pear cider samples were chemically analysed for constituents and contaminants. None of the products exceeded regulatory or toxicological thresholds, but the regular occurrence of acetaldehyde in cider was detected. To provide a quantitative risk assessment, two collectives of exclusive drinkers of cider and vodka were compared and the intake of acetaldehyde was estimated using probabilistic Monte-Carlo type analysis. The cider consumers were found to ingest more than 200-times the amount of acetaldehyde consumed by vodka consumers. The margins of exposure (MOE) of acetaldehyde were 224 for the cider and over 220,000 for vodka consumers. However, if the effects of ethanol were considered in a cumulative assessment of the combined MOE, the effect of acetaldehyde was minor and the combined MOE for both groups was 0.3. We suggest that alcohol policy priority should be given on reducing ethanol intake by measures such as minimum pricing, rather than to focus on acetaldehyde.

Is it my job? Alcohol brief interventions: knowledge and attitudes among future health-care professionals in Scotland.

AIMS: To document knowledge and perceptions relating to the professional role in the area of alcohol misuse within a sample of first year (n = 278) and final year (n = 527) medical, nursing and allied health professional (NAHP) students in Scotland. METHODS: A cross sectional survey design involving self-completed questionnaires administered in autumn 2008 (first year students) and spring 2009 (final year students) through course websites and lectures. RESULTS: Gaps in the knowledge relating to current UK health guidelines were identified but more so among NAHP students than medical students. Exploration of the perceived role in this area of practice identified three broad groups of students: those clear about their role (medical and nursing students), those advocating a role but not identified by fellow students (occupational therapy and pharmacy) and those uncertain of their role (radiographers, speech and language therapists/audiologists and physiotherapy). CONCLUSIONS: Higher education institutions should address the gaps in the knowledge around guidance for alcohol consumption. The effectiveness of brief interventions may depend on it. Additionally, through inter-professional teaching and in collaboration with the relevant professional bodies, more could be done to promote the contribution of practitioners other than those traditionally linked (i.e. medical and nursing) to this important clinical role.

Healthcare and medical graduates of 2009: their reactions to four key proposals in the Scottish Government's strategy for tackling alcohol misuse.

AIMS: This study compares the views of final year medical, and nursing and allied health professional (NAHP) students in relation to four governmental proposals impacting on the sale and purchase of alcohol. METHODS: Against a background of political will to address alcohol abuse in Scotland and moves within the National Health Service promoting a shifting of professional roles, self-completed questionnaires were administered in spring 2009 through course websites and lectures to final year medical and NAHP students. RESULTS: Questionnaires were returned by 406 NAHPs and 121 medical students. Over three quarters of all students agreed with the proposed change to reduce the drink driving limit to 50 mg/100 ml blood. Less support was evident for the raising of the minimum legal purchase age for off-sales (37%), the banning of below cost price promotions of alcohol (47%) and minimum retail pricing (37%). However, there were differences between the NAHP and medical students in the case of the final two proposals; over 60% of the medical students agreed they would have a positive impact. For NAHPs, figures were 41% and 31%, respectively. CONCLUSIONS: Support for four key proposals outlined by the Scottish Government to address alcohol misuse varied. Only the suggestion to lower the drink driving limit received backing overall and within students in these professions. Effectiveness of proposed restrictions on the price of alcohol was less well regarded except by medical students. Evident gaps in knowledge around health guidelines, and the finding that almost half of NAHPs disagreed that they had the appropriate knowledge to advise patients about responsible drinking advice and alcohol misuse problems, suggest a need for improved undergraduate education and continued professional development with respect to public health aspects of alcohol use.

'Binge drinking? It's good, it's harmless fun': a discourse analysis of accounts of female undergraduate drinking in Scotland.

Binge drinking in young people, particularly females and students, is a source of some concern to those engaged in health education. The concept is usually defined in terms of quantities of alcohol consumed within a relatively short space of time. Research suggests that reasons for drinking are varied, and are likely to be influenced by culture and context. This study aimed to explore issues important to female undergraduate students in Scotland. Semi-structured interviews were carried out with 19 participants who were asked to describe what they understand by the term 'binge drinking', why they drink and what might trigger excessive consumption. Discourse analysis was used to explore the possible 'functions' of what was said, as well as the content. Participants showed sensitivity to how others might interpret their responses. They described binge drinking in terms of its behavioural effects rather than quantities consumed. Crucially, they positioned themselves outside the categories of 'serious' or 'anti-social' drinkers. These findings have important implications for our understanding of factors influencing drinking behaviour in this group of people, which in turn impacts on the potential design of health-enhancing interventions. The study also demonstrates the usefulness of a discourse analytic approach to accounts of drinking behaviour.

Descriptors and accounts of alcohol consumption: methodological issues piloted with female undergraduate drinkers in Scotland.

Excessive drinking among young women continues to attract adverse media attention and is the target of UK government-led initiatives. Reliable research on alcohol consumption is needed to inform/evaluate public health interventions. This pilot study, investigating descriptors of alcohol drinking in female Scottish undergraduate students, comprised: (i) self-completed questionnaire survey (n = 95) and (ii) interview plus test pouring of a 'drink' (n = 19). Self-reports by 70% of drinkers (n = 90) indicated alcohol consumption for the 'week past' meriting classification as 'binge' drinking, and 83% of this group reported drinking in this fashion at least fortnightly. However, binge drinking may be underestimated since poured drinks were measured to be on average double the alcohol content of a standard drink, drinking often occurred outwith licensed premises and respondents preferred to quantify consumption in (fractions of) bottles, rather than glasses. Qualitative analysis showed that interviewees oriented to drinking as an accountable practice but were unaware of the clinical definition of binge drinking. They defined it in terms of the effect of alcohol consumed on individual behaviour, not in absolute quantities. Given the unreliability of self-reported consumption, future health surveys and initiatives should consider 'quantifying' alcohol in a way more meaningful to the population of interest, in terms of effect.

Variation in the alcohol content of a 'drink' of wine and spirit poured by a sample of the Scottish population.

The standard UK alcohol unit is used to record alcohol consumption and, in health promotion, as a useful yardstick by which the public may be encouraged to monitor their own drinking levels. To investigate the correspondence between this standard unit and the actual amount contained in the 'usual' drink poured by a sample of the Scottish public, participants (n=251) were recruited from three employers in a major city--a manufacturer, an academic and a financial institution. Following a brief questionnaire, participants were asked to pour their usual drink of wine, and then spirit, into a glass. Among drinkers (n=238), the mean amount of alcohol in a drink of wine corresponded to not 1, but 1.92 UK units. For spirit, the corresponding figure was 2.3 UK units. For wine, 43% of the sample poured more than 2 units, for spirit, 55%. (Males poured significantly more spirit than females.) These findings may have important implications for individuals who wish to promote and to adopt sensible drinking practices when consuming wine and spirit at home. Also, the reliability of many consumption surveys, where there is often the implicit assumption that a 'drink' is equivalent to a 'standard unit', must be questioned.

Reported levels of alcohol consumption and binge drinking within the UK undergraduate student population over the last 25 years.

Results of a literature review of 18 studies investigating the drinking behaviour of undergraduate students at UK universities over a period of 25 years are presented. While comparison between studies is complicated by inconsistencies in the terms employed to describe drinking behaviour, it is concluded that significant numbers of both male and female students are reported to exceed sensible weekly consumption guidelines. Recorded levels of binge drinking among both female and male students are extremely variable between studies. Further research is needed to clarify this position. However, if the most recent research evidence is substantiated, female and male binge drinking levels may exceed those of their peers in the general population and their US counterparts. The reported ramifications of harmful drinking for the health and well-being of students are reviewed. A possible link between poor academic performance and alcohol consumption appears tenuous and merits further investigation. Evidence relevant to the view that the drinking behaviour of female students is changing is considered.