Scottish Health Survey - topic report: equality groups

4 Alcohol Consumption

SUMMARY

• Men were more likely than women to drink at hazardous or harmful levels and to exceed the daily recommended alcohol units.
• Weekly alcohol consumption generally decreased with age, with 16-24 year olds consuming the most. The proportion exceeding daily limits was similar between the ages of 16 to 54 before declining for older groups.
• Pakistani, Chinese, Other Asian, and African, Caribbean or Black respondents were all significantly less likely to drink at hazardous or harmful levels than the national average.
• People who belonged to no religious group were most likely to drink excessively whilst Muslims, Hindus and Buddhists were the least likely religious groups to drink at hazardous or harmful levels.
• Respondents with a disability were less likely to drink excessively and to exceed daily limits than those who did not.
• Respondents who identified themselves as lesbian or gay were significantly more likely to drink at hazardous or harmful levels than the national average.

4.1 Alcohol consumption recommendations

The recommended sensible drinking guideline in the UK is that women should not regularly drink more than 2-3 units of alcohol per day and men should not regularly exceed 3-4 units a day. In addition, the Scottish Government recommends that everyone aim to have at least 2 alcohol free days per week. Over the course of a week, it is also recommended that women and men should not exceeded 14 units and 21 units respectively. The term 'harmful drinking' is used to describe those who are drinking at a level which is already causing physical, social or psychological harm. People whose drinking is not currently causing clear evidences of harm, but which may cause harm in the future have been described as 'hazardous' drinkers.¹ In terms of units, men who consume over 21 and up to 50 units per week and women who consume over 14 and up to 35 units are usually classes as 'hazardous' drinkers, while those who consume above 50/35 units a week are considered to be drinking at 'harmful' levels.²

4.2 Measures of alcohol consumption

Three aspects of alcohol consumption are measured in the Scottish Health Survey: typical weekly consumption, consumption on the heaviest drinking day, and indicators of a potential drinking problem (including physical dependence).

To estimate weekly consumption, participants aged 16 and over were asked preliminary questions on whether they drank alcohol at all; followed by questions on how often during the past 12 months they had drunk each of six different types of alcoholic drink:

• normal beer, lager, cider and shandy
• strong beer, lager and cider
• sherry and martini
• spirits and liqueurs
• wine
• alcoholic soft drinks ("alcopops").

The average number of days a week the participant had drunk each type of drink was estimated from these questions. A follow-up question asked how much of each drink type they had usually drunk on each occasion. These data were converted into units of alcohol and multiplied by the amount they said they usually drank on any one day (see notes for discussion of this process).³

Because the survey's estimates of alcohol consumption are based on self-reported data, it should be noted that surveys often obtain lower estimates of consumption than implied by alcohol sales data. The most recently available estimates of alcohol sales in Scotland show that 11.2 litres of pure alcohol per person aged 16 and over were sold in 2011. This volume is sufficient for every adult to exceed the weekly recommended limits for men of 21 units. Although survey estimates are typically lower than sales estimates, surveys can provide information about the social patterning of individuals' alcohol consumption which sales data cannot. For example, the analysis presented in this report by equality group would not be possible with sales data.

Daily consumption was measured by asking about drinking in the week preceding the interview, and looked at actual consumption on the heaviest drinking day in that week.⁴ The questions asked for details of the amounts consumed of each of the six types of drink listed above, rather than asking participants to give a direct estimate of units consumed. This part of the process was therefore similar to the one used to estimate weekly drinking.

The CAGE questionnaire was asked of participants aged 16 and over, and highlights up to six indicators of problem drinking, including three indicators of physical dependency on alcohol. Due to the sensitive nature of the questions, this questionnaire was administered in self-completion format.

4.3 Alcohol consumption by gender

Men were more likely than women to be hazardous or harmful drinkers (27% of men drank at hazardous or harmful levels compared to 19% of women). They were also significantly more likely to drink above the recommended daily limit on their heaviest drinking day in the previous week (43% of men compared to 34% of women).

These findings support gendered differences in drinking behaviour found elsewhere.⁵

4.4 Alcohol consumption by age

Prevalence of hazardous or harmful drinking was greatest among 16-24 year olds (30%) and dropped to 23%-26% between the ages of 25-64 before falling to 18% for 65-74 year olds and 10% for those aged 75 and over. The proportion of 16-24 year olds drinking above daily recommended limits on their heaviest drinking day was not significantly different from other age groups under 55 (figures ranged from 45% to 47%). From the age of 55 onwards, the proportion of adults drinking over the daily limit decreased with increasing age, reducing to 9% for the 75 and over age group.

Figure 4A :Proportion of adults drinking at hazardous/harmful levels, by age, 2008-2011 combined

4.5 Alcohol consumption by ethnic group

White ethnic groups were broadly similar to each other in terms of weekly alcohol consumption. Pakistani (3%), Chinese (4%), Other Asian (4%) and African, Caribbean or Black respondents (7%) were all significantly less likely to drink at hazardous or harmful levels than the national average (23%).

In relation to exceeding daily limits, the picture was similar but in addition, the White Other group (27%) was significantly less likely to drink above limits than the national average (39%). Pakistani and Chinese respondents (both 4%) were again significantly less likely than White British (40%) and White Irish respondents (41%) to have exceeded the daily limit on their heaviest drinking day. Previous studies have found similar ethnic differences in drinking behaviour; for example, alcohol-related mortality is higher in men and women born in the UK than those born in Pakistan.⁶ Furthermore, Indian, Chinese, and Pakistani youths in Glasgow were found to consume less alcohol than the general population.⁷

African, Caribbean or Black respondents (19%) were also significantly less likely than to be drinking above daily limits than the national average.

Figure 4B: Proportion of adults exceeding daily alcohol limits, by ethnic group, 2008-2011 combined

4.6 Alcohol consumption by religion

Muslims, Hindus and Buddhists were the least likely religious groups to drink at hazardous or harmful levels with 5%, 6% and 10% doing so respectively. Christian faiths (Church of Scotland, Roman Catholic and other Christians) were significantly more likely to drink at hazardous or harmful levels than Muslims, Hindus and Buddhists.

Very few Muslims (2%) reported exceeding daily limits; significantly less than Hindus (14%) and Buddhists (16%), and substantially less than those with Christian faiths (ranging between 32% and 40%) and those who did not belong to any religious group (41%).

Figure 4C: Proportion exceeding daily alcohol limits, by religion, 2008-2011 combined

A notable finding is that respondents who did not belong to any religious group were the most likely to drink excessively. 26% reported drinking at hazardous or harmful levels, significantly higher than the average (23%) and 41% exceeded daily limits compared to the average of 39%. The difference in alcohol consumption between religious and non-religious adults has been noted in previous research. For example, in a study of drinking behaviours in greater Glasgow, those who professed a religious belief were found to drink less alcohol.⁸

4.7 Alcohol consumption by disability

Respondents who reported a disability were less likely to drink excessively than those who did not. 19% of respondents with a limiting long-term condition drank at hazardous or harmful levels compared with 24% of those without a long-term condition. They were also significantly less likely to exceed daily limits (31% compared to 41%).

There was no difference in alcohol consumption between those with a non-limiting condition and those without a condition.

4.8 Alcohol consumption by sexual orientation

Respondents who identified themselves as lesbian or gay (34%) were significantly more likely to drink at hazardous or harmful levels than the average (23%). They were also more likely to exceed daily limits (50%) as were those who identified themselves as bisexual (49%) when compared to the average (39%). There was no significant difference in alcohol consumption between non-heterosexual groups, although gay and lesbian respondents had the highest levels of both hazardous/harmful drinking and exceeding daily limits. This corroborates with other research that found that lesbians and gay men may be at increased risk due to high levels of drinking and smoking.⁹

Those who preferred not to answer the question on sexuality were significantly less likely to exceed daily limits and drink at hazardous / harmful levels than those who identified themselves as heterosexual, gay, lesbian or bisexual.