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Social Determinants of Alcohol Use and Its Consequences

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (31 May 2022) | Viewed by 38577

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Dr. Charlotte Probst

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Guest Editor

1. Heidelberg Institute of Global Health, Universitätsklinikum Heidelberg, 69120 Heidelberg, Germany
2. Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON M5S 2S1, Canada
Interests: population health modeling; epidemiology of alcohol use and attributable burden of disease; social determinants of health; socioeconomic inequality

Dr. Shannon Lange

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Guest Editor

Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON M5S 2S1, Canada
Interests: population health modeling, epidemiology of suicidal thoughts and behaviors, alcohol-attributable harm, fetal alcohol spectrum disorder

Special Issue Information

Dear Colleagues,

Alcohol is an established risk factor for a wide range of outcomes, including numerous noncommunicable diseases and nearly all intentional and nonintentional injuries. With over 200 causally related conditions, alcohol use is known to cause around 3 million deaths and over 130 million disability-adjusted life years annually. What these high-level indicators fail to reflect are the health disparities that exist conditional on the social determinants of health, including sex, gender, socioeconomic status, and, in the broader sense, the social, political, and economic conditions in which people live. For instance, there is mounting evidence that the stagnation and following decline in life expectancy in the United States is linked to alcohol use, with individuals in the low socioeconomic strata carrying the largest part of the burden. To understand the full epidemiological picture of alcohol use and its consequences, the role and impact of the diverse social determinants and the inequalities related to them must be studied.

Not only do social determinants influence alcohol use directly, but there are also several examples where they influence the relationship between alcohol use and health outcomes. For example, the relationship between alcohol use and its various outcomes is more often than not found to differ by sex and gender, as is the case with suicide. Women with an alcohol use disorder have been found to have a two-fold higher risk of death by suicide than men with an alcohol use disorder. Furthermore, the risk relationships between alcohol use and health burden likely differ from one country context to another. However, currently, the bulk of evidence on such relationships is based on a fairly uniform group of western, high-income countries.

Moving forward, alcohol use and its consequences must be understood in the context of wider social and economic determinants, rather than considering it merely as individual health behavior. Accordingly, this Special Issue is intended to draw attention to the importance of social determinants of alcohol use and its consequences by providing a forum to publish this line of research.

Dr. Charlotte Probst
Dr. Shannon Lange
Guest Editors

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Keywords

social determinants of health
alcohol use
alcohol use disorders
alcohol-attributable burden
health inequalities

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Published Papers (8 papers)

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16 pages, 381 KiB

Open AccessArticle

Patterns of Alcohol Consumption and Associated Factors in a Population-Based Sample of 70-Year-Olds: Data from the Gothenburg H70 Birth Cohort Study 2014–16

by Felicia Ahlner, Hanna Falk Erhag, Lena Johansson, Madeleine Mellqvist Fässberg, Therese Rydberg Sterner, Jessica Samuelsson, Anna Zettergren, Margda Waern and Ingmar Skoog

Int. J. Environ. Res. Public Health 2022, 19(14), 8248; https://doi.org/10.3390/ijerph19148248 - 6 Jul 2022

Cited by 7 | Viewed by 2249

Abstract

Older adults of today consume more alcohol, yet knowledge about the factors associated with different consumption levels is limited in this age group. Based on the data from a population-based sample (n = 1156, 539 men and 617 women) in The Gothenburg H70 Birth Cohort Study 2014–16, we examined sociodemographic, social, and health-related factors associated with alcohol consumption levels in 70-year-olds, using logistic regression. Total weekly alcohol intake was calculated based on the self-reported amount of alcohol consumed. Alcohol consumption was categorized as lifetime abstention, former drinking, moderate consumption (≤98 g/week), and at-risk consumption (>98 g/week). At-risk consumption was further categorized into lower at-risk (98–196 g/week), medium at-risk (196–350 g/week), and higher at-risk (≥350 g/week). We found that among the 1156 participants, 3% were lifetime abstainers, 3% were former drinkers, 64% were moderate drinkers, and 30% were at-risk drinkers (20% lower, 8% medium, 2% higher). Among several factors, former drinking was associated with worse general self-rated health (OR 1.65, 95% CI 1.08–2.51) and lower health-related quality of life (measured by physical component score) (OR 0.94, 95% CI 0.91–0.97), higher illness burden (OR 1.16, 95% CI 1.07–1.27), and weaker grip strength (OR 0.96, 95% CI 0.94–0.98). Higher at-risk drinkers more often had liver disease (OR 11.41, 95% CI 3.48–37.37) and minor depression (OR 4.57, 95% CI 1.40–14.95), but less contacts with health care (OR 0.32, 95% CI 0.11–0.92). Our findings demonstrate the importance of classifications beyond abstinence and at-risk consumption, with implications for both the prevention and clinical management of unhealthy consumption patterns in older adults. Full article

(This article belongs to the Special Issue Social Determinants of Alcohol Use and Its Consequences)

19 pages, 1054 KiB

Open AccessArticle

Harmful Alcohol and Drug Use Is Associated with Syndemic Risk Factors among Female Sex Workers in Nairobi, Kenya

by Alicja Beksinska, Emily Nyariki, Rhoda Kabuti, Mary Kungu, Hellen Babu, Pooja Shah, The Maisha Fiti Study Champions, Chrispo Nyabuto, Monica Okumu, Anne Mahero, Pauline Ngurukiri, Zaina Jama, Erastus Irungu, Wendy Adhiambo, Peter Muthoga, Rupert Kaul, Janet Seeley, Helen A. Weiss, Joshua Kimani and Tara S. Beattie

Int. J. Environ. Res. Public Health 2022, 19(12), 7294; https://doi.org/10.3390/ijerph19127294 - 14 Jun 2022

Cited by 15 | Viewed by 4469

Abstract

Background: Female Sex Workers (FSWs) are at high risk of harmful alcohol and other drug use. We use quantitative data to describe the prevalence of alcohol and other drug use and identify associated occupational and socio-economic risk factors, and aim to elucidate patterns of alcohol and drug use through information drawn from qualitative data. Methods: Maisha Fiti was a mixed-method longitudinal study conducted in 2019 among a random sample of FSWs in Nairobi, Kenya. We used baseline date from the behavioural–biological survey, which included the WHO Alcohol, Smoking and Substance Involvement Screening Test that measures harmful alcohol and other drug use in the past three months (moderate/high risk score: >11 for alcohol; >4 for other drugs). In-depth interviews were conducted with 40 randomly selected FSWs. Findings: Of 1003 participants, 29.9% (95%CI 27.0–32.6%) reported harmful (moderate/high risk) alcohol use, 21.5% harmful amphetamine use (95%CI 19.1–24.1%) and 16.9% harmful cannabis use (95%CI 14.7–19.2%). Quantitative analysis found that harmful alcohol, cannabis and amphetamine use were associated with differing risk factors including higher Adverse Childhood Experience (ACE) scores, street homelessness, food insecurity (recent hunger), recent violence from clients, reduced condom use, depression/anxiety and police arrest. Qualitative interviews found that childhood neglect and violence were drivers of entry into sex work and alcohol use, and that alcohol and cannabis helped women cope with sex work. Conclusions: There is a need for individual and structural-level interventions, tailored for FSWs, to address harmful alcohol and other drug use and associated syndemic risks including ACEs, violence and sexual risk behaviours. Full article

(This article belongs to the Special Issue Social Determinants of Alcohol Use and Its Consequences)

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15 pages, 885 KiB

Open AccessArticle

Dark Side or Bright Side: The Impact of Alcohol Drinking on the Trust of Chinese Rural Residents

by Jie Dong, Qiran Zhao and Yanjun Ren

Int. J. Environ. Res. Public Health 2022, 19(10), 5924; https://doi.org/10.3390/ijerph19105924 - 13 May 2022

Cited by 3 | Viewed by 2908

Abstract

Existing studies have explored the causal effect of social capital on harmful drinking, while the effect of drinking habits on trust is scant. In China, drinking rituals and drinking culture are considered important ways of promoting social interaction and trust, especially in rural areas where traditional culture is stronger. Based on a field survey in rural China in 2019, this paper explores the relationship between drinking habits and trust. First, we found a negative relationship between drinking habits and trust, indicating that those people who drink alcohol are more likely to have a lower trust. Second, we found significant heterogeneity in the effect of alcohol consumption on social trust across various groups. Specifically, the negative effects of alcohol consumption on trust were stronger for the females than for males; drinking alcohol did not reduce the level of trust among the Chinese Communist Party (CCP) in rural China; compared with the Han nationality, we found that the effect of drinking on trust was not significant for the ethnic minority. Third, we observed that the negative effects of alcohol consumption on trust had thresholds across age and income. Among people under 51, the risk of trust from drinking was greater than for those over 51; the negative effect of drinking on residents’ trust was more obvious in low-income families, but not significant in the group with an annual household income of more than CNY 40,000. Our empirical study provides a deeper understanding of drinking culture in rural China from a dialectical perspective. Full article

(This article belongs to the Special Issue Social Determinants of Alcohol Use and Its Consequences)

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13 pages, 6959 KiB

Open AccessArticle

Is Buying and Drinking Zero and Low Alcohol Beer a Higher Socio-Economic Phenomenon? Analysis of British Survey Data, 2015–2018 and Household Purchase Data 2015–2020

by Peter Anderson, Amy O’Donnell, Daša Kokole, Eva Jané Llopis and Eileen Kaner

Int. J. Environ. Res. Public Health 2021, 18(19), 10347; https://doi.org/10.3390/ijerph181910347 - 30 Sep 2021

Cited by 27 | Viewed by 4691

Abstract

Zero and low alcohol products, particularly beer, are gaining consideration as a method to reduce consumption of ethanol. We do not know if this approach is likely to increase or decrease health inequalities. The aim of the study was to determine if the purchase and consumption of zero and low alcohol beers differs by demographic and socio-economic characteristics of consumers. Based on British household purchase data from 79,411 households and on British survey data of more than 104,635 adult (18+) respondents, we estimated the likelihood of buying and drinking zero (ABV = 0.0%) and low alcohol (ABV > 0.0% and ≤ 3.5%) beer by a range of socio-demographic characteristics. We found that buying and consuming zero alcohol beer is much more likely to occur in younger age groups, in more affluent households, and in those with higher social grades, with gaps in buying zero alcohol beer between households in higher and lower social grades widening between 2015 and 2020. Buying and drinking low alcohol beer had less consistent relationships with socio-demographic characteristics, but was strongly driven by households that normally buy and drink the most alcohol. Common to many health-related behaviours, it seems that it is the more affluent that lead the way in choosing zero or low alcohol products. Whilst the increased availability of zero and low alcohol products might be a useful tool to reduce overall ethanol consumption in the more socially advantageous part of society, it may be less beneficial for the rest of the population. Other evidence-based alcohol policy measures that lessen health inequalities, need to go hand-in-hand with those promoting the uptake of zero and low alcohol beer. Full article

(This article belongs to the Special Issue Social Determinants of Alcohol Use and Its Consequences)

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11 pages, 1183 KiB

Open AccessArticle

Socioeconomic Inequalities in Chronic Liver Diseases and Cirrhosis Mortality in European Urban Areas before and after the Onset of the 2008 Economic Recession

by Carme Borrell, Laia Palència, Lucia Bosakova, Mercè Gotsens, Joana Morrison, Claudia Costa, Dagmar Dzurova, Patrick Deboosere, Michala Lustigova, Marc Marí-Dell’Olmo, Sophia Rodopoulou and Paula Santana

Int. J. Environ. Res. Public Health 2021, 18(16), 8801; https://doi.org/10.3390/ijerph18168801 - 20 Aug 2021

Cited by 12 | Viewed by 3088

Abstract

Objective: To analyse the trends in chronic liver diseases and cirrhosis mortality, and the associated socioeconomic inequalities, in nine European cities and urban areas before and after the onset of the 2008 financial crisis. Methods: This is an ecological study of trends in three periods of time: two before (2000–2003 and 2004–2008), and one after (2009–2014) the onset of the economic crisis. The units of analysis were the geographical areas of nine cities or urban areas in Europe. We analysed chronic liver diseases and cirrhosis standardised mortality ratios, smoothing them with a hierarchical Bayesian model by each city, area, and sex. An ecological regression model was fitted to analyse the trends in socioeconomic inequalities, and included the socioeconomic deprivation index, the period, and their interaction. Results: In general, chronic liver diseases and cirrhosis mortality rates were higher in men than in women. These rates decreased in all cities during the financial crisis, except among men in Athens (rates increased from 8.50 per 100,000 inhabitants during the second period to 9.42 during the third). Socioeconomic inequalities in chronic liver diseases and cirrhosis mortality were found in six cities/metropolitan areas among men, and in four among women. Finally, in the periods studied, such inequalities did not significantly change. However, among men they increased in Turin and Barcelona and among women, several cities had lower inequalities in the third period. Conclusions: There are geographical socioeconomic inequalities in chronic liver diseases and cirrhosis mortality, mainly among men, that did not change during the 2008 financial crisis. These results should be monitored in the long term. Full article

(This article belongs to the Special Issue Social Determinants of Alcohol Use and Its Consequences)

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Review

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17 pages, 878 KiB

Open AccessReview

Alcohol Consumption Patterns: A Systematic Review of Demographic and Sociocultural Influencing Factors

by Abd Alghani Khamis, Siti Zuliana Salleh, Mohd Sayuti Ab Karim, Noor Ashikin Mohd Rom, Shamini Janasekaran, Aida Idris and Rusdi Bin Abd Rashid

Int. J. Environ. Res. Public Health 2022, 19(13), 8103; https://doi.org/10.3390/ijerph19138103 - 1 Jul 2022

Cited by 20 | Viewed by 8396

Abstract

Background: Excessive alcohol consumption has negative effects not only on the drinkers’ health but also on others around them. Previous studies suggest that excessive alcohol consumption can be related to a combination of factors such as age, family background, religiosity, etc. Investigating and clarifying these roots of alcohol consumption is crucial so that the right type of interventions can be designed in a specific and targeted manner. Objectives: This work was conducted as a systematic review to reveal the factors associated with alcohol consumption and to heighten the understanding of the differences among various communities and segments of the population regarding their usage of alcohol. Data sources: A systematic search of Web of Science, PubMed, ScienceDirect, and Google Scholar was performed. Results: Forty-five studies were included in the review after excluding irrelevant records and duplicates. Conclusions: Alcohol consumption patterns can be associated with several factors related to communities and individuals, and our review revealed demographic factors, including age and proximity to alcohol outlets, as well as social factors, including family background, socioeconomic background, and religious influence. These findings can be used to establish a guideline for further studies in understanding alcohol consumption patterns among individuals according to their personal characteristics and sociocultural backgrounds. Full article

(This article belongs to the Special Issue Social Determinants of Alcohol Use and Its Consequences)

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10 pages, 1003 KiB

Open AccessReview

Employment Status and Alcohol-Attributable Mortality Risk—A Systematic Review and Meta-Analysis

by Celine Saul, Shannon Lange and Charlotte Probst

Int. J. Environ. Res. Public Health 2022, 19(12), 7354; https://doi.org/10.3390/ijerph19127354 - 15 Jun 2022

Cited by 5 | Viewed by 2500

Abstract

Being unemployed has been linked to various health burdens. In particular, there appears to be an association between unemployment and alcohol-attributable deaths. However, risk estimates presented in a previous review were based on only two studies. Thus, we estimated updated sex-stratified alcohol-attributable mortality risks for unemployed compared with employed individuals. A systematic literature search was conducted in August 2020 using the following databases: Embase, MEDLINE, PsycINFO, and Web of Science. The relative risk (RR) of dying from an alcohol-attributable cause of death for unemployed compared with employed individuals was summarized using sex-stratified random-effects DerSimonian-Laird meta-analyses. A total of 10 studies were identified, comprising about 14.4 million women and 19.0 million men, among whom there were about 3147 and 17,815 alcohol-attributable deaths, respectively. The pooled RRs were 3.64 (95% confidence interval (CI): 2.04–6.66) and 4.93 (95% CI 3.45–7.05) for women and men, respectively. The findings of our quantitative synthesis provide evidence that being unemployed is associated with an over three-fold higher risk of alcohol-attributable mortality compared with being employed. Consequently, a global public health strategy connecting brief interventions and specialized care with social services assisting those currently unemployed is needed. Full article

(This article belongs to the Special Issue Social Determinants of Alcohol Use and Its Consequences)

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12 pages, 367 KiB

Open AccessReview

Beyond Behaviour: How Health Inequality Theory Can Enhance Our Understanding of the ‘Alcohol-Harm Paradox’

by Jennifer Boyd, Clare Bambra, Robin C. Purshouse and John Holmes

Int. J. Environ. Res. Public Health 2021, 18(11), 6025; https://doi.org/10.3390/ijerph18116025 - 3 Jun 2021

Cited by 24 | Viewed by 7463

Abstract

There are large socioeconomic inequalities in alcohol-related harm. The alcohol harm paradox (AHP) is the consistent finding that lower socioeconomic groups consume the same or less as higher socioeconomic groups yet experience greater rates of harm. To date, alcohol researchers have predominantly taken an individualised behavioural approach to understand the AHP. This paper calls for a new approach which draws on theories of health inequality, specifically the social determinants of health, fundamental cause theory, political economy of health and eco-social models. These theories consist of several interwoven causal mechanisms, including genetic inheritance, the role of social networks, the unequal availability of wealth and other resources, the psychosocial experience of lower socioeconomic position, and the accumulation of these experiences over time. To date, research exploring the causes of the AHP has often lacked clear theoretical underpinning. Drawing on these theoretical approaches in alcohol research would not only address this gap but would also result in a structured effort to identify the causes of the AHP. Given the present lack of clear evidence in favour of any specific theory, it is difficult to conclude whether one theory should take primacy in future research efforts. However, drawing on any of these theories would shift how we think about the causes of the paradox, from health behaviour in isolation to the wider context of complex interacting mechanisms between individuals and their environment. Meanwhile, computer simulations have the potential to test the competing theoretical perspectives, both in the abstract and empirically via synthesis of the disparate existing evidence base. Overall, making greater use of existing theoretical frameworks in alcohol epidemiology would offer novel insights into the AHP and generate knowledge of how to intervene to mitigate inequalities in alcohol-related harm. Full article

(This article belongs to the Special Issue Social Determinants of Alcohol Use and Its Consequences)

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