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. 2016 Sep 28;11(9):e0160666.
doi: 10.1371/journal.pone.0160666. eCollection 2016.

Deconstructing the Alcohol Harm Paradox: A Population Based Survey of Adults in England

Emma Beard  1   2 , Jamie Brown  1   2 , Robert West  2 , Colin Angus  3 , Alan Brennan  3 , John Holmes  3 , Eileen Kaner  4 , Petra Meier  3 , Susan Michie  1
Affiliations

Deconstructing the Alcohol Harm Paradox: A Population Based Survey of Adults in England

Emma Beard et al. PLoS One. .

Abstract

Background: The Alcohol Harm Paradox refers to observations that lower socioeconomic status (SES) groups consume less alcohol but experience more alcohol-related problems. However, SES is a complex concept and its observed relationship to social problems often depends on how it is measured and the demographic groups studied. Thus this study assessed socioeconomic patterning of alcohol consumption and related harm using multiple measures of SES and examined moderation of this patterning by gender and age.

Method: Data were used from the Alcohol Toolkit Study between March and September 2015 on 31,878 adults (16+) living in England. Participants completed the AUDIT which includes alcohol consumption, harm and dependence modules. SES was measured via qualifications, employment, home and car ownership, income and social-grade, plus a composite of these measures. The composite score was coded such that higher scores reflected greater social-disadvantage.

Results: We observed the Alcohol Harm Paradox for the composite SES measure, with a linear negative relationship between SES and AUDIT-Consumption scores (β = -0.036, p<0.001) and a positive relationship between lower SES and AUDIT-Harm (β = 0.022, p<0.001) and AUDIT-Dependence (β = 0.024, p<0.001) scores. Individual measures of SES displayed different, and non-linear, relationships with AUDIT modules. For example, social-grade and income had a u-shaped relationship with AUDIT-Consumption scores while education had an inverse u-shaped relationship. Almost all measures displayed an exponential relationship with AUDIT-Dependence and AUDIT-Harm scores. We identified moderating effects from age and gender, with AUDIT-Dependence scores increasing more steeply with lower SES in men and both AUDIT-Harm and AUDIT-Dependence scores increasing more steeply with lower SES in younger age groups.

Conclusion: Different SES measures appear to influence whether the Alcohol Harm Paradox is observed as a linear trend across SES groups or a phenomenon associated particularly with the most disadvantaged. The paradox also appears more concentrated in men and younger age groups.

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Conflict of interest statement

EB's and SM's salaries are funded by the NIHR SPHR. EB is also funded by Cancer Research UK (CRUK). JB is funded by CRUK and the Society for the Study of Addiction; RW is funded by CRUK. EB and JB have both received unrestricted research funding from Pfizer, including for the Smoking Toolkit Study (a sister survey of the ATS). RW has received travel funds and hospitality from, and undertaken research and consultancy for, pharmaceutical companies that manufacture and/or research products aimed at helping smokers to stop. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

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