Applying an intersectional lens to alcohol inequities: A conceptual framework

Abstract

Background: Prior research has demonstrated substantial inequities in alcohol consumption, alcohol-related harms, and mortality. These inequities arise from a complex interplay of factors, unlikely addressed by single factor analyses or solutions. Conceptual frameworks, such as the National Institute on Minority Health and Health Disparities (NIMHD) Research Framework, aim to reflect this complexity and support multifaceted research and action. This paper adapts the NIMHD Framework to focus on alcohol-related inequities and integrate core intersectionality principles.

Method: We developed the Intersectional Alcohol Inequities Framework (IAIF) through collaboration among leading scholars in alcohol, intersectionality, and policy modelling. In a workshop centred on the core ideas of intersectional frameworks, we identified key factors influencing alcohol consumption and related harms, using the United States as a case study. Using thematic analysis, we grouped the discussion points, then mapped them against the NIMHD Framework. We searched the literature to expand upon workshop insights, iteratively refining the framework until reaching idea saturation.

Results: To align with the core ideas of intersectionality, the IAIF introduced new elements absent in the NIMHD Framework, specifically a 'power' domain, a 'historical' level, and emphasis on relationality. We also incorporated a 'digital environment' domain, to reflect an important element of contemporary social context, as previously identified by other health equity scholars. We provided examples of their relevance to alcohol inequities, highlighted practical applications for stakeholders, and discussed adaptability to other public health issues and contexts.

Conclusions: The Intersectional Alcohol Inequities Framework offers a tool for critical dialogue on how various factors, across multiple levels and domains, intersect to influence alcohol-related outcomes. It can provide support and guidance for researchers, facilitate the identification of research needs and gaps in current policies, support the design of new policies and interventions, and inform comprehensive patient management.

Keywords: alcohol; conceptual framework; inequities; intersectionality; substance use; theory.