In this guest blog, Abigail Stevely, a researcher in the Sheffield Alcohol Research Group at the University of Sheffield, explores findings from her new study describing the evidence on how drinking contexts (such as drinking in a pub versus at home) influence the amount we drink and the alcohol-related harm we suffer.
Why drinking context matters
It is increasingly clear that the details of how we drink are important, as well as how much and how often. Research finds that people drink more alcohol when they are pre-drinking, drinking with lots of friends or while loud music is playing.
Drinking context is also related to harm such as increased violence when drinking in pubs.
Policy makers care about drinking context
The UK Government’s 2012 Alcohol Strategy set out intentions to change the drinking culture, making it less excessive and more ‘responsible’. The document also suggests we should aim for drinking to be linked to socialising rather than ‘bad behaviour’.
Whilst debates about personal responsibility versus environmental factors continue, the strategy suggests an intention to reduce harms by changing drinking context. Drinking context is one aspect of drinking culture, which includes how we think about alcohol consumption. If policy-makers want to change drinking contexts to reduce harm, then we first need to understand how drinking contexts are related to harm.
What does my study find?
My study aimed to describe the topics and methods of published research on which drinking contexts are associated with alcohol consumption and acute or short term harms, like unprotected sex. This type of study is called a mapping review and it is particularly helpful for identifying gaps in the evidence that future research can address. This review does not look at the findings of previous studies, although I’m working on it so watch this space!
We found that there is lots of research, 278 papers to be exact. Most of these are recent, with 65.1% published after 2010. It looks like this is a growing research area.
However, most of this research is from the United States and focused on students’ drinking. It is likely that students in the United States are quite different to other groups of drinkers around the world, so this limits our understanding of how drinking context changes consumption and harm.
Researchers do not have a clear idea about which drinking contexts might have important effects on alcohol consumption and acute harms. In most of these papers, the authors did not use a theory to inform their choice of contexts to study. This might explain why researchers tend to consider just one or two contextual features of drinking (such as studying both the day of the week and the time of day). This limits our understanding of how different drinking contexts are related to each other. It also means that important contexts might be missing from the literature. It could be helpful to think more about which types of contexts are important to study and how they change drinking behaviour.
Finally, most of these papers focused on how drinking contexts change alcohol consumption, rather than acute harms. Some harms that were studied in the remaining papers include fall injuries, unprotected sex and drunk driving.
What does this mean for policy and practice?
Policy makers have an interest in changing drinking culture. One way of thinking about this is by changing drinking contexts, which are linked to levels of consumption and short-term harms, such as injuries. So there is potential for public health interventions to target particular drinking contexts.
Such issues may be considered in relation to significant changes in drinking culture. For instance, the big shift towards drinking more wine and beer in the home and less beer in the pub. Other related policy issues include questions over the regulation of drinking environments. For example, concerns have been raised over the sale of alcohol to intoxicated people and whether the existing law prohibiting this is enforceable.
Previous studies have found that interventions can change drinking environments in pubs and nightclubs, though the effects on harm may be small. Using better evidence on which drinking contexts are risky might inform future public health interventions in this area. We assess which drinking contexts are consistently linked to harm outcomes in our next study, which is currently under review.
More speculatively, understanding the different ways that people drink might help us to think about why interventions work for some groups and not others. Perhaps we can also consider broader questions such as ‘What would we like our drinking culture to look like in the UK?’ and ‘What level of harm are we willing to accept as a result of drinking alcohol?’.
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