Publication
Health Education Population Survey (HEPS) 1996-2003
8. Alcohol
Alcohol is a major cause of liver cirrhosis and a risk factor for high blood pressure‚ several types of cancer and a number of other health problems. Excessive or inappropriate use of alcohol also increases the risk of accidents and crime‚ and is associated with a variety of social problems. The recent Plan for Action on Alcohol Problems (Scottish Executive‚ 2002) recognises this explicitly in its key priorities: reducing binge drinking and reducing harmful drinking by children and young people. Health education activities have been mainly focused on young people‚ with the HEBS Think About It campaign targeting 12-17 year olds and the Scottish Executive campaign targeting 16-25 year olds. Other health education work in Scotland has focused on raising awareness of alcohol problems in the workplace.
As discussed in Section 2‚ the current sensible drinking guidelines consist of daily benchmarks. However‚ because awareness of this is low‚ knowledge of recommended drinking limits is perhaps more realistically assessed in relation to the better-established weekly limits. The maximum recommended limits for alcohol consumption as set out in Towards a Healthier Scotland (The Scottish Office‚ 1999) are 14 units for women and 21 units for men per week. For the purposes of the survey‚ respondents were classified as ‘drinkers’ if they had consumed any alcohol in the past year.
8.1 Risk behaviour
Respondents classified as ‘drinkers’ were asked if they had drunk any alcohol in the past week and how much they had consumed of each type of alcohol. In relation to sensible drinking behaviour‚ around 15% of respondents could be classified as exceeding the recommended weekly limits described above‚ and this has remained fairly stable over time (Table 8.1). Men were two to three times as likely as women to exceed the limits. There is no evidence of any change over time.
Table 8.1 Percentage exceeding recommended weekly limits for alcohol‚ by sex
% |
1996 |
1997 |
1998 |
1999 |
2000 |
2001 |
2002 |
2003 |
All |
16 |
15 |
15 |
17 |
– |
18 |
17 |
16 |
Men |
25 |
24 |
21 |
26 |
– |
27 |
26 |
25 |
Women |
7 |
6 |
10 |
8 |
– |
9 |
9 |
8 |
Base all respondents: |
1810 |
1795 |
1794 |
880 |
– |
1757 |
1742 |
1720 |
For both sexes‚ older people are less likely to exceed the weekly limits (Table 8.2). This differential is more marked for women than men‚ and may be explained by lifecourse effects such as family responsibilities. It is difficult to discern any pattern across time. Despite some fluctuation in the figures for men and women aged 16-24‚ in the longer term there does not appear to be any change over time. The apparent rise in consumption for young women in 1998 may be related to the addition of a question on alcoholic soft drinks in that year; as these drinks are most commonly drunk by the youngest age group‚ this change in methodology would be likely to affect this group more than others (Shaw et al‚ 2000). This apparent increase was‚ however‚ not sustained and may be the result of random variation in the population.
Table 8.2: Percentage exceeding recommended weekly limits for alcohol‚ by sex and age
% |
1996 |
1997 |
1998 |
1999 |
2000 |
2001 |
2002 |
2003 |
Women |
7 |
6 |
10 |
8 |
– |
9 |
9 |
8 |
Women by age |
|
|
|
|
|
|
|
|
16-24 |
17 |
13 |
30 |
18 |
– |
16 |
14 |
16 |
25-34 |
15 |
8 |
7 |
8 |
– |
11 |
12 |
7 |
35-44 |
4 |
4 |
8 |
7 |
– |
6 |
8 |
7 |
45-54 |
5 |
7 |
11 |
4 |
– |
9 |
9 |
6 |
55-64 |
1 |
4 |
1 |
6 |
– |
8 |
2 |
9 |
65-74 |
1 |
1 |
2 |
2 |
– |
2 |
4 |
* |
Men |
25 |
24 |
21 |
26 |
27 |
26 |
25 |
|
Men by age |
|
|
|
|
|
|
|
|
16-24 |
33 |
26 |
17 |
57 |
– |
43 |
32 |
32 |
25-34 |
33 |
22 |
29 |
18 |
– |
31 |
27 |
36 |
35-44 |
30 |
35 |
22 |
33 |
– |
28 |
30 |
19 |
45-54 |
22 |
19 |
24 |
15 |
– |
24 |
26 |
25 |
55-64 |
14 |
21 |
16 |
17 |
– |
13 |
24 |
16 |
65-74 |
6 |
15 |
11 |
7 |
– |
20 |
9 |
15 |
Base: all men |
886 |
841 |
879 |
431 |
– |
863 |
856 |
728 |
Base respondents answering self-completion section: |
925 |
954 |
916 |
449 |
– |
894 |
886 |
992 |
The gradient by age for men and women in 2003 is illustrated in Figure 8.1. This shows clearly the difference between the sexes.
Fig 8.1: Percentage exceeding recommended weekly limits for alcohol‚ by sex and age‚ 2003
Base: all respondents 2003 (1720)
Data from the General Household Survey do‚ however‚ show that the proportion of women aged 16-24 exceeding the maximum weekly limits rose steadily from 15% in 1988 to 25% in 1998 (ONS‚ 2000) but show little change for men of the same age. The General Household Survey suggests that the drinking habits of young men and women are becoming more similar‚ as are patterns of smoking (ONS‚ 2000). Findings from the 1998 Scottish Health Survey showed an increase in the proportions of young women and men exceeding the recommended limits‚ as well as increases in mean consumption. These findings are not‚ however‚ supported by the HEPS data.
Longer-term data are needed to determine to what extent the scale of any changes is consistent over time‚ in particular whether the behaviour observed in the younger women is maintained over the lifecourse to a greater degree than has been observed in the past. Data from the General Household Survey indicate that drinking patterns in women have previously tended to become more moderate in later life‚ and this to a greater extent than for men‚ possibly due to differentiated responsibilities for childcare. Current changes in working patterns and family formation may have some influence on how such drinking cultures will evolve over the lifecourse.
Table 8.3: Percentage with 4+ binge drinking sessions in past month‚ by sex/age/social grade/self-assessed drinking status
% |
1996 |
1997 |
1998 |
1999 |
2000 |
2001 |
2002 |
2003 |
All |
11 |
9 |
9 |
16 |
– |
12 |
9 |
10 |
Sex |
|
|
|
|
|
|
|
|
Men |
18 |
12 |
12 |
27 |
– |
17 |
13 |
15 |
Women |
4 |
6 |
6 |
6 |
– |
8 |
5 |
5 |
Age |
|
|
|
|
|
|
|
|
16-24 |
21 |
20 |
23 |
36 |
– |
33 |
19 |
15 |
25-34 |
16 |
11 |
10 |
28 |
– |
10 |
14 |
14 |
35-44 |
11 |
8 |
6 |
16 |
– |
14 |
7 |
12 |
45-54 |
7 |
6 |
7 |
3 |
– |
8 |
6 |
8 |
55-64 |
3 |
4 |
4 |
3 |
– |
3 |
5 |
6 |
65-74 |
1 |
3 |
2 |
3 |
– |
2 |
1 |
2 |
Social grade |
|
|
|
|
|
|
|
|
AB |
4 |
7 |
5 |
5 |
– |
6 |
7 |
4 |
C1 |
13 |
6 |
8 |
25 |
– |
14 |
9 |
10 |
C2 |
12 |
11 |
13 |
12 |
– |
12 |
10 |
12 |
D |
12 |
11 |
10 |
16 |
– |
12 |
10 |
12 |
Self-assessed status |
|
|
|
|
|
|
|
|
Light |
3 |
3 |
3 |
4 |
– |
4 |
5 |
4 |
Moderate |
24 |
22 |
22 |
21 |
– |
32 |
19 |
20 |
Heavy |
68 |
45 |
51 |
83 |
– |
74 |
56 |
64 |
Base: all respondents |
1810 |
1795 |
1794 |
880 |
– |
1757 |
1742 |
1720 |
A second measure of excessive drinking is the number of ‘binge drinking’ sessions in the past month. A binge drinking session is defined as exceeding 16 units for men or 10 units for women on one occasion. As explained on page 28‚ there is no agreed definition of binge drinking. The measure used in this survey has been used in previous surveys‚ and was chosen since it was an amount that respondents should consider to represent a binge (rather than just drinking a bit more than normal) and should therefore find easier to recall.
Around one in ten adults reported four or more binge drinking sessions in the past month (Table 8.3). There is little fluctuation in this figure‚ with the exception of 1999‚ where the apparently higher levels are likely to be the result of random fluctuation‚ given the smaller number of respondents.
Men were more likely to report four or more binge drinking sessions‚ as were younger people‚ especially those aged 16-24‚ in most years of the survey. Binge drinking among this youngest group appeared to increase in 1999 and 2001. However‚ in 2002 there was a return to levels seen in 1996. It is possible that the 2003 figures mark the beginning of a further decrease but further years' data are needed to confirm this possible trend. Those in social grades AB were less likely to binge drink. Interestingly‚ two in ten of those who considered themselves moderate drinkers‚ and one in twenty of those who considered themselves light drinkers‚ reported four or more binge drinking sessions in the past month. It is possible that these drinkers only drink once or twice a week‚ but when they do drink‚ do so to excess. This may be why they do not consider themselves heavy drinkers‚ though their binge drinking behaviour would suggest otherwise.
8.2 Knowledge
Respondents were asked how many units of alcohol they thought was the recommended weekly limit for their own sex. This question was only asked in March 1996 and March 1997‚ and was then put to all respondents in the period 2001-2003. From 2001 onwards‚ respondents were able to give daily or weekly limits. For those giving daily limits‚ weekly limits were derived by multiplying their response by seven.
Each year‚ around 15% said they did not know what a unit was‚ and this response is included in the don't know category shown in Table 8.4.
In 1996‚ over four in ten drinkers said they did not know what the recommended weekly limits were‚ and under one in ten correctly identified the weekly limits of 21/14 units. Men were more likely than women to say they did not know. Knowledge levels rose significantly between 1996 and 1997 with 23% identifying the weekly limits of 21/14 units correctly by 1997; this knowledge level was sustained in the period 2001-2003. By 2001/2002 men were more likely than women to know the exact limit for their sex‚ and this was largely because women were more likely to underestimate the limit for women. Men were more likely to have no idea what the recommended limits were for their sex. By 2003 both sexes were equally likely to know the recommended limits.
Table 8.4: Knowledge of recommended weekly limits for own sex
% |
1996 |
1997 |
1998 |
1999 |
2000 |
2001 |
2002 |
2003 |
All |
|
|
|
|
|
|
|
|
Under limit |
23 |
33 |
– |
– |
– |
34 |
35 |
32 |
Exact limit (21/14 units per week) |
9 |
23 |
– |
– |
– |
20 |
20 |
21 |
Over limit |
24 |
11 |
– |
– |
– |
16 |
15 |
17 |
Don’t know |
44 |
33 |
– |
– |
– |
32 |
30 |
30 |
Men |
|
|
|
|
|
|
|
|
Under limit |
19 |
28 |
– |
– |
– |
26 |
29 |
36 |
Exact limit (21 units per week) |
8 |
22 |
– |
– |
– |
23 |
26 |
20 |
Over limit |
19 |
10 |
– |
– |
– |
14 |
11 |
20 |
Don’t know |
53 |
40 |
– |
– |
– |
37 |
34 |
25 |
Women |
|
|
|
|
|
|
|
|
Under limit |
26 |
38 |
– |
– |
– |
41 |
41 |
27 |
Exact limit (14 units per week) |
9 |
23 |
– |
– |
– |
16 |
15 |
23 |
Over limit |
29 |
12 |
– |
– |
– |
17 |
18 |
15 |
Don’t know |
36 |
26 |
– |
– |
– |
26 |
26 |
34 |
Men exceeding weekly limits |
|
|
|
|
|
|
|
|
Under limit |
16 |
34 |
– |
– |
– |
44 |
39 |
28 |
Exact limit (21 units per week) |
12 |
29 |
– |
– |
– |
13 |
16 |
22 |
Over limit |
36 |
14 |
– |
– |
– |
28 |
19 |
30 |
Don’t know |
36 |
23 |
– |
– |
– |
16 |
26 |
20 |
Base: all who have had an alcoholic drink in past year (March waves only 1996-1997) |
903 |
893 |
– |
– |
– |
1570 |
1545 |
1486 |
|
Significant changes (p<0.05) |
Men who exceeded the recommended maximum weekly limits were more likely to think they knew the limit compared with men overall. However‚ in 2001 and 2002 they were less likely to identify the correct limit of 21 than male drinkers overall and more likely to give a limit that was too low or too high. In 2003 men who exceeded the limit were no less likely than all men to give the correct limit‚ although they were still more likely to give a limit that was too high. Too few women exceeded the maximum weekly limits to allow separate analysis for this group.
8.3 Motivation
In the period 1996-1999 approximately one-fifth of drinkers reported having tried to reduce their alcohol consumption in the past year‚ or having wanted to do so; this increased to around one-quarter in the 2001-2003 period (Table 8.5). Among those who exceeded the recommended weekly limits‚ the proportion motivated to cut down their drinking was around four in ten in the 1996-1999 period‚ rising to almost half of those who exceed the weekly limits in the period 2001-2003. The change amongst those exceeding the limits is not statistically significant given the small base size‚ so future data are needed to confirm this apparent trend for this group.
Table 8.5: Motivation to reduce alcohol consumption
% |
1996 |
1997 |
1998 |
1999 |
2000 |
2001 |
2002 |
2003 |
All drinkers |
|
|
|
|
|
|
|
|
Not contemplating |
80 |
81 |
84 |
82 |
– |
78 |
76 |
74 |
Would like to |
4 |
5 |
4 |
5 |
– |
5 |
6 |
5 |
Have tried |
16 |
14 |
13 |
14 |
– |
18 |
18 |
22 |
Those exceeding weekly limits |
|
|
|
|
|
|
|
|
Not contemplating |
61 |
63 |
67 |
61 |
– |
59 |
52 |
53 |
Would like to |
14 |
15 |
10 |
15 |
– |
14 |
15 |
14 |
Have tried |
24 |
23 |
23 |
24 |
– |
27 |
33 |
33 |
Base: all who have had an alcoholic drink in past year (March waves only 1996-1997) |
1630 |
1615 |
1591 |
775 |
– |
1570 |
1545 |
1486 |
|
Significant changes (p<0.05) |
The apparent trends over time in those who have tried to cut down or would like to cut down their alcohol consumption are illustrated below in Figure 8.2.
Fig 8.2: Time trends in motivation to reduce alcohol consumption (have tried or would like to)‚ 1996-2003
Base: all having drink in past year and all exceeding weekly limits
Men were more likely than women to say they had tried to cut down drinking or wanted to do so (around one in four men and one in six women)‚ and this is probably related to the higher levels of drinking among men. While base sizes were relatively low‚ a comparison of men and women who exceeded the weekly limits showed no difference in motivation between the sexes.
Main points
- Men were more likely to exceed the recommended weekly limits and to binge drink than women. Men were also more likely than women to say they did not know what the recommended weekly limits are.
- The proportions of respondents exceeding the weekly limits decreased with age‚ and this was more marked for women.
- There was a significant increase in knowledge levels regarding the recommended weekly limits between 1996 and 1997‚ but these levels are still relatively low and have shown no further increases.
- There has been some increase in motivation to reduce alcohol consumption over time.