Jennifer Boyd1, Olivia Sexton1, Colin Angus1, Petra Meier2, Robin C Purshouse3, John Holmes1. 1. School of Health and Related Research, University of Sheffield, Sheffield, UK. 2. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK. 3. Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield, UK.
Abstract
BACKGROUND AND AIMS: The alcohol harm paradox (AHP) posits that disadvantaged groups suffer from higher rates of alcohol-related harm compared with advantaged groups, despite reporting similar or lower levels of consumption on average. The causes of this relationship remain unclear. This study aimed to identify explanations proposed for the AHP. Secondary aims were to review the existing evidence for those explanations and investigate whether authors linked explanations to one another. METHODS: This was a systematic review. We searched MEDLINE (1946-January 2021), EMBASE (1974-January 2021) and PsycINFO (1967-January 2021), supplemented with manual searching of grey literature. Included papers either explored the causes of the AHP or investigated the relationship between alcohol consumption, alcohol-related harm and socio-economic position. Papers were set in Organization for Economic Cooperation and Development high-income countries. Explanations extracted for analysis could be evidenced in the empirical results or suggested by researchers in their narrative. Inductive thematic analysis was applied to group explanations. RESULTS: Seventy-nine papers met the inclusion criteria and initial coding revealed that these papers contained 41 distinct explanations for the AHP. Following inductive thematic analysis, these explanations were grouped into 16 themes within six broad domains: individual, life-style, contextual, disadvantage, upstream and artefactual. Explanations related to risk behaviours, which fitted within the life-style domain, were the most frequently proposed (n = 51) and analysed (n = 21). CONCLUSIONS: While there are many potential explanations for the alcohol harm paradox, most research focuses on risk behaviours while other explanations lack empirical testing.
BACKGROUND AND AIMS: The alcohol harm paradox (AHP) posits that disadvantaged groups suffer from higher rates of alcohol-related harm compared with advantaged groups, despite reporting similar or lower levels of consumption on average. The causes of this relationship remain unclear. This study aimed to identify explanations proposed for the AHP. Secondary aims were to review the existing evidence for those explanations and investigate whether authors linked explanations to one another. METHODS: This was a systematic review. We searched MEDLINE (1946-January 2021), EMBASE (1974-January 2021) and PsycINFO (1967-January 2021), supplemented with manual searching of grey literature. Included papers either explored the causes of the AHP or investigated the relationship between alcohol consumption, alcohol-related harm and socio-economic position. Papers were set in Organization for Economic Cooperation and Development high-income countries. Explanations extracted for analysis could be evidenced in the empirical results or suggested by researchers in their narrative. Inductive thematic analysis was applied to group explanations. RESULTS: Seventy-nine papers met the inclusion criteria and initial coding revealed that these papers contained 41 distinct explanations for the AHP. Following inductive thematic analysis, these explanations were grouped into 16 themes within six broad domains: individual, life-style, contextual, disadvantage, upstream and artefactual. Explanations related to risk behaviours, which fitted within the life-style domain, were the most frequently proposed (n = 51) and analysed (n = 21). CONCLUSIONS: While there are many potential explanations for the alcohol harm paradox, most research focuses on risk behaviours while other explanations lack empirical testing.
Authors: Hervé Kuendig; Moira L Plant; Martin A Plant; Sandra Kuntsche; Patrick Miller; Gerhard Gmel; Salme Ahlström; Karin Helmersson Bergmark; Hildigunnur Olafsdóttir; Zsuzsanna Elekes; Ladislav Csemy; Ronald Knibbe Journal: Eur Addict Res Date: 2008-06-13 Impact factor: 3.015
Authors: Sebastián Peña; Pia Mäkelä; Tiina Laatikainen; Tommi Härkänen; Satu Männistö; Markku Heliövaara; Seppo Koskinen Journal: Addiction Date: 2021-01-28 Impact factor: 6.526
Authors: Susannah Sadler; Colin Angus; Lucy Gavens; Duncan Gillespie; John Holmes; Jean Hamilton; Alan Brennan; Petra Meier Journal: Addiction Date: 2017-02-06 Impact factor: 6.526
Authors: Emma Beard; Jamie Brown; Robert West; Colin Angus; Alan Brennan; John Holmes; Eileen Kaner; Petra Meier; Susan Michie Journal: PLoS One Date: 2016-09-28 Impact factor: 3.240
Authors: Marta Donat; Gregorio Barrio; Juan-Miguel Guerras; Lidia Herrero; José Pulido; María-José Belza; Enrique Regidor Journal: Int J Environ Res Public Health Date: 2022-04-05 Impact factor: 3.390
Authors: Ruichong Shuai; Justin J Anker; Adrian J Bravo; Matt G Kushner; Lee Hogarth Journal: Front Behav Neurosci Date: 2022-02-14 Impact factor: 3.558