Drinking patterns. Summary

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1 Drinking patterns 6 Linda Ng Fat and Elizabeth Fuller Summary This chapter presents data on frequency of drinking alcohol, the amount consumed on the heaviest drinking day in the previous week, and regular weekly drinking. It discusses the findings in the context of public health concerns about alcohol-related harms and policies to address these. Chapter 7 discusses problems of obtaining accurate data on alcohol use, presents data from a drinking diary used in HSE 2011, and compares the diary results with the interview data. Based on interview data, 87% of men and 81% of women had drunk alcohol at least occasionally in the last year. 18% of men drank alcohol on five or more days in the previous week, compared with 10% of women. Despite prevalence of drinking in the last year being high among adults, a substantial proportion of adults had not drunk in the last week (31% of men, 46% of women). The frequency of drinking increased with age and this increase was greater for men than women. 29% of men aged 75 and over had drunk on five or more days in the last week. Among women, the highest prevalence of drinking on five or more days in the last week was found among those aged 65 to 74 years (19%). Both men and women from higher income households were more likely than those from lower income households to drink on five or more days in the last week. 24% of men and 17% of women in the highest income quintile drank on five or more days in the last week, while for those in the lowest income quintile the proportions were 12% and 6% respectively. Among men, 39% drank above the recommended levels on at least one day in the last week, including 22% who drank more than twice the recommended amount at least once. The corresponding proportions among women were 27% and 13%. Focusing only on those who drank alcohol in the last week, over half exceeded recommended limits on at least one day in the previous week (56% of men, 52% of women), while over a quarter drank more than twice the recommended limit (31% of men, 25% of women). drank an average of 7.7 units, and women an average of 5.0 units on the day they drank the most in the last week. Younger people were the most likely to drink heavily on a single occasion: 67% of men and 68% of women aged drank above the recommended level, and 45% and 46% respectively drank more than twice the recommended amount. Among those aged 75 and over, 27% of men and 16% of women drank more than the recommended amount, and 8% and 2% respectively drank more than twice the recommended amount. Among those who drank alcohol in the last week, those in the North East and North West strategic health authorities (SHAs) were most likely to have exceeded recommended limits (68% of men and 60% of women in the North East, 65% of men and 60% of women in the North West). HSE 2011: VOL1 CHAPTER 6: DRINKING PATTERNS 1

2 The estimated weekly consumption of the majority of men and women was within the levels recommended by the NHS. 64% of men drank some alcohol, but no more than 21 units, and 63% of women drank some alcohol, but no more than 14 units). 23% of men and 18% of women had an estimated weekly consumption of more than the recommended levels, including 6% of men and 4% of women whose consumption put them in the higher risk category (more than 50 units a week for men or 35 units for women). Average (mean) weekly consumption among those who did drink was 17.2 units for men and 9.4 units for women. For both men and women it was lowest among those aged 75 and over (13.6 units in a week for men, 5.3 units for women). aged between 55 and 64 and women aged between 45 and 54 drank more than those in other age groups (19.4 units and 11.6 units respectively). There was some variation between SHAs in the proportions of men and women drinking above the threshold for risk of harm. The proportion of men who drank more than 21 units varied between 18% in London and 31% in the North East. Similarly, the proportion of women who drank more than 14 units in a week varied between 13% in London and 23% in the North East. People living in higher income households, and those in the least deprived areas, were the most likely to drink above the threshold for risk of harm. 2 HSE 2011: VOL1 CHAPTER 6: DRINKING PATTERNS

3 6.1 Introduction Alcohol consumption and harm Drinking alcohol is an enjoyable activity for many in Britain, with most adults drinking at least occasionally. However there is growing concern in the public arena from policy makers, health professionals and the general public due to the harm caused by excessive drinking. Following a wide-ranging review of the current extent and nature of alcoholrelated harms in 1995, 1 successive governments have considered strategies for promoting sensible drinking and reducing alcohol-related harm. These have been set out in the 2004 Alcohol Harm Reduction Strategy for England, 2 Safe. Sensible. Social. The next steps in the national alcohol strategy in 2007, 3 and more recently the government s Alcohol Strategy published in Alcohol has been identified as a causal factor in more than 60 medical conditions, including: mouth, throat, stomach, liver and breast cancers; hypertensive disease (high blood pressure, see Chapter 3); cirrhosis of the liver; and depression. 1,5 Deaths from liver disease, which is associated with alcohol consumption, rose by a quarter from 2001 to and is the only major cause of death to be still rising annually. 7 Hospital admissions broadly related to alcohol consumption doubled to 1,168,300 between 2003 to 2011, with a 40% increase over the same time period in admissions where the primary diagnosis was attributable to alcohol. 8 These trends have been ascribed to a long-term increase in the amount of alcohol drunk in this country. Per capita alcohol consumption in the UK rose over the second half of the twentieth century. 9 From 1990, the average amount drunk each year increased from 9.8 litres of pure alcohol per head to a peak of 11.6 litres in 2004, though it has since declined to 10.2 litres in As well as causing harms to the individual, alcohol consumption can have effects on families, society and the economy as a whole. In 2010 almost half of violent crimes were committed by offenders under the influence of alcohol, with a fifth of violent incidents taking place around a pub or club. 11 The annual cost to the NHS from alcohol misuse has been estimated as 2.7 billion at 2007 prices. 8 One factor which may have influenced the overall increase in alcohol consumption over the last two decades is the increasing affordability of alcohol. From 1980 to 2011, the affordability of alcohol increased by 45%. 8 Alcohol has been subject to heavy discounting in some British supermarkets 12 which is thought to have influenced increased levels of drinking at home, including the practice of pre-loading before a night out, which is believed to be popular among young people. 13 To tackle the availability of cheap alcohol, the government s 2012 Alcohol Strategy proposed setting a minimum unit price for alcohol in England and Wales for the first time. 4 This follows many years of public debate, including criticisms of softer strategies 12,13 which aimed to reduce alcohol-related harm through better education and communication as in the Government s strategy in A law on alcohol pricing was passed in Scotland in 2012, providing for a minimum unit price for alcohol. 14 This is likely to be set at 50 pence per unit, following recommendations from research carried out by the University of Sheffield on behalf of the Department of Health, which suggested that a minimum price of 50 pence per unit of alcohol would have relatively little effect on moderate drinkers but would significantly reduce social harms caused by heavy drinking. 15 At the time of writing, the legislation has not been implemented and is due to be challenged in the courts Guidance on alcohol consumption Official guidance over the amount of alcohol consumed was first introduced in Specifically units of alcohol, previously a term used in clinical practice, was introduced as a means of monitoring the alcohol content of specific drinks 17 following the concept of sensible drinking by government and health educators in the 1980s. 1 The recommended limits, 21 units per week for men, 14 units per week for women, were endorsed by the Royal Colleges of General Practitioners, of Psychiatrists, and of Physicians. 18 This guidance was HSE 2011: VOL1 CHAPTER 6: DRINKING PATTERNS 3

4 revised in 1995 and linked to daily rather than weekly consumption. The NHS now advises that men should not regularly drink more than three to four units of alcohol per day, and women should not regularly drink more than two to three units of alcohol per day. Regularly is defined as most days in the week. Pregnant women are advised to avoid alcohol altogether. 19 In the course of a week, men are advised to drink no more than 21 units, women no more than 14 to avoid the risk of alcohol-related harm. who regularly drink more than eight units a day (or 50 units a week) and women who regularly drink more than six units a day (or 35 units a week) are considered to be at particular risk of harm. 20 These guidelines have remained broadly similar since their revision in More recently The Royal College of Physicians in 2011 refined recommendations to include three alcoholfree days a week in light of evidence that daily drinking is a risk factor for alcohol dependency and alcoholic liver disease. 21 The same report also suggested that new guidelines be given for older people since they are more susceptible to the effects of alcohol, due to physiological changes related to ageing. This was in accord with the Royal College of Psychiatrists which suggested a lower limit for older people of 11 units per week. 22 Until 2004, one unit of alcohol was generally accepted as being equivalent to a half pint of ordinary beer or lager, a small (125ml) glass of wine or a single measure of spirits. 1 In 2004, the Alcohol Harm Reduction Strategy acknowledged that these assumptions were no longer valid. 2 Two changes were identified as being particularly significant. The alcoholic strength of beers and wines had increased over time. For example, the average strength of wine was around 12.5% alcohol by volume (ABV), rather than the 9% assumed earlier, increasing the alcoholic content of an average bottle of wine from six to nine units. In addition, instead of the 125ml glass used previously, a standard glass of wine sold in a pub or bar was likely to be 175ml or even 250ml, increasing the alcohol consumed in one glass from one unit to more than two or three units, respectively. As a consequence, advice on the alcoholic content of drinks became more specific Measurement of alcohol consumption Survey measures of alcohol consumption are generally acknowledged to underestimate consumption. Comparisons of survey measures with HM Revenue and Customs data on alcohol taxed for sale suggest that survey estimates of consumption represent between 55% and 60% of the true figure. However, survey data provide a reliable means of comparing drinking between different groups and of measuring trends in drinking over time. This is the first Health Survey for England to include a drinking diary as a means of investigating drinking behaviour. This chapter will explore drinking patterns through the questions asked in the interview about alcohol consumption, while Chapter 7 compares interview findings with results from the drinking diary. Most data in Chapters 6 and 7 are based on 2011 data. Trend tables for alcohol consumption in the heaviest drinking day in the last week, as well as other key variables, can be found on the Health and Social Care Information Centre s website Methods and definitions Methods The Health Survey for England has asked about drinking alcohol since its inception in Until 1997, drinking was measured using a series of questions that, for each type of drink, recorded the frequency of drinking within the last 12 months and the usual amount drunk on any single day. This information was combined to calculate average weekly consumption (known as the quantity-frequency method of measuring alcohol consumption). 25,26 In 1998, questions were introduced about the maximum amount of alcohol consumed on any day in the previous week. These reflected changes in government guidelines, specifically the move from recommended limits for weekly consumption to those based on 4 HSE 2011: VOL1 CHAPTER 6: DRINKING PATTERNS

5 daily consumption, 27 and have been used in each HSE year since then. The quantityfrequency questions were dropped from the questionnaire from In 2011, for the first time since 2002, both sets of questions were asked. In 2011, the HSE questionnaire covered the following areas: Frequency of drinking in the last 12 months (including those who never drink) Number of drinking days in the last week For those who drank in the last week, the amounts of different types of alcohol drunk on the day they drank most ( heaviest drinking day in the last week ). For those who drank in the last 12 months, the frequency of drinking different types of drink and the amounts of each drunk on a typical day. Adults aged 18 and over who had drunk alcohol in the last 12 months were also asked to complete a drinking diary; this is discussed in Chapter 7 of this report. Information on drinking alcohol is generally collected from adults as part of the main survey interview. In 2011, as in previous years, there were two exceptions to this, designed to provide greater privacy for younger participants. Teenagers aged 16 and 17, below the legal age for buying alcohol, were asked to fill in a self-completion questionnaire covering smoking and drinking; young adults aged between 18 and 24 were offered this questionnaire as an alternative to the interview Measuring alcohol intake Alcohol consumption is reported in terms of units of alcohol; one unit of alcohol is 10ml by volume of pure alcohol. The method used by the HSE to convert drinks to units remained essentially unchanged from 1991 until The assumptions were similar to those which have been used by other major surveys since they were introduced by the General Household Survey (GHS) in However, in the same way that the original health promotion advice about the alcoholic drinks had become out of date as the drinking environment changed (see Section 6.1), it became clear that the assumptions about the strength of drinks and standard glass sizes were no longer valid. In response, changes were made from 2006 onwards to the way the HSE and other surveys estimate alcohol consumption. 25,30,31 In 2007, the questions about the quantities of wine drunk were revised from the previous format which measured consumption by the number of glasses drunk, with no definition of glass size. The new format asked separately about large (250ml), medium (175ml) and small (125ml) glasses, and also included the option of specifying the quantity of wine drunk in bottles or fractions of a bottle; a bottle was treated as the equivalent of six small (125ml) glasses. Table 6A below shows the conversion factors used in this report; drinks other than wine are the same as the revised unit measures used since In 2006, the unit conversion for a glass of wine (size unspecified) was two units (revised from one unit in previous years). Those who drank bottled or canned beer, lager, stout or cider were asked in detail about what they drank, and this information was used to estimate the amount in pints. 32 Table 6A Definitions The current NHS guidelines for sensible drinking are described in Section 6.1. This chapter reflects the different drinking thresholds by reporting on the following: drinking up to the recommended limits in a single day (no more than four units for men, no more than three units for women) drinking above these levels in a single day, but not as much as twice the recommended daily limits (between four and eight units for men, between three and six units for women) drinking more than twice the recommended limits in a single day (more than eight units for men, more than six units for women) drinking within weekly recommendations (no more than 21 units for men, no more than 14 units for women) HSE 2011: VOL1 CHAPTER 6: DRINKING PATTERNS 5

6 Table 6A Conversion factors for estimating alcohol content of drinks Type of drink Normal strength beer, lager, stout, cider, shandy (less than 6% ABV) Strong beer, lager, stout, cider (6% ABV or more) Spirits and liqueurs Sherry, martini and other fortified wines Wine Alcopops Measure Pint Can or bottle Small cans (size unknown) Large cans or bottles (size unknown) Pint Can or bottle Small cans (size unknown) Large cans or bottles (size unknown) Glass (single measure) Glass Small glass (125ml) Medium glass (175ml) Large glass (250ml) Bottle Small can or bottle Units of alcohol 2 Amount in pints multiplied by Amount in pints multiplied by drinking more than 50 units in an average week (men), more than 35 units in an average week (women). The daily categories are based on the maximum drunk in any day in the previous week; this may be on a single occasion or it may be regularly i.e. on most days. The weekly categories are approximate only and do not take into account varying patterns of consumption, for example on different days of the week or at different times of year. 6.3 Prevalence of drinking alcohol Prevalence and frequency of drinking alcohol, by sex and age As in previous years, prevalence of drinking remained high among adults, with men drinking more than women. Table 6.1 shows that 87% of men and 81% of women had drunk alcohol at least occasionally in the last year. 18% of men drank alcohol on five or more days in the previous week, compared with 10% of women, as highlighted in Table 6.2. The frequency of drinking increased with age, and this increase was greater for men than women. Figure 6A shows that 29% of men aged 75 and over had drunk on five or more days in the last week. Among women, the highest prevalence of drinking on five or more days in the last week was found among those aged 65 to 74 years (19%). Despite prevalence of drinking in the last year being high among adults, a substantial proportion of adults did not drink in the last week (31% of men, 46% of women). 13% of men and 19% of women were non-drinkers. Table 6.1, 6.2, Figure 6A Prevalence and frequency of drinking alcohol, by strategic health authority The frequency of drinking varied by strategic health authority (SHA) after estimates were age-standardised to take into account different age profile in each region. London had the highest proportion of men and women who did not drink alcohol in the last week (39% and 54% respectively). The southern areas of England (South East Coast, South Central and South West) had the highest proportion of adults drinking five or more days in the last week compared with other regions (19% or above for men, and 13% or above for women). Table HSE 2011: VOL1 CHAPTER 6: DRINKING PATTERNS

7 Figure 6A Drank on five or more days in the last week, by age and sex Base: Aged 16 and over Percent Age group Prevalence and frequency of drinking alcohol, by equivalised household income Equivalised household income is a measure of household income which takes into account the number of people living in a household. Estimates have been age-standardised to take into account the differing age profile of each quintile. Prevalence of drinking was lowest among those from the lowest income households: 47% of men and 59% of women in the lowest income quintile did not drink alcohol in the last week, compared with 17% and 33% respectively in the highest income quintile. Both men and women from higher income households were more likely than those from lower income households to drink on five or more days in the last week (Figure 6B). 24% of men and 17% of women in the highest quintile drank on five or more days in the last week, while for those in the lowest income quintile the proportions were 12% and 6% respectively. Table 6.4, Figure 6B Prevalence and frequency of drinking alcohol, by IMD The Index of Multiple Deprivation (IMD) 2010 provides a score of deprivation for small area levels in England by combining indicators based on a range of economic, social and housing measures. Estimates have been age-standardised to take into account the differing age profile of each quintile. Overall prevalence of drinking was lowest in the most deprived areas: 45% of men and 60% of women in the most deprived quintile did not drink alcohol in the previous week. Living in a deprived area was also associated with a lower frequency of drinking. Figure 6C shows that those living in the least deprived areas were more likely than those in the most deprived to drink on five or more days in the last week. 21% of men and 14% of women in the least deprived areas drank on five or more days, compared with 12% of men and 4% of women in the most deprived areas. Table 6.5, Figure 6C 6.4 Maximum daily consumption in the last week Maximum daily consumption in the last week, by sex and age Table 6.6 shows consumption of alcohol on the heaviest drinking day in the last week for all participants, including those who did not drink at all that week. 61% of men and 72% of women had either drunk no alcohol in the last week, or had drunk within the recommended levels on the day they drank the most alcohol. This was most common among men and women aged 65 or over. Among men, 39% drank above the recommended levels on at HSE 2011: VOL1 CHAPTER 6: DRINKING PATTERNS 7

8 Figure 6B Number of days drank in the last week, by equivalised household income and sex Base: Aged 16 and over Drank one to two days Drank three to four days Drank on five or more days in last week Percent Highest 2nd 3rd 4th Lowest Equivalised household income quintile Percent Highest 2nd 3rd 4th Lowest Equivalised household income quintile Figure 6C Drank on five or more days in the last week, by Index of Multiple Deprivation and sex Base: Aged 16 and over Percent Least deprived 2nd 3rd 4th Index of Multiple Deprivation quintile Most deprived least one day, including 22% who drank more than twice the recommended amount at least once. The corresponding proportions among women were 27% and 13%. The remainder of this section focuses on those who drank alcohol in the last week. Over half of those who drank in the last week exceeded recommended limits on at least one day in the previous week (56% of men, 52% of women), as shown in Table 6.7, while over a 8 HSE 2011: VOL1 CHAPTER 6: DRINKING PATTERNS

9 quarter drank more than twice the recommended limit (31% of men, 25% of women). drank an average of 7.7 units, and women an average of 5.0 units on the day they drank the most in the last week. Younger people were the most likely to drink heavily on a single occasion, as shown in Figures 6D and 6E. 67% of men and 68% of women aged drank above the recommended level, and 45% and 46% respectively drank more than twice the recommended amount. Among those aged 75 and over, only 27% of men and 16% of women drank more than the recommended amount, and 8% and 2% respectively drank more than twice the recommended amount. Figure 6D Drank more than the recommended limits on the heaviest drinking day in the last week, by age and sex Base: Aged 16 and over, drank in the last week Percent Age group Figure 6E Drank more than twice the recommended limits on the heaviest drinking day in the last week, by age and sex Base: Aged 16 and over, drank in the last week Percent Age group This pattern was also reflected in the average number of units consumed on the heaviest drinking day in the last week. This decreased with age, and the decline was stronger for women than men. Thus men aged consumed an average of 11.0 units on the heaviest day in the last week, and women of this age consumed 7.3 units. Although older people drank more frequently (see Section 6.3.1), the average number of units drunk was lowest on their heaviest drinking day in the last week (3.6 units for men, 2.2 units for women aged 75 and over). Tables 6.6, 6.7, Figures 6D, 6E HSE 2011: VOL1 CHAPTER 6: DRINKING PATTERNS 9

10 6.4.2 Maximum daily consumption in the last week, by strategic health authority Maximum daily consumption in the last week varied according to SHA. The highest proportions exceeding recommended limits came from the North East (68% of men, 60% of women) and the North West (65% of men, 60% of women). Regional variations were also reflected in differing average maximum daily consumption. The average units consumed on the heaviest drinking day exceeded twice the recommended limits for drinkers in the North East (9.3 for men and 6.5 for women), while the average number of units was lowest in London (6.4 for men, 4.2 for women). Table Maximum daily consumption in the last week, by equivalised household income Although frequency of drinking was higher among those in the highest income group, neither the proportion of drinkers exceeding more than twice the recommended daily limits nor the average alcohol consumption varied across income groups. Table Maximum daily consumption in the last week, by IMD There was no significant difference between the proportions of men or women exceeding recommended drinking levels, nor in average alcohol consumption, by quintile of IMD. Table Estimated weekly consumption Estimated weekly consumption, by sex and age In 2011, for the first time since 1999, the Health Survey for England asked about the frequency of consuming different types of drinks and the amounts of each type of drink consumed on a usual day (see Section 6.2). This information has been used to estimate drinking across a typical week. In the population as a whole, 13% of men and 19% of women were non-drinkers, that is to say they had not drunk alcohol in the last 12 months, or said that they never drank alcohol. The estimated weekly consumption of the majority of men and women was within the levels recommended by the NHS. 64% of men drank no more than 21 units, and 63% of women drank no more than 14 units. Drinking above these levels increases the risk of alcoholrelated harm and drinking more than 50 units a week for men or 35 units for women is defined by the NHS as the threshold for higher risk drinking. 23% of men and 18% of women had an estimated weekly consumption of more than the recommended levels, including 6% of men and 4% of women whose consumption put them in the higher risk category. 33 Older people were most likely to be non-drinkers. 21% of men aged over 75 did not drink, compared with between 10% and 15% in younger age groups. Between 14% and 19% of women aged up to 64 did not drink, but this increased to 24% of those aged between 65 and 74 and 35% of those aged 75 and over. Consumption levels also varied with age. As shown in Figure 6F, men aged between 45 and 64 were most likely to drink more than 21 units in an average week (27-29%); among women, those aged between 45 and 54 were most likely to drink more than 14 units in a week (25%). For both men and women, drinking at this level was least common among those aged over 75 (17% of men, 8% of women). The proportion of men who drank more than 50 units a week did not vary significantly with age. aged were most likely to drink more than 35 units a week (7%). Drinking at this level was least common among those aged between 25 and 34 (2%) and those aged over 75 (1%). Average (mean) weekly consumption among those who did drink was 17.2 units for men and 9.4 units for women. For both men and women it was lowest among those aged 75 and 10 HSE 2011: VOL1 CHAPTER 6: DRINKING PATTERNS

11 Figure 6F Drank more than the recommended weekly amount, by age and sex Base: Aged 16 and over, drank in the last week Percent Age group over (13.6 units in a week for men, 5.3 units for women). aged between 55 and 64 and women aged between 45 and 54 drank more than those in other age groups (19.4 units and 11.6 units respectively). Tables 6.11, 6.12, Figure 6F Estimated weekly consumption, by strategic health authority and women in London were much less likely to drink than those living elsewhere in England. 23% of men and 31% of women in London were non-drinkers. Elsewhere the proportion of male non-drinkers varied between 7% in the East of England and 14% in the North West, Yorkshire and the Humber and the East Midlands. The proportion of female non-drinkers outside London ranged from 12% in the South West to 22% in the North West. There was also some variation between SHAs in the proportions of men and women drinking above the threshold for risk of harm. The proportion of men who drank more than 21 units varied between 18% in London and 31% in the North East. Similarly, the proportion of women who drank more than 14 units in a week varied between 13% in London and 23% in the North East. Among those men and women who drank alcohol, mean consumption was lowest among men in the East of England (14.4 units) and women in London (7.3 units), and highest among men and women in the North East (20.0 units and 11.2 units respectively). Table Estimated weekly consumption, by equivalised household income Higher incomes were linked to higher levels of weekly drinking, as illustrated in Figure 6G. The proportion of non-drinkers (including those who had not drunk in the last 12 months) increased from 5% of men and 11% of women in the highest income quintile to 23% of men and 28% of women in the lowest income quintile. and women in more prosperous households were more likely than those with lower incomes to drink above the threshold for risk of harm. 28% of men in the two highest income quintiles drank more than 21 units in an average week, compared with 22% of men in the next two quintiles and 19% of men in the lowest income quintile. Among women, 27% in the highest income quintile and 23% in the next highest quintile drank more than 14 units in a week, compared with 14-16% in three lower income quintiles. Mean consumption among those who did drink did not vary significantly with household income. Table 6.14, Figure 6G HSE 2011: VOL1 CHAPTER 6: DRINKING PATTERNS 11

12 Figure 6G Drank more than the recommended weekly amount, by equivalised household income and sex Base: Aged 16 and over Percent Highest 2nd 3rd 4th Equivalised household income quintile Lowest Estimated weekly consumption by IMD The proportion of non-drinkers increased with the level of neighbourhood deprivation, from 7% of men and 12% of women in the least deprived quintile to 23% of men and 33% of women in the most deprived quintile. and women in less deprived neighbourhoods were also more likely to drink above the threshold of harm than those in more deprived neighbourhoods. In the three least deprived quintiles, between 24% and 25% of men drank more than 21 units in a week, compared with 20% of men in the second most deprived quintile and 21% in the most deprived quintile. Similarly, between 18% and 21% of women in the three least deprived quintiles drank more than 14 units in an average week, compared with 14% of women in the second most deprived quintile and 15% in the most deprived quintile. Different levels of area deprivation were not related to the mean amounts men and women drank in an average week. Table Discussion The methods of measuring alcohol consumption discussed in this chapter produce distinct and sometimes differing pictures of adults alcohol consumption in England. Measuring consumption in the last week produces a clear snapshot of drinking behaviour, but says little about overall patterns of drinking. The quantity-frequency estimates of drinking in a typical week are almost certainly better measures of habitual behaviour, but do not take into account variations in behaviour over time, for example seasonal drinking patterns or a weekly routine that includes relatively modest consumption on most days, as well as one or two days of drinking at a significantly higher level. On all measures, men were more likely to drink than women, and also likely to drink more (a difference between the sexes that has been found internationally). 34 For example, 39% of men and 28% of women had drunk more than the recommended limits on at least one day in the last week, including 22% of men and 13% of women who drank more than twice those amounts, one definition of hazardous drinking. Using another definition of hazardous drinking, 23% of men drank more than 21 units and 18% of women drank more than 14 units in a typical week. Additionally, 18% of men and 10% of women drank on five or more days in the last week; in other words they did not follow the recommendation of the Royal College of Physicians (but not the NHS) to have three alcohol-free days a week. 12 HSE 2011: VOL1 CHAPTER 6: DRINKING PATTERNS

13 Age also plays a significant role in consumption patterns. Young adults were likely to drink a lot on a single occasion, but drank on fewer days in the week than older people. Adults over 45 were more likely to drink on most days, but tended to drink less on the days that they did drink. Consequently, the alcohol-related risks are not the same for each age group. For most young adults, the concern is the amount they drink on individual occasions, rather than their overall consumption. They may be affected by changes to the pricing of alcohol, specifically the introduction of a minimum unit price, given that research suggests that reducing demand through increases in pricing is a more effective measure in tackling alcohol-related harm than through education. 12 Furthermore the research suggests that it is most likely to have an impact on heavy or young drinkers under the age of 18,35,36 Older drinkers are more likely to follow sensible drinking recommendations, but it may be that these recommendations are too generous for those aged 65 and over, and that guidelines should be revised to acknowledge the increased risks of drinking for older people. 21,22 According to the estimates of drinking in a typical week, middle-aged adults are most at risk. These estimates consistently show that drinking was highest among men aged between 45 and 64 and women aged between 45 and 54. In particular, 7% of women in this age group habitually drank more than 35 units of alcohol a week. This is a pattern of drinking that is likely to give rise to dependency and long-term harm. 3 Some clear regional differences stand out. The prevalence of drinking in London is much lower than in other regions, and among those who drink, average consumption is also relatively low in London, both on daily and weekly measures. Although the prevalence of drinking in the North East is at similar levels to other regions, among those who do drink, alcohol consumption is higher in the North East than elsewhere. The evidence about differences between income groups was mixed. Adults in lower income households were less likely to drink, and consumption across a typical week was also lower in low income groups. However, the maximum amount drunk in the last week was at similar levels across income groups. There was a similar pattern in relation to area-level deprivation. References and notes 1 Department of Health. Sensible drinking: the report of an inter-departmental working group. DH, London, Strategy Unit. Alcohol Harm Reduction Strategy for England. Cabinet Office, London, Department of Health, Home Office et al. Safe. Sensible. Social. The next steps in the national alcohol strategy. DH, London, HM Government. The Government s Alcohol Strategy. TSO, London, Rehm J, Room R, Graham K et al. The relationship of average volume of consumption and patterns of drinking to burden of disease: an overview. Addiction 2003;98: NHS National End of Life Care Programme. Deaths from liver disease implication for end of life care in England. Bristol, Office for National Statistics. Health Service Quarterly, Winter 2008, No. 40. p Health and Social Care Information Centre. Statistics on Alcohol: England, 2012, Leeds BMA Board of Science. Alcohol misuse: tackling the UK epidemic. British Medical Association, London, British Beer and Pub Association. Statistical Handbook. Brewing Publications, London, Consumption figures relate to the UK population aged 15 and over. 11 Finney A. Violence in the night-time economy: Key findings from the research. Home Office, London, HSE 2011: VOL1 CHAPTER 6: DRINKING PATTERNS 13

14 12 McKee M. Minimum unit pricing for alcohol the case for action is overwhelming. European Journal of Public Health. 2012;22:451. A striking consequence of such discounting is that beer has been reported as on sale at lower prices than bottled water. 13 House of Commons, Health Committee. Alcohol First report of Session volume 1. London, The Scottish Parliament. Alcohol (Minimum Pricing) (Scotland) Act. Edinburgh, University of Sheffield. Modelling the Potential Impact of Pricing and Promotion Policies for Alcohol in England: Results from the Sheffield Alcohol Policy Model. DH, See, for example, 17 A unit is equivalent to 10ml of pure alcohol. 18 For the Royal College of Psychiatrists, a significant revision from their previous recommendation that sensible drinking indicated an intake of up to 56 units per week for men and women; see Department of Health (1995), reference 1 above. 19 Department of Health. Alcohol Advice. DH, London, webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/publichealth/alcoholmisuse/dh_ Department of Health et al (2007), reference 3 above. Binge drinking is used to describe a pattern of drinking a large quantity of alcohol in a short period of time, often with the aim of getting drunk. In some contexts binge drinking is defined as drinking more than double the recommended daily amounts of alcohol in one day. In practice, this may involve considerably more than twice the recommended daily limits. To avoid confusion, the term binge drinking is not used in this report. 21 Royal College of Physicians. The evidence base for alcohol guidelines. RCP, London, Royal College of Psychiatrists. Our invisible addicts. Royal College of Psychiatrists, London, Goddard E. Estimating alcohol consumption from survey data: improved method of converting volume to units. ONS, London, %3A+Updated+method+of+converting+volumes+to+units 26 Weekly consumption is estimated by multiplying what is usually consumed in a day by a fraction derived from the usual frequency of drinking. Every day or almost every day: usual day s consumption*7 Five or six days a week: usual day s consumption *5.5 Three or four days a week: usual day s consumption *3.5 Once or twice a week: usual day s consumption*1.5 Once or twice a month: usual day s consumption*0.375 Once every couple of months: usual day s consumption*0.115 Once or twice a year: usual day s consumption* See reference 1 above. Questions about average daily consumption, which enabled the estimation of weekly consumption, were last asked by the Health Survey for England in In 2011, 20% of this age group chose to complete the questionnaire rather than be interviewed about their drinking. The proportion who requested the booklet ranged from 34% of 18 year olds to 14% of 24year olds. 29 Smyth M, Browne F. General Household Survey HMSO, London, Fuller E. Chapter 9: Alcohol consumption in Craig R, Mindell J (eds). Health Survey for England 2006.Volume 1: Cardiovascular disease and risk factors in adults. Health and Social Care Information Centre, Leeds, Goddard E. Smoking and drinking among adults ONS, London, (go to link, select General Household Survey, 2006 Report Smoking and Drinking Report) 32 One pint is equivalent to litres Bloomfield K., Gmel G, Wilsnack S. Introduction to special issue: Gender, culture and alcohol problems: A multi-national study. Alcohol Alcoholism Suppl, (Suppl 1):p. i3 i7. 35 Booth A, Meier P, Stockwell T et al. Independent review of the effects of alcohol pricing and promotion. DH, London, Home Office. The likely impacts of increasing alcohol price: a summary review of the evidence base. TSO, London, HSE 2011: VOL1 CHAPTER 6: DRINKING PATTERNS

15 Tables 6.1 Usual frequency of drinking alcohol in the last year, by age and sex 6.2 Number of days on which drank alcohol in the last week, by age and sex 6.15 Estimated weekly alcohol consumption (agestandardised), by Index of Multiple Deprivation and sex 6.3 Number of days on which drank alcohol in the last week (observed and age-standardised), by strategic health authority and sex 6.4 Number of days on which drank alcohol in the last week (age-standardised), by equivalised household income and sex 6.5 Number of days on which drank alcohol in the last week (age-standardised), by Index of Multiple Deprivation and sex 6.6 Summary of maximum alcohol consumption on any day in the last week, by age and sex (among all adults) 6.7 Maximum alcohol consumption on any day in the last week, by age and sex (among adults who drank in the last week) 6.8 Maximum alcohol consumption on any day in the last week (observed and age-standardised), by strategic health authority and sex 6.9 Maximum alcohol consumption on any day in the last week (age-standardised), by equivalised household income and sex 6.10 Maximum alcohol consumption on any day in the last week (age-standardised), by Index of Multiple Deprivation and sex 6.11 Summary of estimated weekly alcohol consumption, by age and sex 6.12 Estimated weekly alcohol consumption, by age and sex 6.13 Estimated weekly alcohol consumption (observed and age-standardised), by strategic health authority and sex 6.14 Estimated weekly alcohol consumption (agestandardised), by equivalised household income and sex Notes on the tables 1. The group on which the figures in the table are based is stated at the upper left corner of the table. 2. The data in most tables have been weighted. See Chapter 7, Volume 2 of this report for more detail. Both unweighted and weighted sample sizes are shown at the foot of each table. 3. Apart from tables showing age breakdowns, data have been age-standardised to allow comparisons between groups after adjusting for the effects of any differences in their age distributions. See Chapter 8.3.3, Volume 2 of this report for more detail. 4. The following conventions have been used in tables: - no observations (zero value) 0 non-zero values of less than 0.5% and thus rounded to zero [ ] used to warn of small sample bases, if the unweighted base is less than 50. If a group s unweighted base is less than 30, data are normally not shown for that group. 5. Because of rounding, row or column percentages may not add exactly to 100%. 6. Missing values occur for several reasons, including refusal or inability to answer a particular question; refusal to co-operate in an entire section of the survey (such as the nurse visit or a self-completion questionnaire); and cases where the question is not applicable to the participant. In general, missing values have been omitted from all tables and analyses. HSE 2011: VOL1 CHAPTER 6: DRINKING PATTERNS 15

16 Table 6.1 Usual frequency of drinking alcohol in last year, by age and sex Aged 16 and over 2011 Usual frequency of Age group Total drinking % % % % % % % % Almost every day Five or six days a week Three or four days a week Once or twice a week Once or twice a month Once every couple of months Once or twice a year Not at all in the last 12 months/ Non-drinker Drank alcohol in the last year Almost every day Five or six days a week Three or four days a week Once or twice a week Once or twice a month Once every couple of months Once or twice a year Not at all in the last 12 months/ Non-drinker Drank alcohol in the last year Bases (unweighted) Bases (weighted) HSE 2011: VOL 1 CHAPTER 6: DRINKING PATTERNS

17 Table 6.2 Number of days on which drank alcohol in the last week, by age and sex Aged 16 and over 2011 Number of days Age group Total % % % % % % % % Did not drink in the last week One Two Three Four Five Six Seven Drank in the last week Drank on five or more days in the last week Mean number of days a Standard error of the mean Did not drink in the last week One Two Three Four Five Six Seven Drank in the last week Drank on five or more days in the last week Mean number of days a Standard error of the mean Bases (unweighted) Bases (weighted) a Based on adults who had drunk alcohol in the last week. HSE 2011: VOL 1 CHAPTER 6: DRINKING PATTERNS 17

18 Table 6.3 Number of days on which drank alcohol in the last week (observed and age-standardised), by strategic health authority a and sex Aged 16 and over 2011 Number of days Strategic health authority North North Yorkshire East West East London South South South East West & the Midlands Midlands of East Central West Humber England Coast % % % % % % % % % % Observed Did not drink in the last week One Two Three Four Five Six Seven Drank in the last week Drank on five or more days in last week Mean number of days b Standard error of the mean Standardised Did not drink in the last week One Two Three Four Five Six Seven Drank in the last week Drank on five or more days in last week Mean number of days b Standard error of the mean Bases (unweighted) Bases (weighted) a This table provides data for regional analysis by the configuration of strategic health authorities (SHAs) in place from July 2006 b Based on adults who had drunk alcohol in the last week. 18 HSE 2011: VOL 1 CHAPTER 6: DRINKING PATTERNS Continued

19 Table 6.3 continued Aged 16 and over 2011 Number of days Strategic health authority North North Yorkshire East West East London South South South East West & the Midlands Midlands of East Central West Humber England Coast % % % % % % % % % % Observed Did not drink in the last week One Two Three Four Five Six Seven Drank in the last week Drank on five or more days in the last week Mean number of days b Standard error of the mean Standardised Did not drink in the last week One Two Three Four Five Six Seven Drank in the last week Drank on five or more days in the last week Mean number of days b Standard error of the mean Bases (unweighted) Bases (weighted) a This table provides data for regional analysis by the configuration of strategic health authorities (SHAs) in place from July 2006 b Based on adults who had drunk alcohol in the last week. HSE 2011: VOL 1 CHAPTER 6: DRINKING PATTERNS 19

20 Table 6.4 Number of days on which drank alcohol in the last week (age-standardised), by equivalised household income and sex Aged 16 and over 2011 Number of days Equivalised household income quintile Highest 2nd 3rd 4th Lowest % % % % % Did not drink in the last week One Two Three Four Five Six Seven Drank in the last week Drank on five or more days in the last week Mean number of days a Standard error of the mean Did not drink in the last week One Two Three Four Five Six Seven Drank in the last week Drank on five or more days in the last week Mean number of days a Standard error of the mean Bases (unweighted) Bases (weighted) a Based on adults who had drunk alcohol in the last week. 20 HSE 2011: VOL 1 CHAPTER 6: DRINKING PATTERNS

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