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      Deconstructing the Alcohol Harm Paradox: A Population Based Survey of Adults in England

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          Abstract

          Background

          The Alcohol Harm Paradox refers to observations that lower socioeconomic status (SES) groups consume less alcohol but experience more alcohol-related problems. However, SES is a complex concept and its observed relationship to social problems often depends on how it is measured and the demographic groups studied. Thus this study assessed socioeconomic patterning of alcohol consumption and related harm using multiple measures of SES and examined moderation of this patterning by gender and age.

          Method

          Data were used from the Alcohol Toolkit Study between March and September 2015 on 31,878 adults (16+) living in England. Participants completed the AUDIT which includes alcohol consumption, harm and dependence modules. SES was measured via qualifications, employment, home and car ownership, income and social-grade, plus a composite of these measures. The composite score was coded such that higher scores reflected greater social-disadvantage.

          Results

          We observed the Alcohol Harm Paradox for the composite SES measure, with a linear negative relationship between SES and AUDIT-Consumption scores (β = -0.036, p<0.001) and a positive relationship between lower SES and AUDIT-Harm (β = 0.022, p<0.001) and AUDIT-Dependence (β = 0.024, p<0.001) scores. Individual measures of SES displayed different, and non-linear, relationships with AUDIT modules. For example, social-grade and income had a u-shaped relationship with AUDIT-Consumption scores while education had an inverse u-shaped relationship. Almost all measures displayed an exponential relationship with AUDIT-Dependence and AUDIT-Harm scores. We identified moderating effects from age and gender, with AUDIT-Dependence scores increasing more steeply with lower SES in men and both AUDIT-Harm and AUDIT-Dependence scores increasing more steeply with lower SES in younger age groups.

          Conclusion

          Different SES measures appear to influence whether the Alcohol Harm Paradox is observed as a linear trend across SES groups or a phenomenon associated particularly with the most disadvantaged. The paradox also appears more concentrated in men and younger age groups.

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          Most cited references68

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          Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption-II

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            Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II.

            The Alcohol Use Disorders Identification Test (AUDIT) has been developed from a six-country WHO collaborative project as a screening instrument for hazardous and harmful alcohol consumption. It is a 10-item questionnaire which covers the domains of alcohol consumption, drinking behaviour, and alcohol-related problems. Questions were selected from a 150-item assessment schedule (which was administered to 1888 persons attending representative primary health care facilities) on the basis of their representativeness for these conceptual domains and their perceived usefulness for intervention. Responses to each question are scored from 0 to 4, giving a maximum possible score of 40. Among those diagnosed as having hazardous or harmful alcohol use, 92% had an AUDIT score of 8 or more, and 94% of those with non-hazardous consumption had a score of less than 8. AUDIT provides a simple method of early detection of hazardous and harmful alcohol use in primary health care settings and is the first instrument of its type to be derived on the basis of a cross-national study.
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              Multiple Imputation after 18+ Years

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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                28 September 2016
                2016
                : 11
                : 9
                : e0160666
                Affiliations
                [1 ]Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
                [2 ]Department of Epidemiology and Public Health, University College London, London, United Kingdom
                [3 ]ScHARR, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
                [4 ]Institute of Health & Society, Newcastle University, Newcastle, United Kingdom
                National Institute of Health, ITALY
                Author notes

                Competing Interests: EB's and SM's salaries are funded by the NIHR SPHR. EB is also funded by Cancer Research UK (CRUK). JB is funded by CRUK and the Society for the Study of Addiction; RW is funded by CRUK. EB and JB have both received unrestricted research funding from Pfizer, including for the Smoking Toolkit Study (a sister survey of the ATS). RW has received travel funds and hospitality from, and undertaken research and consultancy for, pharmaceutical companies that manufacture and/or research products aimed at helping smokers to stop. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

                • Conceived and designed the experiments: EB SM JB RW.

                • Analyzed the data: EB.

                • Wrote the paper: EB.

                • All other authors commented on this first draft and contributed to the final draft: CA AB PM EK JH.

                [¤]

                Current address: Cancer Research UK Health Behaviour Research Centre, University College London, London, United Kingdom

                Article
                PONE-D-16-19032
                10.1371/journal.pone.0160666
                5040414
                27682619
                a071de27-a52d-4721-92df-ddb2531e7545
                © 2016 Beard et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 11 May 2016
                : 23 July 2016
                Page count
                Figures: 0, Tables: 9, Pages: 17
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100001921, Public Health Research Programme;
                Award Recipient :
                The National Institute for Health Research (NIHR) School for Public Health Research (SPHR) primarily funded data collection for the Alcohol Toolkit Study (SPHR-SWP-ALC-WP5). SPHR is a partnership between the Universities of Sheffield; Bristol; Cambridge; Exeter; UCL; The London School for Hygiene and Tropical Medicine; the LiLaC collaboration between the Universities of Liverpool and Lancaster and Fuse; The Centre for Translational Research in Public Health, a collaboration between Newcastle, Durham, Northumbria, Sunderland and Teesside Universities. EB’s and SM’s salaries are funded by the NIHR SPHR. EB is also funded by Cancer Research UK (CRUK; C1417/A14135). JB is funded by the Society for the Study of Addiction and CRUK also provide support (C1417/A14135); RW is funded by CRUK (C1417/A14135). EB and JB have both received unrestricted research funding from Pfizer relating to smoking cessation. RW has received travel funds and hospitality from, and undertaken research and consultancy for, pharmaceutical companies that manufacture and/or research products aimed at helping smokers to stop. EK is funded by the NIHR School of Primary Care Research. CA is funded by SPHR. CA, PM and JH have received funding related to commissioned research from Systembolaget, the Swedish government-owned alcohol retail monopoly. PM is a Scientific Advisor to the Institute for Alcohol Studies (IAS), for which she receives a personal fee. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.
                Categories
                Research Article
                Biology and Life Sciences
                Nutrition
                Diet
                Alcohol Consumption
                Medicine and Health Sciences
                Nutrition
                Diet
                Alcohol Consumption
                Social Sciences
                Sociology
                Social Stratification
                Medicine and Health Sciences
                Health Care
                Socioeconomic Aspects of Health
                Medicine and Health Sciences
                Public and Occupational Health
                Socioeconomic Aspects of Health
                People and Places
                Population Groupings
                Age Groups
                People and Places
                Demography
                Biology and Life Sciences
                Psychology
                Addiction
                Alcoholism
                Social Sciences
                Psychology
                Addiction
                Alcoholism
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Substance-Related Disorders
                Alcoholism
                Medicine and Health Sciences
                Public and Occupational Health
                Substance-Related Disorders
                Alcoholism
                People and places
                Geographical locations
                Europe
                United Kingdom
                England
                People and Places
                Population Groupings
                Ethnicities
                Custom metadata
                The dataset is available at: https://osf.io/abuhr/. For further details please contact the lead author or Dr Jamie Brown ( Jamie.Brown@ 123456ucl.ac.uk ).

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                Uncategorized

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