Understanding stability and change in British drinking using 16 years of market research data

From 2001 to 2016, Great Britain experienced a historic peak in alcohol consumption followed by a sharp decline. These trends coincided with a series of cross-departmental alcohol strategies, licensing reforms, a smoking ban in pubs, debates about alcohol duty and minimum prices, media focus on 'Binge Britain' and 'Ladette' culture, and a new generation of young adults noted for their abstemious approach to alcohol. It has been argued that fundamental changes in our country's drinking culture have resulted but these are, as yet, poorly documented and understood. For example, whilst we have good data on how the amount consumed has changed, we know far less about changes in where, when, why, with whom or how people drink.

This is important as achieving a better understanding of the social and environmental context of health-related behavioural change is increasingly central to efforts to improve public health and well-being. The Lancet, the Medical Research Council, social epidemiologists and complex systems theorists have all highlighted the lack of attention given to the micro-level social, cultural and geographic contexts in which health-related behaviours and interventions to address them take place. This has limited our ability to provide expert commentary on how health behaviours relate to wider cultural and structural shifts, to anticipate and respond to future trends, and to inform public policy and debate.

Alcohol research is a case in point. Despite the subject's long history in the health and social sciences, researchers often struggle to describe, and offer convincing explanations of, changes in drinking culture. A key reason for this is that most of the quantitative evidence treats alcohol use as if it was a single behaviour defined by how much people drink. In reality, there are many different types of occasion in which drinking occurs, characterised by the context in which they take place (e.g. pub lunch, relaxing at home, a night out), and types of occasions are often the focus of attention in lay discourse and policy debate. Quantitative evidence tailored to such perspectives can deliver understanding of how British drinking culture is changing, where to intervene to promote positive trends and curtail negative ones, and which preventative policies effectively tackle the types of drinking causing most concern.

This project responds by shifting attention from drinkers to the drinking occasion. It anticipates delivering a step-change in our understanding of alcohol use by analysing a large internationally-unique dataset of 785,000 occasions reported by 255,000 individuals between 2001 and 2016. The work is divided into three work packages (WP):

WP1 will explore how British drinking changed from 2001 to 2016. It will identify the predominant types of drinking occasions seen, based on characteristics such as the occasion's purpose, location, timing, participants, amount and type of alcohol drunk, and other activities undertaken while drinking (e.g. eating). We will examine if new types of drinking have emerged, which occasions became more or less common, how the characteristics of occasions changed and how these changes relate to the overall consumption trend.

WP2 and WP3 will test a series of hypotheses which seek to explain trends in drinking occasions, use drinking occasions to explain population trends in consumption, and examine the impact of three major societal changes on drinking occasions, namely the 2008 recession, the 2003 Licensing Act and bans on smoking in pubs. In developing explanations for observed trends and variations, we will focus on under-researched and policy-relevant topics such as increased home drinking and drinking among women, drinking in middle- and older-age, variation in drinking cultures across geographic areas, the decline in young adults' drinking, the alcohol harm paradox and relationships between drinking and social roles such as parenthood and employment.

Alcohol use affects the health and wellbeing of drinkers and those around them. It also impacts family and social relationships, crime, work and economic security. Therefore, the range of non-academic users of our research is potentially large.

WHO BENEFITS?

This project has potential benefits for six key groups: (1) Government departments involved in UK and international alcohol-related policy; (2) Parliamentarians contributing to such policy through scrutiny committees or public debate; (3) Decision-makers in Public Health England, the NHS, police and local authorities concerned with reducing alcohol harm and its resulting costs; (4) Alcohol, health and social concerns charities who research, advocate and provide public advice and information; (5) The general public whose lives are reflected and potentially influenced by our results and (6) The media which regularly highlights and discusses trends in alcohol use, drinking culture and alcohol policy.

HOW WILL THEY BENEFIT?

When planning this project, we elicited feedback from stakeholders representing the above groups, especially via the PHE Alcohol Leadership Board, the Alcohol Health Alliance and social media (see Pathways to Impact). Below, we summarise the potential benefits they identified which focus on providing evidence at a new level of detail to inform and possibly transform public debate, priority setting and effective public policy and intervention.

1) Informative alcohol trend data are a critical resource for policy makers. They help to identify policy priorities, evidence the scale of public health threats and warn of emerging problems. Our project outputs will, for the first time, provide stakeholders with detailed quantitative evidence on where, when, why, how and with whom drinking takes place, how it is integrated into other activities, and how this has changed over time. We are able to provide targeted information on key groups of interest including heavy drinkers, older adults, middle-aged women, students, working class men or Scottish drinkers.

2) Insights into heavier drinking: Population- and individual-level policies are increasingly aimed at specific types of drinking within specific settings. We will substantially improve the evidence-base for such interventions by describing different kinds of heavy drinking occasion and their core and non-core characteristics that may be targets for "disruptive" policies.

3) Insights into health inequalities: Reducing health inequalities is a central aim of government policy in the UK and elsewhere. Alcohol contributes substantially to health inequalities and these are likely maintained and reinforced by systematic social and geographic variations in drinking occasions. We will describe these variations and provide new information on how interventions may target or neglect particular groups and their occasions, and thus reduce or exacerbate inequalities.

4) A springboard for evaluation: Stakeholders often aim to target certain kinds of drinking (e.g. street or binge drinking) while protecting others (e.g. moderate home drinking, pubs). We will deliver a springboard for prospective and retrospective evaluation to address previously intractable questions such as (a) how alcohol licensing reform affected drinking practices in the night-time economy; (b) how the reduced Scottish drink-driving limit impacted the frequency, participants and nature of pub drinking; (c) whether these interventions had unintended consequences, e.g. shifts to new problematic occasion types or occasion characteristics.

For the public and media, benefits will derive from an improved understanding of how and why the nation's drinking culture is changing. Alcohol use is a regular topic of interest in public and media debates and our unique data will provide new insights into past, present and future trends. Our Pathways to Impact sets out activities to make this information engaging and easily accessible.