This document discusses challenges in accurately measuring alcohol consumption at a population level. It is difficult to get a representative sample of all drinkers in population surveys due to issues with self-reporting. Sales data may provide a more reliable estimate but can overestimate consumption due to factors like tourists' purchases being included. Even retrospective analyses of longitudinal studies face issues if questionnaire wording and measurements of drinks are not consistent over time. Accurately monitoring consumption across different groups is challenging for informing policy.

1. Liquidity and Validity.
Challenges in measuring alcohol
consumption at a population and individual
level.
Dr Jan Gill
School of health and Social Care
Wednesday 5th October 2016

2. • Cost estimated at £ 3.56 billion (£900.00 per adult) using
2007/08 data.
• (Scottish Government. The societal cost of alcohol misuse in Scotland for 2007.
• Online: Scottish Government; 2010. Available at:
• http://www.gov.scot/Publications/2009/12/29122804/0.)
• Or £7.5 billion with 40% of the costs being linked to the
most deprived 20% of the population.
• Johnson, M.C., Ludbrook, A., Jaffray, A. (2012) Inequalities in the distribution of the costs of alcohol misuse in
Scotland: a cost of illness study. Alcohol and Alcoholism, 47(6), 725-731.
Impact of alcohol consumption on
Scottish society

3. Source: http://www.healthscotland.com/uploads/documents/27345-
00.%20Alcohol%20consumption%20and%20price%20in%20Scotland%202015%20-%20May2016.pdf

4. Responses- Scotland’s Alcohol Strategy
Licensing (Scotland) Act 2005- Implemented 2009
 Test purchasing
 Ban on irresponsible promotions in on-trade
 Restrictions on place of display in off trade
 Plus other measures
Framework for Action 2009
• ABIs in NHS
• Initiatives in alcohol and care services etc
Alcohol etc. (Scotland) Act 2010 – implemented 2011
• Ban on quantity discounts in off-sales
• Restrictions on alcohol display and promotion in off sales
• Mandatory Challenge 25 age verification policy
• etc
Alcohol (Minimum Pricing) (Scotland) Act 2012
• Minimum unit price for alcohol sold in licensed premises

5. Specific Challenges for Public Health
messages.
• Terminology employed.
• Public awareness/understanding of
that terminology.

6. country Grams of pure
ethanol
UK 8 = 1 UK Unit
Australia 10
Canada 13.6
Finland 12
France 10
Japan 19.75
Netherlands 9.9
United States 14
Standard
Drink
Definitions

7. UK
Health Guidelines

8. No-one can say that
drinking alcohol is
absolutely safe.
Men and women are
advised not to regularly
drink more than 14 units
a week.
Spread your drinking
over three days or more
if you drink as much as
14 units a week.

9. Additionally within the UK
• Hazardous drinking
• Harmful drinking
• Binge drinking
• Those drinking above weekly guidelines but have not yet
experienced alcohol-related harm are regarded as
hazardous, (increasing) risk of harm in the future.
• > 50 units of alcohol per day in men and 35 units in
women is regarded as ‘definitely harmful’ (Royal College
of Psychiatrists,1986).
• Those drinking more than eight units per day in men and
six units in women are regarded by the Government as
binge drinkers (Prime Minister‘s Strategy Unit, 2004).

10. Student definitions of Binge drinking
• ‘Enough to make you violently ill’
• ‘Depends on who you are how you would define binge
drinking’
• ‘As many drinks as it takes to get you drunk’
• ‘being drunk to the state where you’re having to kind of get
carried’
• ‘hammered’
(Gill et al (2007) Health Education Research 22, 27-36)

11. Women’s (n=181) self-reported consumption in the index
week expressed in multiples of the UK definition of
harmful consumption (35 UK units per week).

12. SELF REPORT SURVEYS HAVE INHERENT
PROBLEMS –BOTH IN REACHING A
REPRESENTATIVE SAMPLE OF ALL DRINKERS
AND IN MEASURING CONSUMPTION
Challenges for
population surveys.

13. 0
5
10
15
20
25
Scottish Health Survey (2015) Sales records (Mesas,2015)
UKUNITS/WEEK
Estimation of consumption by
Scottish Adults (2014 data)

16. Source: http://www.healthscotland.com/uploads/documents/27345-
00.%20Alcohol%20consumption%20and%20price%20in%20Scotland%202015%20-%20May2016.pdf

17. Most reliable measure may be…………..

18. Source: Beeston C, McAdams R, Craig N, Gordon R, Graham L, MacPherson M,
McAuley A, McCartney G, Robinson M, Shipton D, Van Heelsum A. Monitoring and
Evaluating Scotland’s Alcohol Strategy. Final Report. Edinburgh: NHS Health Scotland;
2016

19. Source: Beeston C, McAdams R, Craig N, Gordon R, Graham L, MacPherson M,
McAuley A, McCartney G, Robinson M, Shipton D, Van Heelsum A. Monitoring and
Evaluating Scotland’s Alcohol Strategy. Final Report. Edinburgh: NHS Health Scotland;
2016
Mean = 229.8 UK units
(95%CI= 216.5-243.1)
N=458
Mean =179.2 UK units
(95%CI= 161.4-197.1)
N=181

20. SALES DATA information

21. Henderson et al (2015) Alcohol and Alcoholism DOI:
http://dx.doi.org/10.1093/alcalc/agv109
Estimated size of
biases linked to
per adult
consumption
extrapolated from
sales data
(Scotland).

22. Implications for retrospective analysis
• Whitehall II cohort study of civil servants. Data from 1997-
1999. n=7010. Took account of larger serving of wine and
use of 175 ml glass in pubs.
• Traced deaths from all causes until June 2015.
• Hazard Ratios estimated.
Britton, A O’Neill D and Bell,S. (2016) Underestimating the alcohol content of a
glass of wine: the implications for estimates of mortality risk. Alcohol & Alcoholism
doi: 10.1093/alcalc/agw027

23. Assuming 1 glass= 1 unit
Assuming 175 ml glass
= 2 units

24. From Britton et al (2016) Alc and Alcoholism doi: 10.1093/alcalc/agw027

25. Assuming higher wine alcohol content
• Proportion of men and women within heavy/very heavy
category increased.
• HR ratios reduced. (46% reduction in risk)
• ? Overestimation of health risks associated with very
heavy drinking (>35/50 units) compared with moderate
(14/21 units).
• ? partially due to increase in proportion of very heavy
drinkers with good diet, physically active, higher SES.

26. In conclusion
• Different population groups pose different challenges
when attempting to monitor accurately their alcohol
consumption.
• Retrospective analysis of longitudinal data must be
preceded by consideration of the precise wording, and
consistency, of consumption questions employed at
different time-points.
• THANK YOU