Reviews research and highlights trends in alcohol consumption over the last 20 to 30 years.

A key part of the Government’s alcohol harm reduction strategy is to monitor changes in drinking habits over time and to identify what factors are potentially contributing to the rising levels of consumption.

This study is a systematic review of research relevant to trends in alcohol consumption over the last 20 to 30 years in the UK.

The review:

• assesses the number, types and quality of existing research studies;
• synthesises the findings to evaluate alcohol drinking trends in the UK, highlighting key changes;
• discusses possible explanations for the trends observed, assessing what factors may have contributed to changes;
• explores implications for policy;
• makes recommendations for future research.

Summary

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Rising alcohol consumption is a cause for concern. This evidence review summarises interesting trends in drinking in the UK and discusses possible causes.

Key points

• There has been a slight overall decline in weekly drinking by men and women in Great Britain in recent years, especially amongst adults aged 16-24. But there has been a notable increase in weekly drinking in Northern Ireland since 1986.
• Average units of alcohol consumed by men and women in Great Britain have increased since 1992. For women over 25 this increase has been marked. However, consumption by men aged 16-24 has fallen since 2000.
• Since 1998, there has been a general increase in drinking over recommended weekly limits, especially for women. Among men aged 16-24 drinking over weekly limits has decreased alongside overall consumption since 2000. In Northern Ireland, there has been a clear increase in both genders and especially in adults aged 18-24.
• Binge drinking levels (twice the recommended daily limit) have changed little between 1998 and 2006 in Great Britain. However, this masks an increase of 7 per cent in women – especially those over 25 – and a fall amongst men aged 16-24.
• There is some evidence that the proportion of drinkers under 16 has fallen slightly since 1988 in England, Northern Ireland and Scotland, though this is not consistent across boys and girls of different ages. Amongst those who do drink, average units consumed increased markedly between 1990 and 2006, with a larger increase amongst 11- to 13-year-old boys. This may have recently decreased in England in 2007: future surveys will show if this trend continues.
• Continued monitoring of women’s and under-16s drinking using consistent consumption measures, and greater recruitment from under-represented groups, such as different ethnic groups, are needed to help interpret future trends.

Background

The UK government's alcohol harm reduction strategy has highlighted the need to promote sensible drinking in the light of rising problems associated with alcohol consumption. Key action points of the strategy are to monitor changes in drinking habits over time and to identify factors influencing drinking behaviour that potentially contribute to rising levels of consumption.

This research gathered evidence to describe alcohol drinking trends in the general population in England, Northern Ireland, Scotland and Wales over the last 20 to 30 years, and to describe how they vary according to age, sex, ethnicity, socio-economic status and geographic region. The review assessed research studies and synthesised findings to evaluate trends. The researchers also discuss possible explanations for trends.

The key surveys included are:

• For adults, seven primary studies: the Continuous Household Survey (CHS), the General Household Survey (GHS), the Health Education Population Survey (HEPS), the Health Survey for England (HSE), the Health Survey for Wales (HSW), the Omnibus Survey and the Scottish Health Survey (SHS). All were large national cross-sectional surveys repeated on a regular basis, every one, two or three years.
• For people under 16, six primary studies: Smoking, Drinking and Drug Use among Young People in England (SDD), the HSE, the Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS), SHS, the Health Behaviour in School-aged Children (HBSC) survey and the European School Survey Project on Alcohol and other Drugs (ESPAD). Four were large national cross-sectional surveys repeated on a regular basis, every one, two or three years, and two were international studies that are conducted every three years (ESPAD and HBSC). One additional study reported a secondary analysis of data from two other surveys (HBSC and the Young Persons Behaviour and Attitudes Survey (YPBAS) in Northern Ireland.

Notable trends

The research highlights five interesting trends:

• increase in drinking amongst women;
• increase in drinking among middle- and older-age groups;
• increase in drinking in Northern Ireland compared with the rest of the UK;
• a possible recent decrease in drinking among 16- to 24-year-olds;
• increase in alcohol consumption amongst very young adolescents.

Increase in drinking amongst women

In the UK, women are less likely than men to drink and women who do drink consume less than men. However, a robust trend identified across several different surveys and different measures of alcohol consumption (GHS, CHS, Omnibus survey, HSE and SHS) shows a recent narrowing of the gender gap. An examination of trends over the last 15 to 20 years indicates that it is generally the drinking behaviour of women that has increased toward that of men, at least in the UK where the gender gap in drinking at excessive and harmful levels has decreased over recent years.

This might be interpreted as one expression of the historically recent emancipation of women in Western society, the pressure of positive advertising and also the increased financial security and independence of women.

Increase in drinking amongst middle- and older-age groups

Whilst alcohol consumption among middle- and older-age groups is lower than for the younger age groups, in recent years there has been a small but steady increase in the amount of alcohol consumed by these older groups. The trend is consistent across different surveys and different consumption measures (GHS, SHS, CHS and HSE).

Alcohol is 65 per cent more affordable now than in 1980 and accounts for only 5.2 per cent of household spending compared with 7.5 per cent in 1980 (Office for National Statistics, 2007). Older people today are better off financially than they have ever been. For the first time, pensioners are no more likely to be living in poverty than others in the general population, although there are large income inequalities amongst older people: all the people as a group are better off, but some are much better off than others. It is likely to be the wealthier, better-off individuals, who are drinking more.

This apparent trend may also reflect a generation of drinkers with drinking habits established during former years when alcohol generally has been more affordable and acceptable. Today’s 50- to 60-year-olds represent the 'baby boom' generation which experienced young adulthood during the 1960s, a time of great social change associated with more liberal and permissive attitudes to many social activities. This generation may be more likely to retain old drinking habits compared with previous generations whose formative drinking years were associated with greater austerity.

Increase in consumption in Northern Ireland

h the proportion of people drinking (‘prevalence’) and excessive weekly drinking have increased in Northern Ireland compared with Great Britain as a whole since 1986. This is especially the case amongst adults aged 16-24. One possible explanation for this increase is the change in the licensing laws in 1996, and the rapid growth in the leisure industry (number of pubs/bars/clubs) since the peace process began. The peace process has led to increased investment, employment, urbanisation, improved personal financial status and independence amongst the population and amongst young people especially. This social and economic emancipation, when set against a historic low baseline of alcohol use because of religious and cultural norms, may have led to the increase in alcohol drinking over recent years toward the levels in the rest of the UK.

Possible recent decrease amongst 16- to 4-year-olds

This is a rather surprising finding, especially in the face of rising consumption in older age groups and amongst women generally across all age groups over the past 15 to 20 years. At first glance, this apparent recent downward trend may seem counterintuitive: this age group has the highest consumption if one compares prevalence or unit consumption across ages, so the often cited message is that drinking is highest in young adults. That message still holds, but in the past few years this age group may not have been drinking quite as much as in preceding years.

However, variability in consumption between successive survey years is greater in this age group than any other. This means that we should be more cautious about interpreting this as a convincing downward trend. It is, however, consistent across different surveys and different consumption measures (GHS, SHS and HSE).

Even if we lack confidence in the apparent downward trend as too recent to state as a robust, definite downward turn, it is still interesting and perhaps surprising that there is no further increase in drinking behaviour in this age group. This warrants further consideration.

Rising consumption amongst very young adolescents

The Government’s alcohol strategy, ‘Safe, Sensible, Social’ (Department of Health, 2007), states that while the proportion of young people who are drinking has declined in recent years, those who do drink are consuming more alcohol, more often. This study found that whilst there is some evidence that the proportion of drinkers under 16 has fallen slightly since 1988 in England, Northern Ireland and Scotland, this is not consistent across boys and girls of different ages. More significantly, young people are drinking twice what they were in 1990 and the amount of alcohol consumed by adolescents aged 11-13 increased substantially between 1992-2006 in England, though may have reached a peak in 2007.

Reasons why consumption amongst 11- to 13-year-olds may show a continuing upward trend include the possibility that younger adolescents have fewer financial pressures than older adolescents and young adults, and may have a higher disposable income, leading to heavier drinking. Alcohol advertising and promotional activities are particularly appealing to young people and can influence the initial development of drinking behaviour. Of note is the fact that alcohol advertising expenditure rose from £150 million to £250 million annually between 1989 and 2000. Over the same period, mean weekly alcohol consumption by young people aged 11 to 15 years also rose in a highly correlated manner.

However, these possibilities would not necessarily lead to different effects on younger versus older teenagers. Therefore, the most compelling consideration when trying to explain the rising trend in consumption amongst 11- to 13-year-olds compared with older teenagers and young adults is the influence of parents, family, friends and the home environment. A 2007 Joseph Rowntree Foundation report indicated that the home is increasingly where young people learn to drink, and as such, young people’s drinking habits need to be understood and addressed in relation to parental attitudes to and use of alcohol.

About the project

The researchers conducted a systematic review of the literature, searching electronic databases, reference lists and specialist websites. The following study designs were sought: general population surveys reporting on cross-sectional analyses at different time points or reports of epidemiological and alcohol expenditure and sales data analysed from official databases such as the Office for National Statistics (ONS) and the World Health Organisation (WHO). For the assessment of factors possibly contributing to a selection of interesting trends the authors summarised and offered brief explanatory notes which were then pooled and edited for the discussion section of the final report.

To be included in the evidence review studies had to meet the following criteria:

• The population had to be from the UK and of any age or ethnic group. Studies covering a broader population had to present results separately for the UK or its constituent countries.
• Studies had to report alcohol consumption for any period of time between the 1970s and 2007, using measures such as quantity and frequency of drinking, drunkenness and binge drinking. Indirect measures of consumption – such as trends in alcohol related morbidity, mortality or crime – were not sought.
• Studies had to provide data which could be reliably used for analysing trends, i.e. change over time, such as repeated cross-sectional surveys; panel studies (repeated cross-sectional time-series); and cohort studies (a type of panel study).

Note: New methods for calculating a unit of alcohol have been recently introduced which affect data recorded for Great Britain for 2006, and SDD 2007. The new method effectively doubles the units of alcohol calculated for a glass of wine. The trends summarised in this report take account of this new method.