Thursday May 9 2013
Risks associated with alcohol include heart and liver disease
"Middle class professionals… are the country’s biggest problem drinkers," is the stark and somewhat misleading claim in The Daily Telegraph, with similar claims appearing across the UK media.
The story is based on a study looking at just 49 ‘white collar’ people’s attitudes towards alcohol consumption. The study involved interviewing five small groups in a ‘focus group’ setting.
Researchers found that among these small groups:
- problem drinking was something that was seen to happen to other people – such as teenagers in city centres or binge drinkers in pubs
- if regular alcohol consumption did not significantly disrupt day-to-day functioning (such as in work or parenting skills) or lower social standards, then it was acceptable and harm-free
- regular ‘controlled’ drinking at home (for example as a way to relax), was also acceptable and harm-free
It is important to note the study was very small and these findings may not be applicable to other countries or cultures. However, the attitudes reported suggest that key messages of some public health campaigns about reducing harm from alcohol are going unheard or being ignored.
It is not just binge drinking that can damage your body; regularly drinking above the recommended limits – whatever the social context – can also be harmful.
Where did the story come from?
The study was carried out by researchers from Newcastle University and the University of Sunderland, UK and was funded by the Public Health NHS Directorate Stockton-on-Tees.
It was published in the peer-reviewed journal, BMC Public Health and made freely available to read on an open-access basis.
The story was picked up widely in the media. While the findings of the study were reported accurately, the tone of some of the reporting was slightly confusing.
It appears that some of the media fail to understand the nature and implication of this method of qualitative research. Such studies can provide useful insights into people’s attitudes and behaviours; however, they cannot provide hard statistical evidence. So headlines such as the Daily Express’s “Middle class ‘drink more than teens’” are misleading, as are sweeping statements like the Telegraph’s “Middle class professionals who drink at home are the country’s biggest problem drinkers”.
What kind of research was this?
This was a qualitative study looking at the drinking habits of a small number of adult ‘white collar workers’ in the UK. The study explored their views on alcohol use, how public health messages about alcohol are perceived, and the role alcohol plays in the workers' personal and professional lives.
The researchers say that little is known about white collar workers’ views on drinking alcohol.
Qualitative research uses individual in-depth interviews, focus groups or questionnaires to collect, analyse and interpret data on people’s behaviours and the reasons behind them. Typically, the number of participants is relatively small, but the transcripts from interviews and focus groups provide a large amount of data. Such studies report on meanings, concepts, definitions, metaphors, characteristics, symbols, and descriptions. As such, their conclusions can be more subjective than quantitative research, as questions are often exploratory and open-ended.
What did the research involve?
The researchers carried out interviews with 49 volunteers (17 male, 32 female) from five workplaces in the UK. The participants were aged between 21 and 55 years and were all working full time (at least 35 hours per week). To be included, participants had to be working in managerial, supervisory, clerical or other professional roles, referred to by the researchers as ‘white collar workers’.
Group interviews (focus groups) were carried out by the researchers at each of the five workplaces during lunch breaks. The five focus groups were made up of workers from:
- local government offices (focus groups one and two)
- a private sector chemical storage company (focus group three)
- a prison (focus group four)
- a tax office (focus group five)
The group interviews lasted between 45 and 75 minutes and were led by two researchers. The researchers used open-ended questions loosely based around four main themes related to drinking alcohol:
- lifestyle behaviours
- drinking at home
- variations in drinking during the week
- the effect of drinking on work
The researchers say areas of agreement and disagreement were explored with the participants, and that questions were continually adapted depending on the flow of conversation. The participants were informed that the purpose of the research was not to find out the quantity or frequency of alcohol consumption of the volunteers. The volunteers were given a £5 voucher and lunch for their time.
The researchers then used a particular technique called ‘constant comparison’ to analyse their results and grouped findings into themes relating to views of alcohol.
What were the basic results?
After analysing the focus group findings, the researchers reported three main themes.
Unacceptable or problem drinking
Unacceptable or problem drinking was perceived by the volunteers as being associated with long-term, heavy or binge drinking of ‘others’. The researchers reported that the participants highlighted ‘others’ as including young people, people with complex needs, and other stereotypes. The perception of excessive drinking was associated with looks and behaviour, rather than how much they have drunk. Personal drinking was viewed as a controlled choice rather than something they ‘need to do’.
Drinking at home
Drinking at home was considered normal, convenient and a socially acceptable form of relaxation from the responsibilities of work or parenting. Volunteers reported less drinking at ‘leisure premises’ such as a bar or pub, and driving was identified as the greatest factor influencing drinking behaviours. Drinking alcohol was considered part of everyday life and not something that interferes with other parts of life or causes harm.
Effect of drinking on functioning
Ability to function at work and act responsibly were key indicators of whether drinking was within acceptable limits. So, if a person was able to maintain employment in skilled jobs, they were therefore perceived to be drinking in a way that was not considered harmful. Despite awareness of guidelines for drinking, little notice was taken by participants and there was confusion about what a ‘unit’ was, the researchers report. Public health messages were also considered to have little or no personal relevance.
The researchers say that discussions indicated that the volunteers' reported alcohol use exceeded recommended guidelines for both the amount and how often drinking occurred. Interestingly, when the ill effects of alcohol were discussed, they were reported as only in relation to coping with a hangover and the loss of valuable time while feeling unwell. More subtle, insidious adverse effects such as gradual loss of liver function did not appear to occur to the volunteers.
Finally, lunchtime drinking at work was considered a 'thing of the past' and very much taboo.
How did the researchers interpret the results?
The researchers say that this study helps reveal the meanings attached to alcohol use by white collar workers and identifies resistance to public health messages. They say, "these findings suggest that current public health interventions have not been effective in engaging this group who are likely to drink at unhealthy levels but be highly resistant to reducing their alcohol consumption – especially as they do not consider their use to be problematic unless it impairs their capacity to fulfil responsibilities or function at work".
They conclude by saying, "future public health messages around alcohol should be less focused upon the crime and personal safety implications of irresponsible drinking and be more sensitive to the lifestyles and long-term health of the populations they target".
They add that further research is needed to identify which factors (other than driving) would engage white collar workers to change their views and drinking behaviours.
Overall, this research provides some early findings of so-called ‘white collar’ workers' views of drinking behaviours in the UK.
Although the study was very small, with only 49 volunteers' views analysed, it is useful in determining emerging themes, and the researchers do state that there was relative consistency across the five groups. The researchers also note that ‘strong personalities’ within the group may have influenced how the other participants responded.
Research among larger groups of white collar workers is needed to draw firmer conclusions about the drinking culture in the UK. It is worth noting that these findings may not be applicable to other countries or cultures. Ethnicity, cultural identity and religious beliefs of the participants were not reported, which may have influenced how participants responded to the questions.
One important final message to stress – and one that seems to have not been grasped by the volunteers in the study – is that it is not where you drink, why you drink, or who you drink with that matters. It is how much you drink.
Regularly exceeding the recommended daily amounts for alcohol can harm your health, regardless of whether it is with three litres of strong white cider on a park bench, or a bottle of Californian merlot in front of a DVD box set.
Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.