Causal mechanisms proposed for the alcohol harm paradox – a systematic review

Boyd, J., Sexton, O., Angus, C., Meier, P. , Purshouse, R. C. and Holmes, J. (2022) Causal mechanisms proposed for the alcohol harm paradox – a systematic review. Addiction, 117(1), pp. 33-56. (doi: 10.1111/add.15567) (PMID:33999487) (PMCID:PMC8595457)

Abstract

Background and Aims: The Alcohol Harm Paradox (AHP) posits that disadvantaged groups suffer from higher rates of alcohol‐related harm compared with advantaged groups, despite reporting similar or lower levels of consumption on average. The causes of this relationship remain unclear. This study aimed to identify explanations proposed for the AHP. Secondary aims were to review the existing evidence for those explanations and investigate whether authors linked explanations to one another. Methods: Systematic review. We searched MEDLINE (1946‐January 2021), EMBASE (1974 – January 2021) and PsycINFO (1967 – January 2021), supplemented via manual searching of grey literature. Included papers either explored the causes of the AHP or investigated the relationship between alcohol consumption, alcohol‐related harm, and socioeconomic position. Papers were set in Organisation for Economic Co‐operation and Development high income countries. Explanations extracted for analysis could be evidenced in the empirical results or suggested by researchers in their narrative. Inductive thematic analysis was applied to group explanations. Results: Seventy‐nine papers met the inclusion criteria and initial coding revealed these papers contained 41 distinct explanations for the AHP. Following inductive thematic analysis, these explanations were grouped into 16 themes within six broad domains: Individual, Lifestyle, Contextual, Disadvantage, Upstream and Artefactual. Explanations related to risk behaviours, which fit within the Lifestyle domain, were the most frequently proposed (n=51) and analysed (n=21). Conclusions: While there are many potential explanations for the Alcohol Harm Paradox, most research focuses on risk behaviours while other explanations lack empirical testing.

• Item Type: Articles
• Additional Information: This work was supported by funding from The Wellcome Trust [Award Number 108903/B/15/Z]. Research reported in this publication was also supported by the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health [Award Number R01AA024443].
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Meier, Professor Petra and Boyd, Dr Jennifer
• Authors: Boyd, J., Sexton, O., Angus, C., Meier, P., Purshouse, R. C., and Holmes, J.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
• Journal Name: Addiction
• Publisher: Wiley
• ISSN: 0965-2140
• ISSN (Online): 1360-0443
• Published Online: 17 May 2021
• Copyright Holders: Copyright © 2021 The Authors
• First Published: First published in Addiction 117(1): 33-56
• Publisher Policy: Reproduced under a Creative Commons License