Behaviours associated with beverage preference

Researchers have examined the relationship between young people’s preferences for different beverages and potentially risky behaviours, including heavy drinking patterns, the use of illicit drugs, smoking cigarettes, and drink driving. This section will explore young people’s use of different beverage types, specifically wine, beer and spirits, and how their choices are associated with potentially risky behaviours.

Consistently, tobacco and alcohol use co-occur; drinkers are more likely to smoke than non-drinkers, and smokers are more likely to drink than non-smokers (Jackson, Colby & Sher, 2010). Evidence also suggests that certain beverages have a stronger relationship with these potentially risky behaviours. Sutherland and Wilner (1998) found among a sample of 11 to 16 year olds in England, that alcohol was combined more with the use of illicit drugs and cigarettes. Spirit and alcopop drinkers, when compared to beer or wine drinkers, were more likely to be cigarette users, take drugs, and reported being drunk more frequently, particularly among 11 to 13 year old girls.

Similarly, Miller and Plant (2003) found that in the UK 15 to 16 year olds with a preference for beer or spirits were more likely to be heavy drinkers, smoke cigarettes, use illicit drugs, and truant from school, compared to wine drinkers. Similar results were found in Finland where smokers were more likely to choose beer or spirits than wine or cider, and drug use was more common among those with a preference for beer and spirits (Lintonen & Konu, 2003). A study in New Zealand found that a

preference for alcopops was associated with higher typical occasion alcohol

consumption and heavier drinking than any other beverage type in females aged 14 to 17 years (Huckle, Sweetsur, Moyes, & Casswell. 2008).

More recently a study of 12 to 18 year olds in America by Siegal, Naimi, Cremeens and Nelson (2011) observed that in general, spirit drinkers engaged in more risky behaviours; 48.4% of spirit drinkers reported being in a physical fight and 49.9%

admitted carrying a weapon. Additionally, a preference for spirits was associated with the use of cigarettes and marijuana. An association with beverage preference and risk behaviours was also found in a Swedish study by Kuntsche, Knibbe, Gme and Engles (2006), where 15 year olds with a preference for beer and spirits liked to have fun, feel the effects of alcohol and drink to get drunk, behaviours that are all associated with an unhealthy and risky pattern of drinking.

Links have also been found between beverage preferences and dangerous levels of drinking among older adults. For example, a Danish study found that male beer drinkers and female spirit drinkers were at a higher risk of becoming heavy drinkers (more than 21 drinks a week) or excessive drinkers (more than 35 drinks a week).

Women who included beer in their alcohol intake also had a higher risk of heavy and excessive drinking, compared to abstainers and moderate wine drinkers, who

appeared to be at lower risk of becoming heavy drinkers or excessive drinkers (Grønbaek, Jensen, Johansen, Sorensen, & Becker, 2004). In Canada, Devolulyte, Stewart and Theakston (2006) also supported the link with beverage specific preference and a heavy drinking pattern, observing that levels of consumption were significantly higher amongst female spirit drinkers (mean age 38.4 years), compared to wine drinkers.

An Australian study found that among 25 to 40 year olds, cask wine (boxed wine) and high strength beer was significantly associated with the rates of night-time assault.

Contrastingly, low alcohol beer, spirits and bottled wine had no association with assaults (Stockwell et al. 1998). The beverages that had the association with assault were those with the lowest federal taxation per standard drink in Australia, adding to the debate over the relationship between alcohol pricing and consumption rates.

Some studies have compared the personality characteristics of wine, beer and spirit

of over 1000 adults in Canada that higher consumption of beer among males was associated with higher levels of neuroticism. The female wine drinkers scored low on the Vando (1969) reducer-augmenter scale, which is a scale measuring levels of stimulation and sensation seeking and infers that participants who score low have lower pain tolerance, and avoid high intensity stimulation (McGregor et al, 2003).

This suggests that women who consume wine are less likely to search out stimulating situations and to sensation-seek.

Although the evidence is limited, beverage preference has also been related to the pattern of drinking known as ‘binge-drinking’ (drinking 5 or more drinks on one occasion). For example Naimi, Brewer, Miller, Okoro and Mehrotra (2007) in a study of 14,150 adults aged between 18 and 56 years in the USA observed that over 70% of binge drinkers consumed beer exclusively or predominantly, compared to 21.9%

being spirit drinkers, and 10.9% wine drinkers. Beer drinkers were also rated as being at a higher risk of causing or incurring alcohol-related harm, with 67% of those aged between 18-20 years old.

Researchers have also noted a link between specific beverage preference and suicide rates. Suicide is an escalating public health problem, with a global 60% increase in the last 45 years (Bertolote et al., 2005). In the UK in 2013 6,233 suicides were registered and 78% were male and 22% were female (ONS, 2015c). There is evidence to suggest an association between chronic alcohol abuse, alcohol dependence and increased suicide risk through depression, which is a known to have a reciprocal relationship with alcohol abuse. In a recent Japanese study, the consumption of spirits was significantly related to male suicide rates, and this risk was higher compared to any other beverage types (beer, wine and other alcohol); there was no significant association in women. More specifically, the researchers suggested that a one litre per capita increase in spirit sales would lead to more than a 20% increase in suicide rates among Japanese males (Norström, Stickley, & Shibuya, 2012). It is worth noting that the researchers controlled for unemployment, which could be seen as another risk factor for suicide, however other factors such as mental illness were not controlled for.

A similar study in America observed a particularly strong association between female acute and chronic drinking and suicide rates, estimating that a litre of ethanol from

spirits would increase suicide rates by 6% in the current year and 9% in the years to come. An association was also found between chronic beer and wine drinking in men and suicide rates in the US from 1950 to 2002. Overall, all beverage types were significantly related to suicide with a 5% effect size per litre of ethanol for beer, 9.1%

for wine and 2.9% for spirits. (Kerr, Subbaraman, & Ye, 2011).

In Russia where alcohol consumption and suicide rates are among the highest in the world, studies have found a strong link between specific alcoholic beverages and suicide rates. This link has been suggested to be a result of Russia’s drinking culture, with a preference for distilled spirits, binge-drinking, socio-cultural tolerance for heavy drinking and concomitant behaviour (Nemtsov, 2000), traits that have been shown to be related to suicide (Razvodovsky, 2003). Pridemore (2006) found a positive and significant association between heavy drinking and suicide rates in Russia amongst males and females in the 1990’s. A further study using time-series analysis (from 1970 to 2005) found that a one litre increase in overall alcohol sales would result in a 4% increase in male suicide rates and a 2.8% increase in female suicide rates. Additionally, a one-litre increase in vodka consumption would increase the suicide rate for men by 9.3% and 6% for women (Razvodovsky, 2009). A later study by Razvodovsky (2011) supported an overall association between alcohol consumption and suicide rates in Russia for both men and women. Binge-drinking has also been found to be associated with suicide occurrence in Russia. Again in a time series analysis Stickley, Jukkala and Norström (2011) found that binge-drinking was significantly associated with the occurrence of suicide in Russia.

In summary, beverage preference is highlighted here as an important factor when attempting to tackle unhealthy levels of drinking as well as harmful patterns of drinking in the UK and throughout the world. Evidence shows that young people’s beverage preferences influence certain types of behaviour, including risky and

potentially life threatening behaviour. The literature review highlights the importance of understanding the relationship between certain drink types and associated negative behaviours, as well as preventative measures that could be used to reduce alcohol related harm and mortality. There is a need for further research in order to ensure that policies are evidence based and lead to accurate interventions for alcohol misuse. The types of alcohol that have been shown to be of most concern are alcopops and spirits,

especially when consumed by adolescents, which have been associated with smoking, the use of illicit drugs and other risky behaviours including truancy from school and heavy drinking (Sutherland & Wilner, 1998; Miller & Plant, 2003; Huckle et al., 2008; Lontonen & Konu, 2003). Among 18 to 24 year olds a preference for beer and spirits has also been shown to be associated with risky behaviours, including being at higher risk of becoming a heavy drinker (Grønbaek et al., 2004; Devolulyte et al., 2006), partaking in crime such as night time assault and being involved in a physical fight and smoking marijuana (Stockwell et al., 1998; Siegel et al., 2011). A preference for spirits has also been shown to have a strong associated with rates of suicide in Japan, Russia and America (Norström et al., 2011; Kerr et al., 2011; Razvodovsky, 2003, 2009, 2011). In addition, beverage-specific findings suggest that all beverage types are related to suicide risk in the US population, with spirits being particularly associated with risks from both acute and chronic drinking for women and beer and wine being associated with risks from chronic drinking for men (Kerr et al., 2011). It is interesting to note that the evidence shows a weak link between these risky

behaviours and wine consumption, compared to beer and spirit consumption. This could be explained by beer and spirit drinking being a marker of a specific drinking culture or socio-economic status and differences in life-style characteristics possibly associated with specific types of preferred alcohol. For example it has been suggested that wine is perceived as a civilised or sophisticated drink and therefore associated with similar behaviour (Charters, 2006). This could also support the evidence of low morbidity and mortality among wine consumers compared to beer and spirit drinkers (Grønbæk, Deis, Sørensen, Becker, Schnohr, Jensen, 1995; Theobald, Bygren, Carstensen, Engfeldt, 2000; Klatsky & Armstrong, 1993). It is also worth noting that the majority of the literature in this area does not include cider consumption when comparing behaviours.