International comparisons of alcohol consumption

Alcohol Research & Health, Wntr, 2003 by Kim Bloomfield, Tim Stockwell, Gerhard Gmel, Nina Rehn

International comparisons of alcohol consumption and its consequences can serve multiple purposes. For example, despite differences among countries in drinking cultures, drink sizes and strengths, and methods of measuring alcohol consumption, international survey research has provided a substantial amount of information on the rates of abstinence or current drinking, the frequency of drinking or binge drinking, and the mean consumption among both adults and youths in many countries. Other studies using aggregate-level data have analyzed per capita alcohol consumption in various countries. These studies can be used to relate per capita consumption to certain alcohol-related outcomes and to evaluate changes of both consumption and different outcomes within a country or across countries over time. Some problems associated with international research, however, such as issues of comparability of surveys, still need to be resolved. KEY WORDS: international AODR (alcohol and other drug related) problems; international differences; cultural patterns of drinking; research quality; alcohol quantity--frequency methods; measure of AOD (alcohol and other drug) volume and strength; cross-sectional study; gender differences; AOD abstinence; aggregate-level statistical data

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Researchers in numerous countries have conducted analyses of alcohol consumption and general population surveys to ascertain the level and consequences of alcohol use. In recent years, investigators also have made attempts to compare drinking rates and other drinking variables across different countries. One reason for researching across national borders is the need for descriptive epidemiology (Room 1988). For example, national governments often want to know how their countries measure up against others in per capita consumption or in other comparative rankings of alcohol use. Another reason for comparative research is the desire to further theoretical knowledge; social scientists often employ comparative designs to develop or test theories. In the case of alcohol research, comparisons among different countries can help researchers determine how variations in social, cultural, political, environmental, and genetic factors can influence drinking behavior. For example, in the case of research on gender differences in alcohol use, international comparisons could help distinguish which differences in men's and women's drinking behavior can be attributed to biological differences and which to sociocultural factors (Wilsnack et al. 2000).

Epidemiologic research into the underlying mechanisms (i.e., the etiology) of any disorder generally addresses two questions (Rose 1985):

* What are the causes of individual cases of the disorder (e.g., alcoholism)?

* What factors, such as sociocultural or political influences, contribute to the incidence of the condition in an entire population?

The type of question to be answered determines the level at which researchers compare data in international research. To answer the first question, investigators would mainly use individual-level studies (e.g., determine the level of alcohol consumption in individual drinkers within a country) to address within-population variability. To answer the second question, it may be more useful to conduct aggregate-level studies that determine overall alcohol consumption in a population (e.g., per capita consumption) to model between-population variability. Such aggregate-level analyses are particularly useful when some societal or environmental factors are constant or almost constant within a population. For example, Rose (1985) notes the hypothetical example of a population in which every person smokes 20 cigarettes per day. An epidemiologist who uses individual-level data to study risk factors for lung cancer in such a society could identify factors that vary between people with and without the disease (e.g., genetic susceptibility) but would not be able to identify smoking as a cause of lung cancer. Similarly, drinking patterns may show little variability within a drinking culture; accordingly, it may be more valuable to study the effects of various drinking patterns by comparing drinking patterns of different cultures. For any research question, however, both aggregate-level and individual-level studies have advantages as well as limitations (e.g., Greenland and Robins 1994).

This article describes some of the methodological problems involved in measuring drinking rates across countries, such as differences in drinking cultures, drink sizes, and measurement instruments. It then reviews the results of various types of studies that have examined drinking rates across countries. Finally, the article discusses how such results should be interpreted given the limitations of such studies, and it gives some recommendations for improving comparative international alcohol epidemiology for the future.

GENERAL METHODOLOGICAL ISSUES IN INTERNATIONAL SURVEY RESEARCH

Differences in Drinking Cultures