Bob Erens
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SUMMARY Adults
Children
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This chapter looks at alcohol consumption among survey informants, with separate sections for drinking among adults (ages 16-74) and children (ages 8-15). Both the 1995 and 1998 Scottish Health Surveys included a set of questions on alcohol consumption, with the questions addressed to adults being the same as those used in the General Household Survey (GHS).1 GHS does not provide data on drinking among those aged under 16. However, since 1982, the Social Survey Division of ONS has carried out biennial in-school surveys of smoking behaviour among children in Scotland, and since 1990 these have included some questions on drinking.2
While moderate alcohol consumption is recognised to have health benefits for men over 40 and post-menopausal women,3 alcohol misuse contributes to a wide range of health and social problems, including high blood pressure, cirrhosis of the liver, accidents, and anti-social behaviour including crime and domestic violence. Excessive drinking affects large numbers of the Scottish population, and there has been an upward trend in recent years in excessive drinking, both among adults and 12-15 year olds.4
Until late 1995, advice to adults on alcohol consumption had been expressed in terms of weekly consumption levels (21 units per week for men and 14 units for women).5 The original target for reducing alcohol misuse was set out by the Scottish Office in Health Education in Scotland.6 It had been estimated that about 24% of men and 7% of women were exceeding these weekly limits in 1986.7 The target was to achieve by the year 2000 a 20% reduction in these 1986 levels. As evidence from the 1998 Scottish Health Survey confirms, this target will not be met. Indeed, the proportion of adults exceeding these limits has been increasing.
More recently, the 1999 White Paper Towards a Healthier Scotland has set new targets for reducing alcohol misuse. Using results from the 1995 Scottish Health Survey as a baseline, the new targets are to reduce the proportion of adults (aged 16-64) exceeding weekly limits:
In late 1995, following the recommendations of an inter-departmental Working Group,9 advice on sensible drinking was revised so that it is now commonly expressed in terms of daily, rather than weekly, consumption. It also reflects evidence that moderate consumption may be beneficial for certain groups of the population. Current advice about sensible drinking is that:
The main series of questions contained in the Health Survey and GHS had been designed to estimate average weekly consumption rather than daily drinking patterns. To provide continuity with the 1995 Scottish Health Survey and with the 1998 Health Survey for England, the results given in this chapter include weekly consumption estimates and show the proportions of men and women exceeding the weekly levels advised before 1996. These results are also necessary to monitor progress in meeting the consumption targets set out in Towards a Healthier Scotland. In addition, some findings are also reported from new questions which were included in the 1998 Health Survey to provide more information on daily consumption.
This chapter contains sections on: weekly (sections 9.2 and 9.3) and daily (9.4) drinking among adults; changes in consumption since the 1995 Health Survey (9.5); an analysis of the blood analyte gamma gt (9.6); problem drinking and drunkenness (9.7); experiences of drinking alcohol and levels of consumption among children aged 8-15 (9.8); and a comparison of results from the Scottish Health Survey with those from the 1998 Health Survey for England (9.9).
9.2 ESTIMATING WEEKLY ALCOHOL CONSUMPTION
Informants aged 16-74, after preliminary questions on whether they drank alcohol at all, were asked how often during the past 12 months they had drunk each of six different types of alcoholic drink:
From this question, the average number of days a week the informant had drunk each type of drink was estimated. A follow-up question asked how much of each drink type they had usually drunk on each occasion. This data was converted into units of alcohol and multiplied by the amount they said they usually drank on any one day.10
The module of drinking questions in 1998 differed in a number of ways from the 1995 Health Survey questions. One change was the distinction made in 1998 between normal (alcoholic strength less than 6%) and strong (6% or more) beer, lager and cider. The separate question on shandy asked in 1995 was dropped, and shandy was included with normal strength beer. Also a question on alcoholic soft drinks (or 'alcopops') was included in 1998. Finally, a new series of questions on drinking behaviour over the seven days prior to interview was added.
It is well known that surveys tend to underestimate adults' levels of alcohol consumption11 for a number of reasons, including problems of memory and the difficulties involved in assigning an average estimate to an activity that varies from day-to-day. Also, as the questions ask about 'usual' behaviour, responses are unlikely to reflect occasions of heavier drinking. Nevertheless, survey estimates provide useful comparisons of the consumption of different population groups and enable change over time to be monitored.
Children aged 8-12 were asked whether they had ever drunk a whole alcoholic drink (not just tasting one), at what age they first did so, and how often they drank at the time of the interview. In addition, informants aged 13-15 were asked to provide details of their consumption in the last week (which is considered a better way of obtaining accurate responses from children than asking about 'usual' drinking over the past year). Thus, only those aged 13-15 were asked the questions needed to estimate the number of alcoholic units consumed in the last week.
A self-completion questionnaire was used to collect information from children aged 8-15 in order to increase the confidentiality of their responses. However, children may still be afraid that their parents may see their replies, and this could lead to some under-reporting of alcohol consumption among this age group. Comparisons with surveys of children's drinking behaviour carried out in schools (such as the ONS surveys referred to in section 9.1) suggest that a home-based interview does indeed result in some under-reporting of drinking as well as smoking (see Chapter 8).
9.3 ADULTS' WEEKLY ALCOHOL CONSUMPTION LEVELS
9.3.1 Usual alcohol consumption by sex and age
Table 9.1 shows consumption bands with estimated overall mean consumption. Seven per cent of men and 12% of women aged 16-74 said that they did not drink at all nowadays. Among them, 4% of men were ex-drinkers and 3% had never drunk alcohol; 5% of women were ex-drinkers and 8% had never drunk alcohol. At the other extreme, 32% of men were drinking over 21 units of alcohol a week, and 14% of women were drinking over 14 units a week. The estimated weekly average alcohol consumption of men was 19.1 units, of women 6.5 units.
Looking only at 16-64 year olds, the proportion of men drinking over 21 units of alcohol a week was 33%, while 15% of women were drinking over 14 units a week. This compares with the targets set by the Scottish Executive of 31% of men and 12% of women exceeding these levels by 2005.
Table 9.1 also shows differences in consumption by age. For both sexes, it was the youngest informants (16-24) who were the most likely to be drinking more than 21 units (men) or 14 units (women) a week: 43% of men and 24% of women in this age group exceeded these amounts. The proportion exceeding these weekly amounts decreased with age, so that by age 65-74 only 21% of men and 4% of women were drinking more than these amounts.
The estimated mean units of alcohol consumption also decreased with age for both men and women. Among men aged 16-24 estimated mean consumption was 23.4 units per week, decreasing to 13.5 weekly units for men aged 65-74. The corresponding estimates for women were 10.0 and 2.8 weekly units.
9.3.2 Usual alcohol consumption by social class
Analysis by social class of chief income earner shows different patterns for men and women. Among women, those in Social Classes I and II were the most likely to consume more than 14 units a week and had the highest levels of mean weekly consumption. In general, women in non-manual social classes had somewhat higher consumption levels than women in manual social classes.
Among men, the picture is less clear-cut. In general, there were few differences between the social classes, although (age-standardised) mean weekly consumption was slightly higher among men in the manual than in the non-manual social classes. Alcohol consumption was lowest for men in Social Class IIINM, both in terms of exceeding 21 units a week (28%) and in mean weekly consumption (16.2 units).
9.3.3 Usual alcohol consumption by region
Table 9.3 shows usual weekly alcohol consumption by region. Among men, those living in the Highland & Islands had lower consumption than men in Forth Valley, Argyll & Clyde and Greater Glasgow, but there were no other significant differences between regions.
Among women, there were also few regional differences. While women in Lothian & Fife had higher (age-standardised) consumption than women in Highland & Islands, aside from these two 'extremes' of the regional distribution, there were no other significant differences between regions.
9.3.4 Drinking frequency
Adult informants were asked a separate question about the number of days a week they usually had any kind of alcoholic drink. Their responses by age and sex are shown in Table 9.4.
Men were twice as likely as women to drink at least three days a week: 36% of men reported drinking this often compared with 18% of women.
The proportion never drinking, or drinking very infrequently, increased with age among both sexes. However, the proportion drinking 'almost every day' also increased with age, although this was more pronounced among men than women. By contrast, the proportion drinking 'once or twice a week' decreased with age. Thus, the situation among older informants is more polarised than among younger ones. In the oldest group of men (65-74) 39% were at the extreme ends of the distribution (25% 'almost every day', 14% 'never), while in the youngest group (16-24) only 10% were at the extremes (5% 'almost every day', 5% 'never'). Among women, the picture was similar with 36% of women aged 65-74 at the 'extremes' (8% 'almost every day' and 28% 'never'), compared with only 10% for women aged 16-24 (1% 'almost every day' and 9% 'never').
Younger informants were more likely than older ones to drink between one and four times a week. Among men aged 16-24, 64% said they drank with this frequency, compared with 39% of men aged 65-74. Among women, 50% of those aged 16-24 drank between one and four times a week compared with 26% of women aged 65-74.
9.3.5 Types of drink
Table 9.5 shows the estimated number of alcohol units consumed for each type of drink. Among men, beer consumption was much higher than for any other type of drink, averaging 11 units a week (out of a total consumption of 19 weekly units). While consumption of beer tended to decrease with age, from a mean of 15 weekly units for ages 16-24 to five weekly units for ages 65-74, average consumption of spirits increased slightly, from four weekly units for the youngest men (16-24) to six weekly units among men aged 45 and over.
Among women overall, it was spirits and wine (three and two mean weekly units respectively) that predominated, but among younger women mean consumption of beer was similar to that of wine.
9.4 ADULTS' DAILY DRINKING LEVELS
9.4.1 Heaviest drinking day last week
Informants were asked whether they had drunk alcohol in the past seven days. If they had, they were asked on how many days and, if on more than one, whether they had drunk the same amount on each day or more on one day than others. If they had drunk more on one day than others, they were asked how much they drank on that day. If they had drunk the same on several days, they were asked how much they drank on the most recent of those days. If they had drunk on only one day, they were asked how much they had drunk on that day. In each case, the questions asked for details of the amounts consumed of each type of drink (similar to those used for establishing average weekly consumption), rather than asking informants to give a direct estimate of units consumed.
The proportions reporting that they had drunk alcohol in the previous seven days were 82% for men and 68% for women. Among men who had drunk in the past week, 27% had drunk on only one day and 25% on two days, with decreasing proportions for three (16%), four (9%), five (6%) and six days (4%) and then increasing again to 13% having drunk alcohol on all seven days. The mean number of drinking days was 3.1 out of seven days (based on all men). (Table not shown.)
Among women, the mean was lower at 2.4 days in the last seven, and women were much more likely than men to drink on only one (43%) or two (25%) days, with only 8% drinking on all seven days. (Table not shown.)
Of the men and women who drank in the last seven days, the proportion drinking every day increased with age: for men, from 3% at ages 16-24 to 29% at ages 65-74; for women, from 3% to 19% respectively. (Table not shown.)
Among informants who drank on two days or more in the previous week, about half of men (50%) and women (54%) said they drank the same amount each day. Older men and women were much more likely to drink the same amount, while younger informants were the most likely to report drinking different amounts: of those aged 18-24,12 66% of men and 63% of women said they drank different amounts on the days they drank; among those aged 65-74, 73% of men and 82% of women drank the same amount each day. (Table not shown.)
These figures, along with the findings noted earlier that the likelihood of daily drinking increases with age, suggest strongly that drinking patterns become more routine with increasing age.
Where amounts differed between days within the last seven, consumption estimates were obtained for the heaviest drinking day. Combining these with estimates where there had been drinking on only one day or where the same amount was consumed on several occasions, it is possible to derive an estimate of the heaviest day's consumption out of the past seven. The base for these estimates is adult informants who had consumed alcohol in the past seven days.
Table 9.6 shows amounts consumed on the heaviest (or only) drinking day by age and sex. The table does not give sufficient information to determine whether current advice on sensible drinking is being followed (as described in section 9.1), since this advice refers to 'regular' drinking rather than consumption on a single day. 'Binge' drinking -that is, drinking an excessive amount on a single occasion -is thought to be less healthy than drinking moderate amounts more regularly.13 The table gives some indication as to whether 'binge-level' amounts are being consumed, although there is no medically-specified criterion for such amounts. For the following analysis, the level chosen is eight or more units for men and six or more units for women, which is double the amounts that people are advised not to exceed on a daily basis.
Among men who had drunk alcohol in the past week, 44% had consumed eight units or more on their heaviest drinking day. This proportion decreased by age, from 62% for men aged 16-24 to 16% for men aged 65-74. The pattern for women was similar, although at lower levels of consumption, with 49% of women aged 16-24 drinking six or more units on their heaviest drinking day, compared with 4% of women aged 65-74 (and 27% for women overall).
9.4.2 Variations in daily drinking by social class and region
With regard to social class, the pattern was similar for men and women, with drinkers in the manual social classes being more likely to exceed these amounts than drinkers in the non-manual social classes. For women, this contrasts with the weekly consumption figures described earlier (in section 9.3.2). Whereas women in Social Classes I and II had the highest mean weekly consumption and were most likely to exceed the limit of 14 units of alcohol per week, it was women drinkers in Social Classes IV and V who had the heaviest drinking days.
Table 9.7, Figure 9A
Figure 9A Weekly alcohol units consumed, and highest daily amount consumed by those who drank in the past week
As described above (section 9.3.3), there were few regional differences in weekly consumption except between the lowest and highest ends of the distribution. This also applied to regional differences in patterns of daily drinking: male drinkers in the Highland & Islands and in Borders, Dumfries & Galloway were less likely than those in Lanarkshire, Ayrshire & Arran and Greater Glasgow to exceed eight units on their heaviest drinking day.
Among women, regional differences in the likelihood of exceeding six units on their heaviest drinking day were even less marked than for men, without any significant differences found between the regions.
9.5 TRENDS OVER TIME IN ALCOHOL CONSUMPTION
9.5.1 Trends in weekly alcohol consumption
As only two years of Scottish Health Survey data are available, identifying trends over time is difficult; this problem will abate as future rounds of the Health Survey are completed. Comparing the 1998 and the 1995 Health Surveys is further complicated by the use of a slightly different module of questions on drinking in the two years (as described in section 9.2). The results described in this section, therefore, are tentative and must be treated with caution; the changes in consumption described below should be considered, at best, as provisional indicators of trends since 1995.
Table 9.9 shows the proportion of men and women, by age group, estimated to be drinking at different levels in 1995 and in 1998. (Note that the proportions in the table for 'all ages' include only 16-64 year olds in both 1995 and 1998, and therefore differ from the earlier tables shown in the chapter which cover ages 16-74.)
Figure 9B Mean weekly alcohol consumption by age, 1995 & 1998
Among men, while there are small year-to-year differences within the various age groups, they do not move in a consistent direction, and the overall proportion of men aged 16-64 drinking more than 21 units per week was 33% in both the 1995 and 1998 Health Surveys. Moreover, overall levels of mean consumption were similar at 20.1 units per week in 1995 and 19.8 units per week in 1998. However, among the youngest group of men (16-24), there does appear to have been an increase in consumption both in terms of exceeding 21 units per week (37% in 1995 and 43% in 1998), and in mean consumption (up from 20.8 to 23.4 weekly units between 1995 and 1998). (As mentioned in section 9.2, the 1998 question module on drinking differed in one respect from that used in 1995 by adding a question on alcoholic soft drinks; as these drinks are most commonly drunk by the youngest age group, this change in methodology would be likely to affect this group more than others.)
Table 9.9, Figure 9B
Among women, the evidence is more consistent and suggests that there has been an upward trend in alcohol consumption between 1995 and 1998. Firstly, the year-to-year differences within the age groups either show an increase in consumption or no change. Secondly, the proportion of women aged 16-64 exceeding 14 units a week has increased overall from 13% to 15%. Thirdly, there has also been an increase in overall mean consumption from 6.3 to 7.1 units per week. As for men, the increase is mainly among the youngest age groups (the under 45s), and is most marked among women aged 16-24.
9.5.2 Trends in weekly alcohol consumption by social class
Table 9.10 shows the proportion of men and women, by social class, estimated to be drinking at different levels in 1995 and in 1998 (for 16-64 year olds only). There were few significant year-to-year differences, and those that were identified tended to be quite small. Looking at the proportion drinking over the previously recommended weekly levels, the biggest change is the increase in the proportion of men and women in Social Class II drinking more than 21 units (men) / 14 units (women) a week.
9.5.3 Trends in weekly alcohol consumption by region
As for age and social class, trends in weekly alcohol consumption by region showed few changes. The biggest difference was found in the Highland & Islands, where there has been a decrease in the proportion of men drinking more than 21 units a week from 33% in 1995 to 25% in 1998. (While statistically significant, this change may be more apparent than real, given the small bases in this region.)
Among women, all the regions either show an increase or no change in the proportion of women drinking more than 14 units a week. The biggest change is found in Borders, Dumfries & Galloway, where there was an increase in the proportion of women exceeding this weekly amount from 9% in 1995 to 18% in 1998 (although this region also has small bases in both years of the Health Survey).
9.6.1 Analytical considerations
Clinical studies, particularly those among alcoholic populations, have shown levels of the biological indicator, gamma-glutamyl transpeptidase (gamma gt), in the blood to be associated with alcohol consumption, and with consequent liver damage.14 Such studies, however, are able to monitor alcohol intake and gamma gt levels over the same period of time and thus differ from the Scottish Health Survey which bases its alcohol consumption data on self-reports of 'usual' drinking behaviour over the past year. As alcohol tends to raise gamma gt levels for only 24 to 48 hours, the Health Survey is less likely to show a close relationship between drinking and gamma gt levels.
9.6.2 Gamma gt results
Gamma gt results are shown in Table 9.12 by age and sex, and in Table 9.13 for different levels of self-reported alcohol consumption.15
The tables show the distribution in a number of bands, and then percentiles including the median (50th percentile). The percentiles start at the bottom of the distribution, so that the 95th percentile (for example) is the boundary for the five per cent with the highest gamma gt levels. Next in the tables are the mean and standard error. Due to the marked skewness of the distribution and the existence of small numbers of very high values, the means are not robust for small sub-groups. For this reason, the geometric mean is also shown; it is less sensitive to very high values and possibly a better measure of central tendency.
As Table 9.12 shows, mean gamma gt levels are higher for men than for women (with geometric means of 27.7 iu/l for men and 18.7 iu/l for women).
Gamma gt also tends to increase with age among both men and women (although it then decreases slightly amongst the oldest age group for men). Among men, the geometric mean increased from 18.5 iu/l in the 16-24 age group to 33.8 iu/l for men aged 55-64, and then dropped slightly to 29.7 iu/l for men aged 65-74. Among women, the geometric mean increased from 14.2 iu/l in the youngest age group to 24.5 iu/l in the two oldest groups.
Table 9.13 shows the distribution of gamma gt by estimated level of alcohol consumption. While there is a clear tendency for mean gamma gt levels to increase among drinkers at high levels of consumption (35 units or more for men and 21 units or more for women), it is also apparent that gamma gt is not a particularly good indicator of alcohol consumption, at least in a study of this sort.
9.6.3 Trends in gamma gt levels
In 1998 a different laboratory undertook the gamma gt assays than in 1995. An earlier split sample test carried out for the 1994 Health Survey for England showed that the results from the two laboratories were very highly correlated, but not identical. The close correspondence between the two laboratories suggests that any significant patterns found in cross-sectional analysis will be robust and not much affected by the laboratory used; however, comparisons between the two years need to be treated with caution.16
As Table 9.14 shows, gamma gt levels are very similar between the 1995 and 1998 Health Surveys. The geometric mean among men aged 16-64 was 28.0 iu/l in 1995 and 27.5 iu/l in 1998; the corresponding figures for women were 17.7 iu/l and 18.0 iu/l.
9.7 PROBLEM DRINKING AND DRUNKENNESS
9.7.1 Problem drinking
Questions for current drinkers on problem drinking were included in self-completion schedules for adults aged 16-74.17 (The same questions were asked in the 1995 Scottish Health Survey, but only asked of informants aged 16-17.)
Informants answered six questions which form part of the 'CAGE' questionnaire, a scale which has been validated in general population studies.18 Three of the six items relate to physical dependence: 'There have been occasions when I felt unable to stop drinking'; 'I have had a drink first thing in the morning to steady my nerves or get rid of a hangover'; and 'I have found that my hands were shaking in the morning after drinking the previous night'. The other three items were: 'I have felt that I ought to cut down on my drinking'; 'I have felt ashamed or guilty about my drinking'; and 'People have annoyed me by criticising my drinking'.
Table 9.15 shows the proportion of adult drinkers endorsing each item. By far the most frequently mentioned item by both men and women drinkers was 'I have felt that I ought to cut down on my drinking' (men 24%, women 12%). The likelihood of agreeing with this item was fairly consistent up to the two oldest age groups, after which it declined (although it was still mentioned by a fifth of men aged 55-74). Men were about twice as likely as women to mention each of the six items.
Agreement with two or more of the six CAGE items is a possible indicator of 'problem drinking'. The proportion of adult current drinkers who agreed with two or more of these items was 12% for men and 5% for women. If all adults rather than current drinkers is taken as the percentage base, these proportions become 10% and 4% respectively. (Table not shown.)
Among both sexes the proportion of 'problem drinkers' declined with age: in men from 16% in the youngest age group (16-24) to 7% in the oldest (65-74), and in women from 8% in the youngest age group to 2% in the oldest.
Looking at the three items on physical dependence, 90% of current male drinkers said none of the three items applied to them, 7% said one applied, 2% two items and 1% all three items. Among current female drinkers, the corresponding figures were 96% none, 3% one, and under 0.5% for two and three items. The likelihood of agreeing with one or more of these three items was highest among 16-24 year olds in both sexes, and then decreased with age.
9.7.2 Drunkenness
The self-completion questionnaire also included three items about drunkenness: 'I have been drunk at least once a week, on average, in the last three months'; 'Drinking has made me slightly (or very) drunk in the last three months'; and (if yes) 'How many times in the last three months'.
Among current drinkers aged 16-74, 51% of men and 31% of women said they had been slightly (or very) drunk at least once in the last three months. (Based on all adults aged 16-74, the figures were 45% for men and 25% for women.) The likelihood of being drunk in the last three months declined sharply with age, from 77% among men aged 16-24 to 56% at ages 35-44 and to 13% at ages 65-74. Among women there was a similar decline, going from 63% at ages 16-24 to only 1% at ages 65-74.
The proportion who reported being at least slightly drunk three or more times in the last three months was 32% among male, and 16% among female, current drinkers. One in five (20%) current male drinkers, and one in 10 (9%) female drinkers said they had been drunk at least once a week on average in the past three months. (Based on all 16-74 year olds in the sample, 18% of men and 7% of women had been drunk at least once a week in the past three months.)
Being drunk at least once a week was also strongly related to age. Current male drinkers aged 16-24 were the most likely to say they had been drunk at least once a week (45%); this proportion declined to 15% in men aged 35-44 and to 4% in men aged 65-74. A similar pattern was found among women, although the proportion saying they were drunk at least once a week showed a greater relative decrease than for men: among women aged 16-24, 24% of current drinkers said they were drunk at least once a week, compared with 10% for current drinkers aged 25-34 and only 1% for those aged 65-74.
9.8 CHILDREN'S ALCOHOL CONSUMPTION
9.8.1 Asking about children's consumption of alcohol
Children aged 8-12 were asked whether they had ever drunk a whole alcoholic drink (not just tasting one), the age when they first did so, and how often they drank nowadays. For children aged 13-15, informants were asked these questions, and also to provide details of their consumption in the last week (which is considered easier for children to recall than providing estimates of weekly consumption over the past year). Questions about drinking were not asked of children aged under eight.
In a home interview survey, children may wish to conceal their drinking (and smoking) behaviour from their parents, so information on alcohol consumption among those aged 8-15 was provided as part of a self-completion questionnaire in order to increase the confidentiality of their responses. Nevertheless, there is still a risk that children will be worried that their parents will see their answers, which could lead to under-reporting of alcohol consumption in this age group. As described in Chapter 8, analysis of saliva cotinine levels shows that there is considerable under-reporting of smoking behaviour among this age group, and it is likely that the same will apply to self-reported drinking habits. Comparisons with surveys of children's drinking behaviour carried out in schools suggest that a home-based interview does in fact lead to under-reports of drinking as well as smoking behaviour.19
9.8.2 Experience of alcohol among children aged 8-15
Table 9.18 and Figure 9C show children's reported experience of alcohol by single years of age separately for boys and girls. The bases by age year are small, but because of the pace with which children's behaviour changes as they grow, amalgamating single years into age bands would obscure the pattern of development. However, the small bases should be borne in mind when interpreting the results.
At the age of eight, 12% of boys and 6% of girls said they had had a proper alcoholic drink (not just a taste). The proportion of boys saying they have had a proper drink increased from 12% at age eight to 67% at age 15. The increase in the proportion having proper drinks is gradual until age 11, and then goes up significantly. (The decrease between ages eight and nine is probably due to sampling variation and is not, in any case, statistically significant.)
Figure 9C Proportion of children who have had a proper alcohol drink, by age and sex
Among girls the pattern is similar to that for boys, with the proportion increasing from 6% at age eight to 68% at age 15. Between ages eight and 11, boys were somewhat more likely than girls to have had an alcoholic drink, but this difference between the sexes ceased by age 12.
Table 9.18, Figure 9C
9.8.3 Reported frequency of drinking alcohol by children aged 8-15
Before age 12, there was very little reporting of alcoholic consumption, with most children saying they never drank or drank only a few times a year. The frequency of consumption increased between ages 13 and 15, although even at age 15 only small proportions of boys (19%) and girls (16%) said they drank more often than about once a month.
Most children under age 16 are unlikely to have developed regular drinking patterns, so a question on usual frequency may well be difficult for them to answer. The Health Survey responses showed less frequent drinking than was found in the 1998 ONS school based survey among children in Scotland in this age range. A large part of this discrepancy between surveys may well be explained by the presence of parents in the Health Survey. (However, the Scottish Health Survey results are also lower than those obtained in the Health Survey for England, which uses the same methodology, as described in section 9.9.2).
9.8.4 Prevalence of alcohol consumption in the last week by children aged 13-15
Children aged 13-15 were also asked which types of drink, and how much, they had consumed over the last seven days. Table 9.20 shows that, among children aged 13-15, 12% of boys and 9% of girls said they had consumed some alcohol in the past seven days.
The percentage saying they drank increased with age: for boys, from 8% at age 13, to 9% at age 14 and to 17% at age 15; for girls, the figures were 5%, 8% and 14% respectively. Again, these proportions are lower than those found in the ONS school based surveys, which finds a higher rate of drinking in the last week among Scottish school children in this age range.
9.8.5 Types of alcoholic drink consumed in the last week by children aged 13-15
Table 9.21 shows the types of alcoholic drink consumed in the past week. The drink mentioned most often by boys aged 13-15 was beer, lager and cider (10%), followed by alcoholic soft drinks (4%), wine (3%), and spirits (2%). Girls were less likely than boys to mention beer, lager and cider (4%); spirits (5%), alcoholic soft drinks (4%), and wine (3%) were all equally favoured by girls. (No distinction was made between 'normal' and 'strong' beer/lager/cider for children aged 13-15.)
9.9 COMPARISON OF SCOTLAND AND ENGLAND
9.9.1 Adults
Table 9.22 compares weekly alcohol consumption in Scotland with that for England as a whole, and separately for Northern England (using results from the 1998 Health Survey for England).20
In 1995, alcohol consumption among men (aged 16-64) was higher in Scotland than in England, but this difference was no longer apparent in 1998 (among men aged 16-74). Mean weekly units consumed was 18.8 in England and 19.1 in Scotland, and the likelihood of exceeding 21 units per week was 32% in both countries.
Looking only at men living in Northern England, however, showed that they had significantly higher consumption than did men in Scotland, both in terms of mean weekly units consumed (21.2 compared with 19.1) and in the proportion drinking more than 21 units a week (36% in Northern England and 32% in Scotland).
Compared with men, the pattern for women informants aged 16-74 is unambiguous: women in England drink more than women in Scotland -overall and in every age category -and women in Northern England drink more than the average for women in all England. Mean weekly consumption for women aged 16-74 was 6.5 units in Scotland, 7.6 in England, and 8.5 in Northern England. The proportion of women drinking more than 14 units a week was 14% in Scotland, 19% in England and 21% in Northern England.
There were few clear-cut differences between Scotland and England with respect to potential indicators of problem drinking. Although men in England had a somewhat lower mean score on the six items asking about problem drinking, the difference was very small.
However, among women, the pattern for problem drinking was consistent with that described above for consumption: women in Scotland were less likely than those in England to report they had any of the problem indicators, and they had a lower mean score. Women in Northern England had the highest mean score.
9.9.2 Children
Comparing the results for children on the 1998 Health Survey for England with those from the 1998 Scottish Health Survey showed quite considerable differences, with children in Scotland being much less likely than children in England to report having experience of alcohol. These differences were found for all ages, although the pattern was quite different for boys and girls.
The differences between Scotland and England in the proportion of boys who reported ever having an alcoholic drink increased with increasing age, so that by age 15, whereas 83% of boys in England said they had had a proper alcoholic drink, only 67% of boys in Scotland said this.
Among girls, the differences between Scotland and England were less marked, and tended to narrow with increasing age. For example, at age 8, girls in England were twice as likely as those in Scotland to say they had ever had an alcoholic drink (11% and 6% respectively); by age 15, 75% of girls in England said this, compared with 68% of girls in Scotland.
Similar differences were found in the amount of alcohol consumed in the past week. Children aged 13-15 in England were both more likely to consume alcohol and had higher mean consumption than did boys and girls of the same age in Scotland.