title: The enigma of 'harmful' alcohol consumption: evidence from a mixed methods study involving female drinkers in Scotland.
abstract: OBJECTIVE
  An appreciation of the drinking patterns of population subgroups may usefully inform tailored interventions. For this purpose, research has highlighted a need to better describe the drinking behaviour of UK women. This study aims to characterise the purchasing and consumption behaviour of female heavy, harmed, drinkers in contact with Scottish health services in two cities and to explore the factors that influence the link to harm.
  
  
  METHODS
  Mixed methods study involving cross-sectional survey questionnaires and one-to-one interviews (5). The questionnaires documented (1) demographic data (including derived deprivation score), last week's (or 'typical' weekly) consumption (type, brand, volume, price, place of purchase), self-reported illnesses, and (2) Alcohol-Related Problem Questionnaire score. A total of 181 patients with serious health problems linked to alcohol were recruited within National Health Service (NHS) hospital clinics (in- and outpatient settings), in two Scottish cities during 2012.
  
  
  RESULTS
  Median consumption was 157.6 UK units for the recorded week, with almost exclusive purchase from 'off-sale' retail outlets. Preferred drinks were white cider, vodka and white wine. Increasing problems was positively associated with drinking more in the week, being younger and belonging to Glasgow.
  
  
  CONCLUSIONS
  For Scottish women, the current definition of 'harmful' consumption likely captures a fourfold variation in alcohol intake, with gender differences less apparent. While current alcohol-related harm is positively associated with dose and being younger, there is clear evidence of an influence of the less tangible 'Glasgow effect'. Future harm concerns are warranted by data relating to pattern, alcohol dose and cigarette use.
authors.affiliation: School of Nursing, Midwifery & Social Care, Edinburgh Napier University, UK j.gill@napier.ac.uk.
authors.forename: Jan S
authors.initials: JS
authors.lastname: Gill
authors.affiliation: School of Health Sciences, Queen Margaret University, Edinburgh, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Rush
authors.affiliation: School of Nursing, Midwifery & Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, UK.
authors.forename: Heather
authors.initials: H
authors.lastname: Black
authors.affiliation: School of Health Sciences, Queen Margaret University, Edinburgh, UK.
authors.forename: Fiona P
authors.initials: FP
authors.lastname: O'May
authors.affiliation: School of Nursing, Midwifery & Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Chick
authors.affiliation: Division of Nursing, School of Health Sciences, Queen Margaret University, Edinburgh, UK.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Rees
authors.affiliation: Institute for International Health and Development, School of Health Sciences, Queen Margaret University, Edinburgh, UKThe Nossal Institute for Global Health, The University of Melbourne, Carlton, VIC, Australia.
authors.forename: Barbara
authors.initials: B
authors.lastname: McPake
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects* / Q000523:psychology*; D019973:Alcohol-Related Disorders / Q000453:epidemiology*; D002947:Cities; D003132:Commerce / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D036301:Qualitative Research; D012606:Scotland / Q000453:epidemiology; D011795:Surveys and Questionnaires
keywords: alcohol; female; harmful consumption