ArticlePloS one
Deconstructing the Alcohol Harm Paradox: A Population Based Survey of Adults in England.
Article in PloS one. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 54 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
54 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Causal mechanisms proposed for the alcohol harm paradox-a systematic review.Addiction (Abingdon, England) · 2022Pooled it
- The Moderating Effect of Educational Background on the Efficacy of a Computer-Based Brief Intervention Addressing the Full Spectrum of Alcohol Use: Randomized Controlled Trial.JMIR public health and surveillance · 2022Trial
- Identifying Hazardous Alcohol Use in Primary Care: Concordance Between Phosphatidylethanol and Self-Reports.Annals of family medicine · 2026Article
- A Data-Driven Exploratory Analysis of the Alcohol-Harm Paradox in South-East Wales.International journal of environmental research and public health · 2026Article
- A community-based qualitative study of perspectives on alcohol public health interventions and experiences of alcohol use.BMC public health · 2026Article
- Alcohol Use Associated With Gambling Harm in a Population Representative Australian Sample.Drug and alcohol review · 2026Article
- Mind the Gap: Exploring Social Inequalities in Alcohol Consumption using Nationally Representative Data from the 2019 and 2021 Health Survey for England.BMC public health · 2026Article
- Trends of Tobacco and Alcohol Consumption Among People with Diabetes Mellitus in Spain: A Population-Based Study (2014-2020).Epidemiologia (Basel, Switzerland) · 2026Article
- Responses to the AUDIT questionnaire in the population-based Tromsø surveys as predictor of a diagnosis of alcohol use disorder in Norwegian central health registries-an NCDNOR study.European journal of public health · 2025Article
- The interplay of alcohol use symptoms and sociodemographic factors in the HELIUS study: A network perspective.Social psychiatry and psychiatric epidemiology · 2025Article
- Psychosocial factors associated with alcohol use in lower socioeconomic position populations: a scoping review.BMC public health · 2025Article
- Current and future trends in the consumption, sale and purchasing of alcohol-free and low-alcohol products in Great Britain, 2014 to 2023.Addiction (Abingdon, England) · 2025Article
- Understanding the alcohol harm paradox: A multivariable mendelian randomization approach.PLoS genetics · 2025Article
- Trends in use of alcohol-free or low alcohol drinks in attempts to reduce alcohol consumption in Great Britain, 2020-2024: a population-based study.BMJ public health · 2025Article
- Article
- Socioeconomic status, alcohol use and the role of social support and neighbourhood environment among individuals meeting criteria for a mental health problem: a cross-sectional study.Social psychiatry and psychiatric epidemiology · 2024Article
- Public health involvement in alcohol licensing decisions in the UK: a systematic review of qualitative studies.BMJ public health · 2024Article
- The alcohol harm paradox: is it valid for self-reported alcohol harms and does hazardous drinking pattern matter?BMC public health · 2024Article
- Socioeconomic disparities in alcohol-related depression: a national cohort study of low-income medical aid beneficiaries and national health insurance beneficiaries in Korea.BMC public health · 2024Article
- Dose-response relationship between alcohol consumption and workplace absenteeism in Australia.Drug and alcohol review · 2023Article
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
backgroundThe Alcohol Harm Paradox refers to observations that lower socioeconomic status (SES) groups consume less alcohol but experience more alcohol-related problems. However, SES is a complex concept and its observed relationship to social problems often depends on how it is measured and the demographic groups studied. Thus this study assessed socioeconomic patterning of alcohol consumption and related harm using multiple measures of SES and examined moderation of this patterning by gender and age.
methodData were used from the Alcohol Toolkit Study between March and September 2015 on 31,878 adults (16+) living in England. Participants completed the AUDIT which includes alcohol consumption, harm and dependence modules. SES was measured via qualifications, employment, home and car ownership, income and social-grade, plus a composite of these measures. The composite score was coded such that higher scores reflected greater social-disadvantage.
resultsWe observed the Alcohol Harm Paradox for the composite SES measure, with a linear negative relationship between SES and AUDIT-Consumption scores (β = -0.036, p<0.001) and a positive relationship between lower SES and AUDIT-Harm (β = 0.022, p<0.001) and AUDIT-Dependence (β = 0.024, p<0.001) scores. Individual measures of SES displayed different, and non-linear, relationships with AUDIT modules. For example, social-grade and income had a u-shaped relationship with AUDIT-Consumption scores while education had an inverse u-shaped relationship. Almost all measures displayed an exponential relationship with AUDIT-Dependence and AUDIT-Harm scores. We identified moderating effects from age and gender, with AUDIT-Dependence scores increasing more steeply with lower SES in men and both AUDIT-Harm and AUDIT-Dependence scores increasing more steeply with lower SES in younger age groups.
conclusionDifferent SES measures appear to influence whether the Alcohol Harm Paradox is observed as a linear trend across SES groups or a phenomenon associated particularly with the most disadvantaged. The paradox also appears more concentrated in men and younger age groups.
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