A community-based qualitative study of perspectives on alcohol public health interventions and experiences of alcohol use

BACKGROUND: The alcohol harm paradox is where lower socioeconomic position (SEP) groups experience higher rates of alcohol-related health consequences than higher SEP populations, despite drinking less alcohol. The reasons behind this are not certain, and limited research has examined the acceptability of alcohol interventions. This study aimed to inform alcohol public health interventions targeted to lower SEP individuals by addressing two research questions: (1) What are the perspectives on alcohol public health interventions? (2) What are the experiences of alcohol use? METHODS: Six focus groups (n = 23) were conducted in community settings with individuals who drink alcohol. We recruited from community organisations located in relatively disadvantaged areas (identified by Index of Multiple Deprivation) and workplaces with routine and manual occupations. Questions explored were the: (1) acceptability of UK alcohol public health interventions and (2) behavioural drinking patterns and reasons for drinking. Inductive and deductive framework thematic analysis was used to develop two themes. RESULTS: Theme one highlighted a lack of trust towards the government's motivations for implementing alcohol interventions, including perceptions that the government does not care about alcohol-related health harms and that perceived unnecessarily high alcohol-related taxes represent the reason for its legal status. Perceived authoritative interventions and interference with free will was resented. There was scepticism towards the perceived effectiveness of interventions, including perceptions of negative outcomes and that interventions do not address the underlying reasons for alcohol use. Theme two highlighted social environmental facilitators of and barriers to alcohol use, including high alcohol availability locally. Motivations for and patterns of alcohol use were outlined, including alcohol use as a coping strategy for daily life stress and preferences for cheap high strength alcohol. CONCLUSIONS: Lack of trust in government alcohol intervention was salient in this sample and may be an important consideration for intervention design. Future research could examine levels of trust in government for providing alcohol health advice and how this may be affected by SEP, and which intervention sources would be most acceptable to different SEP populations. Tailored interventions could address high alcohol availability in underserved communities, and specific motivations for and patterns of alcohol use.