Addiction Research and Theory February 2004, Vol. 12, No. 1, pp. 11–30 DRINKING IN SECOND GENERATION BLACK AND ASIAN COMMUNITIES IN THE ENGLISH MIDLANDS JIM ORFORD a, *, MARK JOHNSON b and BOB PURSER c a Alcohol, Drugs and Addiction Research Group, School of Psychology, The University of Birmingham and Northern Birmingham Mental Health NHS Trust, UK; b Mary Seacole Research Centre, De Montfort University, Leicester, UK; c Aquarius Action Projects, Birmingham, UK Previous research has suggested low levels of drinking and high rates of abstinence amongst members of ethnic minority groups in Britain, but it was not clear that those conclusions applied equally to those born or educated in Britain. Using quota sampling and street interviewing methods, a sample of 1684 second or subsequent generation men and women from Black (African), African-Caribbean, and Black (British), Indian Hindu, Indian Sikh, Bengali, and Pakistani communities in two Midlands cities completed a brief structured interview during February and March 1999. Results differed markedly by ethnic group, and some- times by sex. Most Black men and women and most Sikh men were drinkers, and rates of heavy drinking in those groups were comparable to those found in national general population samples. The drinking of sub- stantial minorities in those groups gives cause for concern on account, for example, of regular heavy drinking and associated behaviour carrying social or health risks. Hindu, Pakistani and Bengali men and women, and Sikh women, on the other hand, reported high levels of abstinence, with much smaller proportions of the total (but similar proportions of drinkers) drinking heavily and giving cause for concern. Both men’s and women’s drinking (ethnic groups combined) was correlated with a lower self-rated identity with religion, and in addi- tion women’s drinking was correlated with a range of other social and cultural variables (more qualified, employed, single, smaller household, fewer friends from own ethnic group). Large proportions of South Asian men and women drinkers believed their parents did not know about their drinking, and preferred that parents should not know. GPs and health centres were widely recognised as sources of external advice for drinking problems. Community centres and leaders and places of worship were very little mentioned as sources of such help, and in nearly all groups there was a high level of reluctance to seek help outside the family or friendship network. It is concluded that, whilst many second and subsequent generation South Asian people in Britain remain protected from indigenous patterns of drinking by cultural and religious norms, that is no longer the case for Sikh men nor for Black men and women, nor for small minorities of other South Asian groups who drink. Keywords: Drinking; Black Communities; Asian Communities; Abstinence BACKGROUND British studies, from the 1978–80 General Household Survey (Balarajan and Yuen, 1986) onwards, have consistently shown a lower level of alcohol consumption and *Corresponding author. Tel.: 0121 414 4918/7195. Fax: 0121 414 4897. E-mail: [email protected]ISSN 1606-6359 print: ISSN 1476-7392 online ß 2004 Taylor & Francis Ltd DOI: 10.1080/1606635021000059493 Addict Res Theory Downloaded from informahealthcare.com by University of Guelph on 10/12/12 For personal use only.
Transcript
Addiction Research and TheoryFebruary 2004, Vol. 12, No. 1, pp. 11–30
DRINKING IN SECOND GENERATION
BLACK AND ASIAN COMMUNITIES
IN THE ENGLISH MIDLANDS
JIM ORFORDa,*, MARK JOHNSONb and BOB PURSERc
aAlcohol, Drugs and Addiction Research Group, School of Psychology,The University of Birmingham and Northern Birmingham Mental Health NHS Trust, UK;
bMary Seacole Research Centre, De Montfort University, Leicester, UK;cAquarius Action Projects, Birmingham, UK
Previous research has suggested low levels of drinking and high rates of abstinence amongst members ofethnic minority groups in Britain, but it was not clear that those conclusions applied equally to those bornor educated in Britain. Using quota sampling and street interviewing methods, a sample of 1684 second orsubsequent generation men and women from Black (African), African-Caribbean, and Black (British),Indian Hindu, Indian Sikh, Bengali, and Pakistani communities in two Midlands cities completed a briefstructured interview during February and March 1999. Results differed markedly by ethnic group, and some-times by sex. Most Black men and women and most Sikh men were drinkers, and rates of heavy drinking inthose groups were comparable to those found in national general population samples. The drinking of sub-stantial minorities in those groups gives cause for concern on account, for example, of regular heavy drinkingand associated behaviour carrying social or health risks. Hindu, Pakistani and Bengali men and women, andSikh women, on the other hand, reported high levels of abstinence, with much smaller proportions of the total(but similar proportions of drinkers) drinking heavily and giving cause for concern. Both men’s and women’sdrinking (ethnic groups combined) was correlated with a lower self-rated identity with religion, and in addi-tion women’s drinking was correlated with a range of other social and cultural variables (more qualified,employed, single, smaller household, fewer friends from own ethnic group). Large proportions of SouthAsian men and women drinkers believed their parents did not know about their drinking, and preferredthat parents should not know. GPs and health centres were widely recognised as sources of external advicefor drinking problems. Community centres and leaders and places of worship were very little mentioned assources of such help, and in nearly all groups there was a high level of reluctance to seek help outside thefamily or friendship network. It is concluded that, whilst many second and subsequent generation SouthAsian people in Britain remain protected from indigenous patterns of drinking by cultural and religiousnorms, that is no longer the case for Sikh men nor for Black men and women, nor for small minorities ofother South Asian groups who drink.
Keywords: Drinking; Black Communities; Asian Communities; Abstinence
BACKGROUND
British studies, from the 1978–80 General Household Survey (Balarajan and Yuen,1986) onwards, have consistently shown a lower level of alcohol consumption and
ISSN 1606-6359 print: ISSN 1476-7392 online � 2004 Taylor & Francis Ltd
DOI: 10.1080/1606635021000059493
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alcohol-related problems amongst Black and Asian people than in the population as awhole (Johnson and Carroll, 1995). The comprehensive national mental health surveyconducted by the Office of Population Censuses and Surveys (OPCS) in 1993 (Meltzeret al., 1995) found that abstaining or occasional drinking (less than one unit of alcohola week) was three times as often reported by African-Caribbean than White partici-pants, and 14 times more often reported by those of Asian or Oriental ethnicity.Very heavy drinking by the OPCS definition (men more than 50 units, women morethan 35 units a week) was less likely for those in the minority ethnic groups (butonly significantly so for those of Asian or Oriental ethnicity). Reporting any one ormore of 16 alcohol-related problems was significantly less likely amongst those inethnic minority groups.
Other, smaller surveys have reinforced that picture whilst noting considerable differ-ences between groups and between the sexes (e.g. Bhopal, 1986; Ahmad et al., 1988;Pilgrim et al., 1993; Lip et al., 1996). National data from a study conducted by thePolicy Studies Institute (PSI) in 1994 (Modood et al., 1997; Nazroo, 1997) foundrates of abstinence of over 90% amongst Pakistani and Bangladeshi men andwomen. Other minority ethnic groups reported rates of abstinence which were lowerbut still higher than amongst the White participants, and rates of regular drinking(weekly or more) that were lower than amongst Whites. Sex differences were particu-larly marked amongst Indian and East African Asian groups.
In the English West Midlands two studies conducted by Cochrane and colleagues,based on samples recruited via general practice, also showed low levels of alcohol con-sumption and problems amongst both South Asian (Cochrane and Bal, 1990) andAfrican-Caribbean participants (Cochrane and Howell, 1995) compared to Whites.Amongst South Asian groups, Sikh men were found to have highest rates of consump-tion and problems.
All the above studies included a mix of people who were immigrants to Britain andthose who were born or received most of their education in Britain. A qualitativeenquiry into attitudes amongst self-identified drinkers recruited a comparativelyyoung sample amongst whom were a number of Muslims who it was thought,‘‘. . .may have adopted White British drinking habits’’ (Mathrani and Dijshoorn,1994). The PSI study (Modood et al., 1997) was the first to examine differences betweenimmigrants and others, finding lower rates of abstinence amongst those born in the UKor who had migrated before the age of 11 years, amongst both the African-Caribbeanand Asian groups.
Good information about consumption and problems is necessary if services forethnic minority groups are to be well planned. It has been suggested that in the generalpractice context in Britain case recognition is poor amongst ethnic minority groups(Commander et al., 1999), and it has often been reported that members of ethnic min-ority communities, particularly older people, prefer to access help via religious orcommunity organisations (Johnson and Carroll, 1995; Johnson, 1996). A number of‘ethnic-specific’ projects offering services for people with alcohol-related problemshave been reported (e.g. Adebowale, 1994; Joshi, 1994; ARP, 1996; DAWN, 1998).
In 1998 Alcohol Concern, a national non-statutory agency in Britain, invited tendersfor a study that would identify drinking patterns among members of Black and Asiancommunities in Britain, who were ‘second (or later) generation’ British, the effects oftheir drinking, and some of the factors underlying those patterns. The contract wasawarded to Aquarius Action Projects which runs a range of alcohol problem services
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in the English West Midlands. A Steering Group was set up for the project, the mem-bership of which consisted of members of organisations representing the interests ofethnic minority communities in Birmingham and Leicester (e.g. Hindu and SikhCouncils in Birmingham, The Race Equality Team of Birmingham City Council, TheConfederation of Indian Organisations in Leicester, and Sia, a national developmentagency for minority ethnic community organisations, based in Leicester).
METHODS
Sample
The sampling objective was to obtain interviews with 125 men and 125 women in eachof the following six ethnic-cultural groups: African-Caribbean, Indian Hindu, IndianSikh, Pakistani, Bengali (understood to be the identifier generally preferred toBangladeshi), and East African Asian (we were advised that this was the preferred iden-tifier for a large minority of people in the East Midlands).
A number of survey methods were considered, including door to door surveys, accessthrough General Practitioners, and street surveys. Each of these approaches hadadvantages and disadvantages and it was recognised that the chosen method wouldbe a compromise. To use GP lists with a sample of this size within the time availablewould pose logistical difficulties and using identifying names as the source for intervie-wees, whilst it would identify the Asian communities, would fail to identify potentialAfrican-Caribbean participants. A randomised electoral roll method would haverequired a far higher initial sample in order to produce the requisite final samplesize, because of the high proportion of people who would not have fitted the final selec-tion criteria. There were also concerns that a home based survey method might leadsome respondents to feel inhibited in providing answers, leading to under-reportingof drinking among some groups. It was therefore decided to use an interviewer gener-ated quota sample, with quotas for ethnic group and sex. A market research companybased in the Midlands, Bostock Marketing Group (BMG), was engaged to carry outthe fieldwork. The company had a trained group of field workers representing therange of ethnic groups that we hoped to sample, and the necessary capacity toobtain and provide initial processing of data on the scale and in the time required.
BMG used 22 interviewers to carry out the fieldwork. A key contribution BMGbrought to the project was their use of a group of young, ethnically diverse interviewerswho had experience of administering structured and semi-structured questionnaires.Ten interviewers were male, 12 female; 7 were 20 years of age or younger, 10 agedbetween 21 and 25 years, and 5 older; 2 identified themselves as being White, theremainder Pakistani, Indian, ‘mixed race’, African-Caribbean, Black Asian, Bengaliand Nigerian British. Nine described themselves as ‘non-drinkers’.
To locate participants and carry out interviews districts were chosen where it wasknown that members of the sample communities were likely to congregate. Locationswere chosen by interviewers to reduce the risk of bias towards either non-drinking orheavy drinking. They also chose places where younger, second generation membersof ethnic minority groups could be located. Personal contacts were used to ensurethat hard to reach groups were properly represented. Respondents were approachedin a number of locations and asked to participate in the survey. In approachingpotential respondents, the interviewers assured them of the confidential nature of the
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survey and respondents were not asked for their names and addresses. Screening ques-tions were asked to ensure inclusion only of respondents who were born in the UK orwho had come to the UK before the age of 5 years. The five different types of location,and the numbers contributed by each, are shown in Table I.
The Questionnaire
The interview was limited in size to questions that could be asked and answered withina period of about 15–20min. Content was therefore limited to the following sections:drinking in the past 7 days; drinking in the past 12 months; perceived drinkingnorms and perceived benefits and drawbacks of own drinking; signs of risky drinking(asked at the end of the interview); sources of help for drinking problems; cultural,ethnic and lifestyle information.
Questions on Alcohol Use
Drinking in the last 7 days was assessed by asking about type and quantity of alcoholconsumed on each of the last 7 days, starting with ‘yesterday’. Consumption was con-verted into standard units and summed across the 7 days (65% of drinkers thoughttheir last week’s drinking was typical, and 15 and 14% respectively thought the lastweek’s drinking was greater or lesser than usual; 6% were unable to say).
Since evidence from studies in Canada and the USA (e.g. Room et al., 1995; Midaniket al., 1996) has suggested that the frequency of heavy drinking may be more importantthan weekly volume of consumption, at least for social problems, respondents wereasked to estimate the number of days in the previous 12 months on which they had con-sumed more than 10 units (men) or more than seven units (women) in the day, and toestimate the maximum number of units of alcohol consumed on any single day in thelast 12 months.
A technique developed for the Birmingham Untreated Heavy Drinkers Project(BUHD: Dalton and Orford, 2001; Orford et al., 2002), asking for estimates of degreeof benefit and degree of drawback associated with the person’s drinking in each of 13life areas, was used to gather information on the functions that alcohol fulfilled inpeople’s lives. Drinking participants were also asked whether they had engaged, inthe last 12 months, in each of 23 risky activities ‘while or after drinking’, ‘after drinkingor while drunk’, or ‘because of drinking’ (depending upon the wording of the item).
TABLE I Interview locations
Location Interviews Description
In-street 1049 Shopping centres, High streets,Outside Temples, In parks
Personal contacts 319 Personal acquaintances of theinterviewers
Public offices 150 Outside Job Centres,Birmingham City CouncilNeighbourhood Offices,Leisure Centres
Education 66 Universities and CollegesOther 100 Outside places of work, Libraries
1684
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Items were taken from those employed in the BUHD project, supplemented by ques-tions about job problems, police contact, and accidents covered in the OPCS survey(Meltzer et al., 1995). The contemplation and precontemplation sub-scales of theReadiness to Change Questionnaire (Heather and Rollnick, 1993) used in the BUHDstudy were also used in the present study.
Questions on Sources of Help
Three questions were asked to establish knowledge about and acceptability of existingservices and preferred sources of help. The first two questions asked respondents to sayto whom they would go with concerns about (1) their own, and (2) someone else’sdrinking (questions were open-ended and coded under one or more of the headings:doctor, family, friend, community worker, other, no-one). The third question askedfor the preferred source of external advice about a friend’s or own drinking (singleanswer, forced choice: health centre, community centre, place of worship, advicecentre, charity or helpline, nowhere, don’t know).
Questions about Culture and Ethnicity
A single question was asked at the beginning of the interview in order to establish ethnicgroup for inclusion in the study. Based on methods used in the National Census of1991, the PSI study (Modood et al., 1997), and public data collection exercises at theOffice of National Statistics, and ethnic monitoring activities of health and local autho-rities and housing associations (Jones, 1995), participants were asked to choose theirpreferred cultural-ethnic identifier from the following: White; Black Caribbean; BlackAfrican; Black British; Indian (Hindu); Indian (Muslim); Indian (Sikh); Pakistani;Bengali; East African Asian; British Asian; Chinese; Mixed race; None of the above.Those who indicated White, Chinese, or None of the above were not included. Foranalysis purposes those who had chosen Black Caribbean, Black African or BlackBritish were combined into a single African-Caribbean group. Indian Hindu, IndianSikh, Pakistani, and Bengali, were each sufficiently large groups to be treated separatelyin the analysis. Indian Muslim, East African Asian, British Asian, and Mixed race, weretoo small for separate analysis and were combined into an ‘other’ group. For analysisby religious group, the Indian Muslim group was combined with Pakistani and Bengaligroups to make a single Muslim group.
Four questions were asked towards the end of the interview. Two separate questionswere asked about the degree to which respondents (1) agreed with the statement, I thinkof myself as. . . [chosen cultural-ethnic identifier e.g. Black Caribbean, Indian Hindu],and (2) agreed with the statement, I think of myself as British. Both were forcedchoice, with reply options varying from strongly agree to strongly disagree. Two sepa-rate questions were asked following authors such as Hutnik (1991) and Modood et al.(1997) who conceived of cultural identification of minority groups as being constitutedof those two separate dimensions. That conceptualisation allows for the possibility thatsome respondents will identify more strongly with their ‘minority’ cultural-ethnic groupthan with being British; others the reverse; others identifying relatively strongly withboth; and yet others expressing weak or little identification with either culturalgroup. A third question asked respondents what proportion of their close friendscame from within their ‘minority’ cultural-ethnic group (5 response options varying
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from ‘a quarter or less’ to ‘all or most’). The fourth question asked how closely respon-dents identified with their religion (after asking which faith a respondent identified withmost closely) (5 response options varying from ‘not at all’ to ‘very closely’).
RESULTS
Table II summarises the achieved sample in terms of city (Birmingham or Leicester),age group, sex, educational attainment, economic activity, marital status, andnumber of people in the respondent’s household. It also shows the numbers choosingto identify themselves according to the different ethnic-cultural identifiers that wereoffered, and the numbers identifying with different religious faiths.
Levels of Drinking
Drinking and Non-drinking
A very high proportion of the total sample were non-drinkers: 61% reporting nothaving had any alcohol in the past 12 months (69% reported no drinking in the last7 days). As Table III shows, non-drinking was very unevenly spread across the differentethnic groups (men, chi squared¼ 236.4, women 221.2, both df¼ 4, p<0.001). Themajority of Hindu, Pakistani and Bengali men and women, were non-drinkers, andthe same was true of Sikh women. Most Sikh men, and most Black men and women,were drinkers.
Heavy Drinking
Table III also shows the percentages of men and women in the different ethnic groupswho reported drinking above two threshold levels. The first of these is the level referredto in earlier surveys as ‘fairly heavily’ or ‘more than recommended sensible levels’ (morethan 21 units a week for men and more than 14 units for women). The second is thatdescribed as drinking ‘very heavily’ (men more than 50 units and women more than 35units). To obtain an idea of how these results compare with general population figures,a useful comparison is with results of the 2000 General Household Survey (Office forNational Statistics, 2001) which showed 41% of men aged 16 to 24 years drinking atleast fairly heavily and 14% drinking very heavily, the figures for women at the sameage being 33 and 9% respectively. Many of the present respondents fell into an olderage group: the 2000 GHS figures for 25–44 year old men were: 30% drinking at leastfairly heavily and 7% very heavily; and for women of the same age 19 and 3% respect-ively. Compared to those results based upon a sample which, by definition, consistedmainly of White people rather than those in ethnic minority groups, the figures forfairly heavy or very heavy drinking shown in Table III are generally comparable(this applied to Black men), somewhat lower (Black women and Sikh men) or consid-erably lower (Sikh women, and Hindus, Pakistanis and Bengalis of both sexes) (num-bers in some cells are too small for statistical analysis).
It should be noted that the percentage of those drinking fairly heavily and veryheavily shown in Table III are based on the full samples. When these percentages arerecalculated, based only upon those who said that they sometimes drank, the figuresfor those groups where there are many non-drinkers become much larger. For example,
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TABLE II Description of the sample
CityBirmingham 1228 72.9%Leicester 456 27.1%
Age group18 or 19 131 7.8%20–24 515 30.6%25–29 381 22.6%30–34 299 17.8%35–39 234 13.9%40 plus 109 6.5%No answer 15 0.9%
Economic activityEmployed 700 41.6%Student 359 21.3%Looking after home 248 14.7%Unemployed 347 20.6%Other 30 1.8%
Marital statusMarried/cohabiting 831 49.3%Single, never married 756 44.9%Other 97 5.8%
No of people in the respondent’s home (including respondent)1 99 5.9%2 153 9.1%3 216 12.8%4 381 22.6%5 Plus 788 46.8%Not answered 47 2.8%
Ethnic-cultural groupBlack Caribbean 200 11.9%Black African 27 1.6%Black British 71 4.2%Indian Hindu 377 22.4%Indian Muslim 78 4.6%Indian Sikh 371 22.0%Pakistani 286 17.0%Bengali 226 13.4%East African Asian 10 0.6%British Asian 25 1.5%Mixed race 13 0.8%
Religious faithChristian 194 11.5%Hindu 372 22.1%Muslim 582 34.6%Sikh 355 21.1%Other 12 0.7%None or no answer 169 10.0%
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whereas the percentage of all Muslim men (Pakistani, Bengali and Indian Muslimgroups combined) who said that they drank more than sensible amounts (more than21 units) last week was only 4%, as a percentage of Muslim men who sometimesdrink this rises to 26%.
Perceived Benefits and Drawbacks of Drinking
Table IV summarises the results obtained (from last year drinkers only) from questionsasking respondents about benefits and drawbacks they had personally experienced ineach of 13 life areas. The figure shows percentages of all drinkers (separately for menand women), who reported experiencing any benefit or any drawback in each of 13life areas. Ethnic groups have been combined to show these results since men of allethnic groups reported a similar pattern of benefits and drawbacks, and the samewas true for women. A picture of the benefits thought to be conferred by drinkingemerges: giving greater self-confidence, helping to relax, being associated with abetter social life, contributing to fun and good humour, and enhancing friendship.Sleeping, eating, sex life, and even physical well-being were also thought by many tohave benefited from drinking.
Sex differences, running across all ethnic groups, were apparent in terms of some ofthe benefits, men seeing more benefit than women from drinking, particularly in theareas of finance and business, community, sleeping, and eating. Drawbacks wereacknowledged to outweigh benefits, by both sexes and all ethnic groups, in the areaof physical well-being, and many respondents acknowledged drawbacks in theareas of finances and business, marriage, and sex life (men being more aware thanwomen of drawbacks in the latter area).
Risky Activities Related to Drinking
At least half the drinkers in the study reported committing at least one of theactivities shown in Table V, while, after, or because of drinking, and comparatively
TABLE III Numbers and percentages of each ethnic group who sometimes drink, and who drank heavilylast week
Black Indian Hindu Indian Sikh Pakistani Bengali
Sometimes drinkMen 136 57 116 24 23
(87%) (34%) (71%) (15%) (24%)
Women 113 45 52 10 19(80%) (22%) (25%) (8%) (15%)
Drank at least fairly heavily last weekMen 54 6 39 6 5(>21 units) (34%) (4%) (24%) (4%) (5%)
large proportions of last year drinkers reported experiencing seven or more of thoseactivities in the last 12 months (36% men, 18% women). Table V shows the percentageof men and women drinkers reporting each of the 23 risky activities.
The proportion of men experiencing risks exceeded that of women in almost allinstances, but the sex imbalance was far greater in the case of risks involving aggressive
TABLE V Percentages of drinkers reporting risky drink related activities, by sex(drinkers only)
Men(n¼ 373)
%
Women(n¼ 266)
%
Gone off with people you did not know 24 18Walked alone through unsafe areas 44 31Gambled more than you would normally 31 4Had unprotected sexual intercourse 30 18Shared hypodermic needles 1 1Taken drugs you would not otherwise have taken 14 13Argued with bouncers or people bigger than yourself 36 15Taken other risks you would not normally have taken 36 29Had an accident 20 10Been aggressive when you should not have been 40 19Been in a violent argument or fight 37 14Damaged property 23 6Paid less attention to a child 5 5Driven a car 27 10Been asked to leave a pub or bar 23 7Been stopped by the police 21 4Been convicted of an offence 8 2Done anything else you later regretted 27 19Lost any days off work or college etc 24 25Worked below your normal pace/standard 33 29Received a warning about poor performance at work 8 3Been criticised by your family 20 10Felt ashamed or felt shame 15 16
TABLE IV Percentages of drinkers reporting experiencing benefits anddrawbacks from their drinking in each of 13 life areas (drinkers only)
incidents, drinking and driving, and gambling. Factor analysis of these data suggestedthe existence of two distinguishable factors. The first, particularly associated with argu-ments or fights, aggressiveness, damage to property, being stopped by the police, askedto leave a bar, and drinking and driving, was the more frequently occurring factor forboth sexes, but was more common amongst men than women. The second, associatedwith losing days from work or working below normal, feeling ashamed, taking drugs,walking through unsafe areas, going off with strangers, and having unprotected sex,was as common amongst women as amongst men. The former group of risks mightbe thought of as risks directed at other people, the latter as actions more harmful tooneself.
Six Indicators for Concern
Six indices of drinking that might reasonably give cause for concern were calculated,each in a different way reflecting that drinking had been, compared to the sampleas a whole, relatively heavy, frequent, risky, or in need of change. The six indicators(or signs), along with the numbers and percentages of men and women whosedrinking was classified as concerning according to each sign separately, are shownin Table VI. Some of the figures shown in Table VI will be picked out for specialmention.
In terms of drinking reported for the previous 12 months, drinking was more risky interms of large quantities consumed on certain occasions than in terms of frequency, atleast according to our chosen criteria. This was particularly the case for women,amongst whom a number (31 or 12% of drinkers) reported drinking quite large quan-tities very occasionally, but amongst whom very regular drinking was extremelyunusual (4 or 2% of drinkers). Substantial minorities (16% of men drinkers and14% of women drinkers) could be described as ‘contemplators’ in terms of the stages
TABLE VI Percentages of men and women showing each of six signs that their drinking was of concern
Days last year 45 12 6 12 5 1drinking>10or 7 units3
Maximum 64 17 8 31 12 4units in oneday last year4
Risky 135 36 17 48 18 5activities 5
Contemplation 58 16 NA 36 14 NAof change6
1Men 35 or more units last week, women 25 or more; 2Drinking on more than 300 days last 12 months; 3More than 100 dayslast 12 months drinking more than 10 units (men) or seven units (women); 4Men 28 or more units in any one day last 12months, women 20 or more units; 5Seven or more out of 23 risky activities last 12 months; 6Positive total score on fourcontemplation items.
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of change model, scoring positively on the four-item contemplation sub-scale of theReadiness to Change scale.
Adding up, for each drinker in the sample, the number of indicators out of apossible six, produces the findings that 53% of all men drinkers, and 32% of allwomen drinkers, had at least one sign that drinking might be of concern. Decreasingproportions had increasing number of signs. For example, 7% of drinking menand 5% of drinking women had four or more indicators of risky drinking. Sincelarge numbers were non-drinkers, these percentages recalculated as percentages ofall men or all women look more modest. For example, only 25% of all men inthe sample, and 10% of all women, had one or more sign that drinking might be ofconcern.
Table VII shows the numbers and percentages of all men, and all women, in thefive main ethnic groups, who had no signs that drinking might be of concern, onesign, or two or more signs. The table shows that having any sign that drinking mightbe of concern vary markedly between the groups (men, chi squared¼ 130.4, df¼ 4,p<0.001; women, numbers too small in some cells to calculate chi squared).Approximately a third of Black men had two or more such indicators and the samewas true of about 20% of the next most concerning group, Sikh men. Black women fol-lowed next at 11%. All of the other groups of women produced very low percentageswith two or more signs.
The figures in Table VII are based on the full samples of men and women, includingnon-drinkers, and hence they reflect the larger proportion of certain groups who drinkat all and who drink relatively heavily (particularly Black men and women and Sikhmen). The different ethnic groups are ordered very differently when the figures arerecalculated based solely upon drinkers. The comparatively small groups of Pakistanimen drinkers (n¼ 24, see Table III) now becomes the group with the highest proportionwho obtained two or more signs that drinking might be of concern (9 men, or 37%).Other groups with comparatively high percentages of drinkers who obtained two ormore signs that drinking might be of concern are Black men (35%), Sikh men(30%), Pakistani women (30%), and Bengali men (26%).
TABLE VII Number of signs that drinking might be of concern, out of six, by ethnic group (includesdrinkers and non-drinkers)
Asked to what extent they thought of themselves as ‘British’, and to what extent aspart of an ethnic minority, the majority of respondents saw themselves in terms oftheir ‘minority’ identity. Over half of all groups (57% men, 53% women) ‘stronglyagreed’ with the statement regarding their ethnic minority identity, with very fewindeed stating that they disagreed (4% men, 3% women). About half of the sampleagreed with the statement in respect of feeling ‘British’, but only about a quarterdid so ‘strongly’. Only 18% of males, and 11% of females, felt that they were not‘British’.
The combination of these variables produced four groups: 46% of males and 51% offemales being identified with both identities (Acculturative) and 44% of males and 29%of females feeling that their ethnic minority identity outweighed their Britishness(Dissociative). Around one in 12 of both sexes felt part of neither world (Marginal),and about one in 15 (more females than males) were ‘more British than minority’(Assimilative), using Hutnik’s (1991) labels. Identification with ethnic origin wasmost marked among those of Black, Pakistani and Bengali origin. Indian Hindusand Sikhs were the most likely to see themselves as belonging in both worlds. Thesepatterns were the same for men and women.
Social, Cultural and Religious Position and Drinking
A total of nine variables, indicative of social position or ethnic and religious identity,were examined for their association with drinking, and the results are shown inTable VIII. Two drinking variables were employed in these analyses: first, whetheror not a respondent was a past year drinker (results shown in Columns 1 and 2 ofTable VIII); and secondly whether a respondent had signs that drinking might be ofconcern (one or more such signs for women, but two or more signs for men sincehaving one sign that drinking might be of concern was comparatively common formen) (shown in Columns 3 and 4 of Table VIII).
The pattern of results is very clear: whether women were drinkers was strongly influ-enced by where they were positioned socially, culturally and in terms of their religion.For example only 17% of women without NVQ equivalent educational qualificationswere drinkers compared to 46% of the most qualified (NVQ equivalents 3, 4, 5). Togive another example, only 19% of those who said that all or most of their close friendswere from their own ethnic group, were drinkers, compared to 44% of those who saidthat half or fewer of their friends were from their own ethnic group. There were equallystrong relationships for women between being a non-drinker and being married, notbeing employed outside the home, having a relatively large number of people livingin the same household, and strength of identity with their religion and own ethnicgroup.
Furthermore, these analyses revealed that, for women, social, cultural and religiousvariables were related to drinking in complex fashion. There were many instances ofcomplex interactions. Some of these interactions are difficult to interpret, but othersmore readily suggest an interpretation. An example of the latter was an interactionbetween women’s ethnic group, their employment outside the home, and whether ornot they were drinkers. Employment outside the home had little bearing on whether
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Black or Sikh women were drinkers or not, but employment was related to drinkingfor Hindu, Pakistani and Bengali women. To give another example, the importanceof proportion of close friends who were from their own ethnic group varied by agefor women. Of younger women, under the age of 25, between one third and a halfwere drinkers irrespective of who their friends were. Above that age, in particular inthe intermediate age group 25–34, the composition of a woman’s friendship groupwas related to her drinking.
For women drinkers signs of concern were associated with a similar range ofvariables, amongst which being single, living alone or in a small household, less stronglyidentifying with one’s religion, and having a relatively smaller proportion of closefriends from within one’s own ethnic group, were the most strongly associated.
As Table VIII also shows, relationships between being a drinker and these social,cultural and religious variables were largely non-existent for men, or weaker thanthose found for women. The single exception was the closeness of men’s identificationwith their own religion which, as for women, was highly significantly related to being anon-drinker. Weak identification with one’s religion was also highly significant in theprediction of signs that men’s drinking might be of concern as was living alone or insmaller households.
Religion therefore emerges as a strong inverse correlate of both drinking and drink-ing which is of concern amongst both men and women. Only one in 12 (8%) said they
TABLE VIII A summary of multiple regression analyses, regressing drinking variables on nine variablesindicative of social, cultural and religious position
Drinking Variable
Drinker vs non-drinker Signs of concern
Men Women Men Women Drinker and(2þ signs vs 0 or 1) (1þ signs vs 0) concerns
No of people ns p<0.001 p<0.001 p<0.001 Fewer in thein the home5 homeIdentifying p<0.001 p<0.001 p<0.001 p<0.001 Less closewith religion6 identificationIdentify as ns p<0.05 ns p<0.05 StrongerBritish7 identityIdentify as ns p<0.001 ns p<0.05 Weakerethnic group8 identityClose friends p<0.05 p<0.001 ns p<0.001 Fewer fromfrom own ethnic groupethnic group9
118 or 19, 20–24, 25–29, 30–34, 35–39, 40 plus; 2NVQ equivalent, 0–5; 3Working (self employed or full or part-time employee)or not working; 4Married, single, other; 51, 2, 3, 4, 5 plus; 61–3 vs 4–5 on a scale from 1¼not al all to 5¼ very closely; 71–3 vs4–5 on a scale from 1¼ strongly disagree to 5¼ strongly agree; 81–4 vs 5 on a scale from 1¼ strongly disagree to 5¼ stronglyagree; 9Half or less, half to three-quarters, all or most.
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had no religion. Islam, which formally prohibits the use of alcohol, was associated withthe lowest level of drinking, only 14% of those saying they were Muslim (includingIndian Muslims) also stating that they were drinkers. Of the men who said they identi-fied ‘very closely’ with Islam, only 7% could be described as drinkers of alcohol; andnone of the 95 Muslim women in this identification bracket reported drinking.Degree of identification with religion also affected the propensity of Sikhs to drink;the percentage of Sikh men who were drinkers ranging from 94% of low-adheringSikh men to 60% of strong adherents. Sikh women who saw themselves as strongadherents of their religion were very unlikely to drink (7%).
Family Life and Drinking
Who Knows about Drinking
While the majority of drinking respondents said that their friends knew about the factthat they drank alcohol (85%), just under half said that their fathers (44%) andmothers (43%) did not know that they drank. A similar proportion said that theirbrothers and sisters did not know. When asked if there was anyone that they did notwant to know of their drinking, very few (under 3%) mentioned friends, while one infive did not want a parent to know, and a proportion did not want their brothers(11%) to know, or sisters (8%). On the other hand, the majority (62%) did not mindwho knew. As Table IX (Rows 3–6) shows, members of different ethnic and sexgroups find themselves in very different positions in these respects, varying fromBlack and Sikh men, most of whom are content that their parents know about theirdrinking, to most Sikh and Muslim women who believe their drinking is best keptsecret from their parents.
TABLE IX Respondents’ views on whether their parents drink, whether their parents know about therespondent’s drinking, and whether the respondent would prefer parents not to know about their drinking,by ethnic/religious group (in percentages; base n for each figure in brackets)
Black Hindu Sikh Muslim
Fathers drink1 64 20 45 3(148) (165) (163) (286)
Mothers drink2 55 4 3 1(139) (199) (204) (280)
Parents know about respondent’s drinking3
– Male respondents 72 61 72 25(136) (57) (116) (53)
1All parents. Male respondents’ replies (females very similar); 2All parents. Female respondents’ replies (males very similar);3Drinkers only. Replies re fathers (replies re mothers very similar).
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Family Members and Drinking
There was considerable variation in the patterns of reported alcohol use among familymembers. Sex was clearly important, with female relatives being much less likely to bereported as drinking. There were, as expected, very clear differences between the ethnicand religious groups. Table IX (Rows 1 and 2) show the results for parents. Whereasnearly half or more of Black and Sikh fathers and of Black mothers were thought tobe drinkers, it was very rare for Hindus and Sikhs to report that their mothersdrank, or for Muslims to believe that either parent was a drinker.
In most groups the likelihood of the respondents drinking was strongly associatedwith their responses to questions about their family members’ behaviour. The strongestassociation was found with reports of parental drinking. That effect is shown inTable X. It can be seen that whether a parent drank was of little consequence for thedrinking of Black men, of some importance for Black women and of very considerableconsequence for South Asian men and women. It might be expected that maternalbehaviour would have a stronger effect on women than on men. There is at least asuggestion in Table X that this might be the case.
Help Seeking
The results of questions about whom respondents would go to with concerns abouttheir own or someone else’s drinking, and which external source of help they wouldprefer, are shown in Table XI. Differences between ethnic groups were slight. Therole of the GP was widely recognised, and the health centre was the overwhelmingchoice amongst those who were able to nominate a source of external advice. Few, how-ever, would approach their doctors on behalf of another person whose drinking was ofconcern to them. There was a very high level of self-sufficiency – or reluctance to seekhelp outside the family or friendship network – among nearly all groups. There was aslight indication that Sikh men were less likely than other groups to recognise their owndrinking problems (i.e. to ask no-one). Among all groups, the use of friends for advicewas very common, particularly among South Asian women.
TABLE X Percentages of respondents who drink by whether respondents believe theirfathers and mothers are drinkers (base n for each figure in brackets)
Father Mother
Drinker Non-drinker Drinker Non-drinker
Black men 88 85 91 83(95) (53) (81) (67)
South Asian men 83 26 92 36(115) (499) (13) (601)
Black women 86 67 93 63(97) (42) (76) (63)
South Asian women 39 14 89 25(152) (531) (18) (665)
Note: Hindu, Sikh and all Muslim groups are combined into a single South Asian group in this tablebecause the numbers in certain groups believing their parents drank are too small for separate analysis.
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Community workers (by which was also meant priests and religious leaders) werealmost without exception not seen as a resource for personal help. Very few peoplewould approach a community worker on behalf of other people. Community centresand places of worship were mentioned by slightly more people as ‘external’ sourcesof advice, when prompted as an option. Charities and helplines as places to get helpabout their own, or someone else’s drinking, were quite often mentioned. Women ofBlack/Christian background were most likely to mention charities and helplines. Afew Black women mentioned Alcoholics Anonymous, as did a small number ofBengali men but there was otherwise no pattern of identified ‘other’ sources apparent.There was a large proportion of people of all ethnic groups and sexes, but particularlyin the South Asian groups, who said that they did not know where they would go for‘external’ advice.
DISCUSSION
Surveys of drinking practices and problems face a number of methodological problems,and the present study had a number of strengths and possible limitations. The size ofthe sample and the main analysed sub-groups, the characteristics of the field workers,and the use of a number of sets of questions used in previous studies, we believe to bestrengths. Possible weaknesses include: the inability to make finer distinctions amongstethnic minority groups (e.g. African-Caribbean people with family origins in differentCaribbean islands); the absence of questions about levels of dependence as well as anymore objective measures such as blood or breath tests; the quota sampling method ofrecruitment of participants which may have incurred unknown biases (e.g. over-repre-senting people who drink outside the home and under-representing those who drink athome); the use of a comparatively brief street interview method. We believe, however,that the in-street interviewing method was preferable to interviewing at home. Although
TABLE XI Sources of potential support and advice (percentages, which add to more than 100% because ofmultiple response)
To whom one To whom one Preferred source ofwould go about would go about advice about own
one’s own someone else’s or a friend’sdrinking drinking drinking
(drinkers only N¼ 639) (N¼ 1684) (N¼ 1684)
Doctor 28 12 –Family 27 21 –Friend(s) 37 28 –Community worker 1 2 –The person concerned NA 48 –Other 3 1 –No-one 15 7 –Health centre – – 35Community centre – – 4Place of worship – – 3Advice centre – – 1Charity or helpline – – 14Other – – 2Nowhere – – 11Don’t know or no answer 12 17 30
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the sample is not a nation-wide one, comparison of local studies of specific minoritygroups has found a considerable degree of consistency across geographic locations(Johnson et al., 2000), and we believe that the results of this survey in the Midlandshave relevance for the same minority ethnic communities in other parts of the country.
The results of the present study are in some ways consistent, and in others inconsis-tent with results of earlier studies, most of which involved mainly older immigrants tothe UK or did not distinguish between immigrants and non-immigrants. Non-drinkingwas still found to be the predominant experience for most South Asian participants, theexception as in earlier research being Sikh men (Cochrane and Bal, 1990). There is aminority of other South Asian groups, however, including Muslim men, who drinkheavily and in a way that gives rise to concern and their needs should not be ignored.Where there are significant differences in male and female drinking levels, such as in theSikh community, particular attention may need to be given to women victims of maleheavy drinking (Ahuja et al., 2003), although such family issues were not exploreddirectly in the present research.
Higher levels of drinking and fairly heavy drinking were found amongst Black menand women, and the highest levels of very heavy drinking and drinking that might be ofconcern were found amongst Black men. That rates of heavy drinking were at least ashigh as are national figures for the whole, largely White population (e.g. ONS, 2001)may itself be an indicator for concern for the Black community. Those results areinconsistent with previous findings from studies with African-Caribbean participants(e.g. Cochrane and Howell, 1995) and further investigation to confirm these new find-ings is required. In the 1999 Health Survey for England (Erens and Laiho, 2001) whichfocused on the health of minority ethnic groups, Black Caribbean men and women andIndian men were found, as in the present study, to more often be drinkers, and moreoften at least fairly heavy drinkers, than other South Asian groups. Results were notanalysed by whether participants were first, second or subsequent generation British,although surprisingly drinking for Black Caribbean and Indian men did not varymuch by age.
The present study is the first that has sampled young Black adults born and/or edu-cated in the UK, and the results may simply reflect the fact that youthful Black drinkingin Britain is now much like that engaged in by Whites. Other explanations should beconsidered. For example Black male respondents might have been inclined to exagge-rate their drinking, although that seems unlikely since under-estimation of drinkingis generally considered to be more of a problem in such research, and African-Caribbean women also described frequencies of heavy drinking similar to thosefound in the general population. The more likely explanation, in our view, lies in chang-ing norms and patterns of leisure which include drinking patterns, and a reduction inprotective factors such as strong religious adherence, living in households with author-ity figures such as parents, and being members of exclusively kinship and/or ethnic min-ority social networks. Variables reflecting such factors were strong correlates ofdrinking and drinking that might give cause for concern in the present study, particu-larly amongst women. In line with much research from a range of cultures (Miller,1998), strength of identification with religion was consistently inversely associatedwith drinking in the present study. The pattern of perceived benefits from drinkingacross the sample as a whole was broadly similar to that reported by a general(mostly White) sample of people in the West Midlands (Orford et al., 2001), althoughthe latter sample was confined to very heavy drinkers. Future research should examine
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these issues in more detail. It should also explore patterns of drinking, including whenand where people drink, which it was not possible to include in the present study.
The more frequently reported indicators for concern were related to single episodehigh consumption drinking, and behavioural risks associated with such drinking, nodoubt reflecting the perceived self-presentational benefits of drinking (e.g. increasedself-confidence and benefits to sex life) for this predominantly young adult sample. Itmay be unlikely, therefore, that individuals will identify themselves as having alcoholproblems; they would be more likely to identify behavioural problems resulting fromtheir drinking. The main areas of risk experienced by Black and South Asian menwhich involved others were violence, arguments and unprotected sex. Therefore, it isimportant to ensure that wider community safety initiatives such as drink drive cam-paigns, promoting safer public houses, schemes to tackle domestic violence, andpublic health initiatives to promote safer sex, actively include these groups.
For women, the risks experienced as a result of drinking were primarily about takingpersonal risks and the effects on their work. This was also an issue for men and raisesthe importance of workplace alcohol initiatives. This is reinforced by the finding thatmany more people reported being affected at work by their alcohol use than the num-bers who reported a warning from their employer about poor performance at work.Some of the personal risks, including walking alone through unsafe areas, may alsobe of concern to those agencies involved in community safety initiatives, althoughany preventive work needs to address the right to safe access to public areas, and therisks themselves (for example improving street lighting and public transport) as wellas drinking behaviour.
The finding that over half of all men drinkers and one in three women drinkersreported some aspects of their drinking which might give cause for concern does suggestsignificant numbers of young adult members of ethnic minority groups who might ben-efit from brief advice or more extended intervention targeted at drinking. Present evi-dence suggests that the numbers of Black and South Asian people accessing specialistalcohol problem services are lower than these results would suggest they should be(Malseed, 1990; Hyare, 1993, 1996). Suggestions from the present results about helpseeking include: a role for specialist agencies in developing materials for brief interven-tions appropriate for members of ethnic minority groups; the need to build on people’swillingness to talk to their GPs or attend their health centres by developing joint initia-tives between primary care and specialist agencies; work amongst communities toenable people better to elicit the help and support of their families; and an examinationof the role of ethnic minority community groups and religious institutions attended bylarge numbers of people from ethnic minority groups, since previous research has sug-gested they may have a considerable role in the prevention and treatment of alcoholproblems (e.g. Johnson, 1996; Morjaria and Orford, 2001), but the present results sug-gest that predominantly young, second generation ethnic minority groups generally donot regard them as sources of relevant help or advice.
CONCLUSION
Despite a number of evident limitations, we believe that the present findings provide abasis from which planners, commissioners and service providers can discuss with com-munities the development and targeting of preventive and treatment services which
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meet the specific needs of the black and ethnic minorities in the areas they serve. Theyalso provide local communities with information from which to identify issues for theirown communities and to discuss with planners, commissioners and providers what ser-vices are appropriate for their needs. Finally they provide information which shouldensure that the National Alcohol Strategy is inclusive of the needs of ethnic minoritycommunities in the United Kingdom as drinkers, those affected by other people’sdrinking, and as non-drinkers.
Acknowledgments
The authors would like to thank the people of Leicester and Birmingham who took partin the survey, and also the following members of the Steering Group for their importantcontributions: Vinod Kotachia, Confederation of Indian Organisations, Leicester;Emmanuel Williams, SIA, Leicester; Arif Chohan, Birmingham; Deepak Naik,Hindu Council of Birmingham; Narinder Nijar, Race Equality Team, BirminghamCity Council; Jagdev Singh Bopari, Sikh Council, Birmingham; Richard Abraham,Alcohol Concern. We would also like to extend thanks to Peter Davis, ProjectManager, and his colleagues at BMG Research in Birmingham, who were involvedin the collection and initial analysis of data. Our thanks also to Pami Kang, YvonneDoherty-Rowe and Pat Evans who prepared manuscripts of this paper and thelonger report on which it is based; and to Jane Roebuck for her comments on an earlierdraft. The present paper summarises, with permission, material contained in a longerreport produced for Alcohol Concern and subsequently published by them (AlcoholConcern, 2001).
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