ABSTRACT
Objectives: To determine the way Canadians consume alcohol beyond drinking amounts and to verify if the drinking act is similar across provinces given that, in Canada, alcohol policies come under provincial jurisdiction.
Methods: Subjects were 10,466 current drinkers (5,743 women and 4,723 men) aged 18 to 76 years, who participated in the GENACIS Canada study.
Results: In Canada, there are three main patterns of consuming alcohol. Maritimers tend to drink more per occasion, report more binge drinking and largely prefer beer. In the Prairies, people tend to drink less, to drink less often during a meal and to favour spirits. Finally, drinkers from Qu�bec, Ontario and British Columbia drink more often, drink wine more often, drink spirits less often, and drink more often during a meal than drinkers from the other provinces. The same patterns are observed in both sexes, although the differences across provinces are less pronounced among women.
Conclusion: Knowledge about these three drinking groups should be used to increase the legitimacy and effectiveness of alcohol policies in general.
Key words: Culture; alcoholic beverages; Canada; gender
La traduction du r�sum� se trouve � la fin de l?article.
Can J Public Health 2010;101(4):275-80.
In Canada, health and social problems resulting from alcohol consumption are becoming a concern. Over the last decade, both the annual volume of consumption and high-risk drinking have increased.1-4 Consequently, in order to avoid a proliferation of alcoholrelated damages, effective recommendations are needed. While commonly reported numeric measures of alcohol consumption are accurate predictors of various problems, they are limited in their scope to help understand the drinking act and its relationships to alcohol-related harm.5,6 Yet, this could be improved if more thought were given to the qualitative dimensions of drinking such as the types of beverages consumed and the circumstances surrounding the drinking act.
Drinking occasions, characterized by relational, temporal, circumstantial and locational dimensions, represent a distinct social world that has its own norms and, as such, influence drinking outcome. 7-10 For instance, the probability for heavy drinking is generally higher in bars, discos or taverns than in restaurants or homes.11-16 Accordingly, drinking in a bar is associated with acute social consequences such as suicide, violence, motor vehicle and other accidents.17,18 By contrast, light drinking with meals may be associated with improved cardiac functioning and reduced risk of heart attack.19
While damages from alcohol are strongly related to total volume of alcohol consumed and heavy drinking episodes, some studies have shown that beverage choices can also be associated with drinking outcomes. Beer drinkers are more often involved in alcoholrelated accidents than other types of drinkers,20 whereas wine drinkers have a lesser risk of alcohol-related problems,21 morbidity and mortality from all causes.22,23 While these differences can be explained by the health-promoting components of different alcoholic beverages,22,24-27 they might also be an artifact of the qualitative ways a standard dose of alcohol is taken,6 the personality of the drinker and his lifestyle,28-32 or the circumstances in which drinkers find themselves.33,34 Beverage choice is also a significant indicator of social status, a fact that may also impact on drinking consequences.10
To develop effective alcohol recommendations, alcohol consumption needs to be considered as a social behaviour and each and every dimension of the drinking act must be analyzed. Hence, this paper's key questions are:
1) What are Canadians? drinking patterns in terms of drinking amounts as well as beverage and drinking context preferences?
2) Are Canadians? drinking patterns similar across provinces?
This paper aims to be a first step toward finding out whether Canadians share a drinking culture.
METHODS
Survey
The GENACIS* survey was developed to study the influence of social and cultural variation on gender differences in alcohol use. Between January 2004 and January 2005, telephone interviews were performed and responses from 14,067 Canadians between the ages of 18 and 76 originating from ten provinces were collected. The overall response rate was 53%. Although provinces with smaller populations were over-sampled to allow provincial comparisons, there were still an insufficient number of respondents from the Maritime provinces to carry out the present analyses. Consequently, these provinces were grouped together as preliminary analyses revealed that they shared very similar drinking practices.
The analytical sample includes 10,466 current drinkers (5,743 women and 4,723 men). The age distribution of respondents was not statistically different across provinces. Data were not weighted, in accordance with the GENACIS technical report's suggested protocol when comparing provinces.35
Measures
Analyses are based on the annual frequency of drinking, the occurrence of a binge drinking occasion (5+ drinks on one occasion), the usual daily quantity and the annual volume. We further calculated the percentage of the total volume due to each type of beverage as well as the percentage of the annual frequency attributable to specific drinking contexts, by dividing beverage-specific/contextspecific responses by the general ones. Details about variables and relevant questions are shown in Appendix 1.
Analyses
Analyses were conducted to reveal drinking patterns and verify whether these patterns vary across provinces. Descriptive analyses and pairwise comparisons based on estimated marginal means were performed using SPSS 12.0. Analyses were stratified according to gender and were conducted separately for each drinking measure, each beverage type and each drinking context. Level of significance was set at p?0.05.
RESULTS
Men's drinking amounts and drinking patterns
On average, a Canadian male drinker has 432 drinks a year. This average varies from 486 drinks in the Maritimes to 318 drinks in Manitoba and these two extremes are significantly different from one another. The average annual drinking frequency for Canadian men is 95 occasions. The highest number is observed in Qu�bec where men report 109 drinking occasions, i.e., significantly more occasions than the number reported in the Maritimes (84), Alberta (82), Saskatchewan (78) and Manitoba (71). Canadians? usual daily quantity is 3.3 drinks whereas Maritimers? intake is significantly higher than that observed in every other province, with a usual daily quantity of 4.1 drinks. Accordingly, while 64% of Canadians binge drink at least once a year, 73% of Maritimers do so - a significantly greater proportion than everywhere else in Canada except Alberta (64%) and Saskatchewan (64%).
Men's beverages and context preferences
Beer - the preferred alcoholic beverage in every province - accounts for 51% of men's annual volume, though the annual intake of Maritimers is significantly more (59%) than in any other province except Qu�bec (53%). While wine constitutes 26% of Canadian men's annual volume, Quebecers have a distinct preference for this beverage. More than one third (36%) of Quebecers? annual volume is wine, a proportion that is significantly greater than in all other provinces. Spirits constitute 19% of Canadians? annual volume, but these beverages are significantly more appreciated in the Prairies. In Saskatchewan, the annual volume attributable to spirits (32%) is significantly higher than in the Maritimes (24%), British Columbia (19%), Ontario (19%) and Qu�bec (8%). Notably, Quebecers? percentage of the annual intake consisting of spirits is significantly lower than everywhere else in Canada. Finally, coolers are not popular among men. Yet, Ontarians (5%) drink significantly more coolers than both Quebecers (2%) and Maritimers (2%).
With regards to drinking contexts, results indicated provincial differences. Drinking during a meal is more prevalent in Qu�bec (58%) than in Alberta (45%), Saskatchewan (41%) and the Maritimes (40%). Drinking at a restaurant is less frequent in the Maritimes (23%) than in Alberta (30%) and Ontario (29%). Drinking at a party is significantly more popular in Manitoba (46%) than in BC (37%) and Qu�bec (37%). Finally, Quebecers report significantly less drinking occasions at a bar (24%) than men from other provinces except BC and Ontario. Quebecers also report less drinking with friends (37%) than drinkers from Alberta (44%), Manitoba (48%) and Ontario (42%).
Women's drinking amounts and drinking patterns
On average, a Canadian female drinker has 183 drinks annually. It is in British Columbia that women drink the most (207 drinks), followed by women from Ontario (190), and those numbers are significantly higher than that observed in Saskatchewan where women drink the least (134). The average annual drinking frequency of Canadian women is 62 occasions. The highest number is observed in BC where women report 71 drinking occasions, i.e., significantly more occasions than that reported by women in Alberta (56), Manitoba (51), the Maritimes (45) and Saskatchewan (39). While Canadian women usually have 2.2 drinks per day, the highest average is found in the Maritimes where women usually have 2.5 drinks per day, i.e., significantly more than in Qu�bec (2.2), British Columbia (2.1), Alberta (2.1) and Ontario (2.1). Finally, 37% of women report binge drinking at least once a year. This proportion is largest in the Maritimes (43%) and significantly higher than that observed in Ontario (35%) and Qu�bec (35%).
Women's beverages and context preferences
Among women, wine is the preferred beverage (47%) and the proportion of the annual intake that is attributable to this beverage is significantly higher in Qu�bec (59%) than in every other province. Beer constitutes 20% of Canadian women's annual intake and again, it is in Qu�bec that we observed the largest proportion of the intake attributable to this beverage (25%) - a significantly larger proportion than in the Maritimes (19%), BC (18%), Ontario (18%) and Manitoba (17%). Spirits are preferred in the Prairies. Manitoba women report that 31% of their annual intake consists of spirits. This proportion is significantly higher than in every other province except Saskatchewan (31%). Finally, while coolers represent 13% of Canadian women's annual intake, in the Maritimes they represent 18%, i.e., significantly more than everywhere else in Canada except Manitoba (15%).
With regards to drinking contexts, data indicate that drinking during a meal is more prevalent in Qu�bec (70%) than in Saskatchewan (56%), Manitoba (53%) and the Maritimes (51%). It is in Alberta (41%) that the highest percentage of drinking in a restaurant is observed and this number is significantly higher than that observed in the Maritimes (28%) where women drink significantly less in a restaurant than women from every other province except Manitoba. Maritime women drink significantly more often during a party (57%) than women in Ontario (49%), BC (48%), Alberta (48%) and Qu�bec (47%). Women from Qu�bec report significantly fewer drinking occasions at a bar (18%) than women from other provinces, and they also report the lowest proportion of drinking occasions with friends (44%), one that is significantly lower than in the Maritimes (52%) and Ontario (50%).
DISCUSSION
In the alcohol field, it is commonplace to treat nation states and their drinking culture as congruent. However, by looking beyond drinking amounts and paying attention to the qualities of the drinking act, present analyses reveal that in Canada, a large country with ten provinces, there may not be just one single way of consuming alcohol. Preliminary analyses presented in this paper suggest the possibility of three main patterns among Canadian drinkers.
At one end of the spectrum, Maritimers tend to drink more per occasion and report more binge drinking, and Maritime men largely prefer beer. Men and women from the Maritimes drink less often during a meal than elsewhere in the country.
A second way of drinking is observed in the Prairies where men and women tend to drink less, to drink less often and to strongly favour spirits - a type of beverage that constitutes one third of their annual intake.
Finally, there is a way of drinking typified by Quebecers and to a lesser extent by male and female drinkers from Ontario and British Columbia. Actually, given the pronounced preference of Quebecers for wine - a preference which impacts the proportion of volume associated with every other beverage - we could justify putting Quebecers in an exclusive category. However, recent longitudinal data indicate that the value of wine sales increased more noticeably in BC and Ontario than in Qu�bec3 and therefore, we expect that in the future, drinking practices in these three provinces will grow even more similar. Overall, drinkers from Qu�bec, Ontario and BC show a drinking style that is closer to the Mediterranean culture, i.e., men and women in these provinces drink more often, drink more wine, drink less spirits, and drink during a meal more often than drinkers from the other provinces.
Overall, this paper prepares the ground for further development of a Canadian alcohol consumption typology, as we were able to identify three distinct ways of consuming alcohol in Canada. We argue that awareness about these three subgroups of Canadian drinkers could be taken into account in the development of alcohol recommendations. This knowledge can be used to strengthen the links between alcohol-related problems and prevention strategies such as low-risk drinking guidelines, which in turn can contribute to increasing the legitimacy of alcohol policies in general.
[Sidebar]
R�SUM�
Objectif : Cet article d�crit de quelles mani�res les Canadiens consomment de l?alcool au-del� des quantit�s consomm�es. �tant donn� qu?au Canada, les politiques relatives � l?alcool rel�vent d?une juridiction provinciale, les profils individuels de consommation � travers les provinces sont pr�sent�s.
M�thodologie : Les sujets de cette �tude sont 10 466 consommateurs d?alcool (5743 femmes et 4723 hommes), �g�s entre 18 et 76 ans, qui ont particip� � l?enqu�te GENACIS Canada.
R�sultats : Au Canada, il existe trois grandes fa�ons de consommer de l?alcool. Les r�sidents des Maritimes pr�f�rent la bi�re, ils boivent de plus grandes quantit�s par occasion et ils sont plus nombreux � rapporter une consommation �pisodique et abusive. Les r�sidents des Prairies pr�f�rent les spiritueux, ils boivent moins et ils boivent moins souvent lors d?un repas. Finalement, les Qu�b�cois, les Ontariens et les r�sidents de la Colombie-Britannique boivent plus de vin et moins de spiritueux, ils boivent plus fr�quemment et ils boivent plus souvent lors d?un repas que les r�sidents des autres provinces. Ces profils sont les m�mes selon le sexe, mais les diff�rences r�gionales sont moins prononc�es chez les femmes.
Conclusion : La connaissance de ces trois groupes est utile pour l�gitimer et am�liorer l?efficacit� des politiques relatives � l?alcool.
Mots cl�s : Culture; boissons alcoolis�es; Canada; genre
* GENder Alcohol and Culture: an International Study
[Reference]
REFERENCES
1. Adlaf EM, Begin P, Sawka E (Eds.). Canadian Addiction Survey (CAS): A National Survey of Canadians? Use of Alcohol and Other Drugs: Prevalence of Use and Related Harms: Detailed Report. Ottawa, ON: CCSA, 2005.
2. Health Canada. The Canadian Alcohol and Drug Use Monitoring Survey (CADUMS). Ottawa, ON: Health Canada, 2008.
3. Statistics Canada. The control and sale of alcoholic beverages in Canada: Fiscal year ended March 31, 2007. Ottawa, ON: Ministry of Industry, 2008.
4. Brewers Association of Canada. 2007 Annual Statistical Bulletin. Ottawa, ON: Brewers Association of Canada, 2008.
5. Grant M, Litvak J. Introduction: Beyond per capita consumption. In: Grant M, Litvak J (Eds.), Drinking Patterns and Their Consequences. Florence, KY: Taylor & Francis Group, 1998.
6. Heath DB. Drinking Occasions: Comparative Perspectives on Alcohol and Culture. New York, NY: Brunner/Mazel, Taylor & Francis Group, 2000.
7. Demers A, Kairouz S, Adlaf EM, Gliksman L, Newton-Taylor B, Marchand A. Multilevel analysis of situational drinking among Canadian undergraduates. Soc Sci Med 2002;55:415-24.
8. Kairouz S, Gliksman L, Demers A, Adlaf EM. For all these reasons, I do drink: A multilevel analysis of contextual reasons for drinking among Canadian undergraduates. J Stud Alcohol 2002;63:600-8.
9. Kairouz S, Greenfield TK. A comparative multi-level analysis of contextual drinking in American and Canadian adults. Addiction 2007;102:71-80.
10. Social Issues Research Center. Social and Cultural Aspects of Drinking. Oxford, UK: SIRC, 2000.
11. Clapp JD, Reed MB, Holmes MR, Lange JE, Voas RB. Drunk in public, drunk in private: The relationship between college students, drinking environments and alcohol consumption. Am J Drug Alcohol Abuse 2006;32:275-85.
12. Cosper RL, Okraku IO, Neumann B. Tavern going in Canada: A national survey of regulars at public drinking establishments. J Stud Alcohol 1987;48:252-59.
13. Kypri K, Paschall MJ, Maclennan B, Langley JD. Intoxication by drinking location: A web-based diary study in a New Zealand university community. Addict Behav 2007;32:2586-96.
14. Paschall MJ, Saltz RF. Relationships between college settings and student alcohol use before, during and after events: A multi-level study. Drug Alcohol Rev 2007;26:635-44.
15. Single E, Worthley S. Drinking in various settings as it relates to demographic variables and level of consumption: Findings from the national survey in Canada. J Stud Alcohol 1993;54:590-99.
16. Snow RW, Landrum JW. Drinking locations and frequency of drunkenness among Mississippi DUI offenders. Am J Drug Alcohol Abuse 1986;12:389-402.
17. Bondy SJ. Overview of studies on drinking patterns and consequences. Addiction 1996;91:1663-74.
18. Naimi TS, Nelson DE, Brewer RD. Driving after binge drinking. Am J Prev Med 2009;37:314-20.
19. Giesbrecht N, Russell M, Rehm J. Background paper for the National Alcohol Strategy Working Group. Alcohol and chronic disease: Implications for policies and prevention strategies in Canada. Toronto, ON: Centre for Addiction and Mental Health, 2005.
20. Greenfield TK, Rogers JD. Alcoholic beverage choice, risk perception and self-reported drunk driving: Effects of measurement on risk analysis. Addiction 1999;94:1735-43.
21. Smart RG. Behavioral and social consequences related to the consumption of different beverage types. J Stud Alcohol 1996;57:77-84.
22. Gronbaek M, Becker U, Johansen D, Gottschau A, Schnohr P, Hein HO, et al. Type of alcohol consumed and mortality from all causes, coronary heart disease, and cancer. Ann Intern Med 2000;133:411-19.
23. Wannamethee SG, Shaper AG. Type of alcoholic drink and risk of major coronary heart disease events and all-cause mortality. Am J Public Health 1999;89:685-90.
24. Berger A. Science commentary: Why wine might be less harmful than beer and spirits. BMJ 1998;317:844.
25. Frankel EN, Kanner J, German JB, Parks E, Kinsella JE. Inhibition of oxidation of human low-density lipoprotein by phenolic substances in red wine. Lancet 1993;341:454-57.
26. Prescott E, Gronbaek M, Becker U, Sorensen TI. Alcohol intake and the risk of lung cancer: Influence of type of alcoholic beverage. Am J Epidemiol 1999;149:463-70.
27. Shimada K, Watanabe H, Hosoda K, Takeuchi K, Yoshikawa J. Effect of red wine on coronary flow-velocity reserve [letter]. Lancet 1999;354(9183):1002.
28. Jensen MK, Andersen AT, Sorensen TI, Becker U, Thorsen T, Gronbaek M. Alcoholic beverage preference and risk of becoming a heavy drinker. Epidemiology 2002;13:127-32.
29. Klatsky AL, Armstrong MA, Kipp H. Correlates of alcoholic beverage preference: Traits of persons who choose wine, liquor or beer. Br J Addict 1990;85:1279-89.
30. Naimi TS, Brewer RD, Miller JW, Okoro C, Mehrotra C. What do binge drinkers drink? Implications for alcohol control policy. Am J Prev Med 2007;33:188-93.
31. Nielsen NR, Schnohr P, Jensen G, Gronbaek M. Is the relationship between type of alcohol and mortality influenced by socio-economic status? J Intern Med 2004;255:280-88.
32. Tjonneland A, Gronbaek M, Stripp C, Overvad K. Wine intake and diet in a random sample of 48,763 Danish men and women. Am J Clin Nutr 1999;69:49-54.
33. Gruenewald PJ, Johnson FW, Millar A, Mitchell PR. Drinking and driving: Explaining beverage-specific risks. J Stud Alcohol 2000;61:515-23.
34. Gruenewald PJ, Millar AB, Ponicki WR, Brinkley G. Physical and economic access to alcohol: The application of geostatistical methods to small area analysis in community settings. In: Wilson RA, Dufour MC (Eds.), Epidemiology of Alcohol Problems in Small Geographic Areas. Darby, PA: Diane Pub Co., 2001.
35. Elsbett-Koeppen R. Gender, Alcohol, and Culture: An International Study (GENACIS): Technical documentation. Toronto, ON: York University, 2005.
Received: September 8, 2009
Accepted: April 5, 2010
[Author Affiliation]
Catherine Paradis, MSc,1 Andr�e Demers, PhD,1 Elyse Picard, MSc2
[Author Affiliation]
Author Affiliations
1. D�partement de sociologie, GRASP, Universit� de Montr�al, Montr�al, QC
2. GRASP, Universit� de Montr�al, Montr�al, QC
Correspondence: Catherine Paradis, GRASP, Pavillon 7077 av. du Parc, Universit� de Montr�al, C.P. 6128, succursale Centre-ville, Montr�al (Qu�bec) H3C 3J7, Tel: 514- 343-6193, E-mail: catherine_paradis@yahoo.ca
Acknowledgements: Funding for this research was provided through an operations grant from the Canadian Institutes of Health Research (CIHR) (Kate Graham (PI) and Demers (Co-PI)). We are grateful to the staff at the Institute for Social Research (ISR) at York University and to Jolicoeur for their assistance in implementing the survey, especially David Northrup and Ren�e Elspett-Koeppen of ISR for their contributions to the design of the survey. This research was conducted as part of the GENACIS project, a collaborative multinational project led by Sharon Wilsnack and affiliated with the Kettil Bruun Society for Social and Epidemiological Research on Alcohol.
Conflict of Interest: None to declare.
Appendix 1. Relevant survey questions on drinking patterns, beverage preferences and drinking context preferences
Four dimensions of drinking patterns were studied: the annual frequency, the prevalence of five drinks or more per occasion, the usual daily quantity and the annual volume.
For the annual frequency of drinking, respondents were asked: ?During the last 12 months, how often did you usually have any kind of drink containing alcohol?? Possible responses were 1) every day, 2) five or six days a week, 3) three or four days a week, 4) once or twice a week, 5) one to three days a month, 6) less than once a month, or 7) never. Those categories were recoded into absolute average numbers, i.e., 365, 286, 182, 78, 24, 6 or 0 annual drinking days. The same procedure was used for the annual frequency of 5 drinks or more per occasion.
The usual daily quantity is a continuous variable where respondents were asked the following question: ?In the past 12 months, on those days when you had any kind of beverage containing alcohol, how many drinks did you usually have??
The annual volume is a continuous variable derived from multiplying the annual frequency of drinking by the usual daily quantity.
Questions regarding the annual volume were then asked again but specifically for each type of beverage (wine, beer, spirits, coolers). Afterward, proportions of the total volume due to each type of beverage were calculated.
Regarding drinking contexts, respondents were asked how often they drank in various circumstances, i.e., during a meal, at a party, at home, with friends, at work, at a bar/pub/disco/nightclub, at a restaurant, alone. Again, the percentage of the annual frequency of drinking that occurred in each of those contexts was calculated.
