Perceptions of alcohol health harm among midlife men in England: a qualitative interview study

Abstract In recent years attention has been directed at harmful levels of alcohol consumption among middle-aged and older people. In England, midlife men are over-represented in the social patterning of risk of alcohol harm. Insights into midlife men’s understandings of alcohol harm are limited, and research suggests poor effectiveness of existing alcohol education messaging and guidance. A better understanding of the ‘lay epidemiology’ of alcohol health harm can inform and thus enhance the effectiveness of public health and alcohol education measures. In-depth individual interviews were undertaken with 42 men aged 45–60 drinking over 240 grams (30 UK units) of alcohol per week. The men’s perceptions reflected three dimensions of how alcohol health harm: 1) is experienced and perceived, 2) is understood to work and 3) is best managed and communicated. The harmful bodily effects from alcohol were recognised in ‘problem drinkers’ and as acute effects. The men understood the effect of alcohol as a poison linked to excessive consumption or when consumption was continuous. Alcohol health harms were understood in relation to wider lifestyle behaviours and the men requested that public health advice should give them choices, and not simply tell them what to do. The men had a limited understanding of how alcohol affected their bodies and, drawing on the medical anthropological concept of ‘explanatory models’, it is suggested that providing clear and accessible explanations of how specific alcohol-related health harms occur may help people to make informed choices of moderation and improve the effectiveness of public health messages.