A qualitative exploration of the Alcohol Harm Paradox among different socioeconomic groups in Australia

Introduction
Alcohol-related harms differ across socioeconomic groups in Australia and around the world. Drinkers from the most disadvantaged areas experience disproportionate harms from alcohol for the same or lower levels of consumption compared to those more advantaged. This is known as the ‘alcohol harm paradox’. This study aims to explore the alcohol harm paradox qualitatively using an eco-social perspective.
Methods
We conducted 45 semi-structured interviews with drinkers from different socio-economic areas in Victoria, Australia. We used thematic analysis to explore how socioeconomic conditions influence alcohol-related harms.
Results
Participants from wealthier areas were self-reflective about their alcohol use, including consciously limiting the number of days and quantities of alcohol they consumed, as well as actively implementing healthy hobbies. Participants from middle-class areas often reported struggling to reduce their alcohol use due to competing demands of families and work but were also conscious of the impact alcohol had on their lives. Participants living in lower socioeconomic areas seemed less conscious of their drinking patterns, which were either habitual (daily) or opportunistic (heavy episodic). They were also more likely to undertake shift or casual work, around which their drinking occurred. Problems or harms from alcohol were not as commonly worried about as in other groups, with broader life worries more immediate for them. 
Discussion
Findings support calls for an eco-social perspective and approaches that consider important contextual factors for a better understanding of alcohol-related health inequality. They also provide insights for targeted health promotion activities tailored to different groups, and for environmental prevention approaches to effectively tackle differences in alcohol-related harm that are driven by broader social and structural issues.