Drinking pattern is more strongly associated with under-reporting of alcohol consumption than socio-demographic factors: evidence from a mixed-methods study
Open accessAbstract
BACKGROUND: Under-reporting of alcohol consumption is widespread; surveys typically capture 40-60% of alcohol sales. However the population distribution of under-reporting is not well understood. METHODS: Mixed-methods study to identify factors associated with under-reporting, using the nationally-representative Health Survey for England (HSE) 2011 (overall response rate 66%). Comparison of retrospective computer-assisted personal interview and seven-day drinking diary (n = 3,774 adults 18+, 50% women, diary response rate 69%) to identify factors associated with diary responses exceeding those of the interview using multivariable linear regression for three outcomes: drinking days in the week recorded, volume consumed on heaviest drinking day in the week recorded, and weekly alcohol consumption. Qualitative semi-structured interviews (n = 10) explored reasons for under-reporting in further detail. RESULTS: Number of drinking days was slightly greater in the diary than the interview (P < 0.001). Reported consumption was higher in the diary than in the interview for heaviest drinking day in the week recorded (0.7 units greater among men, 1.2 units among women, P < 0.001), and weekly alcohol consumption in women only (1.1 units among women, P = 0.003). Participants who drank more frequently, more heavily, and had a more varied drinking pattern with respect to the types of drink consumed or choice of drinking venues had a larger difference between their diary week and their interview week.The qualitative interviews identified having a non-routine drinking pattern, self-perception as a non-frequent drinker, and usually tracking drinking using experiential approaches as linked to more drinking being reported in the diary than the retrospective interview. CONCLUSIONS: Heavy drinking and non-routine drinking patterns may be associated with greater under-reporting of alcohol consumption. Estimates of drinking above recommended levels are likely to be disproportionately under-estimated.
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The observed decline in AUD may be partly explained by self-underreporting of alcohol consumption, especially during the pandemic, when limited healthcare access, heightened stigma in remote surveys, and disruptions in data collection likely played a role.
“This may partly explain the observed decline in AUD in our findings, especially during the pandemic, when limited healthcare access, heightened stigma in remote surveys, and disruptions in data collection likely played a role [44].”
From Global epidemiology of alcohol-related liver disease, liver cancer, and alcohol use disorder, 2000–2021 (2025) · cites this paper as [44]
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- Authors
- Boniface, S., Kneale, J., & Shelton, N.
- Affiliations
- University College London (GB)
- Corresponding author
- Boniface, Sadie
- Venue
- BMC Public Health
- Published
- 2014-12
- Volume
- 14
- Issue
- 1
- Pages
- 1297-1297
- ISSN
- 1471-2458 (ISSN-L)
- PMC
- PMC4320509
- OpenAlex
- W1804495225
- Cited by
- 171
- References
- 32
- Citations by year
- 2026: 11 · 2025: 21 · 2024: 21 · 2023: 11 · 2022: 18 · 2021: 30 · 2020: 14 · 2019: 9 · 2018: 9 · 2017: 13 · 2016: 9 · 2015: 5
- FWCI
- 6.80
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Public Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Sociology and Political Science › Survey Methodology and Nonresponse
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Keywords
- drinking patterns, heavy drinking, retrospective self-report, weekly alcohol consumption, drinking venues
- MeSH terms
- Adult, Aged, Aged, 80 and over, Alcohol Drinking, Cross-Sectional Studies, England, Female, Health Surveys, Humans, Male, Middle Aged, Retrospective Studies, Self Concept, Socioeconomic Factors
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