All drinking is not equal: how a social practice theory lens could enhance public health research on alcohol and other health behaviours

Abstract

Background: The social meanings, settings and habitual nature of health-related activities and their integration into our daily lives are often overlooked in quantitative public health research. This reflects an overly individualised approach to epidemiological surveillance and evaluations of public health interventions, based on models of behaviour that are rooted in social cognition and rational choice theories. This paper calls for a new approach to alcohol epidemiology and intervention research informed by theories of practice.Argument: Practices are conceptualised as routinized types of human activity that are made up of, and can be recognised by, the coming together of several interwoven elements in the same situation (e.g. materials, meanings, skills, locations, timings). Different practices are interconnected they can occur simultaneously (e.g. drinking and eating), hold each other in place (e.g. after-work drinks) or compete for time (e.g. parenting versus socialising). Applying these principles to alcohol research means shifting attention away from individuals and their behaviours and instead making drinking practices an important unit of analysis. Studying how drinking practices emerge, persist and decay over time, how they spread through populations and local or social networks, and how they relate to other activities of everyday life promises new insights into how, why, where, when and with whom drinking and getting drunk occur. Conclusions:Theories of practice provide a framework for generating new explanations of stability and change in alcohol consumption and other health behaviours. This framework offers potential for novel insights into the persistence of health inequalities, unanticipated consequences of policies and interventions, and new interventions targets through understanding which elements of problematic practices are likely to be most modifiable. SUMMARY STATEMENTSApplying theories of practice principles to research on alcohol consumption would mean shifting our attention from average drinking volumes and frequencies to drinking practices as a core unit of analysis to gain insight into how, why, where, when and with whom we drink and get drunk.We hope this will generate novel insights into the emergence and decay of drinking practices over time and into the geographical and socio-demographic patterning of drinking.Theories of practice-informed research would consider how alcohol policies and population-level interventions might differentially affect different drinking practices.

Practising drinking, practising health

“…In their highly engaging commentary Meier, Warde & Holmes [1] outline the benefits of a social practice approach for quantitative research on alcohol use. Here I make two additional points about practice approaches, drawing upon Australian material.…”

“…Meier, Warde & Holmes [1] seek to correct this oversight by offering the notion of practice as a methodological and epistemological alternative to more established approaches in alcohol studies. They are especially critical of approaches that emphasize the social determinants of variations in consumption within and between populations, and those that focus on the agency of individual drinkers, arguing that population interventions grounded in either orientation have 'delivered only limited public health gains' [1].…”

“…They are especially critical of approaches that emphasize the social determinants of variations in consumption within and between populations, and those that focus on the agency of individual drinkers, arguing that population interventions grounded in either orientation have 'delivered only limited public health gains' [1]. What is most welcome about Meier et als' analysis is their insistence on the need for new quantitative approaches to studying alcohol consumption, rather than heeding the more common call for richer and more varied qualitative studies [2,3], which have had narrower impacts on the forms of knowledgemaking that underpin public health interventions.…”

“…The designation of particular patterns (or practices) of alcohol consumption as problems within contemporary public health discourses rests on an apparent consensus with two key features; one that Meier et al, acknowledge, and another that they do not. With respect to the first aspect, public health discussions of problems arising from the consumption of alcohol share the assumption that individuals are independent 'decision-makers' with 'substantial autonomy' [1] over their drinking behaviours. This is the major reason why, as Meier et al note, public health interventions tend to be 'heavily influenced' by theories of behaviour change [1].…”

“…With respect to the first aspect, public health discussions of problems arising from the consumption of alcohol share the assumption that individuals are independent 'decision-makers' with 'substantial autonomy' [1] over their drinking behaviours. This is the major reason why, as Meier et al note, public health interventions tend to be 'heavily influenced' by theories of behaviour change [1]. It reflects a consensus that individuals are the most important agents of change in any effort to transform drinking behaviours.…”