Beyond Behaviour: How Health Inequality Theory Can Enhance Our Understanding of the 'Alcohol-Harm Paradox'.
Beyond Behaviour: How Health Inequality Theory Can Enhance Our Understanding of the 'Alcohol-Harm Paradox'.
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DOI：
10.3390/ijerph18116025
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发表时间：
2021-06-03
影响因子：
--
通讯作者：
Holmes J
中科院分区：
文献类型：
--
作者：
Boyd J;Bambra C;Purshouse RC;Holmes J
在酒精相关危害方面存在很大的社会经济不平等。酒精危害悖论（AHP）是一项一致的发现，即社会经济地位较低的群体与社会经济地位较高的群体消费相同或更少的酒精，但其危害率更高。迄今为止，酒精研究人员主要采用个性化的行为方法来理解AHP。本文呼吁采用一种新的方法，利用健康不平等的理论，特别是健康的社会决定因素、根本原因理论、健康的政治经济学和生态社会模型。这些理论由几个相互交织的因果机制组成，包括基因遗传、社会网络的作用、财富和其他资源的不平等可得性、较低社会经济地位的心理经验，以及这些经验随着时间的积累。迄今为止，探索AHP成因的研究往往缺乏明确的理论基础。在酒精研究中利用这些理论方法不仅可以解决这一差距，而且还可以通过结构化的努力来确定AHP的原因。鉴于目前缺乏支持任何特定理论的明确证据，很难断定一种理论是否应该在未来的研究工作中占据主导地位。然而，借鉴这些理论中的任何一种，都将改变我们对这一悖论原因的看法，从孤立的健康行为转向个人与其环境之间复杂相互作用机制的更广泛背景。与此同时，计算机模拟有可能通过综合不同的现有证据基础，在抽象和经验上测试相互竞争的理论观点。总的来说，在酒精流行病学中更多地利用现有的理论框架将为AHP提供新的见解，并产生如何干预以减轻酒精相关危害的不平等的知识。
There are large socioeconomic inequalities in alcohol-related harm. The alcohol harm paradox (AHP) is the consistent finding that lower socioeconomic groups consume the same or less as higher socioeconomic groups yet experience greater rates of harm. To date, alcohol researchers have predominantly taken an individualised behavioural approach to understand the AHP. This paper calls for a new approach which draws on theories of health inequality, specifically the social determinants of health, fundamental cause theory, political economy of health and eco-social models. These theories consist of several interwoven causal mechanisms, including genetic inheritance, the role of social networks, the unequal availability of wealth and other resources, the psychosocial experience of lower socioeconomic position, and the accumulation of these experiences over time. To date, research exploring the causes of the AHP has often lacked clear theoretical underpinning. Drawing on these theoretical approaches in alcohol research would not only address this gap but would also result in a structured effort to identify the causes of the AHP. Given the present lack of clear evidence in favour of any specific theory, it is difficult to conclude whether one theory should take primacy in future research efforts. However, drawing on any of these theories would shift how we think about the causes of the paradox, from health behaviour in isolation to the wider context of complex interacting mechanisms between individuals and their environment. Meanwhile, computer simulations have the potential to test the competing theoretical perspectives, both in the abstract and empirically via synthesis of the disparate existing evidence base. Overall, making greater use of existing theoretical frameworks in alcohol epidemiology would offer novel insights into the AHP and generate knowledge of how to intervene to mitigate inequalities in alcohol-related harm.
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影响因子：
5.4
作者：
Beckfield, Jason;Bambra, Clare
通讯作者：
Bambra, Clare
影响因子：
7.7
作者：
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通讯作者：
Kaplan, George A.
DOI：
10.1111/add.15567
发表时间：
2022-01
期刊：
Addiction (Abingdon, England)
影响因子：
--
作者：
Boyd J;Sexton O;Angus C;Meier P;Purshouse RC;Holmes J
通讯作者：
Holmes J
影响因子：
2.8
作者：
Herttua, Kimmo;Makela, Pia;Martikainen, Pekka
通讯作者：
Martikainen, Pekka
DOI：
10.1186/1742-5573-9-1
发表时间：
2012-02-01
期刊：
Epidemiologic perspectives & innovations : EP+I
影响因子：
--
作者：
El-Sayed AM;Scarborough P;Seemann L;Galea S
通讯作者：
Galea S