The European Journal of Public Health Advance Access originally published online on August 2, 2005
The European Journal of Public Health 2005 15(6):593-600; doi:10.1093/eurpub/cki056
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Alcohol and Drugs |
Social capital, the miniaturisation of community and consumption of homemade liquor and smuggled liquor during the past year
A population-based study
Martin Lindström** Department of Community Medicine, Malmö University Hospital, Malmö, Sweden
Correspondence: Martin Lindström, Department of Community Medicine, Malmö University Hospital, Lund University, 205 02 Malmö, Sweden, tel: +46 040 333003, fax: +46 040 336215, e-mail: martin.lindstrom{at}smi.mas.lu.se
Received March 30, 2004, accepted September 9, 2004
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Abstract |
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Background: To study the impact of social participation, trust and the miniaturisation of community, i.e. high social participation/low trust, on consumption of homemade liquor and smuggled liquor during the past year. Methods: The Scania 2000 public health survey is a cross-sectional, postal questionnaire study. A total of 13,604 persons aged 18–80 years were included. A logistic regression model was used to investigate the association between the social capital variables and illegal alcohol consumption. The multivariate analyses analysed the importance of confounders (age, country of origin, education and economic stress) on the differences in consumption of homemade and smuggled liquor according to the social capital variables. Results: A 28.2% proportion of all men and 14.9% of all women had consumed homemade liquor during the past year. The proportions who had consumed smuggled liquor during the past year were even higher, 40.1% among men and 21.4% among women. Both forms of illegal alcohol consumption were significantly positively associated with social participation and negatively associated with trust. The miniaturisation of community category, i.e. high social participation/low trust, had significantly higher risks of consumption during the past year of the consumption of both forms of illegally provided alcohol compared to the high social capital (high social participation/high trust) category, while the low social participation/high trust category had significantly lower risks. Conclusion: High social participation combined with low trust is positively associated with consumption of illegally provided alcohol. The results have implications for alcohol prevention programs, because structural/social factors that may hinder information and norms concerning illegal alcohol have been identified in this study.
Keywords: alcohol consumption, homemade liquor, miniaturisation of community, smuggled liquor, social capital, social participation, trust
The total per capita consumption of pure (100%) alcohol among all citizens aged 15 years and above has increased in Sweden since the mid-1990s. The registered per capita consumption, i.e. the sales through the Swedish State Monopoly and through the restaurants, has increased from 5.8 litres of 100% alcohol per capita in 1998 to 6.5 litres in 2001. However, one part of the total alcohol consumption in Sweden is not registered in the official sales statistics. This unregistered part of the consumption in Sweden seems to have been rising for several years. In 2001 it added almost another 3 litres of 100% alcohol per capita to the total per capita consumption, which was estimated to be 9.2 litres. The unregistered alcohol consumption can be divided into legal unregistered and illegal unregistered alcohol. Legal unregistered alcohol includes both alcohol purchased abroad within allowed limits and alcohol made in Sweden within restrictions provided by the authorities (mostly wine). In contrast, illegal unregistered alcohol consists of smuggled alcohol (amounts above the allowed limits brought into the country) and homemade liquor.1 Although the consumption of strong liquor (spirits) has declined in Sweden for several decades, it still represents somewhat more than 20% of the total registered alcohol consumption and a much higher proportion of the unregistered alcohol consumption. A total 70% of the total consumption of alcohol is registered. In contrast, only 55% of the total consumption of strong liquor (spirits) is registered. An important 16% of the total consumption of strong liquor in Sweden has been estimated to be consumption of illegally provided liquor (homemade and smuggled liquor).2 This substantial consumption of unregistered and illegally provided alcohol partly obstructs the official aims of the Swedish authorities to restrict the access to alcohol in Swedish society. It thus seems to be of high interest to investigate social and structural factors which may explain why some people consume liquor which they know has been illegally provided.
The consumption patterns of illegally provided alcohol in Sweden according to demographic and socioeconomic characteristics are only partly known. The amount of total registered and unregistered alcohol consumed is twice as high among men as among women, higher in younger age groups, somewhat higher among persons born in Sweden compared to persons born in countries other than Sweden and varies in different age groups when it comes to occupational position and education.3 It is also highly plausible that the consumption of illegally provided homemade and smuggled alcohol is influenced by economic stress. However, the inclination in a general population to consume illegally provided strong liquor may also be affected by social and contextual circumstances. In recent years, the social capital literature has provided a basis for the analysis of the effects of social and contextual factors on health.4,5 Social capital has mostly been operationalised as social participation/social networks and trust, although the debate concerning the ‘essence’ of social capital is still ongoing. While some theorists regard social capital as ‘ties’ and norms binding individuals within large organisations or linking them across a variety of institutional and formal and informal associational realms,6,7 others emphasise that social capital is a ‘moral resource’ such as trust.8 Macinko and Starfield even define four different levels for the analysis of social capital: countries/regions, neighbourhoods, social networks and individual attitudes such as trust.9 According to Robert D. Putnam, social participation and trust are mutually dependent and mutually enhance each other. High levels of social participation tend to increase generalised trust in other people, and generalised trust often enhances social participation.10 However, their relationship may not always be completely reciprocal. Social participation has to some extent changed to much more ideologically narrowly defined single issue movements and formal and informal social networks entailing a much smaller ‘radius of trust’.11 These new forms of social participation do not seem to enhance generalised trust in other people. This phenomenon of a decreasing radius of trust among socially active persons has been defined by Francis Fukuyama as the miniaturisation of community.12 The miniaturisation of community represents a combination of social networks that may be hypothesised to facilitate the acquisition of illegal strong liquor among persons and groups of persons who at the same time are inclined to consume such liquor because of psychological traits associated with low generalised trust. The other theoretically unexpected combination, i.e. low social participation combined with high trust, has in a previous paper been termed traditionalism. This group may include, both in different respects, disabled persons and older persons with high trust who may previously have had high social participation, because older people are heavily overrepresented in this group.13 The hypothesis of this paper is that the miniaturisation of community and low social capital are properties associated with a higher inclination to consume illegally provided alcohol.
The aim of this paper is to investigate the impact of social participation, trust and the miniaturisation of community on inclination to consume illegally provided, homemade or smuggled liquor. The main hypothesis is that miniaturisation of community, i.e. high social participation combined with low trust, and low social capital, i.e. low social participation/low trust, cause a higher inclination to consume illegally provided alcohol.
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Methods |
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Study population
The 2000 public health survey in Scania is a cross-sectional study. A total of 24,922 randomly selected persons born between 1919 and 1981 answered a postal questionnaire over the period November 1999 to February 2000. Three letters of reminder were sent to the non-respondents. Finally, each person who had not responded was telephoned on one occasion. A total of 1207 persons were impossible to reach during this period. A total of 13,715 persons answered the questionnaire. The participation rate was 59%, but information concerning age and/or sex was lacking for 111 persons. The random sample was weighted to some extent by age, sex and geographic area. This has been corrected by a weighting variable, so that the representative prevalences (%) for the entire Scania region are given. The differences in prevalences between the uncorrected and corrected data are very small.
Dependent variables
Consumption of homemade liquor at any time during the past 12 months was assessed with the item ‘Have you at any time during the past 12 months consumed any homemade liquor?’ The alternatives ‘Yes, regularly’, ‘Yes, several times’, ‘Yes, at one or a few occasions’ and ‘Never’ were dichotomised with the three first alternatives depicting consumption of homemade liquor during the past year and the last alternative depicting no consumption.
Consumption of smuggled liquor at any time during the past 12 months (known to have been smuggled by someone else) was assessed with the item ‘Have you at any time during the past 12 months consumed any smuggled liquor, which you believe had been smuggled by somebody else?’ The alternatives ‘Yes, regularly’, ‘Yes, several times’, ‘Yes, at one or a few occasions’ and ‘Never’ were dichotomised with the three first alternatives depicting consumption of smuggled liquor during the past year and the last alternative depicting no consumption.
Independent variables
Age groups were divided into the age intervals 18–34, 35–44, 45–54, 55–64 and 65–80 years of age.
Country of origin. All persons born in countries other than Sweden were merged into a single category, which yielded the two categories ‘Sweden’ and ‘other’.
All analyses were stratified by sex.
Education was divided by length of education into 9 or less years, 10–12 years and 13 years of education or more.
Economic stress was categorised by the answer to the question ‘How many times during the past year did you not have money enough to afford the food or the clothes you and your family need?’. The respondents were classified by the alternatives: (i) (almost) every month, (ii) about 6 months a year, (iii) very occasionally and (iv) never.
Social participation (during the past year) describes how actively the person takes part in the activities of formal and informal groups in society. Respondents were asked whether in the previous 12 months they had been involved in any of the following 13 activities: study circle/course at workplace, other study circle/course, union meeting, meeting of other organisations, theatre/cinema, arts exhibition, church, sports event, writing a letter to the editor of a newspaper/journal, demonstration, nightclub/entertainment, large gathering of relatives and private party. It was measured as an index consisting of the 13 items and dichotomised into ‘low social participation’ (three activities or less) and ‘high social participation’ (four activities or more).
Trust is a self-reported variable that reflects the person's perception of generalised trust in other people. It was assessed by the item ‘Generally, You can trust other people’ that contained four alternative answers: ‘Do not agree at all’, ‘Do not agree’, ‘Agree’ and ‘Completely agree’. It was dichotomised with the two first alternatives as low trust.
The combination of social participation and trust results in four alternatives: high social participation/high trust (high social capital), high social participation/low trust (‘the miniaturisation of community’), low social participation/high trust (traditionalism) and low social participation/low trust (low social capital).
Statistics
Prevalences (%) of consumption of homemade liquor during the past year, consumption of smuggled liquor during the past year, demographic, socioeconomic, economic stress and social capital variables were assessed. Crude odds ratios (ORs) and 95% confidence intervals (CI) were calculated in order to analyse associations between demographic, sociodemographic and economic stress variables, social capital variables and consumption of homemade liquor and smuggled liquor during the past year. The multivariate analysis was performed using a logistic regression model in order to investigate the potential importance of possible confounders on the differences in consumption of homemade liquor during the past year and smuggled liquor during the past year between individuals with high versus low social participation, high versus low trust and their combination categories. The statistical analysis was performed using the SPSS software package.14
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Results |
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Table 1 shows that 28.2% of all men and 14.9% of all women had consumed homemade liquor at least once during the past year. A 40.1% proportion of all men and a 21.4% proportion of all women had consumed smuggled liquor brought into the country by others during the past year. The proportion (%) of persons who had consumed illegal liquor during the past year was twice as high among men as among women for both the dependent variables, which is the rationale for stratifying the analyses in tables 2, 3, 4 and 5 by sex. All the other variables were rather evenly distributed between the sexes. Almost 90% of both men and women were born in Sweden. The proportion with 13 years of formal education or more was 24.8% among men and 27.3% among women, while the proportion with 9 years of education or less was 30.4% among men and 31.4% among women. 70.5% of all men and 68.2% of all women had experienced no economic stress during the past year. The proportion with low social participation was 32.1% among men and 31.6% among women. The corresponding numbers for low trust were 41.2% among men and 45.4% of all women. The assessments of the social participation/trust combinations revealed that 43.1% of men and 40.7% of women had high social capital (high/high), 25.2% of men and 28.2% of women could be characterised as miniaturisation of community (high/low), 16.1% of men and 14.0% of women as traditionalists (low/high) and 15.6% of men and 17.1% of women as low social capital (low/low).
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Tables 2 and 3 show that the odds ratios of both forms of consumption of illegally provided alcohol were significantly more prevalent among younger persons, persons born in Sweden (compared to persons born in countries other than Sweden), persons with 10–12 years of education (compared to the group with 13 years of education or more) and persons who had experienced economic stress during the past year among both men and women. Men with low education, 9 years or less, also had significantly higher odds ratios of consumption of both forms of illegally provided liquor. The odds ratios of having consumed homemade liquor and smuggled liquor (known by the respondent to have been smuggled by someone else) were significantly higher for the low trust compared to the high trust category and also significantly higher for the miniaturisation of community category (high social participation/low trust) compared to the high social capital (high/high) category. In contrast, significantly lower odds ratios of illegal alcohol consumption in the low social participation category compared to the high social participation category and in the traditionalist (low social participation/high trust) category compared to the high social capital category were observed.
Tables 4 and 5 show that after adjustments for age, country of origin, education and economic stress in the multivariate logistic regression analyses, the odds ratios of having consumed homemade liquor and smuggled liquor (known by the respondent to have been smuggled by someone else) were significantly higher for the low trust compared to the high trust category and also significantly higher for the miniaturisation of community category (high social participation/low trust) compared to the high social capital (high/high) category. In contrast, significantly lower odds ratios of illegal alcohol consumption in the low social participation category compared to the high social participation category and in the traditionalist (low social participation/high trust) category compared to the high social capital category were observed and remained after adjustments in the multivariate analysis.
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Discussion |
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This study shows that both forms of illegal alcohol consumption were significantly positively associated with social participation and significantly negatively associated with trust. The miniaturisation of community category, i.e. high social participation/low trust, had significantly higher risks of consumption during the past year of both forms of illegally provided alcohol compared to the high social capital (high social participation/high trust) category, while the low social participation/high trust (traditionalism) category had significantly lower risks.
The 59% participation rate can be considered as somewhat low. The prevalence of consumption of illegally provided alcohol is similar to that observed in other studies.2 Unpublished data show that the Scania 2000 population has the same distribution as the total Scania population when it comes to age, sex and education compared to official registers. The only exception is the group born abroad, which is underrepresented by approximately 4% compared to official register statistics (12% versus 16%). There are thus no strong reasons to believe that this study is subject to serious selection bias.
Studies of self reported consumption of smuggled or illegally produced alcohol are very scarce. A study and review conducted in Sweden suggests that the validity concerning items on the occurrence of recent consumption of illegal alcohol without any attempt at quantification is high in a general population. On the other hand, the validity of self-reported quantity of illegal alcohol consumed is low.2 The reliability and validity of the social participation index variable has already previously been demonstrated to be good.15 Trust is a self-reported and subjective variable which is impossible to directly validate. The patterns of the prevalence of trust agree in a reasonable way with the patterns reported in other studies.16,17
Age, sex, country of origin, education and economic stress might be confounders of the association between the social capital and miniaturisation of community variables and the self reported homemade and smuggled liquor variables. Stratifying for sex and adjusting for the other variables in a multivariate analysis, however, only affected the estimates to some extent.
The cross-sectional study design is a weakness because it is theoretically possible that the direction of causality between the social capital variables and the consumption of illegally provided alcohol may go in both directions. However, the direction of causality investigated here is certainly the most plausible. Social capital and trust are often founded in early life, during childhood and adolescence,11,18 while the experience of consuming illegally provided alcohol is measured in the age interval 18–81 years in this study.
The findings of this study are of importance for alcohol prevention strategies and policies, especially price regulation, in Sweden as well as in other countries. It may be argued that price regulations will plausibly be counteracted by an increase in illegal home production and smuggling. However, official data from Sweden and Denmark during the 20th century clearly demonstrate that the per capita consumption of alcohol has decreased following either price regulations or other restrictions on the availability of alcohol. Furthermore, during such periods of price restrictions or other restrictions, the injuries related to high alcohol consumption and mortality in diagnoses related to high alcohol consumption have also decreased, often dramatically, indicating that the restrictions have not been outweighed by the consumption of illegally provided alcohol.19,20 This study shows that social capital variables and especially the miniaturisation of community combination of high social participation with low trust represent structural and social factors which may counteract such price regulations and restrictions. Social capital, social participation, trust and their combinations may be crucial factors in deciding to what extent regulations on alcohol availability are counteracted by the illegal provision of alcohol. The miniaturisation of community, i.e. the combination of good access to social participation and social networks combined with low trust may be of special importance in this regard.
The miniaturisation of community has been named and used by Fukuyama in the meaning of generalised trust in other people. However, generalised trust in other people has also been demonstrated to be strongly positively associated with political trust and trust in the institutions of society,21 which implies that the results of this study may both reflect the higher inclination to consume illegally provided alcohol in relation to the miniaturisation of community and in relation to political and institutional distrust.
The idea that the combination of high social participation/rich social networks in combination with low trust may affect health-related behaviours and other health outcomes in less benevolent ways is both highly plausible and appealing. The miniaturisation of community has already been shown to be associated with health-related behaviours such as intermittent, non-daily smoking,13 and cannabis smoking among young adults.22 Furthermore, the miniaturisation of community category has also been demonstrated to be associated with self-reported poor psychological health,23 as well as patient dissatisfaction among patients consulting the primary health care system.24
A previous study shows that high social capital and the miniaturisation of community have significantly higher prevalences of all the 13 activities in the social participation index variable than the two categories that contain low social participation. Comparisons between the high social capital and the miniaturisation of community categories show that study circles at work, other study circles, meetings of other organisations, theatre/cinema, arts exhibition, and gathering of relatives are more prevalent in the high social capital category than in the miniaturisation of community category. On the other hand, visit(s) to a nightclub/entertainment during the past year is significantly more prevalent in the miniaturisation of community category than in the high social capital category.13
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Conclusion |
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High social participation combined with low trust is positively associated with consumption of illegally provided alcohol. The results have implications for alcohol prevention programs, because structural/social factors which may hinder information and norms concerning illegal alcohol have been identified in this study.
Key points
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Acknowledgments |
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This study was supported by the ALF Government Grant Dnr M:B 19 1003/2004.
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1 Centralförbundet för alkohol-och narkotikaupplysning (The Central association for Alcohol- and Narcotics Upplysning). Drogutvecklingen i Sverige (Trends in alcohol and other drugs in Sweden). Report 2002. Stockholm, 2002.
2 Kuhlhorn E, Hibell B, Larson S, Ramstedt M, Zetterberg H. Alkoholkonsumtionen i Sverige under 1990-talet (The consumption of alcohol in Sweden during the 1990s). Stockholm: Oberoende alkoholsamarbetet (OAS) (The independent alcohol collaboration), The Social Department, 1999.
3 Socialstyrelsen (National Board on Health and Welfare). Folkhälsorapport 2001 (National Public Health Report 2001). Stockholm: Socialstyrelsen (National Board on Health and Welfare), 2001.
4 Kawachi I, Colditz GA, Ascherio A, et al. A prospective study of social networks in relation to total mortality and cardiovascular disease in men in the USA. J Epidemiol Community Health 1996;50:245–51.
5 Kawachi I, Kennedy BP, Lochner K, Prothrow-Stith D. Social capital, income inequality, and mortality. Am J Public Health 1997;87:1491–8.
6 Rueschemeyer D, Evans P. The state and economic transformation: Toward an analysis of the conditions underlying effective intervention. In: Evans P, Rueschemeyer D, Skocpol T, editors, Bringing the state back in. New York, Cambridge: Cambridge University Press, 1985.
7 Granovetter M. The strength of weak ties. In: Wilson WJ, editor, When work disappears: the world of the new urban poor. New York: Knopf, 1996.
8 Fukuyama F. Trust. The social virtues and the creation of prosperity. New York, London, Toronto, Sydney, Tokyo, Singapore: The Free Press, 1995.
9 Macinko J, Starfield B. The utility of social capital in research on health determinants. Milbank Q 2001;79:387–427.[CrossRef][Web of Science][Medline]
10 Putnam RD. Making Democracy Work. Civic Traditions in Modern Italy. Princeton: Princeton University Press, 1993.
11 Putnam RD. Bowling Alone. The Collapse and Revival of American Community. New York, London: Simon and Schuster, 2000.
12 Fukuyama F. The Great Disruption. Human Nature and the Reconstitution of Social Order. London: Profile Books, 1999.
13 Lindström M. Social capital and the miniaturization of community among daily and intermittent smokers: A population-based study. Prev Med 2003;36:177–84.[CrossRef][Web of Science][Medline]
14 Norusis MJ. SPSS for Windows. Advanced Statistics. Release 10.0. Chicago: SPSS Inc., 2000.
15 Hanson BS, Östegren P-O, Elmståhl S, et al. Reliability and validity assessments of measures of social network, social support and control- results from the Malmö Shoulder and Neck Study. Scand J Soc Med 1997;25:249–57.[Web of Science][Medline]
16 Holmberg S, Weibull L. ‘Förtroendets fall’ (The fall in confidence). In: Holmberg S, Weibull L, editors, Ett missnöjt folk (A dissatisfied people). SOM Rapport no. 18. Gothenburg: SOM-institutet, 1996.
17 Rothstein B. Sociala fällor och tillitens problem (Social traps and the problems with trust). Stockholm: SNS Förlag, 2003.
18 Putnam RD. Bowling alone: America's declining social capital. J Democracy 1995;6:65–78.
19 Nilsson C-A. ‘Det danske system’ i 1920-talets förbudstid (‘The Danish system’ in the time of prohibition during the 1920s). In: Krantz O, Ohlsson R, editors, Ekonomisk-historiska vingslag (Economic-historic wing-beats). Lund: Studentlitteratur, 1987.
20 Socialdepartementet (The Department of Social Affairs). Svensk alkoholpolitik-en strategi för framtiden(Swedish Alcohol Policy- a Strategy for the Future). Stockholm: Major Consideration by the Alcohol Political Commission, 1994.
21 Brehm J, Rahn W. Individual-level evidence for the causes and consequences of social capital. Am J Political Sci 1997;41:999–1023.
22 Lindström M. Social capital, the miniaturization of community and cannabis smoking among young adults. Eur J Public Health 2004;14:204–8.
23 Lindström M. Social capital, the miniaturization of community and self reported global and psychological health. Soc Sci Med 2004;59:595–607.[CrossRef][Web of Science][Medline]
24 Lindström M, Axén E. Social capital, the miniaturization of community and assessment of patient satisfaction in primary health care: A population-based study. Scand J Public Health 2004;32:243–9.[Medline]
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