Unlocking patterns of alcohol consumption in British Columbia using alcohol sales data: a foundation for public health monitoring.
This research aims to better understand the variation of alcohol use and consequences in British Columbia, both over time and across geographic regions. Such variation is of major public health significance since per capita alcohol consumption is a strong predictor of a wide variety of serious harms, notably alcohol-caused mortality and morbidity (World Health Organization (WHO), 2000; Norstrom & Skog, 2000). Statistics Canada does compile yearly per adult sales of alcohol for each province, but this information is limited in that no geographic breakdowns are provided within the provinces. Furthermore, no details are provided on the strength of beverages sold, potential seasonal fluctuations, or type of establishment where the alcohol was sold. In fact, prior to this report, there has been no accurate consumption information for beverage type, seasonal variation, sales by type of establishment, or geographical regions in BC. This article describes the progress towards more comprehensive documentation of alcohol consumption among BC residents.
Official sales records provide more accurate data on per adult consumption of alcohol than population surveys. Survey data based on amount of alcohol consumed are associated with considerable error (Kerr, Greenfield, Tujague, & Brown, 2005) and can underestimate overall consumption by as much as 55% (Stockwell, Donath, Cooper-Stanbury, Catalano, & Mateo, 2004). Sales data are also preferable to population surveys in that sales data allow for simple and accurate calculations of absolute alcohol (i.e., amount of pure alcohol contained) since the exact concentration of alcohol for each beverage type is known. Sales data are also less expensive to acquire than population surveys, which generally require large sample sizes for examining regional variations. Sales data alone, however, have some limitations. First, sales data do not include alcohol produced through home production, cross-border shopping or illegal market activity. Second, an assumption in using sales data is that all the alcohol purchased is consumed. Moreover, the conversion of sales data into alcohol consumption rates for a geographic area entails the assumption that all alcohol purchased in a given area is consumed in the same area. Therefore, very small geographic areas of analysis may be associated with more error due to the mobility of BC residents and influx of tourists. Finally, sales data cannot of course identify individual level drinking patterns and are only an indicator only of total consumption by an entire population.
In Canada, sales of alcohol are controlled individually by each of the 13 provincial or territorial governments. As a result, large differences exist in how liquor is sold. All provinces, except Alberta, have some direct government control over the sales of alcohol. Alberta has a completely privatized system. Many provinces also have some form of privatization, which is most common for wine and beer sales. In all provinces independent wineries are permitted to sell their wines directly to customers for take-out. Quebec allows the sale of both wine and beer in grocery stores. Ontario has a separate distribution system exclusively for beer. Ontario and BC allow customers to make beer and wine in privately controlled environments, called U-Brews and U-Vins, with varying provincial requirements for reporting sales. For example, in Ontario, U-Brews and U-Vins are required to report dollar sales for tax purposes but not volumes of beer or wine sold, whereas in BC actual liters produced are reported. All provinces allow individuals to make wine or beer at home, but not spirits. BC is a unique province in that both private outlets and government outlets can sell spirits, wine, coolers and beer for take-out.
All provinces are required to report the dollar sales and gross liters of spirits, wine, coolers and beer through liquor, wine and beer authorities and their agents to Statistics Canada. Notably, information regarding home production, sales from U-Brews and U-Vins, and duty free sales are not reported to Statistics Canada. Statistics Canada reports on the absolute alcohol consumption per adult (i.e., 15 years and older) by using the following average concentrations of alcohol, also known as ethanol conversion factors: spirits 40%, liqueurs 20%, coolers 5%, and wines 11.5% (Statistics Canada, 2006). Given the variations in regulations and reporting mechanisms across provinces, the methods used in this report for BC may not be feasible in other provinces; however, it is likely that more detailed information can be collected in every province than what is currently reported by Statistics Canada.
The primary aim of this paper is to provide descriptive epidemiological data on alcohol consumption in BC that can be used for research and programming purposes. The specific objectives of this paper are threefold. First, absolute alcohol consumption per adult in BC over time and across regional districts will be documented. This objective includes an analysis by product type (i.e., spirits, wine, coolers and beer), seasonal fluctuations, and source of alcohol (i.e., U-Brews/U-Vins, take-out at government regulated or private stores, and on-premise consumption at restaurants and bars). The second goal is to examine the relationships between per adult consumption patterns and population characteristics (i.e., age and sex distributions) in the 28 BC regional districts. Finally, this paper will describe and discuss a number of methodological issues that need to be addressed when making estimates of local levels of per capita alcohol consumption for epidemiological monitoring purposes.
Data sources Alcohol sales data
The BC alcohol sales data were obtained from the Ministry of Public Safety and Solicitor General Liquor Distribution Branch (LDB). The data were aggregated by the Liquor Distribution Branch into 28 BC regional districts and into 4 or 5 week periods, roughly corresponding to months of the year, from April 2001 to March 2006. The data included the liters of absolute alcohol sold at take-out government and private liquor stores, and on-premise establishments (i.e., bars and licensed restaurants) for the years April 2001 to March 2006. Alcohol sales were categorized by type of beverage (beer, ciders/coolers, wines and spirits), and then by percentage of alcohol content. The number of establishments by take-out premises (take-out government liquor stores and private liquor stores) and two categories of on-premise sales were also included.
U-Brew/ U-Vin data
The LDB provided U-Brew and U-Vin data by BC municipalities for the calendar years 2002-2006. The 28 regional district estimates were based on the data for municipalities, which compose the regional districts. Ethanol conversion factors used for U-Brew/U-Vin products were 5.0% for beer and ciders, and 12.0% for wine.
Homemade alcohol is not government monitored; therefore, the estimate of alcohol consumption involving beverages produced at home was derived from the 2004 Canadian Addiction Survey (Health Canada, 2004). This survey asked participants questions relevant to their intake of home-brewed and U-brew/U-Vin-produced alcohol. By analyzing the responses of the 986 BC respondents who participated in this survey it was estimated that BC residents consume on average a total of 0.712 liters of absolute home-brewed and U-Brew/U-Vin-produced alcohol per person. Subtracting known U-brew/U-Vin consumption based on official government sales data provided an estimate of the absolute homemade alcohol consumption.
Provincial population data, classified into 28 regional districts, was obtained from BC Statistics (2006). This data was collected in order to calculate per adult (age 15 years and older) consumption for the province and for each of the 28 regional districts. This dataset incorporated information from the 2001 Census data and population estimates for non-census years. Population estimates pertain to July 1st of the year stated.
Socioeconomic variables were obtained from BC Statistics in order to examine the relationship between alcohol consumption and socioeconomic factors within the 28 regional districts. Socioeconomic variables were based on Census data and included average household income, a measure of ethnic self-identification in the population (percent with multiple origins), a measure of aboriginal self-identification in the population (percent with aboriginal origins), and a measure of residential stability (movers to population). These variables are accessible at http://www.bcstats.gov.bc.ca/and more details on the 2001 Census can be found elsewhere (Statistics Canada, 2003).
In order to estimate the impact of tourism on alcohol sales, tourism room revenue for each regional district was obtained from the BC Statistics Website (www.bcstats.gov.bc.ca/) for years 2001-2005. Tourism room revenue provides an indicator of tourism in BC that can be broken down in detailed geographical areas and by month of the year.
Estimate of alcohol consumption
Recorded per capita alcohol consumption was estimated by compiling the official government sales data on the total liters of absolute alcohol at U-Brews and U-Vins, restaurants, bars, government liquor stores, and private liquor stores, and dividing by the population estimates for each of the 28 regional districts and the entire province. This was done for the years 2002-2005 and quarterly for each year from April 2001 to March 2006. Unrecorded consumption from home-brew was estimated as previously defined and divided by the population.
Estimate of ethanol conversion factors
Ethanol conversion factors for beer, coolers, wine and spirits were estimated based on the official government sales data for U-Brews/U-Vins, restaurants, bars, government liquor stores, and private liquor stores from April 2001 to March 2006. The average concentrations of alcohol sold within several subcategories for each beverage type (i.e., beer, coolers, wine and spirits) were used to determine the absolute alcohol per adult.
A correlation analysis was conducted in order to examine the relationship between alcohol consumption and sociodemographic factors, tourism room revenue, and alcohol-related mortality in 28 regional districts.
Regional variation in alcohol consumption
As can be seen in Table 1, per adult absolute alcohol consumption increased in the province, from 8.18 liters in 2002 to 8.53 liters in 2005. These estimates are uniformly higher than those derived by Statistics Canada. Large differences in per adult consumption were noted among the districts. The Greater Vancouver area and the bordering Fraser Valley district had the lowest per adult consumption at 7.45 and 6.99 in 2005, respectively. Very high per adult consumption was noted in Squamish-Lillooet (19.00 in 2005), Northern Rockies (18.05 in 2005), and Stikine (15.31 in 2005). All the other districts had per adult consumption levels of between 9.00 and 13.00 in 2005.
Seasonality of alcohol consumption
Figure 1 shows seasonal per adult absolute alcohol consumption in liters by type of products from April 2001 to March 2006. Not surprisingly, seasonal peaks in consumption differed by product types. While consumption of beer and coolers peaked in summer months, consumption of wine and spirits peaked in winter months.
Alcohol consumption by establishment type
It is also of interest to examine the sources where alcohol is purchased. Figure 2 shows the breakdown of percent of absolute alcohol sold by various sources in BC in 2004 (2004 was chosen in order to utilize the home-brew data which was only available for that year). As can be seen in Figure 2, take-out government stores were the biggest source of alcohol consumption, accounting for 45.1% of total alcohol consumption. Alcohol consumption from private liquor stores accounted for 27.5% of the total. Approximately 19% of alcohol was consumed in restaurants and bars. Alcohol consumption from U-Brews and U-Vins accounted for 4.0% of the total, while home-made alcohol accounted for 4.3% of total alcohol consumption.
[FIGURE 1 OMITTED]
Alcohol consumption by different establishment types has, however, shifted between years 2002-2005. As can be seen in Table 2, alcohol consumption from U-Brews/U-Vins, bars, and government liquor stores decreased from 0.41, 1.24 and 4.24 absolute liters per capita in 2002, to 0.36, 1.08 and 3.66 liters per capita in 2005, respectively. On the other hand, alcohol consumption from restaurants and private liquor stores has increased, from 0.55 and 1.75 liters per capita in 2002 to 0.60 and 2.84 liters per capita in 2005, respectively. These trends are most likely related to the changes in government regulations that occurred in 2002, when the government permitted private operators to sell all alcohol products for take-out sales. Between 2002 and 2005, the number of private liquor stores increased dramatically from 648 to 938, while the number of government liquor stores declined slightly.
Alcohol consumption by content
Official government sales data allow for a precise examination of the average alcohol content in the four beverage groups of beer, coolers, wine and spirits. As can be seen in Table 3, each of these beverage categories has a range of products that varies in alcohol content. When comparing these figures with the Statistics Canada data (see Table 4), it is apparent that the average percent of alcohol used by Statistics Canada (2006) to calculate ethanol conversion factors (spirits 40%, liqueurs 20%, coolers 5%, and wines 11.5%) is fairly accurate for beers and spirits, but underestimates the actual percent of absolute alcohol in wines (12.53%) and coolers (6.77%). This discrepancy may explain why Statistics Canada's estimates of absolute alcohol sold in BC are lower than our figures (even when excluding U-Brew/U-Vin sales which are not accounted for in Statistics Canada's estimates).
It is also interesting to note that beverages of low-alcohol content represent a relatively small proportion of the total absolute alcohol sold. For example, as can be seen in Table 3, beers of 5% accounted for 75.1% of total absolute alcohol sold while alcohol from low alcohol beers (2.9-3.9%) accounted for only. 13% of total beer consumption. The same is true of coolers. Coolers of 7% accounted for majority of total cooler consumption (82.76%) while low alcohol (3.84.9%) coolers accounted for only 0.41% of total cooler consumption. For spirits, concentrations of 40% accounted for the majority (86.57%) of total spirit consumption. For wines, concentrations of 11-13.5% accounted for 82.03% of total wine consumption.
Sociodemographic factors of alcohol consumption
The correlation coefficients between per adult absolute alcohol consumption and demographic characteristics in BC's 28 regional districts in 2002-2005 were calculated. Previous studies using population surveys have found that alcohol consumption does relate to some demographic characteristics. In particular, it has been found that males drink more than females, and that younger people drink more than older people (Stockwell et al., 2004).
The correlation between the average of per adult alcohol sales (2002 to 2005) and the sex ratios (i.e., males and females aged 15 and over) in the regional districts was calculated. As expected, a regression line showed a significant positive relationship ([R.sup.2] = 0.2217, p<0.0067).
The ratio of population aged 20-29 to population aged 15 and over was also calculated for each district and then correlated with alcohol consumption. This relationship was also significant ([R.sup.2] = 0.1797, p = 0.0142). Other demographic variables considered, (i.e., household income, percentage of multiple origins, and percentage of aboriginal origins) were not significant predictors of alcohol consumption.
Effects of tourism on alcohol consumption
Analyses of the effect of tourism on consumption rates involved calculating the ratio of alcohol consumption of summer (July-September) versus winter (January-March) sales for each of the 28 regional districts for aggregated 2002-2005 data. More alcohol was sold in the summer months than in the winter months in 26 regional districts (the exceptions were the Northern Rockies and Squamish-Lillooet). Moreover, the ratio of summer to winter sales was also significantly correlated to tourism room revenue ([R.sup.2] = 0.3504, p = 0.0007). The statistically significant relationships between seasonal alcohol consumption ratios and room revenue ratios suggest that some of the elevated levels of alcohol consumption may be due to tourism.
Alcohol-related mortality and alcohol consumption
The relationship between per adult consumption and standardized alcohol-related mortality ratio was examined (Ministry of Health, 2007). A weak non-significant positive relationship was found ([R.sup.2] = .036, p = .172). When high-risk drinking was correlated with alcohol-related mortality, the relationship became marginally stronger, although still not significant ([R.sup.2] = .082, p = .08). Lack of significance is likely related to several factors. Alcohol-related mortality is a composite variable composed of several acute outcomes (e.g., accidental poisonings, fetal alcohol syndrome, etc.) and chronic alcohol conditions (e.g., alcoholic cirrhosis, alcoholic hepatitis, and alcohol psychoses). More precise measures and advanced models, such as time lagged models, are likely needed here.
Our analyses show that per capita alcohol consumption has increased in BC from 2002 to 2005, consistent with trends reported by Statistics Canada. However, our estimates are more complete since they 1. include information on U-Brew and U-Vin production, 2. make allowance for home produced alcohol, and 3. have more accurate ethanol conversion factors reflecting the increasing alcohol content of certain beverages. After including homemade alcohol estimated in the 2004 Canadian Addiction Survey, the actual alcohol consumption for 2004 increased to 8.78 liters from 8.42 liters. In addition, the analysis of the average percentage of alcohol in the four major beverage groups showed that the ethanol conversion factors used by Statistics Canada (5% for coolers and 11.5% for wines) have underestimated the concentrations of alcoholic beverages sold in BC (6.72% for coolers and 12.20% for wines). This suggests that conversion factors used by Statistics Canada for provinces other than BC may also be too conservative, underestimating alcohol consumption.
Overall, using alcohol sales data is a particularly accurate means of estimating alcohol consumption. However, alcohol consumption from cross-border shopping (i.e., duty free sales) and illegal channels is not captured in official data and may slightly increase these figures. Alcohol sold and then removed from BC for consumption may counterbalance this effect slightly. Nevertheless, greater volumes of alcohol (usually in the form of spirits) have likely entered into Canada than into the U.S. due to large price differentials, with lower prices found in the U.S. than in Canada. Anecdotal reports of crossborder shopping appear to substantiate this claim. Estimates from other provinces suggest that duty free sales account for about 2% of total alcohol purchases, while illegal alcohol sales in Canada likely account for less than 1% of total sales (Macdonald, Wells, & Giesbrecht, 1999).
Another source of error that may result in an underestimation of consumption rates is the lack of information pertaining to homemade alcohol. Rates of homemade alcohol consumption were estimated using information from the Canadian Addiction Survey. As discussed previously, consumption data gathered through surveys (which rely on self-reports) typically underestimates actual consumption (Stockwell et al., 2004). Consequently, the figures derived from the Canadian Addiction Survey to estimate consumption from home production are also likely higher than reported.
On the other hand, tourism in BC likely inflates alcohol consumption rates slightly, as suggested by the correlation between the measure of tourism (tourism revenue) and alcohol consumption. Although effects of tourists consuming alcohol in the province are counterbalanced to some extent by BC residents travelling and consuming alcohol outside the province, the net effect on per adult consumption would remain since BC is a province with considerable tourism. Therefore, an adjustment for local tourism would enhance accuracy. More detailed analyses are required to definitively account for the effect of tourism on consumption in BC; however, overall, the figures are likely more accurate and detailed than other figures previously published for BC.
Our analyses showed that alcohol consumption was associated with sex ratio and proportion of adult (age 15+) population aged 20-29. Areas made up of high proportions of males and/or more young people may increase the amount of alcohol consumed in an area. This finding is consistent with population surveys which show that younger people drink more than older people, and that males drink more than females (Stockwell et al., 2004).
The observations of changes over time and differences in per adult consumption across various geographic regions are useful for the identification of districts that may benefit from prevention initiatives. For example, this study identified three districts, Stikine, Squamish-Lillooet, and Northern Rockies, which have highly elevated per adult consumption. This study has also been useful for identifying trends in alcohol consumption which may be associated with changes in liquor law. Notably, in BC, sales from restaurants and take-out private liquor stores have increased, with a slight decrease in take-out sales from government liquor stores for the period of 2002 to 2005. These shifts in market share were accompanied by a slight decrease in the number of government stores and a large increase in private stores. Consequently, changes in the liquor distribution could have substantial impacts in terms of public health. The issue of privatization and its impact on public health in BC will be the focus of a forthcoming investigation.
Future objectives of the project include incorporating more detailed data on alcohol consumption from unrecorded sources, such as home production, cross-border shopping and illegal sources, and estimating tourism effects. In addition, better models are needed to examine the relationships of per adult consumption with alcohol-related diseases, including the separation of acute and chronic alcohol-related diseases. Finally, more research is needed to better identify regional differences in consumption of higher risk beverages, which have higher absolute alcohol content per dollar, such as fortified wines.
Some of the current challenges include collapsing data into common geographic units, because different reporting systems exist which tend to use different geographic units. For instance, data are available in Census tracts, local health areas, regional districts, and local health authorities. Also, the size of the populations in the districts varies considerably from over 1,800,000 in Greater Vancouver to about 1,000 in Stikine. Alcohol consumption and rates of morbidity and mortality can become unstable with small population sizes; however, with larger populations considerable heterogeneity may exist in the populations and important differences can be missed. We currently seek to obtain alcohol sales data by 89 local health areas of BC, which would allow the flexibility in grouping the data into different geographic units of particular relevance to decision makers, such as health authorities.
A question of importance is the extent to which the methodological approach described in this report can be applied to other provinces in order to develop a comprehensive alcohol monitoring system for Canada. Since the systems of collecting and reporting data vary across Canada, the level of detail and accuracy presented in this report may not be feasible in other provinces. As well, the liquor distribution authorities in other provinces may not be as cooperative to release the data. However, detailed data on alcohol consumption has been reported in Ontario (Rush, Macdonald, & Giesbrecht, 1982) and it is very likely more detailed data is available in every province.
The data presented here provide an accurate picture of the recorded alcohol consumption, with year-to-year changes among the 28 regional districts of BC. The data can be used for a variety of research purposes, including the identification of trends and differences between geographic regions in per adult consumption, which in turn can lead to generation of hypotheses to explain them. Furthermore, the data will be helpful in the evaluation of prevention initiatives or changes in alcohol policy. Future work will address the relationships between per adult alcohol consumption and various indicators of morbidity and mortality. The longterm aim of this project is to provide an open access database on alcohol sales with the level of detail that can be used for a variety of research purposes.
AUTHORS' NOTE: We are indebted to Tierra Evans, who helped prepare the figures .for this paper. We would also like to express our appreciation to Gord Hall, Liquor Distribution Branch, who facilitated data collection.
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TABLE 1 Per adult liters of absolute alcohol consumption for U- Brews/U-Vins and official sales for 28 regional districts and the whole province in 2002-2005 Year Regional districts 2002 2003 2004 2005 O1. Alberni-Clayoquot 11.76 12.03 12.06 12.23 02. Bulkley-Nechako 9.25 9.51 8.87 9.03 03. Capital 9.08 9.44 9.67 9.86 04. Cariboo 9.44 9.47 9.28 9.36 O5. Central Coast 11.34 13.75 13.82 12.83 06. Central Kootenay 9.71 9.94 10.00 10.14 07. Central Okanagan 9.93 10.25 10.52 10.82 08. Columbia-Shuswap 10.27 10.49 10.21 10.36 09. Comox-Strathcona 10.21 10.62 10.91 11.01 10. Cowichan Valley 9.24 9.54 9.66 9.72 11. East Kootenay 11.37 11.65 11.39 11.30 12. Fraser Valley 6.85 7.03 7.10 6.99 13. Fraser-Fort George 8.92 8.78 8.61 9.00 14. Greater Vancouver 6.84 7.05 7.00 7.45 I5. Kitimat-Stikine 8.99 8.62 8.41 8.40 16. Kootenay-Boundary 9.30 9.47 9.46 9.49 17. Mount Waddington 13.13 13.35 12.62 12.21 18. Nanaimo 9.85 10.15 10.27 10.42 19. North Okanagan 9.30 9.68 9.77 9.97 20. Northern Rockies 17.77 20.54 19.66 18.05 21. Okanagan-Similkameen 10.41 13.12 11.34 11.82 22. Peace River-Liard 9.26 9.75 9.31 9.97 23. Powell River 9.58 9.72 9.92 9.80 24. Skeena-Queen Charlotte 11.22 11.25 10.85 10.87 25. Squamish-Lillooet 20.30 20.49 19.70 19.00 26. Stikine 16.28 14.76 15.92 15.31 27. Sunshine Coast 11.76 12.18 12.32 12.39 28. Thompson-Nicola 9.85 10.02 10.05 10.22 Total 8.18 8.46 8.42 8.53 Statistics Canada estimates for BC 7.7 7.8 8.0 8.1 Note: Estimate of alcohol consumption was based on the sale and U-Brew/U-Vin data from the LDB. TABLE 2 Number of establishments and absolute alcohol sold in liters per capita in BC for 2002 and 2005 Type of establishments Number of Absolute alcohol sold establishments in liters per adult 2002 2005 2002 2005 U-Brew/U-Vin 287 322 0.41 0.36 Restaurants 3,776 4,045 0.55 0.60 Bars 1,869 1,866 1.24 1.08 Government liquor store (take-out) 222 208 4.24 3.66 Private liquor store (take-out) 648 938 1.75 2.84 All 6,802 7,379 8.18 8.53 TABLE 3 Percentage of total absolute alcohol sold by strength of alcoholic beverages from April 2001 to March 2006 Strength of alcoholic Percentage of total alcohol measured in percentage sold per Beverage type Beer 2.9-3.9 0.13 4.0 4.75 4.1-4.9 7.23 5.0 75.10 5.1-5.9 7.03 6.0+ (average=6.5) 5.76 TOTAL 100 Coolers 3.9-4.9 0.41 5.0 5.37 5.1-6.9 11.36 7.0 82.76 7.1+ (average=7.5) 0.10 TOTAL 100.00 Spirits 7.00-34.99 6.42 35.00-39.99 5.87 40 86.57 40.10-59.9 0.79 60+ (average=65) 0.35 TOTAL 100.00 Wine 5.0-10.9 4.05 11.00 13.10 11.1-11.4 0.52 11.5 16.30 11.6-11.9 0.97 12.0 20.35 12.01-12.49 0.78 12.5 12.87 12.51-13.49 9.79 13.50 7.35 13.51-13.99 1.32 14.00-14.99 6.10 15.00-19.99 4.53 20+ (average=22.5) 1.95 TOTAL 100.00 Note: The estimates were based on the alcohol sale data from the Liquor Branch. TABLE 4 Ethanol conversion factors for April 2001 to March 2006 Alcoholic Ethanol Conversion Factors (%) beverages BC Sales Records Statistics Canada Beers 5.04 5.00 Coolers 6.77 5.00 Spirits 38.74 40.00 Wines 12.53 11.50 FIGURE 2 Percent absolute alcohol sold by source in BC in 2004 Government store 45.1% Private liquor store 27.5% Bars/restaurants 12.6% Food restaurant 6.6% Homemade 4.3% U-brew/U-vin 4.0% Note: Table made from pie chart.
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|Author:||Macdonald, Scott; Zhao, Jinhui; Pakula, Basia; Stockwell, Tim; Martens, Lorissa|
|Publication:||Contemporary Drug Problems|
|Date:||Sep 22, 2009|
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