Assessing Young Adult Drinking Practices to Develop Alcohol Harm Prevention Strategies in Hong Kong: A Mixed Methods Approach

Alcohol consumption, the third largest contributing risk factor towards global morbidity, has increased in the past 5 years despite global calls for action to reduce its significant impact on public health. Compared to most developed nations, Hong Kong has been shown to have lower levels of alcohol consumption by previously conducted research. However, Hong Kong's low alcohol taxes, wide availability of alcohol, and lax restrictions on marketing practices have the potential to increase the prevalence of alcohol use and binge drinking particularly among young adults 18--25 of age, leading them towards increased risks of neurological damage, unsafe sex, intentional and unintentional injuries, and impacts on school and work performance in addition to chronic health harms in the future. This thesis employs a mixed-methods approach to comprehensively examine the behavioral and environmental contexts of Chinese young adult drinking behavior, as well as to generate feasible, effective strategies at the health promotion and policy levels to reduce alcohol-related harm among this population subgroup.;Cantonese-speaking young adults of Hong Kong (n=684) were invited between April and September 2011 to participate in a cross-sectional random telephone survey, during which they were asked about their drinking patterns and perceptions on a set of alcohol expectancy statements. Twelve focus groups (n=63) were then conducted between June 2012--May 2013 to explore individual motivations to drink as well as possible environmental and social facilitating factors. A series of interviews conducted in January--April 2014 with key policy stakeholders, including representatives of the law enforcement, education, government, food and beverage sectors, non-governmental organizations, and the alcohol industry, (n=16) then aimed to produce appropriate, actionable policies and interventions which can be undertaken as a means to reduce alcohol-related harm among young adults in Hong Kong.;At the behavioural level, positive outcome expectancies were found to be significantly associated with various levels of alcohol use. Those who held social facilitation of drinking to a high regard were significantly more likely (OR = 6.67; 95% CI: 2.87,15.49) to have had at least one binge drinking episode in the past month. Qualitative investigations also illustrated drinking among Hong Kong young adults as heavily focused on planned socializing and self-presentation in personal and business situations, and further enabled by the availability of local drinking games and granting and losing face, a Chinese cultural concept based on dignity with competitive undertones. Drinking occasions were also facilitated by the convenience of bars and lounges, viewed as accommodating alternatives to homes for social gatherings. Point-of sale promotions providing inexpensive or free drinks further strengthened alcohol use as a convenient and normal practice among young adults.;Instead of adopting strategies to limit access to alcohol as recommended by global alcohol experts, key policy stakeholders of alcohol issues in Hong Kong expressed preference for softer approaches such as health education campaigns to properly inform young adults about the physical harms of alcohol. For legislative actions, only those that aim to limit alcohol's physical availability, restrictions on discounted drink specials, and bans on event-centric promotions were favored as viable options.;This series of studies marks the first attempt in alcohol research to comprehensively establish a profile of drinking behavior of Chinese young adults at individual, social, and environmental levels. Based on these findings, a deeper understanding of the previously unexplored cultural context of Chinese drinking, particularly those involving face-based interactions and business situations, is warranted in future behavioral research on alcohol use among this ethnic subgroup. Health campaigns and community interventions challenging the perceived social benefits of drinking among young adults may be useful at the community level in reducing alcohol-related harms among Chinese youth, but further research is required to ascertain their actual effectiveness in Hong Kong. The government-endorsed Liquor Licensing Board may also expand its current role in limiting the physical availability of alcohol in Hong Kong by imposing a licensing system on outlets that sell alcohol for consumption outside of their premises (off-premise sales), and restricting point-of-sale promotions of alcoholic beverages at licensed venues.