Abstract
BackgroundBoth risky drinking and unhealthy eating behaviours have been associated with adverse social, emotional, and cultural outcomes during adolescence and early adulthood. Food and Alcohol Disturbance (FAD), colloquially coined as "drunkorexia", encompasses compensatory behaviours such as calorie restriction, over-exercising, fasting, and self-induced vomiting to reduce caloric intake or maximise intoxication. This phenomenon has been observed mainly among emerging adults, especially women. While there are studies on emerging adults, to date, there are no known qualitative studies that have focused on the links between food and alcohol consumption in adolescents' emotional, social, and cultural lives.
Aim
To utilise a mixed-methods approach and explore the sociocultural factors influencing the relationship between alcohol consumption and eating behaviours among mid-adolescent girls.
Methods
To answer the aim of this study, the following methods were undertaken:
1. A systematic review of the international literature on alcohol consumption and eating behaviours among mid-adolescent girls (14-17 years) to identify existing literature gaps.
2. A secondary analysis of quantitative data from a previously conducted pilot study in the North East of England to understand the trends in alcohol use and health behaviours among mid-adolescents (14-15 years).
3. Semi-structured qualitative interviews to examine the relationship between alcohol consumption and eating behaviours among mid-adolescent girls (14-17 years) in England.
4. Triangulation of results from the systematic review, secondary data analysis, and qualitative research to develop recommendations for practice and early intervention.
Results
The systematic review comprised of seven studies and found that the sociocultural factors affecting the relationship between alcohol consumption and eating behaviours among adolescent girls were i. social learning (family and social circle) and ii. knowledge and beliefs. The secondary data analysis found that females had higher odds of risky drinking and lower odds of good mental well-being when compared to males. Risky-drinking adolescents had higher odds of having inadequate fruit and vegetable consumption (a proxy indicator for eating behaviours) and lower odds of having inadequate physical activity than non-risky drinkers. Fourteen qualitative interviews were conducted with adolescent girls aged 14-17 in England. Four themes emerged from the interviews: i. social learning (family, friends, and media) ii. Social cognitive factors (motivators and demotivators, knowledge and beliefs) iii. Interaction between drinking levels and eating behaviours (low-risk drinkers, risky drinkers, and physical activity) and iv. effect of the COVID-19 pandemic on drinking levels. Triangulation of results found rigidness over regular physical activity among high-risk drinkers as the only theme which converged across all three methods.
Conclusion
This PhD thesis identified sociocultural factors affecting Food and Alcohol Disturbance among mid-adolescent girls, and the mixed methods used in this study were triangulated to develop recommendations for future practice, policy and research. Policy recommendations include clearer nutritional labelling on alcoholic products and local health needs assessments. Practice recommendations emphasise comprehensive education, parental engagement, social media awareness, and training for healthcare professionals. Research recommendations call for longitudinal and culturally diverse studies, and the development of peer- and family-based interventions. The research has not only contributed to existing literature but also has the potential to shape the direction of future research in Food and Alcohol Disturbance.
| Date of Award | 22 Aug 2025 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Dorothy Newbury-Birch (Supervisor), Judith Eberhardt (Supervisor) & Mia Campbell (Supervisor) |