Relationships between consumption patterns, health beliefs, and subjective wellbeing in Chinese Baijiu consumers

Alcohol consumption has increased rapidly in China in recent years, and has brought with it an increase in health-related and social problems [1]. It is estimated that 8.4% of men and .2% of women have an alcohol use disorder in China [2]; and there are very high rates of binge drinking, especially among men [2, 3]. China has less stringent policies around consumption of alcohol compared to other countries in the region [3] and there are few national alcohol laws or significant programs aimed at regulating alcohol consumption to reduce health and social problems [1, 2]. There is a clear need to reduce rates of alcohol consumption in China, and there have been calls for the government to address the issue through policy changes and public health campaigns [1, 3‐5]. Newman [5] has argued that adopting a western-style approach to reduction in alcohol-related harms is likely to backfire if such policies interfere with traditional drinking practices, and suggests that a careful consideration of the role of alcohol in Chinese culture is essential in policy development. More broadly, the World Health Organisation [6] has argued that the development and implementation of policies to reduce alcohol consumption should be tailored to accommodate local contexts.

Jiu (alcohol) is inextricably linked to Chinese culture, and many Chinese believe that moderate consumption of alcohol is healthy and improves social relationships [7]. Alcohol is seen as a representation of happiness [5]; has cultural associations with career advancement and prosperity [4], and is an important element of business negotiations [8]. Alcohol consumption often occurs as part of complex toasting rituals at family, business and community meal gatherings and Chang [9] and others [8] have argued that consumption of alcohol in this context is central to the development and maintenance of relationships. According to Hwang [10], in Chinese culture effective relationships may help people maintain “psychological homeostasis” (p.171), and navigate systems of government and gain access to resources. Drinking may therefore perform important social and business functions for many Chinese, which may impact attempts by others to limit consumption [5, 8, 9].

Specific types of alcoholic beverages may also have cultural associations and meanings that may impact on attempts to promote responsible drinking [11]. In China, one such type of alcohol is Baijiu, a crystal clear alcoholic fermented spirit that originated in China, and that is one of the oldest distilled liquors in the world [12]. Baijiu is widely consumed throughout China, where 67% of alcohol consumed is in the form of spirits, including Baijiu [2]. Baijiu is inextricably entwined into Chinese culture and traditions and is considered to be China’s national drink [13, 14]. Many Chinese believe that consumption of a small amount of baijiu every day is good for health [14]. Historically, baijiu was the drink of choice at ritualised drinking parties through which individuals sought to establish and strengthen social ties, and attain creative and spiritual development [15]. Today, it remains popular in social situations such as the abovementioned toasting rituals at business, community and family meal gatherings through which personal and business relationships may be fostered and maintained [8, 13].

Because of the high cultural value placed on baijiu as a traditional and healthy product, and because it is consumed in contexts which may be associated with material and social benefits for individuals, understanding baijiu consumption in China may therefore inform the development and implementation of policies to address alcohol-related problems. Despite the strong cultural associations between baijiu and wellbeing, the authors could not identify any previous research linking the two. Geiger and MacKerron [16] note the relative lack of research on subjective wellbeing and alcohol consumption in general, and argue for the importance of a more complex understanding of this relationship to inform policy development.

Contemporary theories of subjective wellbeing provide a useful context in which to consider the potential relationship between subjective wellbeing and baijiu consumption. The theory of subjective wellbeing homeostasis suggests that subjective wellbeing is under genetically determined homeostatic control through processes that return it to a set point after changes in environmental conditions [17, 18]. Subjective wellbeing is theorised as being primarily an enduring, background mood state (happy, content, alert), and it is this mood state that is understood as being under homeostatic protection [18]. Several buffers (cognitive and external) operate to help maintain homeostatically protected mood near the set point when the environment becomes adverse. These include money, personal relationships, and a sense of purpose or meaning in life [18‐20]. Factors such as lack of social support, poverty, and lack of meaning in life may lead to homeostatic failure when these are chronic and sufficiently severe [17, 20]. As discussed above, in China alcohol (including in particuar baijiu) is often consumed in contexts that facilaite the operation of buffers such as personal relationships and access to resources.

This article reports on research on the perceived benefits and cultural importance of baijiu consumption; consumption (frequency and volume); and whether consumption is associated with subjective wellbeing, measured using the Personal Wellbeing Index [21]. Subjective wellbeing has been found to be associated with income and with age in Chinese samples, with those on higher incomes and those in older age groups typically scoring higher on measures of subjective wellbeing [22, 23]. We therefore controlled for these variables when exploring the relationship between baijiu consumption and subjective wellbeing.

All variables were checked for statistical assumptions. Where assumptions were not met, appropriate non-parametric procedures were chosen.

Results indicated that baijiu was frequently consumed (once a week or more) by more than half of the participants (54.6%). Frequency of consumption is reported in Table 1.

Volume of baijiu consumed was determined by asking participants how many 750 ml or equivalent bottles of Baijiu they personally consumed per month. Volume was also translated into the equivalent in standard drinks (based on 10 g alcohol) using the following formula: bottle size (.750) x alcohol content x gravity of ethyl alcohol (.789). Equivalent average daily standard drink consumption was based on a 31-day month. Because Baijiu varies in alcohol content, two calculations were made, one for 35% alcohol, and one for 60% alcohol. These findings suggest that 20.8% of Chinese are drinking more than 2 standard drinks a day, based on an alcohol percentage of 35%; and 33.7% are drinking more than 2 standard drinks a day based on an alcohol percentage of 60% (see Table 2).

There was a small to medium correlation between consumption frequency and income, r = .311, p < .001, and between consumption volume and income, r_S = .278, p < .001. Higher levels of income were associated with greater consumption frequency, and consumption volume, in the sample population. There was also a small correlation between consumption and age, with older age being associated with both higher consumption frequency (r = .184, p < .001) and higher consumption volume (r_S = .120, p < 001).

This study investigated baijiu consumption in China, within the context of a need to understand the cultural and social importance of alcohol in China, and how this relates to subjective wellbeing. Over half the participants in the present study reported drinking baijiu once a week or more, and large numbers consumed more than two standard drinks a day (based on 10 g alcohol (for a discussion of differences in alcohol content in standard drinks internationally, see Kalinowski and Humphries [31]. Given consumption levels reported here and elsewhere [1‐3], there is clearly a need for policy and interventions that ameliorate alcohol-related harms in China. However, our research also indicates that alcohol-reduction campaigns run the risk of being incongruent with views held by many Chinese. We found that just over 50% of Chinese think that drinking baijiu is healthy. Research conducted in other contexts [32] has found that the belief that wine is healthy is associated with an increase in frequency of consumption, but not volume. The present research found a medium association between belief that baijiu is healthy and both frequency and volume of consumption. This indicates that this belief may play a role in overconsumption of baijiu in China, and highlights the importance of culturally specific research into this issue. We also found small associations between perceived cultural importance of baijiu, and the belief that culture dictated that one should drink baijiu, and consumption.

In addition, we found small associations between baijiu consumption (frequency and volume) and wellbeing, after controlling for income and age. This should not be taken to suggest that baijiu consumption is directly associated with or causes positive wellbeing. Instead, it is more likely that baijiu is being consumed in contexts that foster wellbeing (for example through promoting positive relationships and access to material resources) in the Chinese context. This suggestion is drawn from Chang [9] and Szto [8], who have argued that toasting rituals perform important social and business functions for many Chinese. Chang [9] also noted that it may be virtually impossible for some Chinese to drink less, even though they may want to, because of these important social functions; and campaigns aimed at reducing alcohol consumption should find ways for such social functions to be maintained [8, 9]. Overall, our results therefore support previous contentions [5, 8, 9] that efforts to curb consumption may be counter-productive unless they take the long-standing values and practices associated with baijiu consumption into consideration. Szto [8], for example, discusses the dangers of ignoring drinking rituals in business negotiations, and argues for the need for inter-disciplinary forums on alcohol reduction, and culturally specific interventions that recognise and value traditional customs while promoting moderation.

It is worth noting that the total mean converted (0–100) score for the PWI in the current study was 73.53 (SD = 14.70, n = 1992). This is higher than previously reported for Chinese-speaking populations, where means typically fall between 60 and 70 [25‐27]. This may reflect the sampling strategy, which involved third-party recruitment via a database of individuals who had indicated an interest in participating in online research. Potentially, such individuals may have been less impacted by cultural response biases that have been suggested to account for the lower means in China [19, 28, 29]. It is also worth noting that in the current study, our sample was skewed towards those with higher than average incomes; in full employment; and with a university degree or equivalent. China has experienced rapid and significant economic and social transformation in the past decades, and wellbeing is becoming more associated with individualistic values [33]. Further research could help to determine if the present high mean for the PWI is an anomaly, or if it instead reflects wider changes in Chinese society. Such changes have resulted in improvements in material conditions for many, and may potentially be associated with decreased salience of cultural response biases associated with collectivist culture (e.g. modesty) that lead to lower means on the PWI. This may be most apparent in the population of middle class affluent Chinese (such as that represented in the present sample) who have benefited from economic changes and are at the forefront of social change and most exposed to Western ideas.

Alcohol consumption, and in particular the consumption of baijiu, has cultural associations with health, happiness and prosperity in Chinese society. Alongside this, alcohol consumption is leading to significant social and health-related problems. It has been argued that attempts to address the growing social and health problems associated with alcohol consumption in China must take local customs and values into account. The present research aimed to understand baijiu consumption in China in this regard. Traditional and health values accorded to baijiu were associated with higher consumption. Furthermore, higher consumption was also modestly associated with higher subjective wellbeing. It is beyond the scope of the present research to fully account for these associations. It is unlikely, however, that baijiu makes a direct contribution to wellbeing. Instead, we suggest that this result may reflect the fact that baijiu is consumed in contexts which contribute to material and social wellbeing for individuals. A greater understanding of the relationships found in the present research may benefit the development of harm reduction campaigns. To gain traction, such campaigns may consider working alongside traditional values and practices, not against them.