Research on alcohol has generally only focused on its use or overuse as a psychoactive substance [3, 35], meaning there are few studies on the behavior of alcohol gifting. In this study, two provinces in southern and northern China were selected to explore alcohol gifting, associated factors, and behavioral outcomes. We also distinguished between actively offering and passively receiving alcohol gifts. This study showed that nearly half of the participants had received alcohol, and nearly one-third had offered alcohol, suggesting that alcohol gifting is common in China.
There are some differences in alcohol gifting across sociodemographic characteristics. Our research showed that men were more likely to offer and receive alcohol than women. We posit two potential explanations for this difference. One, there are sex differences in drinking alcohol behavior in China, where drinking frequency in men is higher than in women [3, 35]. This higher drinking frequency in men might explain why alcohol gifting is more common among men. Two, compared to women, men are more likely to participate in social interaction where alcohol consumption is normative in the Chinese socio-cultural context, especially on business occasions.
In addition, the study also suggests that married people have higher odds of receiving alcohol. Consistent with this finding, a previous study of Chinese drinking behaviors showed that being married is associated with more alcohol consumption [36]. We hypothesize that married people may be more invested in maintaining interpersonal relationships than those who aren’t married, especially on special holidays when alcohol gifting is common. Married people may have more social and family ties that are accompanied by gift-giving expectations, and therefore may be more likely to receive alcohol as a gift. Moreover, Chinese society emphasizes filial respect, and gift-giving is a way for the younger generation to show respect for the elder generation. As married people are generally more mature and have higher status within the family hierarchy, they may be more likely to receive gifts such as alcohol.
The finding that participants with a high level of social participation were more likely to give and receive alcohol is consistent with the role that alcohol plays in Chinese culture, where alcohol consumption is commonly involved in social interaction. Chinese people traditionally consider drinking an important tool of social contact and emotional expression. Alcohol often accompanies business meetings, social activities, weddings, funerals, holidays, and other special celebrations [37]. Gift giving can reduce uncertainty while producing positive emotions, social cohesion, and commitment [38]. Feelings of obligatory reciprocity often accompany gift-giving, even when altruistic motives are also present [39]. As consequence, those who have received alcohol may feel obligated to reciprocate after receiving an alcohol gift by offering the gift-giver help, strong emotional ties, etc. While social participation was found to be significantly associated with offering alcohol, we did not find a significant relationship with cognitive social capital and social network. Social Exchange Theory holds that all human behaviors are exchange behaviors, and gift-giving is also a social exchange behavior [40]. In other words, the cognitive perception of social capital and the extent of social network might not promote the occurrence of gifting behaviors. Perhaps gift-giving behavior can only be promoted through social engagement, where there is real interaction with people in the context of social participation.
The behaviors of offering and receiving alcohol were also related to family annual income. Higher annual household income indicates higher economic status. It was previously illustrated that individuals of higher economic status are more likely to offer expensive wines to demonstrate their prestige and high social standing [41]. Our results offer additional support for the relationship between higher SES and alcohol gifting.
This study found that compared with Guangdong, the southern coastal area in China, the phenomenon of alcohol offering and receiving is more common in Shaanxi, an inland city in northwest China. This may be partially explained by the regional differences in drinking prevalence. According to a study on regional differences in alcohol consumption in China, the prevalence of regular drinking in the northern region is higher than prevalence in the central-southern region [42]. It is possible that northerners perceive drinking as an effective way to cope with cold weather, and northern culture emphasizes hospitality with frequent gatherings and exhortation to drink [43]. In addition, Guangdong has higher economic and cultural development than Shaanxi due to the advantages of economic reform and being a coastal area which has more foreign trade activities with the outside. This higher level of economic development may be associated with receiving more information about the harms of drinking, leading to more concern about its effects on health and avoidance of alcohol [44]. This difference may also be related to the cultural differences of gifting between the North and the South.
Drinking status was also found to be strongly associated with giving and receiving alcohol. Behavioral Susceptibility Theory posits that behavior will gradually increase when that behavior is convenient [45]. Drinkers are more likely to approve of drinking than non-drinkers and may have more regular, convenient access to alcohol. Drinkers may therefore be more inclined to choose alcohol as gifts.
In another study in China, smoking outcomes were associated with cigarette gifting behaviors [22]. Notably, a similar relationship was found in the current study, where gifting alcohol was significantly associated with not only drinking, but also smoking. Many studies have demonstrated that tobacco and alcohol were complementary products, and co-use is common [46,47,48,49]. Drinkers are also more likely to smoke cigarettes than nondrinkers [50]. These findings may indicate that receiving alcohol as a gift may facilitate the consumption of addictive substances including tobacco and alcohol.
With regards to policy implications, the result of the current study can be used to inform prevention and intervention. First, alcohol gifting is associated with higher odds of current drinking and current smoking. Previous studies have suggested that limiting alcohol advertising is an effective intervention to control drinking [51, 52]. While it might be difficult to ban all alcohol advertising, restrictions could be pursued that restricts advertising from using gifting themes and imagery. Interventions that teach people how to refuse alcohol as gifts and suggest alternative gifts could also be pursued. Such interventions should be targeted at specific populations that have higher odds of alcohol gifting, for example, people who are male, married, currently drink alcohol, reside in the northern region, have larger social networks and more social participation, and people with higher economic status. Finally, given the differences in alcohol giving in North and South, local alcohol gifting culture should receive attention when formulating policies and interventions programs, particularly in the northern region.
Limitations
Some limitations should be considered. First, the cross-sectional design prohibits causal associations. Additionally, self-reported questionnaires are vulnerable to recall bias and social desirability bias. Second, selection bias might misrepresent the prevalence of alcohol offering and receiving because the sample only included the household heads whose children were college students. Moreover, results may not generalize to the entire country, and the selected provinces might reflect north–south cultural differences due to their geographical and economic characteristics.
