Those harmed by others' drinking in the US population are more depressed and distressed

The secondhand effects of alcohol use and the risks of drinking to cope

Objective:The secondhand effects of alcohol use (SEA) are adverse consequences caused by another's drinking. This study explored the relationship among the experience of SEAs, alcohol use, and alcohol related consequences (ARC). In addition, we examined whether coping (i.e., adaptive, maladaptive, substance use coping, maladaptive coping without substance use items) served as a moderator of SEA effects on alcohol outcomes. Method: 1,168 students completed a survey assessing SEA, alcohol outcomes, ARC, and coping strategies. Results: SEA was significantly positively associated with alcohol use (RRheavydrinking = 1.05, SE = 0.005, p < .01; RRAUDIT = 1.04, SE = .005, p < .01) as well as ARC (RR = 1.06, SE = .005, p < .01). Various forms of maladaptive coping moderated the relationship between SEA and alcohol outcomes. Conclusion: This study provided evidence for a relationship between SEA and more alcohol use and ARC. This relationship was exacerbated by maladaptive coping.

Emotional Distress in a Marginalized Population as a Function of Household-Level Social Determinants of Health

Low-income, underrepresented communities of color are disproportionally affected by emotional distress. Little is known about malleable, household-level determinants of emotional distress, addressable by feasible, stigma-neutral interventions. The present study addressed this knowledge gap by analyzing secondary data from a cross-sectional community needs assessment survey in a marginalized urban community (N = 677). Relying on dominance analyses, authors found that, on average, the largest household-level contributions to respondents' emotional distress included exposures to fellow household members' alcohol use and anger-driven behaviors. Both determinants are arguably feasible to address via household-level interventions and community-level preventive efforts. Household members' physical and serious mental illness and drug use were moderately associated with respondents' emotional distress; household cohesion and communications, residential overcrowding, and child behavior played a minimal role. Article concludes with a discussion of public health implications of the results.

The association of lowered alcohol prices with birth outcomes and abortions: A population-based natural experiment

BACKGROUND AND AIMS

Alcohol use during pregnancy remains an important risk factor for adverse birth outcomes, but little is known regarding how alcohol prices affect pregnancy outcomes on the population level. We assess the associations between decreased alcohol prices with birth outcomes and abortions.

DESIGN

Using national registers, we used interrupted time-series modelling to compare outcomes of pregnancies conceived before and after a tax cut, resulting in 33% mean decrease of off-premise alcohol prices on 1 March 2004. We also addressed possible heterogeneity of the associations by maternal age and household income.

SETTING

Finland.

PARTICIPANTS

All registered pregnancies starting 2 years before and 1 year after the alcohol price cut (analysis sample consisted of 169 735 live births and 32 441 abortions).

MEASUREMENTS

The outcomes were birth weight, gestational age, the probability of low birth weight (< 2500 g at birth), preterm birth (< 37 weeks of gestation), any congenital malformations and share of registered abortions of pregnancies.

FINDINGS

On the population level, lowered alcohol prices were associated with an increase in abortions immediately after the price cut [+0.84 percentage points; 95% confidence interval (CI) = 0.2, 1.4]. For birth outcomes, negative associations were observed among women in the lowest income quintile; for example, increased probabilities of low birth weight (+1.5 percentage points; 95% CI = 0.4, 2.6) and preterm birth (+1.98 percentage points; 95% CI = 0.8, 3.2). All changes were strongest immediately after the price cut and attenuated during the course of the following year.

CONCLUSIONS

Lowered alcohol prices in Finland were associated with a short-term increase in adverse birth outcomes among low-income mothers and an overall increase in abortions.

Does the relationship between alcohol retail environment and alcohol outcomes vary by depressive symptoms? Findings from a U.S. Survey of Black, Hispanic and White drinkers

AIMS

To assess whether associations between alcohol availability and consumption, drinking to drunkenness, and negative drinking consequences vary among individuals with elevated depressive symptoms.

METHODS

10,482 current drinkers in 2005-2015 National Alcohol Surveys (50.0% female; 74.4% White, 8.7% Black, 11.1% Hispanic). Elevated depressive symptoms was defined as having symptoms suggestive of major depressive disorder (above CES-D8/PHQ-2 cut-offs) versus no/sub-threshold symptoms (below cut-offs). Inverse probability of treatment weighted and covariate adjusted Poisson models with robust standard errors estimated associations of ZIP-code bar density and off-premise outlet density (locations/1,000 residents), elevated depressive symptoms, and their interaction with past-year volume consumed, monthly drinking to drunkenness, and negative drinking consequences. Models were then stratified by sex and race and ethnicity.

RESULTS

Overall, 13.7% of respondents had elevated depressive symptoms. Regarding density, the only statistically significant association observed was between off-premise density and volume consumed (rate ratio = 1.3, 95% confidence interval = 1.0, 1.7). Elevated depressive symptoms were associated with higher volume consumed, prevalence of drinking to drunkenness, and prevalence of negative consequences when controlling for off-premise density or bar density. However, there was no evidence of interaction between symptoms and density in the full sample nor among subgroups.

CONCLUSION

This study suggests that, while elevated depressive symptoms do not alter associations between alcohol availability and alcohol use and problems, they remain associated with these outcomes among past-year drinkers in a U.S. general population sample even when accounting for differential availability. Addressing depressive symptoms should be considered along with other policies to reduce population-level drinking and alcohol problems.

Prevalence and self-rated health and depression of family members affected by addictive disorders: results of a nation-wide cross-sectional study

AIMS

To estimate the prevalence of family members affected by addictive disorders (FMA) with regard to various types of addictive disorders, and self-rated health and depression in the general population.

DESIGN

Cross-sectional general population survey.

SETTING

The German Health Update study (GEDA) 2014/2015, a nationally representative panel of German residents aged 15 years or older.

PARTICIPANTS

A total of 24 824 residents aged 15 years or older.

MEASUREMENTS

Participants were asked if they had a family member with current or past addictive disorder, the type of addiction and the relationship status. In addition, self-rated health and depression were assessed using standardized questionnaires.

FINDINGS

Of the respondents, 9.5% [95% confidence interval (CI) = 9.0-10.0] reported being affected by a current addictive disorder of a relative (cFMA), with a further 4.5% (95% CI = 4.2-4.9) reported having been affected by the addictive disorders of a relative in the past but not within the last 12 months (pFMA). Most FMAs reported having been affected by disorders due to alcohol, followed by cannabis and other drugs. Compared with life-time non-FMAs, FMAs reported significantly (P < 0.001) higher odds ratios for depression (cFM = 2.437; 95% CI = 2.082-2.853; pFMA = 1.850; 95% CI = 1.519-2.253) and ill-health (cFMA = 1.574; 95% CI = 1.374-1.805; pFMA = 1.297; 95% CI = 1.082-1.555).

CONCLUSIONS

In Germany, family members affected by addictive disorder are a substantial group within the general population. This group is characterized by ill-health and has not yet been adequately addressed by the addiction treatment system.

Primary Outcome from a cluster-randomized trial of three formats for delivering Community Reinforcement and Family Training (CRAFT) to the significant others of problem drinkers

BACKGROUND

Community Reinforcement and Family Training (CRAFT) is an intervention designed to help the concerned significant others (CSOs) of people with alcohol problems who are reluctant to seek treatment. It aims to improve the well-being of CSOs and teach them how to change their behavior in order to positively influence the "identified patient" (IP) to seek treatment.

METHODS

The aim of the present pragmatic cluster-randomized trial was to compare the effectiveness of three formats for delivering CRAFT in real life settings: group sessions, individual sessions, and written material only (control group). Eighteen public treatment centers for alcohol use disorders were randomly assigned to deliver CRAFT in one of the three formats as part of their daily clinical routine. CSOs were recruited via pamphlets, general practitioners, and advertisements on social media. Trained clinicians delivered CRAFT in individual and group format, and self-administered CRAFT was limited to handing out a self-help book. The primary outcome was treatment engagement of the IP after three months.

RESULTS

A total of 249 CSOs were found to be eligible and randomly assigned to receive CRAFT delivered in group, individual, or self-administered format. The three-month follow-up rate was 60%. At three months follow-up, 29% (n = 32) of the CSOs who received group/individual CRAFT reported that their IP had engaged in treatment. The corresponding rate for the CSOs who received self-administered CRAFT was lower (15%; n = 5) but did not differ significantly from the other group of CSOs (Odds ratio (OR) = 2.27 (95% CI: 0.80, 6.41)).

CONCLUSION

We hypothesized that CSOs receiving CRAFT in a group format would improve the most, but although our findings pointed in this direction, the differences were not statistically significant.

TRIAL REGISTRATION

Clinical trials.gov ID: NCT03281057 . Registration date:13/09/2017.

You're Stressing Me Out: The Secondhand Effects of Alcohol

Introduction: Secondhand effects of alcohol use (SEA) are adverse consequences experienced by an individual due to another's drinking (i.e., study/sleep interrupted, being insulted or humiliation, sexual assault or rape). SEA is a serious public health concern among college students due to its serious consequences and high prevalence (60-84%). The present study examined the associations among SEA, personal alcohol use, depression, anxiety, and stress. Methods: 836 students completed an online survey that assessed for study variables. Results: SEA significantly predicted all outcomes with those endorsing SEA reporting higher levels of depression, anxiety, and stress. Moreover, participants who endorsed SEA also reported 30% more frequent binge drinking and 18% more drinks on their heaviest reported drinking day. Conclusions: Findings indicate that the experience of SEA is a risk factor for poor mental and behavioral health outcomes among college students.

How concerned significant others experience Community Reinforcement and Family Training (CRAFT) - a qualitative study

Introduction

Heavy drinking causes serious harm, not only to the drinker but also to relationships and concerned significant others (CSOs). Community Reinforcement and Family Training (CRAFT) is an intervention developed to help the CSOs of substance users. The aim of this study was to investigate the drivers and aims underlying CSO participation in CRAFT, as well as their experience of the intervention itself and their module preferences.

Method

This is a qualitative study based on data from semi-structured interviews with 11 female help-seeking CSOs of individuals with alcohol problems. The participants were recruited from an RCT study of a variety of CRAFT delivery formats (group sessions + written material, individual sessions + written material or self-delivered CRAFT with written material only). The interviews were audio-recorded, transcribed, and analyzed by Interpretative Phenomenological Analysis.

Results

CSOs reported CRAFT helpful when both delivered by means of individual sessions or group sessions. The “Communication Element” in CRAFT, the module focusing on positive reinforcement and acquiring a clearer understanding of AUD, appeared to be particularly helpful elements of CRAFT. Furthermore, being met with acceptance and non-judgmental attitudes seemed to count highly for the CSOs. The written material a helpful supplement to the face-to-face interventions. The written material a helpful supplement to the face-to-face interventions.

Conclusion

CSOs who participated in the CRAFT intervention felt helped by its components, irrespective of delivery format.

Drinking and Neighborhood Contexts of Alcohol's Harms from Others

AIMS

Negative consequences of alcohol (or secondhand effects) extend beyond drinkers to affect other people, including both known others (friends, family members, spouses/partners) and strangers. Secondhand effects of alcohol manifest across various social environments, including the places where people drink and the neighborhoods where they live. These neighborhoods are characterized by different levels of alcohol availability and degrees of residential social cohesion. Hence, social environments may confer risk or protect from harms from others' drinking. The current study explores: (a) how drinking venues and neighborhood contexts relate to harms from other people's drinking (both known others and strangers), and (b) whether these associations vary by gender.

METHODS

Using pooled data from the National Alcohol Survey and National Alcohol's Harms to Others Survey (N = 5425), we regressed harms from various drinking others on social environment characteristics (drinking venues, alcohol availability and social cohesion) for the full sample and separately by gender. We used the false discovery rate method to adjust for multiple testing.

RESULTS

Overall, greater neighborhood social cohesion was associated with lower odds of harm from drinking others and, specifically, harm from drinking strangers. The effect of social cohesion was most pronounced for men.

CONCLUSIONS

Social cohesion was the most salient neighborhood factor associated with reduced alcohol-related harms from strangers. Directions for future research and policies to mitigate these harms are discussed.

“He is lovely and awful”: The challenges of being close to an individual with alcohol problems

Introduction: In the last 20 years, there has been growing evidence that heavy drinking causes serious harm not only to the person who drinks but also to the person's relations and concerned significant others (CSOs). A relationship with a heavy drinker is often full of conflicts, and CSOs are frequently exposed to aggression, psychological, and sometimes physical violence from the heavy drinker. Despite their struggles, CSOs often feel it is difficult to seek professional help for these problems. The aim of this study was to investigate what problems CSOs of people with alcohol problems experience prior to seeking professional help to handle these issues. Moreover, to investigate what led to seeking professional help at all. Methods: This is a qualitative study with 12 female help-seeking CSOs of persons with alcohol problems. The participants were recruited from a randomised controlled trial (RCT) on Community Reinforcement and Family Training (CRAFT). Semi-structured interviews were conducted, audio-recorded, and transcribed. The analysis was based on interpretative phenomenological analysis. Results: Three overall themes and one sub-theme emerged from the analysis: (1) The CSO’s feelings and experiences of the situation prior to help-seeking, (2) The relationship with the drinker, (3) Reasons for help-seeking and its trajectory; and the sub-theme, What the CSOs hoped to gain from help-seeking. Conclusion: The present study showed that female CSOs of people with alcohol problems had suffered for a long time before seeking professional help. They felt their daily lives were unpredictable and stressful. They were often exposed to verbal and mental abuse and their relationships with the drinking relative were often characterised by frequent rowing. The CSOs had tried to cope for a long time using a number of different strategies; seeking help seemed to be the last option considered. Despite all the struggles and pain, the CSOs also felt a lot of love for their drinking relative and hoped for the return of their once sober relative. Our findings can be viewed as a support to the stress-strain-coping-support (SSCS) model proposed by Orford and colleagues.

Childhood Experiences and High-Intensity Drinking Among American Indian and Alaska Native Adults: Findings From the 2000-2015 National Alcohol Surveys

OBJECTIVE

The purpose of this study was to examine associations with high-intensity drinking (HID) in American Indian/Alaska Native (AI/AN) populations and compare them to White and other minority groups using four National Alcohol Surveys, 2000 to 2015 (total N = 29,571; AI/ANs = 434).

METHOD

Current drinking and HID (8+ and 12+ drinks on any day) from maximum drinks in the prior 12 months were analyzed with independent variables and race/ethnicity (AI/AN, non-Hispanic White, and other racial/ethnic groups combined). Adjusted logistic regression models comprised gender, age, marital status, employment, education, survey year, rurality, and especially, childhood trauma (physical/sexual abuse), and biological family alcohol problem history (each dichotomous).

RESULTS

In adjusted population models, Whites had twice the odds of current drinking as AI/ANs, with no difference between other racial/ethnic groups and AI/ANs. Descriptively, AI/AN drinkers consumed at higher intensity levels than other groups, with higher prevalence of childhood trauma and family problem drinking than others. However, on a population basis, adjusting for all factors, apparent differences between AI/AN and White HID were eliminated; other minority groups together, compared with AI/ANs, showed lower odds of consuming 8+ drinks.

CONCLUSIONS

AI/ANs had a higher prevalence of childhood trauma and family alcohol problems as well as lower current drinking likelihood compared with Whites. In adjusted population models, the combined other minorities group was less likely to ever consume 8+ drinks than AI/ANs. In all populations, childhood trauma and family alcohol problems increased the risk of HID, strongly so in AI/ANs. Addressing childhood trauma and family problems is important among AI/ANs to break generational cycles of drinking extreme amounts per occasion.

Childhood Experiences and High-Intensity Drinking Among American Indian and Alaska Native Adults: Findings From the 2000-2015 National Alcohol Surveys

OBJECTIVE

The purpose of this study was to examine associations with high-intensity drinking (HID) in American Indian/Alaska Native (AI/AN) populations and compare them to White and other minority groups using four National Alcohol Surveys, 2000 to 2015 (total N = 29,571; AI/ANs = 434).

METHOD

Current drinking and HID (8+ and 12+ drinks on any day) from maximum drinks in the prior 12 months were analyzed with independent variables and race/ethnicity (AI/AN, non-Hispanic White, and other racial/ethnic groups combined). Adjusted logistic regression models comprised gender, age, marital status, employment, education, survey year, rurality, and especially, childhood trauma (physical/sexual abuse), and biological family alcohol problem history (each dichotomous).

RESULTS

In adjusted population models, Whites had twice the odds of current drinking as AI/ANs, with no difference between other racial/ethnic groups and AI/ANs. Descriptively, AI/AN drinkers consumed at higher intensity levels than other groups, with higher prevalence of childhood trauma and family problem drinking than others. However, on a population basis, adjusting for all factors, apparent differences between AI/AN and White HID were eliminated; other minority groups together, compared with AI/ANs, showed lower odds of consuming 8+ drinks.

CONCLUSIONS

AI/ANs had a higher prevalence of childhood trauma and family alcohol problems as well as lower current drinking likelihood compared with Whites. In adjusted population models, the combined other minorities group was less likely to ever consume 8+ drinks than AI/ANs. In all populations, childhood trauma and family alcohol problems increased the risk of HID, strongly so in AI/ANs. Addressing childhood trauma and family problems is important among AI/ANs to break generational cycles of drinking extreme amounts per occasion.

Are Countries' Drink-Driving Policies Associated With Harms Involving Another Driver's Impairment?

INTRODUCTION

International drink-driving policy research generally focuses on aggregate outcomes (e.g., rates of crashes, fatalities) without emphasizing secondhand alcohol-related vehicular harms. In contrast, we investigate associations between drink-driving policies and harms involving another driver's impairment.

METHODS

Alcohol's harms to others (AHTO) survey data from 12 countries (analytic N = 29,616) were linked to national alcohol policy data from the World Health Organization. We examined separately associations of two 12-month driving-related AHTOs (passenger with an impaired driver; vehicular crash involving someone else's drink driving) with 3 national drinking-driving policies-legal blood alcohol concentration (BAC) limits, use of random breath testing, use of sobriety checkpoints, and comprehensive penalties for drink-driving (community service, detention, fines, ignition interlocks, license suspension/revocation, mandatory alcohol treatment, vehicle impoundment, and penalty point system), plus 2 alcohol tax variables (having excise taxes and value-added tax [VAT] rate). Multilevel logistic regression addressed clustering of individuals within countries and subnational regions, while adjusting for individuals' gender, age, marital status, risky drinking, and regional drinking culture (% male risky drinkers in sub-national region).

RESULTS

Controlling for national-, regional-, and individual-level covariates, comprehensive penalties were significantly and negatively associated with both outcomes; other vehicular policy variables were not significantly associated with either outcome. A society's VAT rate was negatively associated with riding with a drunk driver. Regional male drinking culture was positively associated with riding with an impaired driver, but was not significantly associated with being in a vehicular crash due to someone else's drinking. In both models, being male, being younger, and engaging in risky drinking oneself each were positively associated with vehicular harms due to someone else's drinking.

CONCLUSIONS

Although results are associational and not causal, comprehensive penalties may be promising policies for mitigating driving-related harms due to another drinker. Higher VAT rate might reduce riding with a drunk driver.

Harm from Others' Drinking Among Sexual Minority Adults in the United States

Purpose: Due to discrimination and stigma, sexual minority adults may be more likely than their heterosexual counterparts to experience harms from other people's drinking. We compared prevalence of second-hand alcohol harms for sexual minority and heterosexual adults in the United States. Methods: Data from the 2014-15 U.S. National Alcohol Survey (n = 5516; 10.2% sexual minority adults) were analyzed using logistic regression with survey weights to account for sampling and nonresponse. Multivariable models included simple main effects of sexual identity on the past-year harm outcomes, as well as interactions of drinker status with sexual identity. Results: In bivariate results stratified by sex, bisexual women were significantly more likely than heterosexual women to report all five types of harms. Lesbian respondents had greater odds relative to heterosexual women of reporting harm by a friend/coworker and assault or physical harm by a drinker. Bisexual identity among men was associated with greater odds of reporting assault/physical harm relative to heterosexual men in bivariate models. In adjusted models, differences by sexual identity were substantially reduced, with significance remaining only for friend/coworker-perpetrated harms and assault/physical harm among lesbian respondents compared with heterosexual women. For assault/physical harm, an interaction of sexual identity with the respondent's own drinking showed that the increased odds of harm associated with heavy drinking was even greater among sexual minority respondents (both bisexual and lesbian/gay respondents) than among heterosexual respondents. Conclusion: These findings underscore the importance of preventive interventions that consider disparities in risk for alcohol-related harms, particularly interpersonal violence, among sexual minority adults in the United States.

Solidarity or self-interest? Public opinion in relation to alcohol policies in Sweden

Aim

The aim of this article is to study how people sometimes accept policies that could in a narrow sense be seen as in conflict with their own self-interest.

Design

The study is based on survey data relating to public opinion on alcohol policy in Sweden targeted at people aged 16-85 years 2016-2017. Among the 3400 people questioned, the response rate was 52%.

Results

The results show that people's perception of the problematic societal consequences of alcohol, in combination with ideological norms regarding the responsibility of individuals, is much more important in explaining public opinion than self-interest factors. It is the view that there is a problem at the societal level, rather than at the personal level, that is most essential for explaining opinions on alcohol restrictions. General knowledge of alcohol-related matters has some effect, whereas personal experiences of close affiliates excessive drinking does not seem to color the opinions expressed.

Conclusion

Support for restrictive alcohol policies in Swedish public opinion is mainly founded on norms of solidarity and astute problem analyses at the societal level, and to a much lesser extent on egoism and personal experiences.

Alcohol's Secondhand Harms in the United States: New Data on Prevalence and Risk Factors

OBJECTIVE

This study examined a range of indicators of alcohol's harm to others (AHTO) among U.S. adults and assessed sociodemographic and alcohol-related risk factors for AHTO.

METHOD

The data came from 8,750 adult men and women in two parallel 2015 U.S. national surveys conducted in English and Spanish. Both surveys used computer-assisted telephone interviews and two-stage, stratified, list-assisted, random samples of adults ages 18 and older.

RESULTS

One in five adults experienced at least one of ten 12-month harms because of someone else's drinking. The prevalence of specific harm types and characteristics differed by gender. Women were more likely to report harm due to drinking by a spouse/partner or family member, whereas men were more likely to report harm due to a stranger's drinking. Being female also predicted family/financial harms. Younger age increased risk for all AHTO types, except physical aggression. Being of Black/other ethnicity, being separated/widowed/divorced, and having a college education without a degree each predicted physical aggression harm. The harmed individual's own heavy drinking and having a heavy drinker in the household increased risk for all AHTO types. The risk for physical aggression due to someone else's drinking was particularly elevated for heavy drinking women.

CONCLUSIONS

Secondhand effects of alcohol in the United States are substantial and affected by sociodemographics, the harmed individual's own drinking, and the presence of a heavy drinker in the household. Broad-based and targeted public health measures that consider AHTO risk factors are needed to reduce alcohol's secondhand harms.

Association between state-level alcohol availability and taxation policies on the prevalence of alcohol-related harms to persons other than the drinker in the USA, 2000-2015

INTRODUCTION AND AIMS

Alcohol-related harms to others (AHTO) are consequences of alcohol use borne by persons other than the drinker. This study assessed whether the odds of experiencing AHTO are associated with alcohol availability and taxation policies.

DESIGN AND METHODS

This study pooled data from four waves of the National Alcohol Survey (n = 20656 adults). We measured past-year AHTO exposure using three binary variables: physical (pushed/hit/assaulted or property damage by someone who had been drinking), family or financial (family/marital problems or financial harms by someone who had been drinking) and driving AHTO (riding in a vehicle with a drink-driver or being in a drink-driving crash). Policies included bar and off-premise alcohol outlet density (separately), alcohol retail hours, beer and spirits taxes (separately) and monopoly on retail/wholesale alcohol purchases.

RESULTS

Monopolies were associated with 41.2% lower odds of physical harms [adjusted odds ratio (aOR) = 0.59, 95% confidence interval (CI) 0.45, 0.77, q < 0.001 correcting for multiple analyses], and a 10% increase in bar density was associated with a 1.2% increase in odds of driving-related harms ( e ^{ln(1.1) * β} =1.01, 95% CI 1.00, 1.02, q = 0.03). Among men, beer taxes were associated with lower odds of physical harms ( e^{ln(1.1) * β} =0.93, 95% CI 0.88, 0.98 q = 0.03) and monopolies were associated with lower odds of physical (aOR = 0.45, 95% CI 0.35, 0.59, q < 0.001) and driving harms (aOR = 0.66, 95% CI 1.00, 1.02, q = 0.03).

DISCUSSION AND CONCLUSIONS

Monopolies, taxes and outlet density are associated with odds of some AHTO. Future longitudinal research should test whether physical availability and taxation policies may be protective for bystanders as well as drinkers.

Gender Equality, Drinking Cultures and Second-Hand Harms from Alcohol in the 50 US States

BACKGROUND

Gender inequality and cultures of binge drinking may increase the risk of second-hand harms from alcohol.

METHODS

Using the 2014-2015 National Alcohol Survey and 2015 National Alcohol's Harm to Others Survey (N = 7792), we examine associations of state-level gender equality measures (contraceptive access, abortion rights, women's economic equality) and binge drinking cultures (rates of men's and women's binge drinking) with individual-level indicators of second-hand harms by drinking strangers and partners/spouses.

RESULTS

In main effects models, only male binge drinking was associated with greater odds of harms from drinking strangers. There were significant interactions of gender equality with male binge drinking: High male binge drinking rates were more strongly associated with stranger-perpetrated harms in states low on contraceptive access or abortion rights compared to states high on these measures. Conversely, male binge drinking was more strongly associated with spouse/partner-perpetrated second-hand harms in states with more economic equality, compared to states lower on this measure.

CONCLUSIONS

Detrimental effects of high male binge drinking rates may be modified by gender equality. Targeted interventions may reduce alcohol-related harms experienced by women in states with high rates of male binge drinking. Restrictions in access to contraception and abortion may exacerbate harms due to men's drinking.

Alcohol's Harm to Others: Opportunities and Challenges in a Public Health Framework

The emergent and growing body of research on alcohol's harm to others (AHTO), or secondhand effects of drinking, has important implications for prevention, intervention, and policy. Those victimized by other drinkers tend to favor effective alcohol policies more than their nonvictimized peers, but often a community's impulse will be to combat AHTO by targeting and stigmatizing individual heavy drinkers, rather than taking a public health approach to reducing harm. Here we discuss opportunities and challenges in selecting ways of reducing AHTO. We make a case for adopting joint public health and individual approaches to reduce AHTO.

Harm from other people's drinking among college students in India

INTRODUCTION AND AIMS

There is a paucity of studies on the harms experienced by college students from India due to others' drinking, despite their increased risk. We studied the prevalence and correlates of harm from others' drinking among college students in the state of Kerala, India.

DESIGN AND METHODS

A total of 5784 students from 58 colleges completed a self-administered questionnaire, which included the World Health Organization-Thai Health Harm to Others from Drinking Master Protocol and other structured instruments to assess correlates. The frequencies of various harms were determined and a mixed effect multivariable negative binomial regression model was used to identify the factors responsible for harms.

RESULTS

Of the 4487 valid responses, 68.3% were females. The mean age of the sample was 19.5 years. Harm from others' drinking was reported by 68.7% of respondents. Among various harm domains, psychological harm was reported by 65.7%, physical by 15.2%, financial by 20.9%, and property harm by 5.0%. Strangers were the most common perpetrators. Being male and having a part-time job increased harms. Increasing age, urban residence, and staying in a hostel were correlated with psychological-but not physical-harm. Subjects who reported harm had higher odds of reporting alcohol use and psychological distress. 'Any harm' or psychological harm was associated with suicidal thoughts; only physical harm was correlated with suicidal attempts.

DISCUSSION AND CONCLUSIONS

The high prevalence of harms from others' drinking and its negative correlates underscore the need for colleges to focus on second-hand effects in programs for tackling alcohol use.

Alcohol's harms to others in Wales, United Kingdom: Nature, magnitude and associations with mental well-being

Aim

To explore the nature and magnitude of alcohol's harms to others (AHTOs), and associations with mental well-being.

Methods

Cross-sectional survey implemented amongst 891 randomly selected Welsh residents (aged 18+ years), via computer assisted telephone interviews. Questions established past 12-month experience of nine direct harms resulting from another person's alcohol consumption (e.g. violence) and five linked outcomes (e.g. concern for a child). The source (e.g. partner/stranger) and frequency of the AHTO were collected, and respondents' socio-demographics, drinking behaviours and mental well-being status.

Results

During the past 12 months, 43.5% of respondents had experienced at least one direct harm (45.5% at least one direct harm/linked outcome). In demographically adjusted analyses, the odds of experiencing any direct harm decreased sequentially as age group increased (Adjusted Odds Ratio [AORs]: 1.9 [age 65–74 years] - 4.2 [age 18–34 years]), and was higher amongst binge drinkers (AOR, 1.5, p < 0.05). Associations between age group and suffering the direct harms anxiety, disrupted sleep, feeling threatened, property damage and emotional neglect were found. Experience of feeling threatened was lower amongst females (AOR 0.6, p < 0.05). In demographically adjusted analyses, low mental well-being was higher amongst those who had suffered alcohol-related financial issues (AOR 2.2, p < 0.001), emotional neglect (AOR 2.3, p < 0.01) and property damage (AOR 2.2, p < 0.05).

Conclusion

AHTOs place a large, although unequal burden on adults in Wales. Individuals' drinking patterns are associated with experience of AHTOs. Critically, experience of some harms is associated with low mental well-being.

•

The harms from alcohol extend from the drinker to those around them (i.e. alcohol's harms to others [AHTOs]).

•

AHTOs place a large, although unequal burden on the Welsh adult population, with young people and binge drinkers most at-risk.

•

Experience of some AHTOs is associated with low mental well-being.

•

AHTOs should be a consideration in the development, targeting and evaluation of alcohol policy and prevention activity.

The Relationship Between the U.S. State Alcohol Policy Environment and Individuals' Experience of Secondhand Effects: Alcohol Harms Due to Others' Drinking

BACKGROUND

Although restrictive state alcohol policy environments are protective for individuals' binge drinking, research is sparse on the effect of alcohol policies on alcohol's harms to others (AHTO). We examined the lagged associations between efficacy of U.S. state alcohol policies and number of harms from others' drinking 1 year later.

METHODS

Individuals with AHTO data in a nationally representative sample of U.S. adults (analytic sample n = 26,744) that pooled the 2000, 2005, 2010, and 2015 National Alcohol Surveys and a 2015 National Alcohol's Harm to Others Survey were linked with prior-year state policy measures. We used 2 measures from the Alcohol Policy Scale (APS)-effectiveness in reducing (i) binge drinking and (ii) impaired driving, based on experts' efficacy judgments regarding 29 state alcohol policies. Three 12-month AHTO measures (due to another drinker) were experiencing: (i) either family/marriage difficulties or financial troubles; (ii) being assaulted or vandalized; and (iii) passenger with drunk driver or traffic accident. Multilevel models accounting for clustering within states and stratified by age-groups (<40 vs. ≥40) examined associations between the APS and AHTO measures, controlling for individual covariates (gender, race, education, employment and marital status, family problem-drinking history) of the victim.

RESULTS

Only for those aged <40, the lagged APS-Binge drinking and APS-Impaired driving scores were each inversely associated with aggression-related harms and, separately, with drunk driving-related harm from someone else's drinking (ps < 0.05 to < 0.01). Family/financial harms were not associated with APS scores for either age-group. Composite AHTO measures (any of 3 harm-types) also were inversely associated with stronger state alcohol policy environments (ps < 0.05 to <0.01).

CONCLUSIONS

State alcohol policies may be effective in reducing, to a meaningful degree, aggression-related harms and vehicular hazards due to other drinkers, but mainly in those under 40.

Sex differences in the impact of secondhand harm from alcohol on student mental health and university sense of belonging

PURPOSE

University students report high rates of secondhand harm from alcohol (i.e., harm from another person's drinking). The current study investigated the association between students' exposure to secondhand harm and student mental health and university sense of belonging. We also assessed whether students' sense of belonging mediated the association between secondhand harm and mental health and sex differences in these associations.

METHODS

A total of 941 students (70% female) completed an online survey. Path analysis was employed to test our hypotheses. Secondhand harm was assessed across three dimensions; strains (e.g., having sleep/studies interrupted), threats (e.g., physical/sexual assault), and interpersonal harm (e.g., taking care of intoxicated friends).

RESULTS

Eighty-nine percent of participants reported secondhand harm exposure in the last 30 days. Interpersonal harm was the most common type of harm experienced by students. Strains were associated with higher levels of anxiety and stress, threats were associated with higher levels of anxiety and depression, and interpersonal harm predicted higher levels of anxiety, depression, and stress. Gender moderated these effects, such that only interpersonal harm was associated with men's mental health outcomes. Sense of belonging was associated with fewer mental health symptoms, and significantly mediated the effect of threats on anxiety, depression, and stress for females only, such that threat exposure was associated with reduced sense of belonging, which in turn increased anxiety, depression, and stress.

CONCLUSION

This study supports the growing body of literature demonstrating the high prevalence of secondhand harm exposure among university students and the association of these experiences with poor student mental health. Furthermore, this research provides evidence that sense of belonging may be one mechanism that explains this association.

Harms from a partner's drinking: an international study on adverse effects and reduced quality of life for women

BACKGROUND

Partners of heavy drinking individuals can be detrimentally affected as a result of their partner's drinking.

OBJECTIVES

The aim of this study was to identify the proportion of heterosexual intimate partner relationships with a heavy drinking male that resulted in reported alcohol-related harm and to investigate the impact of this on well-being in 9 countries.

METHODS

This study used survey data from the Gender and Alcohol's Harm to Others (GENAHTO) Project on Alcohol's Harm to Others in 9 countries (10,613 female respondents, 7,091 with intimate live-in partners). Respondents were asked if their partners drinking had negatively affected them as well as questions on depression, anxiety, and satisfaction with life.

RESULTS

The proportion of partnered respondents that reported having a harmful heavy drinking partner varied across countries, from 4% in Nigeria and the US to 33% in Vietnam. The most consistent correlate of experiencing harm was being oneself a heavy episodic drinker, most likely as a proxy measure for the acceptability of alcohol consumption in social circles. Women with a harmful heavy drinking partner reported significantly lower mean satisfaction with life than those with a partner that did not drink heavily.

CONCLUSIONS

Harms to women from heavy drinking intimate partners appear across a range of subgroups and impact on a wide range of women, at least demographically speaking. Women living with a heavy drinking spouse experience higher levels of anxiety and depression symptoms and lower satisfaction with life.

Estimating mental health impacts of alcohol's harms from other drinkers: using propensity scoring methods with national cross-sectional data from the United States

BACKGROUND AND AIMS

Alcohol's harms to others (AHTO) may cause substantial distress, particularly when harms are perpetrated by close others. One challenge to identifying causal impacts is that people harmed by drinkers differ in many ways from those not so harmed, so our aim was to assess mental health in relation to two serious types of AHTO, financial harm and assault by someone who had been drinking, using propensity score (PS) weighting to adjust for potentially confounding differences.

DESIGN

Cross-sectional, nationally representative, random sample of adults.

SETTING

United States.

PARTICIPANTS

Seventy-six respondents reporting financial harm compared with 4625 with no past-year AHTO; 192 respondents reporting assault compared with 4623 with no past-year AHTO.

MEASUREMENTS

Predictors were reported exposure to financial problems due to someone's drinking and assault by someone who had been drinking. Mental health outcomes were quality of life, distress and positive affect. Confounders included family history of alcohol problems, child physical/sexual abuse, substance use/dependence, impacts of recent economic recession, racial/ethnic discrimination, poverty and other demographics.

RESULTS

In double-robust PS weighted models for financial harm, there were associations with reduced quality of life (B = -0.28, P = 0.02) and increased distress [adjusted odds ratio (aOR) = 4.69, P < 0.001], and for assault by a partner or family member, there were associations with increased distress (aOR = 2.23, P = 0.09). For assault by a friend or stranger, none of the associations are statistically significant after PS weighting (all P > 0.10).

CONCLUSIONS

Financial troubles due to someone else's drinking and assaults perpetrated by drinking intimates (spouses, other partners or family members) are associated with reduced mental health.

The Future of Research on Alcohol-Related Disparities Across U.S. Racial/Ethnic Groups: A Plan of Attack

OBJECTIVE

Research suggests striking disparities in alcohol use, problems, and treatment across racial/ethnic groups in the United States. However, research on alcohol-related disparities affecting racial/ethnic minorities remains in its developmental stages. The current article aims to support future research in this growing field by highlighting some of the most important findings, questions, and approaches, focusing on psychosocial research.

METHOD

This article advances seven research needs (i.e., questions and topics meriting attention) that we believe are of crucial importance to the field. We draw on the existing literature to illuminate under-explored areas that are highly relevant to health intervention and that complement the field's existing focus.

RESULTS

Identified research needs include research that (a) better describes disparities in alcohol-related health conditions and their drivers, (b) identifies appropriate screening and brief intervention methods for racial/ethnic minorities, (c) investigates disparities in access to and use of alcohol treatment and support services, (d) examines the comparative efficacy of existing alcohol interventions and develops tailored interventions, (e) explores the impacts of specific alcohol policies across and within racial/ethnic groups, and (f) describes the full spectrum of alcohol-related harms and how and why these may vary across racial/ethnic groups. We also call for (g) continuing research to monitor disparities over time.

CONCLUSIONS

This article points to specific strategies for describing, explaining, intervening on, and monitoring some of the most substantial alcohol-related disparities. Conclusions outline methods and processes that may be advantageous in addressing these priorities, including the use of longitudinal designs; consideration of life course changes; attention to nontraditional intervention settings; and inclusion of disadvantaged populations in all aspects of research.

Examination of associations between early life victimisation and alcohol's harm from others

INTRODUCTION AND AIMS

Study aims were to examine: (i) how physical and sexual victimisation in early life are associated with alcohol's harm from others; and (ii) whether respondents' current drinking is a mediator of the association between early life victimisation and alcohol's harm from others among men and women.

DESIGN AND METHODS

Data were from national computer-assisted telephone interviews, using the landline sample (3335 men and 3520 women ages ≥18) from the 2010 US National Alcohol Survey. Harms from someone else's drinking included family/marital problems, financial troubles, assault and vandalism in the past 12 months. Victimisation was measured with severe physical abuse or sexual assault before age 18.

RESULTS

Severe physical or sexual victimisation before age 18 was reported by 3.4% of men and 8.1% of women. Significantly more men (5.2%) than women (2.4%) reported assault by other drinkers, and significantly more women reported family/marital (5.3%) and financial problems (2.8%) than did men (2.6 and 1% respectively). Severe early life victimisation was robustly associated with a greater likelihood of experiencing past-year harms from other drinkers for both men and women. Men's drinking partially mediated associations between early life victimisation and recent assaults and vandalism by other drinkers.

DISCUSSION AND CONCLUSIONS

Early life victimisation may increase risk of harms from someone else's drinking. Health services and interventions that screen for histories of victimisation may help decrease risk of later harms from others' drinking. Reductions in drinking among men with histories of victimisation also could help reduce their exposure to such harms. [Kaplan LM, Greenfield TK, Karriker-Jaffe KJ. Examination of associations between early life victimisation and alcohol's harm from others.

Is Personality Associated with Secondhand Harm from Drinking?

BACKGROUND

Prior research suggests more than 70% of undergraduates have experienced harm from other students' drinking. This study built on the literature by, first, investigating whether secondhand harm cluster into latent factors that reflect distinct but related types of harm. Second, given the paucity of research examining factors that increase students' vulnerability to secondhand harm, we examined dimensions from Castellanos-Ryan and Conrod's 4-factor personality model for alcohol disorders (impulsivity [IMP], sensation seeking [SS], hopelessness [HOP], anxiety sensitivity [AS]) as predictors of secondhand harm exposure. We also investigated the possible mediating role of students' own problematic alcohol use in explaining personality-secondhand harm relationships.

METHODS

An online survey was administered to 1,537 first-year Canadian undergraduates (68% women). Problematic alcohol use was measured by the Alcohol Use Disorders Identification Test, and personality was measured by the Substance Use Risk Profile Scale. Eleven secondhand harm items were included.

RESULTS

The secondhand harm clustered into 3 distinct but related factors: "strains" (e.g., interruption of sleep or study), "threats" (e.g., harassment or assault), and "interpersonal harm" (e.g., arguments with peers). Sixty-eight percent of respondents reported strains, 44% threats, and 64% interpersonal harm, and 35% reported experiencing all 3 types of harm, in the last term. All 4 personality dimensions were independently associated with greater secondhand harm exposure. HOP was directly associated with threats and interpersonal harm, and AS was directly associated with all 3 types of harm. SS and IMP were both indirectly associated with all 3 types of harm through students' own problematic alcohol use. In addition, IMP was directly related to threats.

CONCLUSIONS

The prevalence of secondhand harm from alcohol is high among undergraduates. Findings suggest that distinct personality risks may predispose students to experience secondhand harm, albeit perhaps through different mechanisms. Implications for future research, prevention, and policy development are discussed.

Distress and alcohol-related harms from intimates, friends, and strangers

Alcohol's harms to others (AHTO) has gained increased research and policy attention, yet little information is available on different social relationships involved in such harms or consequences of harms perpetrated by various types of drinkers. Using data from the 2014-15 U.S. National Alcohol Survey (N=5,922), we present analyses comparing frequency and impacts of eight past-year harms from other drinkers. In this sample (53% female; 66% White/Caucasian, 13% Black/African American, and 15% other race; 15% Hispanic/Latino of any race; mean age=47 years), 19% reported at least one harm in the prior 12 months, 8% reported more than one harm, 4.9% reported a family perpetrator, 3.5% a spouse perpetrator, 6.1% a friend perpetrator, and 8.1% a stranger perpetrator. Controlling for basic demographics, the number of harms in the past year and harms perpetrated by known others (but not strangers) were significantly associated with recent distress. When comparing specific harms, financial problems due to a family member's or a spouse/partner's drinking each were associated with significantly greater distress, as were feeling threatened or afraid of family members, spouses/partners or friends who had been drinking. These new data shed light on possible intervention points to reduce negative impacts of AHTO in the U.S.

The families and friends of heavy drinkers: Caught in the cross-fire of policy change?

INTRODUCTION AND AIMS

Research highlights the need to better understand the impact of alcohol-related harm on families and communities. Scottish policy initiatives to reduce alcohol consumption and alcohol-related harm include the planned introduction of a minimum unit price for alcohol. We aimed to explore existing and proposed changes in alcohol policy, from the standpoint of heavy drinkers, through accounts of their involvement and repercussions for family and friends.

DESIGN AND METHODS

Interviews were conducted with 20 heavy drinkers, recruited from hospital alcohol treatment centres in Scotland's two largest cities. Participants were part of a larger longitudinal mixed methods study. Interviews explored experiences of alcohol-related harm and the impact, or potential impact, of alcohol policy changes on drinking patterns, risk-taking, consumption and wellbeing. Data coded for 'family and friends' were thematically analysed using a constant comparison method.

RESULTS

Family and friends were portrayed as important for aiding moderation and abstinence, but more often for sustaining continued heavy drinking. Heavy drinkers with complex needs and those living in deprived communities suggested that increased alcohol prices could exacerbate the detrimental effect on their health and social circumstances, and that of their family, should their consumption remain excessive.

DISCUSSION AND CONCLUSIONS

Population level policy initiatives to reduce alcohol consumption, such as minimum unit pricing, will impact on the families and social networks of heavy drinkers in addition to the drinker. The most vulnerable may be affected disproportionately. Alcohol policy changes and evaluations need to consider consequences for drinkers, families and communities. [O'May F, Whittaker A, Black H, Gill J. The families and friends of heavy drinkers: Caught in the cross-fire of policy change? Drug Alcohol Rev 2017;36:192-199].

Harm Experienced from the Heavy Drinking of Family and Friends in the General Population: A Comparative Study of Six Northern European Countries

BACKGROUND

Epidemiological research on alcohol-related harm has long given priority to studies on harm to the drinker. A limitation with this perspective is that it neglects the harm drinking causes to people around the drinker, and thus, it fails to give a full picture of alcohol-related harm in society.

AIM

The aim was to compare the prevalence and correlates of experiencing harm from the heavy drinking by family and friends across the Nordic countries and Scotland and to discuss whether potential differences match levels of drinking, prevalence of binge drinking, and alcohol-related mortality.

DATA AND METHOD

Data from recent national general population surveys with similar questions on experiences of harms from the drinking of family and friends were collected from Sweden, Finland, Denmark, Norway, Iceland, and Scotland.

RESULTS

National estimates of the overall population prevalence of harm from the drinking of family and friends ranged from 14% to 28% across these countries, with the highest prevalence in Finland, Iceland, and Norway and lower estimates for Denmark, Sweden, and Scotland. Across all countries, the prevalence of harm from heavy drinking by family and friends was significantly higher among women and young respondents.

CONCLUSION

This study revealed large differences in the prevalence of harm across the study countries, as well as by gender and age, but the differences do not match the variation in population drinking and other indicators of harm. The implications of the findings for future research are discussed.

Trends in Alcohol's Harms to Others (AHTO) and Co-occurrence of Family-Related AHTO: The Four US National Alcohol Surveys, 2000-2015

Various harms from others' drinking have been studied individually and at single points in time. We conducted a US population 15-year trend analysis and extend prior research by studying associations of depression with combinations of four harms - family/marriage difficulties, financial troubles, assault, and vandalism - attributed to partners or family members. Data come from four National Alcohol Surveys conducted by telephone in 2000, 2005, 2010, and 2015 (analytic sample = 21,184). Weighted logistic regression models estimated time trends adjusting for victim characteristics (gender, age, race/ethnicity, marital status, poverty, employment, family history of alcohol problems, and drinking maximum). The 2015 survey asked the source of the harm; we used similar models to examine characteristics, including anxiety and depression, associated with various combinations of family/marriage, financial, and assault harms due to partner's/spouse's/family members' drinking. A significant upward trend (P <0.001) from 2000 to 2015 was seen for financial troubles but not for other harms due to someone else's drinking. In 2015, depression and/or anxiety were strongly associated with exposures to harms and combinations of harms identified as stemming from drinking spouse/partner and/or family members. The results shed new light on 15-year trends and associations of harms with personal characteristics. A replicated finding is how the victim's own heavy drinking pattern is implicated in risks for exposures to harms from someone else's drinking. Documenting risk factors for and mental health impacts is important for interventions to reduce alcohol's harm to others.