A gender-focused multilevel analysis of how country, regional and individual level factors relate to harm from others' drinking

BACKGROUND

The aim of this study was to examine how gender, age and education, regional prevalence of male and female risky drinking and country-level economic gender equality are associated with harms from other people's drinking.

METHODS

24,823 adults in ten countries were surveyed about harms from drinking by people they know and strangers. Country-level economic gender equality and regional prevalence of risky drinking along with age and gender were entered as independent variables into three-level random intercept models predicting alcohol-related harm.

FINDINGS

At the individual level, younger respondents were consistently more likely to report harms from others' drinking, while, for women, higher education was associated with lower risk of harms from known drinkers but higher risk of harms from strangers. Regional rate of men's risky drinking was associated with known and stranger harm, while regional-level women's risky drinking was associated with harm from strangers. Gender equality was only associated with harms in models in models that did not include risky drinking.

CONCLUSIONS

Youth and regional levels of men's drinking was consistently associated with harm from others attributable to alcohol. Policies that decrease the risky drinking of men would be likely to reduce harms attributable to the drinking of others.

Children, Parental Alcohol Consumption, and Intimate Partner Violence: A Multicountry Analysis by Perpetration Versus Victimization and Sex

Both living with children and alcohol consumption are positively associated with intimate partner violence (IPV). We assessed their combined relationship with physical IPV (P-IPV) victimization and perpetration, and explored possible moderating roles of sex and culture. Data included 15 surveys of 13,716 men and 17,832 women in 14 countries from the GENACIS (Gender, Alcohol, and Culture: An International Study) collaboration. P-IPV was measured as victim of physical aggression by an intimate partner (Vic-Only), perpetrator of physical aggression toward a partner (Perp-Only), or both victim and perpetrator (i.e., bidirectional) (Bi-Dir). Participants reported whether they lived with children below 18 years of age, whether the participant was a drinker/abstainer, and, among drinkers, usual frequency and quantity of alcohol consumed. Multilevel multinomial logistic regression, controlling for age and nesting of data within countries, indicated that Vic-Only, Perp-Only, and Bi-Dir (compared with no P-IPV) were positively associated with living with children, being a drinker, and quantity/frequency of drinking among drinkers (especially higher quantity). The positive association of P-IPV with living with children and being a drinker was evident within most countries. Significant interactions with sex were found, with (a) living with children more strongly associated with Perp-Only for men and Vic-Only for women, and (b) Perp-Only and Bi-Dir more strongly associated with being a drinker for men but with quantity consumed for women. Also, alcohol consumption was more strongly related to Perp-Only and Bi-Dir than with Vic-Only. In conclusion, higher risk of P-IPV with alcohol consumption is compounded when living with children-putting children who live with drinkers, especially drinkers who consume large amounts per occasion, at special risk of exposure to P-IPV. This is an important area for future research and prevention.

Do relationships provide the same levels of protection against heavy drinking for lesbian and bisexual women? An intersectional approach

PURPOSE

Sexual minority women (SMW; e.g., lesbian, bisexual) are more likely than heterosexual women to be heavy drinkers, with bisexual women showing the highest risk. There is ample literature demonstrating that intimate relationships protect against stress-related health risk behaviors in the general population. However, very little research has focused on SMW's relationships and far less is known about the relationships of SMW of color. Using intersectionality theory as our framework, we tested two competing models to determine whether the effects of minority sexual identity (lesbian, bisexual) and race/ethnicity (African American, Latinx, White) are: 1) additive, or 2) multiplicative in the associations between relationship status and heavy drinking.

METHODS

Data are from a diverse sample of cisgender sexual minority women (N = 641) interviewed in Wave 3 of the CHLEW study, a 20-year longitudinal study of SMW's health.

RESULTS

Findings from two- and three-way interactions provide mixed evidence for both the additive and multiplicative hypotheses; support for each varied by sexual identity and race/ethnicity. Overall, we found that Latinx SMW, particularly single and bisexual Latinx SMW report the highest rates of heavy drinking compared to their cohabiting and lesbian counterparts, respectively. African American single SMW reported significantly higher rates of heavy drinking compared to their cohabiting counterparts.

CONCLUSION

Our findings suggest that the protective qualities of SMW's intimate relationships vary based on sexual identity and race/ethnicity-and the intersections between them. These results highlight that research among SMW that does not take into account multiple marginalized identities may obscure differences.

PUBLIC SIGNIFICANCE

Little research has focused on health within sexual minority women's relationships, particularly among sexual minority women of color. Given the potential additive or multiplicative effects of multiple sources of oppression such as heterosexism, racism, and sexism, understanding the potential protective effects of relationships is important. Our findings demonstrate that the protective qualities of intimate relationships among SMW vary based on sexual identity and race/ethnicity - and the intersections between them.

Cross-sectional surveys of financial harm associated with others' drinking in 15 countries: Unequal effects on women?

INTRODUCTION AND AIMS

That physical, emotional and social problems occur not only to drinkers, but also to others they connect with, is increasingly acknowledged. Financial harms from others' drinking have been seldom studied at the population level, particularly in low- and middle-income countries. Whether financial harm and costs from others' drinking inequitably affect women is little known. The study's aim is to compare estimates and correlates of alcohol's financial harm to others than the drinker in 15 countries.

METHODS AND MATERIALS

Cross-sectional surveys of Alcohol's Harm To Others (AHTO) were conducted in Australia, Brazil, Chile, Denmark, India, Ireland, Lao PDR, New Zealand, Nigeria, Sri Lanka, Sweden, Switzerland, Thailand, the US and Vietnam.

PARTICIPANTS

17,670 men and 20,947 women.

MEASUREMENT

The prevalence of financial harm in the last year was assessed as financial trouble and/or less money available for household expenses because of someone else's drinking.

ANALYSIS

Meta-analysis and country-level logistic regression of financial harm (vs. none), adjusted for gender, age, education, rurality and participant drinking.

RESULTS

Under 3.2 % of respondents in most high-income countries reported financial harm due to others' drinking, whereas 12-22 % did in Thailand, Sri Lanka and India. Financial harm from others' drinking was significantly more common among women than men in nine countries. Among men and women, financial harm was significantly more prevalent in low- and middle- than in high-income countries.

CONCLUSIONS

Reports of financial harm from others' drinking are more common among women than among men, and in low- and middle-income than in high-income countries.

Cross-National Comparisons and Correlates of Harms From the Drinking of People With Whom You Work

BACKGROUND

While research in high-income countries (HICs) has established high costs associated with alcohol's harm to others (AHTO) in the workplace, scant attention has been paid to AHTO in the workplace in lower- or middle-income countries (LMICs).

AIM

To compare estimates and predictors of alcohol's impacts upon coworkers among workers in 12 countries.

METHODS

Cross-sectional surveys from 9,693 men and 8,606 women employed in Switzerland, Australia, the United States, Ireland, New Zealand, Chile, Nigeria, Lao PDR, Thailand, Vietnam, India, and Sri Lanka. Five questions were asked about harms in the past year because of coworkers' drinking: Had they (i) covered for another worker; (ii) worked extra hours; (iii) been involved in an accident or close call; or had their (iv) own productivity been reduced; or (v) ability to do their job been affected? Logistic regression and meta-analyses were estimated with 1 or more harms (vs. none) as the dependent variable, adjusting for age, sex, rurality of location, and the respondent worker's own drinking.

RESULTS

Between 1% (New Zealand) and 16% (Thailand) of workers reported that they had been adversely affected by a coworker's drinking in the previous year (with most countries in the 6 to 13% range). Smaller percentages (<1% to 12%) reported being in an accident or close call due to others' drinking. Employed men were more likely to report harm from coworkers' drinking than employed women in all countries apart from the United States, New Zealand, and Vietnam, and own drinking pattern was associated with increased harm in 5 countries. Harms were distributed fairly equally across age and geographic regions. Harm from coworkers' drinking was less prevalent among men in HICs compared with LMICs.

CONCLUSIONS

Workforce impairment because of drinking extends beyond the drinker in a range of countries and impacts productivity and economic development, particularly affecting men in LMICs.

Children's experience of physical harms and exposure to family violence from others' drinking in nine societies

AIM

To study caregiver reports of children's experience of physical harm and exposure to family violence due to others' drinking in nine societies, assess the relationship of harm with household drinking pattern and evaluate whether gender and education of caregiver affect these relationships.

METHOD

Using data on adult caregivers from the GENAHTO (Gender and Alcohol's Harm to Others) project, child alcohol-related injuries and exposure of children to alcohol-related violence (CAIV) rates are estimated by country and pooled using meta-analysis and stratified by gender of the caregiver. Households with and without heavy or harmful drinker(s) (HHD) are compared assessing the interaction of caregiver gender on the relationship between reporting HHD and CAIV, adjusting for caregiver education and age. Additionally, the relationship between caregiver education and CAIV is analysed with meta-regression.

RESULTS

The prevalence of CAIV varied across societies, with an overall pooled mean of 4% reported by caregivers. HHD was a consistent correlate of CAIV in all countries. Men and women in the sample reported similar levels of CAIV overall, but the relationship between HHD and CAIV was greater for women than for men, especially if the HHD was the most harmful drinker. Education was not significantly associated with CAIV.

CONCLUSION

One in 25 caregivers with children report physical or family violence harms to children because of others' drinking. The adjusted odds of harm are significantly greater (more than four-fold) in households with a heavy or harmful drinker, with men most likely to be defined as this drinker in the household.

A Multilevel Analysis of Regional and Gender Differences in the Drinking Behavior of 23 Countries

Introduction: Drinking behavior differs not only among countries, but also among regions within a country. However, the extent of such variation and the interplay between gender and regional differences in drinking have not been explored and are addressed in this study. Methods: Data stem from 105,061 individuals from 23 countries of the GENACIS data set. The outcomes were heavy drinking (10/20 g or more of pure ethanol per day for women/men), and risky single occasion drinking (RSOD) (5+ drinks per occasion) at least monthly. Analyses used binary logistic mixed models. Variance at specific levels was measured by the intra-class correlation coefficient (ICC). Gender differences in outcomes were measured using gender ratios. Results: Country-level ICC was 0.13 (95% CI: 0.09-0.18) for heavy drinking and 0.16 (95% CI: 0.10-0.26) for RSOD. Within-country regional-level ICC for heavy drinking and RSOD was 0.02 (95% CI: 0.009-0.05; 0.01-0.04, respectively), implying that 2% of variation in heavy drinking and RSOD was explained by regional variation. Variance in drinking indicators was larger for women compared to men across countries. Gender ratios were higher in low- and middle-income countries. Conclusions: Regional variations in risky drinking were more often present in low- to middle-income countries as well as in a few higher-income countries, and could be due to cultural and demographic differences. Variations in gender differences were larger on the country level than on the regional level, with lower-income countries showing larger differences. These results can help to better identify specific high-risk groups for prevention strategies.

International differences in alcohol use according to sexual orientation

Most research on sexual orientation and alcohol use in the United States has found higher rates of alcohol use and abuse among gay men and lesbians. Studies from other countries have found smaller or no differences between sexual minority and heterosexual women and men. The present study used general population survey data from 14 countries to examine high-volume and risky single-occasion drinking by sexual orientation. Data from 248 gay men and lesbians and 3720 heterosexuals were analyzed in a case-control design. In several countries partnered or recently partnered gay men and lesbians had no greater risk of heavy drinking or engaging in heavy drinking than heterosexual controls. Only lesbians in North America showed higher risk for both indicators. Future general population health research should include larger samples of gays and lesbians and use more comprehensive measures of sexual orientation for investigating the prevalence of health risk factors.

Cohabitation, gender, and alcohol consumption in 19 countries: a multilevel analysis

We used an ecological paradigm and multilevel analytic techniques to analyze gender-specific relationships of cohabitation (versus marriage) to drinking in 19 countries (n = 32,922) and to "heavy episodic drinking" (HED) in 17 countries (n = 24,525) in surveys (1996-2004) from Gender, Alcohol, and Culture: An International Study. Cohabitation was associated with elevated risk of HED among drinkers of both genders, controlling for age, education, and societal characteristics. The association between cohabitation and HED tended to be stronger for female drinkers than for male drinkers. HED was more prevalent among younger drinkers, especially among younger women in countries with higher per capita gross domestic product. Cross-culturally, cohabiters deserve special attention in prevention efforts for hazardous drinking, considering both individual-level and societal factors.

Introduction to special issue 'Gender, Culture and Alcohol Problems: a Multi-national Study'

This paper provides an introduction to a series of articles reporting results from the EU concerted action "Gender, Culture and Alcohol Problems: A Multi-national Study" which examined differences in drinking among women and men in 13 European and two non-European countries. The gender gap in alcohol drinking is one of the few universal gender differences in human social behavior. However, the size of these differences varies greatly from one society to another. The papers in this issue examine, across countries, (1) men's and women's drinking patterns, (2) the prevalence of men's and women's experience of alcohol-related problems, (3) gender differences in social inequalities in alcohol use and abuse, (4) gender differences in the influence of combinations of social roles on heavy alcohol use, and (5) how societal-level factors predict women's and men's alcohol use and problems on a regional and global level. Country surveys were independently conducted and then centralized at one institution for further data standardization and processing. Several results indicated that the greater the societal gender equality in a country, the smaller the gender differences in drinking behavior. In most analyses the smallest gender differences in drinking behaviour were found in Nordic countries, followed by western and central European countries, with the largest gender differences in countries with developing economies.