Harm from others’ drinking-related aggression, violence and misconduct in five Asian countries and the implications

National and regional prevalence of interpersonal violence from others' alcohol use: a systematic review and modelling study

Background

While alcohol use is an established risk factor for interpersonal violence, the extent to which people are affected by interpersonal violence from others' drinking has not yet been quantified for different world regions. This modelling study aims to provide the first estimates of the national and regional prevalence of interpersonal violence from others' drinking.

Methods

An international systematic literature search (02/28/2023, Prospero: CRD42022337364) was conducted to identify general adult population studies assessing the prevalence of interpersonal violence from others' drinking with no restrictions to publication date or language. Reports that did not provide data on interpersonal violence from others' drinking (primary outcome), were no original research studies, or captured a selected group of people only, were excluded. Observed prevalence data were extracted and used to build fractional response regression models to predict past-year prevalence of emotional and physical violence from others' drinking in 2019. Random-effects meta-regression models were used to aggregate the observed prevalence of sexual and intimate partner violence. Study risk of bias (ROB) was assessed using a modified version of the Newcastle-Ottawa Scale.

Findings

Out of 13,835 identified reports, 50 were included covering just under 830,000 individuals (women: 347,112; men: 322,331; men/women combined: 160,057) from 61 countries. With an average prevalence of 16·8% (95% CI: 15·2-18·3%) and 28·3% (95% CI: 23·9-32·4%) in men and women combined in the GBD super regions High Income and Central Europe, Eastern Europe, & Central Asia, respectively, emotional violence was the most common form of interpersonal violence from others' drinking. Physical violence averaged around 3% (women) and 5% (men) in both regions. The pooled prevalence of sexual violence from others' drinking in men and women was 1·3% (95% CI: 0·5-3·3%, 95% PI: 0·1-16·9%) and 3·4% (95% CI: 1·4-8·3%, 95% PI: 0·2-35·3%), respectively, and ranged between 0·4% (95% CI: 0·1-1·6%, 95% PI: 0·0-7·3%) and 2·7% (95% CI: 1·1-6·3%, 95% PI: 0·2-30·0%) for different forms of intimate partner violence. ROB was moderate or critical for most reports; accounting for critical ROB did not substantially alter our results.

Interpretation

The share of the population experiencing harms from others' drinking is significant and should be an integral part of public health strategies.

Funding

Research reported in this publication was supported by the Canadian Institutes of Health Research (CIHR; grant: CIHR FRN 477887).

Can alcohol policy prevent harms to women and children from men's alcohol consumption? An overview of existing literature and suggested ways forward

The World Health Organization's list of cost-effective alcohol control policies is a widely-used resource that highlights strategies to address alcohol-related harms. However, there is more evidence on how recommended policies impact harms to people who drink alcohol-such as physical health problems caused by heavy alcohol use-than on secondhand harms inflicted on someone other than the person drinking alcohol, i.e., alcohol's harms to others. In this essay, we describe evidence of impacts of alcohol policy on harms to women and children resulting from men's alcohol consumption, as well as options for making policies more relevant for reducing intimate partner violence and child abuse. We begin with an overview of harms to women and children resulting from men's alcohol consumption and review cost-effective alcohol policies with potential to reduce these harms based on likely mechanisms of action. Next, we present a rapid review of reviews to describe existing evidence of impacts of these policies on the outcomes of physical violence, sexual violence, and child abuse and neglect. We found little evidence of systematic evaluation of impacts of these important alcohol policies on harms to women and children. Thus, we advocate for increased attention in evaluation research to the impacts of alcohol policies on harms experienced by women and children who are exposed to men who drink alcohol. We also argue for more consideration of a broader range of policies and interventions to reduce these specific types of harm. Finally, we present a conceptual model illustrating how alcohol policies may be supplemented with other interventions specifically tailored to reduce alcohol-related harms commonly experienced by women and children as a result of men's alcohol use.

Alcohol and Public Health: Failure and Opportunity

Policy Points Public health science regarding alcohol consumption and problems, alcohol's role in equity and social justice, and identification of effective policy interventions has grown steadily stronger in the past 30 years. Progress on effective alcohol policies has stalled or gone backward in the United States and much of the world. Because alcohol influences at least 14 of the 17 sustainable development goals, as well as more than 200 disease and injury conditions, reducing alcohol problems should offer a platform for collaboration across public health silos but will require that public health itself respect and follow its own science.

Alcohol's harm to others in Japan: Different rates for different relationships to the drinker in a 2018 national survey

INTRODUCTION

No study in Japan has investigated alcohol's harm to others (AHTO). Therefore, this study aimed to reveal the situation of AHTO in Japan and examine the factors associated with it based on the relationship with the drinker.

METHODS

A cross-sectional population-based survey was performed in 2018 with 2121 men and 2507 women. Respondents were asked questions about factors such as verbal or physical aggression, being forced to drink alcohol, sexual harassment and their relationship with the drinker. Binomial logistic regression was performed to quantify the associations of AHTO with participants' socio-demographic status and drinking patterns.

RESULTS

The lifetime experience of AHTO was 24.7% for men and 19.3% for women. AHTO from the father and co-workers were the most common in and outside the home, respectively. The frequency of AHTO from the spouse or co-workers showed no significant difference for abstainers and drinkers. However, AHTO from the father was more commonly reported among drinkers and those with Alcohol Use Disorders Identification Test scores ≥8 points than abstainers. Of those who experienced AHTO, 24.5% of men and 27.6% of women, and 6.1% of men and 12.9% of women were profoundly affected by it in and outside the home, respectively.

DISCUSSION AND CONCLUSIONS

One in five Japanese residents experienced AHTO in their life, and the characteristics associated with AHTO differed according to the affected individual's relationship with the drinker. Continued monitoring of AHTO and measures aimed at reducing alcohol-related harm that include AHTO should be promoted.

Inter-ethnic differences in self-reported alcohol-related harm to children in Han vs. Yi ethnic minority households in Yunnan Province, China

China is a multi-ethnic country, but inter-ethnic disparities in alcohol-related harm to children have not been described. In this study, we assessed differences in prevalence of self-reported alcohol-related harm to children in Yi and Han households in Chuxiong Yi Prefecture, Yunnan Province, China. We conducted a cross-sectional study among caregivers in households with a child age less than 18 years using structured questionnaire interview. Participants included 241 Yi caregivers and 610 Han caregivers (overall refusal rate = 1.1%). Heavy drinking was more common in Yi households than Han households (41.9% vs. 30.8%, respectively), but there was no difference in alcohol-related harm to children (21.2% vs. 17.9%; Adjusted OR = 0.98; 95% CI = 0.65, 1.46). Caveats such as social desirability in reporting sensitive issues and the cross-sectional study design should be considered in the interpretation of the study findings.

Prevalence of Alcohol-Related Harms in Yi and Han Ethnic Groups in a Prefecture in Yunnan Province, China

BACKGROUND

Although differences in the prevalence of alcohol-related harm between ethnic minority and majority groups have been reported in many countries, such data are scarce in China. The findings of such assessment can provide empirical data to inform stakeholders in prioritization and allocation of resources for programs to manage and control alcohol-related problems. The objective of this study is to compare the prevalence of alcohol-related harm from others among Han and Yi populations in the Chuxiong Yi Autonomous Prefecture, Yunnan Province, China.

METHOD

We conducted a cross-sectional study in 1370 households from 21 villages. Enumerators used convenient sampling to recruit one person aged 18 years or older from each selected household, obtained informed consent to participate, and conducted an interview using a structured questionnaire. The questionnaire included three parts: (1) demographic characteristics of the participant (including ethnic identity); (2) history of alcohol-related harm from other in the past 12 months, and; (3) drinking behaviors. We analyzed data using descriptive statistics and multivariate regression analyses, stratified by sex of the participant.

RESULTS

The prevalence of experiencing alcohol-related harm from others in Han men, Yi men, Han females, and Yi females, were 69.9%, 62.1%, 75.3%, and 63.4%, respectively. The Han vs. Yi disparity was higher among females (Adjusted OR = 2.06; 95% CI = 1.41, 3.01) than males (Adjusted OR = 1.47; 95% CI = 1.05, 2.07). The most common type of harm was feeling scared or threatened (36.9% among males, 32.4% among females) and the least common type was financial difficulty (3% among males, and 3.3% among females).

CONCLUSIONS

Yi ethnic minorities in Yunnan Province had lower prevalence of alcohol-related harm from others than Han persons in the same region. However, measurement and translation-related issues of the study instrument and limited generalizability should be considered as caveats in the interpretation of the study findings.

The effects of others' drinking on the harms to children in Thailand: Lessons from the WHO-ThaiHealth project

BACKGROUND

Many knowledge gaps exist in the area of alcohol-related harms in children research such as the potential impact of other's drinking and their social demography. Thus, this study aims to evaluate the effects of characteristics of household members and others' alcohol drinking on harms to children in Thailand.

DATA AND METHODS

This study examined 952 parents caring for children and adolescents under 18 years of age, using the questionnaire (i.e., The Harm to Others from Drinking under the WHO/ThaiHealth International Collaboration Research Project). They were interviewed between September 2012 and March 2013.

RESULTS

The study found that 15.89% of children and young people were affected by someone's drinking in at least one category of harms. People over 60 years of age were less likely to cause alcohol-related harm to children than those aged 18 to 29 (adjusted odds ratio [AOR] 0.19, 95% confidence interval [Cl]: 0.06-0.58). Households with a binge drinker or regular drinker (≥1 time/week) were more likely to have children at higher risk of suffering alcohol-related harm in comparison to households without alcohol drinker (AOR 4.75 and 1.92, respectively).

CONCLUSION

This study found that children whose family members are young adult or consume alcohol (i.e., weekly drinker or binge drinker) were significantly adversely affected. The most common problems were domestic violence and verbal abuse. Most of the problems, affecting children, were caused mostly by their parents.

Country-Level Heavy Episodic Drinking and Individual-Level Experiences of Harm from Others' Drinking-Related Aggression in 19 European Countries

INTRODUCTION

There is limited knowledge about how individual experiences of harm from others' drinking are influenced by heavy episodic drinking (HED) at the country level. The present study aimed to assess (1) the association between the country-level prevalence of HED and the risk of experiencing harm from others' drinking-related aggression and (2) if HED at the country level modifies the association between consumption of alcohol per capita (APC) and such harm.

METHODS

Outcome data from 32,576 participants from 19 European countries stem from the RARHA SEAS study. Self-reported harm from others' drinking included having been verbally abused, harmed physically, or having serious arguments. Data on country-level drinking patterns were derived from the World Health Organization. Associations between country-level prevalence of monthly HED and experiences of aggression (at least 1 of 3 studied harms) were derived through multilevel models - adjusted for country-level age structure and by including the respondent's own HED patterns as a mediator.

RESULTS

A 1% increase in the prevalence of monthly HED was associated with 5% higher odds (odds ratio [OR] 1.05) of experiencing others' alcohol-related aggression among men, and 6% (OR 1.06) among women. The results suggest that the association between APC and harm was stronger in countries with high prevalences of HED, but the modifying effect could not be confirmed.

DISCUSSION/CONCLUSION

Harm from others' drinking-related aggression depends not only on individual factors but is also influenced by the drinking patterns of the population. However, the country-level prevalence of HED only explains a small part of the variance of this type of harm.

First- and second-hand alcohol-related harms among urban Chinese: A population-based study from Hong Kong

INTRODUCTION

Alcohol consumption has been steadily increasing in East Asia, however, there is comparatively little regional data of alcohol-related harms. This study examines the alcohol-related harms prevalence and risk factors in Hong Kong, a high population density city with limited alcohol regulation.

METHODS

A cross-sectional telephone survey was conducted in 2019 on Chinese adults aged 18-74 (n = 3200). Respondents were asked about various past-year first-hand drinking harms (after one's own drinking), second-hand harms (harms from other people's drinking) and views of neighbourhood alcohol outlet regulation.

RESULTS

Of drinkers, 21.1% reported first-hand alcohol harms, with physical/mental health harms (15.7%) most commonly reported. Younger-aged drinkers (adjusted odds ratios [AOR] 2.64, 95% confidence interval [CI] 1.63, 4.48) and heavy drinkers (AOR 2.34, 95% CI 1.55, 3.55) were more likely to report first-hand harms. Of the sample, 18.2% experienced past-year second-hand harms, with public harms (12.9%) most commonly reported. Young age (AOR 1.88, 95% CI 1.43, 2.49), higher education (AOR 1.44, 95% CI 1.13, 1.83), past-year binge drinking (AOR 4.29, 95% CI 3.04, 6.05) and communal living (AOR 2.04, 95% CI 1.13, 3.75) predicted greater likelihood of second-hand alcohol harms. Higher neighbourhood alcohol outlet density was not associated with any first-hand harms and only significantly predicted being inconvenienced by drinkers. Although victims of second-hand alcohol harms were more supportive of regulating outlet density, 93.3% of respondents were opposed to such policies.

DISCUSSION AND CONCLUSIONS

Although high levels of alcohol-related harms were not reported by Hong Kong adults, regulations should target young drinkers and binge drinkers who are most likely to experience drinking-related harms.

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.

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.

Recent advances in genetics of aggressive behavior

One of the most important problems of modern neurobiology and medicine is an understanding of the mechanisms of normal and pathological behavior of a person. Aggressive behavior is an integral part of the human psyche. However, environmental risk factors, mental illness and somatic diseases can lead to increased aggression to be the biological basis of antisocial behavior in a human society. An important role in development of aggressive behavior belongs to the hereditary factors that may be linked to abnormal functioning of neurotransmitter systems in the brain yet the underlying genetic mechanisms remain unclear, which is due to a large number of single nucleotide polymorphisms, insertions and deletions in the structure of genes that encode the components of the neurotransmitter systems. The most studied candidate genes for aggressive behavior are serotonergic (TPH1, TPH2, HTR2A, SLC6A4) and dopaminergic (DRD4, SLC6A3) system genes, as well as the serotonin or catecholamine metabolizing enzyme genes (COMT, MAOA). In addition, there is evidence that the hypothalamic-pituitary system genes (OXT, OXTR, AVPR1A, AVPR1B), the sex hormone receptors genes (ER1, AR), neurotrophin (BDNF) and neuronal apoptosis genes (CASP3, BAX) may also be involved in development of aggressive behavior. The results of Genome-Wide Association Studies (GWAS) have demonstrated that FYN, LRRTM4, NTM, CDH13, DYRK1A and other genes are involved in regulation of aggressive behavior. These and other evidence suggest that genetic predisposition to aggressive behavior may be a very complex process.