Collective efficacy, alcohol outlet density, and young men's alcohol use in rural South Africa

Alcohol Use as a Predictor of Risky Sexual Behaviour among Young Adults in the Western Cape Province of South Africa

The aim of this study was to investigate the relation between alcohol consumption and risky sexual behaviour (RSB). This study further aimed to examine whether alcohol use, gender, and employment status predicted RSB among young adults in the Cape Flats. A better understanding of these predictors could potentially lead to a more thorough comprehension of the relation between alcohol consumption and RSB among young adults within the South African context. The study employed a cross-sectional correlational survey design, with a sample of 1001 participants aged 18 to 25 (51% women), using the street-intercept method. Participants were selected using purposive sampling, with age and geographical location employed as inclusion criteria. We used the Self-Report Risky Sexual Behaviours Scale (SRSBS) and the Alcohol Use Disorder Identification Test (AUDIT), which were cognitively tested and modified, in English and Afrikaans. The data were analysed via multivariate multiple regression analysis in Stata. The key findings indicate that alcohol consumption is an important predictor of RSB. Alcohol consumption accounted for 23.22% of the variation in RSB. We also found that alcohol consumption and gender were significant (p < 0.1) predictors of RSB, but not employment status (p > 0.01). Being a woman decreased RSB. The model indicates that alcohol use and gender explain 18.41% of the variance in RSB. This study provides support for the growing body of research evidence that has established a significant link between alcohol consumption and RSB, highlighting the need for longitudinal research to determine patterns of risky drinking in the general population.

Spatial Analysis of the Alcohol, Intimate Partner Violence, and HIV Syndemic Among Women in South Africa

The co-occurrence of and synergistic interactions between substance abuse, violence, and HIV, known as the "SAVA syndemic," is thought to be a driver of women's elevated risk for HIV in sub-Saharan Africa. This study uses data from the 2016 South African Demographic and Health Survey (DHS) and the 2016 South African Census to examine geospatial associations between alcohol use, intimate partner violence (IPV), unprotected sex, and HIV status among a population-based sample of 8528 South African women (age 15-49). Results support the geographic clustering of alcohol use, unprotected sex, and IPV, but not HIV, and geospatial clustering of HIV alone. This study highlights the need for geographically-tailored interventions to address syndemics through integrated interventions, such as those simultaneously focused on alcohol, IPV, and sexual risk reduction, and points to the need for more targeted research to link these factors to HIV from a place-based risk perspective.

Partnership preferences, economic drivers, and health consequences of Gambian men's interactions with foreign tourists: A mixed methods study

The Gambia has a thriving tourist industry, but in recent decades has developed a reputation as a destination for older, female tourists to seek sexual relationships with young Gambian men. During partnerships or in return for sex, Gambian men may receive financial support or in some cases the opportunity to travel to Europe with a partner. There has been little previous research among these men on sexual risk behaviours, physical and mental health, and health service utilisation. This study describes the economic drivers and health implications of interactions between Gambian men and foreign tourists near tourist resorts in The Gambia. We conducted simultaneous mixed method data collection among Gambian men who regularly interact with tourists: a cross-sectional quantitative survey and discrete choice experiment (DCE) with 242 respondents, three focus group discussions, and 17 in-depth interviews. The survey asked questions on demographic characteristics, sexual history and health-seeking, the DCE elicited trade-offs between partnership characteristics, and qualitative data explored individual and group experiences in depth. We found that sexual activity between Gambian men and tourists was prevalent with 50% of the sample reporting ever having sex with a tourist. Condom use at last sex was significantly higher with tourist (63%) than with Gambian partners (40%, p<0.01). Condom use, money, and opportunity to travel to Europe were most important to respondents in the DCE. Qualitative data validated and explained quantitative findings, notably pressures to engage in unprotected sex and potential travel to Europe. Although men's physical health needs were broadly met, mental health, substance use and sexual health needs were not. Young men working on the beaches of The Gambia face substantial health risks, including from STIs and mental health issues. The health system needs to understand barriers to existing health services, and how they can meet the needs of these vulnerable men.

Alcohol brings burdens: A global and continent wise study on alcohol consumption and global burden of diseases

This article investigates alcohol consumption attributable burden of diseases. The present study considers the overall effect of Human Development Index (HDI), Socio Demographic Index (SDI) and Gross Domestic Product (GDP) for income to measure how these variables impact Global Burden of Diseases (GDB), bringing a different perspective to the results. Data from over 177 countries mainly including European, Asian, North American, South American, African and Australian regions were analysed from 2000 to 2019. A Panel regression technique was applied, and Fixed Effects (FE) and Random Effects (RE) estimations were chosen to derive outcomes of the Hausman test. The findings reflected that alcohol consumption (wine, beer, spirit and other alcohol) has a positive significant relationship with the Global Burden of Diseases (GBD) globally and in the African continent excluding North America and South America. Human Development Index (HDI) have a negative impact on GBD on all countries. Particularly HDI have a negative impact on GBD in African continent except other continents. Also, in the African continent and globally, GBD has a significant positive and in Europe, a significant negative impact on the Socio Demographic Index (SDI). The findings demonstrate the overall picture of the impact of alcohol consumption and other variables on GBD and provide suggestions on how these variables should be tackled in the future to reduce GBD. This is the initial empirical study that investigates the impact of alcohol consumption, analysing the combined effect of HDI, SDI and income on the GBD of continent wise and globally.

'There is nowhere to take the child': a qualitative study of community members' views on managing early childhood substance use in Mbale, Uganda

Background

Harmful alcohol use by 5–8-year-old children has been identified in Mbale District, Uganda. To further examine this finding, the present study explores the experiences and perceptions of community members regarding how childhood substance use (before age 10) is managed in this area.

Methods

We conducted eight focus group discussions with 48 parents of children aged < 10 years and 26 key informant interviews with teachers, health workers, child protection workers, police, local stakeholders, brewers, and others. Thematic content analysis was performed.

Results

Three main themes were identified:

‘We don’t talk about it’: Despite concern, childhood substance use was not addressed in the community. Participants attributed this to three main factors related to a lack of leadership in addressing it, changing acceptability for peer parental interference, and uncertainty about repercussions related to children’s rights.

‘There is nowhere to take the child’: Schools, police, and remand homes were intuitively considered appropriate arenas for managing childhood substance use but were considered inaccessible, unresponsive, and inadequate due to insufficient resources, competence, and training. Since substance use was not considered a medical problem, help from the health sector was only sought for adverse consequences, such as injury. This left the participants with the experience that there was in effect nowhere to take the child.

‘The government has not done so much’: The participants called for government action and clear laws that would regulate the availability of alcohol and other substances to children, but they had limited trust in the capacity and commitment of the government to act.

Conclusions

The participants were concerned about childhood alcohol and substance use, but the complexity and magnitude of the problem left them feeling incapacitated in responding. Relevant factors were identified on the community, institutional, and the government level, such as a lack of leadership in addressing it, a loss of mandate to interfere in child-rearing, inadequate services, weak legal structures, and missing government action. A strengthening of collective agency and public policy is necessary to prevent and address childhood alcohol and substance use.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13548-4.

Association of Neighborhood Alcohol Environment With Alcohol Intake and Cardiovascular Risk Factors in India: Cross-Sectional Evidence From APCAPS

There are more and more proofs about the impact of neighborhood alcohol environment on alcohol-associated events. The relationship between the neighborhood availability and accessibility of alcohol outlet with individual level of alcohol consumption along with 11 cardiovascular risk factors was explored for the first time in India using data from the 3rd follow-up of the Andhra Pradesh children and parents study (APCAPS) (n = 6156, for liquor intake and 5,641 for heart and blood vessel risk elements). In fully adjusted models, volunteers in the lowest tertile performed worse than volunteers in the highest tertile of distance to the closest alcohol outlet were more probably to exhibit less alcohol consumption (-14.40 g/day, 95% CI: -26.21, -2.59). A unit per km2 rise in alcohol outlet density in 400 m buffering area was related to a rise in waist circumference (1.45 mm, 95% CI: 0.13, 2.77), SBP (0.29 mmHg, 95% CI: 0.09, 0.49), and DBP (0.19 mmHg, 95% CI: 0.03, 0.35). A unit per 100 m rise in distance to the closest alcohol outlet was related to a rise in waist circumference (-2.39 mm, 95% CI: -4.18, -0.59), SBP (-0.41 mmHg, 95% CI: -0.68, -0.15), and DBP (-0.29 mmHg, 95% CI: -0.51, -0.07). Neighborhood availability of alcohol outlets within immediate locality of participants' households had a closer relationship with cardiovascular risk factors than that within the whole village. Public health policies designed to limit neighborhood availability and accessibility of alcohol outlets ought to be advocated in southern India.

'As soon as they can hold a glass, they begin taking alcohol': a qualitative study on early childhood substance use in Mbale District, Uganda

Background

Globally, substance use is a leading contributor to the burden of disease among young people, with far reaching social, economic and health effects. Following a finding of harmful alcohol use among 5-8-year-old children in Mbale District, Uganda, this study aims to investigate community members’ views on early childhood substance use among children below the age of 10 years.

Methods

In 2016, we conducted eight focus group discussions with 48 parents and 26 key informant interviews with teachers, health workers, alcohol distributors, traditional healers, religious leaders, community leaders and youth workers. We used thematic content analysis. Four participants and two research assistants reviewed and confirmed the findings.

Results

Alcohol in everyday life: ‘Even children on laps taste alcohol’: Almost all participants confirmed the existence of and concern for substance use before age 10. They described a context where substance use was widespread in the community, especially intake of local alcoholic brews. Children would access substances in the home or buy it themselves. Those living in poor neighbourhoods or slums and children of brewers were described as particularly exposed.

Using substances to cope: ‘We don’t want them to drink’: Participants explained that some used substances to cope with a lack of food and resources for childcare, as well as traumatic experiences. This made children in deprived families and street-connected children especially vulnerable to substance use. Participants believed this was a result of seeing no alternative solution.

Conclusions

To our knowledge, this is the first study to describe the context and conditions of childhood substance use before age 10 in Mbale District, Uganda. The study shows that community members attributed early childhood substance use to a social context of widespread use in the community, which was exacerbated by conditions of material and emotional deprivation. These social determinants for this practice deserve public health attention and intervention.

Youths' Perceptions Of The Relation Between Alcohol Consumption And Risky Sexual Behaviour in the Western Cape, South Africa: A Qualitative Study

The purpose of this study is to explore the factors that youth identify as contributing to alcohol consumption, and more specifically its relation to risky sexual behaviour among youth. We employed an exploratory qualitative method using focus group discussions with 34 young people between the ages of 18-25-years-old in low socio-economic status communities in the Western Cape province of South Africa. Data were analyzed thematically utilizing Braun and Clarke's (2006) six-step thematic analysis process. We identified two thematic domains pertaining to alcohol consumption and risky sexual behaviour, namely individual and social factors, each comprising three themes. The individual factors thematic domain comprises intrapersonal influences, employment and educational attainment; while the social factors thematic domain includes interpersonal influences, social influences, and hope for the future. Youth living in low socio-economic status communities were thought to be at greater risk of alcohol misuse and subsequent risky behaviour, given the political and social history of marginalisation, systematic oppression, and social inequality. To address alcohol use and risky sexual behavior among youth, we recommend interventions with adolescents, parents or guardians, and the community. More specifically, interventions aimed at adolescents should focus on the transition to young adulthood. Interventions with parents should focus on their role in modelling and potentially regulating alcohol consumption. Finally, community interventions should centre on drinking behaviors, levels of drinking, what constitutes harmful drinking, and how to identify when treatment and recovery support is likely to be required.

Rural Child Maltreatment: A Scoping Literature Review

TOPIC OF REVIEW

The current study sought to review the state of existing knowledge on rural maltreatment.

METHOD OF REVIEW

We conducted a scoping literature review to answer two research questions: (1) Is maltreatment higher in rural areas compared to urban areas? and 2) Are there unique correlates of maltreatment in rural areas?

NUMBER OF RESEARCH STUDIES MEETING THE CRITERIA FOR REVIEW

This review included studies that compared child maltreatment in rural and urban areas in the United States (9) and predictors of maltreatment in rural areas (7).

CRITERIA FOR INCLUSION

Studies that compared child maltreatment in rural and urban areas in the United States were included. For our second research question, related to understanding maltreatment in rural areas, we included those studies that exclusively examined rural areas, when maltreatment was the outcome variable.

HOW RESEARCH STUDIES WERE IDENTIFIED

Studies were reviewed from relevant databases (Annual Reviews, PsychINFO, PubMed, Web of Science) between 1975 and 2019.

MAJOR FINDINGS

Findings were mixed on whether rates of maltreatment were higher or lower in rural areas. While five studies reported higher rates of maltreatment in rural areas, four reported higher rates in urban areas. Overall, child maltreatment rates tended to be higher in urban areas among people of color and higher in rural areas among White people. One study found that community economic factors were not related to maltreatment in a rural area, in stark contrast to robust findings from urban areas.

Psychosocial interventions for reducing alcohol consumption in sub-Saharan African settings: a systematic review and meta-analysis

BACKGROUND

Harmful alcohol use is a leading cause of morbidity and mortality in sub-Saharan Africa (sSA); however, the effects of non-pharmacological alcohol interventions in this region are unknown.

DESIGN

A systematic review and meta-analysis of the available literature through 14 March 2019 was undertaken. Two authors extracted and reconciled relevant data and assessed risk of bias. Meta-analyses were conducted. The review protocol is registered on International Prospective Register of Systematic Reviews (PROSPERO) (CRD42019094509).

SETTING

Studies conducted in sSA were eligible for inclusion.

PARTICIPANTS

Individuals participating in interventions aimed at reducing alcohol use.

INTERVENTIONS

Randomized and non-randomized controlled trials testing non-pharmacological interventions (psychosocial and structural) on alcohol consumption in sSA.

MEASUREMENTS

Eligible outcomes included the Alcohol Use Disorders Identification Test (AUDIT) scores; alcohol abstinence; measures of drinking quantity and frequency; and biomarkers of alcohol consumption.

FINDINGS

Nineteen intervention trials (18 reports) testing psychosocial interventions (no structural interventions included), judged of moderate quality, were included in meta-analyses. A beneficial effect was identified for psychosocial interventions on alcohol abstinence at 3-6 months [odds ratio (OR) = 2.05, 95% confidence interval (CI) = 1.20-3.48, k = 5, n = 2312, I²  = 79%] and 12-60 months (OR = 1.91, 95% CI = 1.40-2.61, k = 6, n = 2737, I²  = 63%) follow-up. There were no statistically significant effects found for AUDIT score [2-3 months: mean differences (MD) = -1.13, 95% CI = -2.60 to 0.34, k = 6, n = 992, I²  = 85%; 6 months: MD = -0.83, 95% CI = -1.92 to 0.26, k = 6, n = 1081, I²  = 69%; 12 months: MD = -0.15, 95% CI = -1.66 to 1.36, k = 4; n = 677; I²  = 75%], drinks per drinking day (3 months: MD = -0.22, 95% CI = -2.51 to 2.07, k = 2, n = 359, I²  = 82%; 6-36 months: MD = -0.09, 95% CI = -0.49 to 0.30, k = 3, n = 1450, I²  = 60%) or percentage of drinking days (3 months: MD = -4.60, 95% = -21.14 to 11.94; k = 2; n = 361; I²  = 90%; 6-9 months: MD = 1.96, 95% CI = -6.54 to 10.46; k = 2; n = 818; I²  = 88%).

CONCLUSION

Psychosocial interventions show promise at increasing self-reported alcohol abstinence in sSA, but clinical, methodological and statistical heterogeneity across meta-analytical outcomes suggests that results should be interpreted with caution.

Social and structural determinants of youth alcohol use in Tanzania: The role of gender, social vulnerability and stigma

Adolescent alcohol use remains an under-addressed population health issue across Africa. Although the literature explores the intersection of alcohol use and vulnerability to HIV and AIDS, there is limited evidence on the gendered uptake and use of alcohol among adolescents. Capturing adolescents' voiced experiences about the societal influences shaping their alcohol usage is essential for identifying contextually relevant interventions to reduce their vulnerability to alcohol and related risky behaviours, such as unsafe sex. We conducted qualitative research in urban Tanzania, including key informant interviews, systematic mapping of alcohol availability, in-depth interviews with adolescents in and out of school and adults, and participatory methodologies with adolescents ages 15-19. The findings described here were drawn from the participatory methodologies (n = 177); and in-depth interviews with adolescents (n = 24) and adults (n = 24). Three key themes emerged: (1) boys' increased social vulnerability to alcohol consumption; (2) the ways in which stigma shapes girls' alcohol usage; and (3) how gendered perceptions of alcohol use reinforce societal inequalities. There exists an urgent need to address the social and gendered vulnerabilities of youth in Africa to the uptake and use of alcohol, and identify interventions that reshape notions of masculinity increasing boy's vulnerability to use.

A systematic review of interventions for reducing heavy episodic drinking in sub-Saharan African settings

OBJECTIVE

Assess the effect of non-pharmacological alcohol interventions on reducing heavy episodic drinking (HED) outcomes in sub-Saharan Africa.

METHODS

A systematic review of the available literature through August 19, 2020 was conducted. Randomized and non-randomized controlled trials testing non-pharmacological interventions on alcohol consumption in sub-Saharan Africa were eligible for inclusion. Eligible outcomes included measures of HED/binge drinking, and measures indicative of this pattern of drinking, such as high blood alcohol concentration or frequency of intoxication. Three authors extracted and reconciled relevant data and assessed risk of bias. The review protocol is available on PROSPERO (registration number: CRD42019094509). The Cochrane Handbook recommendations for the review of interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines guided all methodology.

RESULTS

Thirteen intervention trials were identified that met our inclusion criteria and measured change in HED. Studies were judged of moderate quality. A beneficial effect of non-pharmacological interventions on HED was reported in six studies, three of which were deemed clinically significant by the review authors; no statistically significant effects were identified in the other seven studies. Interventions achieving statistical and/or clinical significance had an intervention dose of two hours or greater, used an array of psychosocial approaches, including Motivational Interviewing integrated in Brief Intervention, cognitive behavioral therapy and integrated risk reduction interventions, and were delivered both individually and in groups.

CONCLUSIONS

Evidence for the effectiveness of non-pharmacological interventions to reduce HED in sub-Saharan African settings was limited, demonstrating the need for more research. To strengthen the literature, future research should employ more rigorous study designs, improve consistency of HED measurement, test interventions developed specifically to address HED, and explore structural approaches to HED reduction.

Alcohol Outlet Density and Deprivation in Six Towns in Bergrivier Municipality before and after Legislative Restrictions

Introduction. In 2016, after the Western Cape Liquor Act was enacted, alcohol outlets were mapped in the six towns from a previous 2008 study to determine: (1) alcohol outlet density; (2) the association between deprivation and alcohol outlet density; (3) geospatial trends of alcohol outlet densities; and (4) the impact of alcohol legislation. Methods. Latitude and longitude coordinates were collected of legal and illegal alcohol outlets, and alcohol outlet density was calculated for legal, illegal and total alcohol outlets by km2 and per 1000 persons. To determine the impact of legislation, t-tests and hot spot analyses were calculated for both 2008 and 2016 studies. Spearman coefficients estimated the relationship between alcohol outlet density and deprivation. Results. Although not statistically significant, the number of alcohol outlets and the density per 1000 population declined by about 12% and 34%, respectively. Illegal outlets were still more likely to be located in more deprived areas, and legal outlets in less deprived areas; and a reduction or addition of a few outlets can change a town’s hot spot status. Conclusions. Further studies with larger sample sizes might help to clarify the impacts of the Liquor Act, and the more recent 2017 Alcohol-Related Harms Reduction Policy on alcohol outlet density in the province.

Community collective efficacy is associated with reduced physical intimate partner violence (IPV) incidence in the rural province of Mpumalanga, South Africa: findings from HPTN 068

BACKGROUND

Intimate partner violence (IPV) is a human rights violation and is associated with a variety of adverse physical and mental health outcomes. Collective efficacy, defined as mutual trust among community members and willingness to intervene on the behalf of the common good, has been associated with reduced neighbourhood violence. Limited research has explored whether community collective efficacy is associated with reduced incidence of IPV. This is of particular interest among adolescent girls and young women (AGYW) in sub-Saharan Africa, where the burden of HIV is greatest and IPV is common.

METHODS

We collected longitudinal data among 2533 AGYW (ages 13-20) enrolled in the HPTN 068 cohort in Mpumalanga province, South Africa between 2011 and 2016. We included participants from 26 villages where community surveys were collected during the HPTN 068 study. Collective efficacy was measured at the village level via two population-based cross-sectional surveys in 2012 and 2014. Multivariable Poisson generalised estimating equation regression models estimated the relative risk ratio (RR) between village collective efficacy scores and subsequent physical IPV 12 month incidence, adjusting for village-level clustering and covariates.

RESULTS

Thirty-eight per cent of the cohort (n=950) reported at least one episode of recent physical IPV during follow-up. For every SD higher level of collective efficacy, there was a 6% lower level of physical IPV incidence (adjusted RR: 0.94; 95% CI 0.89 to 0.98) among AGYW after adjusting for covariates.

CONCLUSIONS

Community-level interventions that foster the development of collective efficacy may reduce IPV among AGYW.

The Relative Association of Collective Efficacy in School and Neighborhood Contexts With Adolescent Alcohol Use

Background

It is unclear whether either neighborhood collective efficacy or school collective efficacy is associated with adolescent alcohol use. This study aimed to examine the relative contributions of collective efficacy, both in school and in the neighborhood contexts, to alcohol use among Japanese adolescents.

Methods

A cross-sectional study was conducted in public high schools across Okinawa and Ibaraki Prefectures in Japan in 2016. The study participants consisted of 3,291 students in grades 10 through 12 cross-nested in 51 schools and 107 neighborhoods. Alcohol use was measured as current alcohol drinking, which was defined as self-reported drinking on at least 1 day in the past 30 days. Collective efficacy was measured using scales of social cohesion and informal social control in school and the neighborhood. Contextual-level collective efficacy was measured using aggregated school-level and neighborhood-level individual responses, respectively. We used non-hierarchical multilevel models to fit the cross-nested data.

Results

Significant variation in alcohol use was shown between schools but not between neighborhoods. After adjusting for covariates, school collective efficacy at individual- and contextual-levels was protectively associated with alcohol drinking (odds ratio [OR] for the increase of one standard deviation from the mean 0.72; 95% confidence interval [CI], 0.63–0.82 and OR 0.61; 95% CI, 0.49–0.75, respectively), whereas neighborhood collective efficacy at individual- and contextual-levels was not associated with alcohol consumption.

Conclusion

The school-level associations of collective efficacy with adolescent alcohol use may have the greater impact than the neighborhood-level associations. Adolescent drinking prevention efforts should include enhancing school collective efficacy.

Context matters: Community social cohesion and health behaviors in two South African areas

BACKGROUND

Understanding how social contexts shape HIV risk will facilitate development of effective prevention responses. Social cohesion, the trust and connectedness experienced in communities, has been associated with improved sexual health and HIV-related outcomes, but little research has been conducted in high prevalence settings.

METHODS

We conducted population-based surveys with adults 18-49 in high HIV prevalence districts in Mpumalanga (n = 2057) and North West Province (n = 1044), South Africa. Community social cohesion scores were calculated among the 70 clusters. We used multilevel logistic regression stratified by gender to assess individual- and group-level associations between social cohesion and HIV-related behaviors: recent HIV testing, heavy alcohol use, and concurrent sexual partnerships.

RESULTS

Group-level cohesion was protective in Mpumalanga, where perceived social cohesion was higher. For each unit increase in group cohesion, the odds of heavy drinking among men were reduced by 40% (95%CI 0.25, 0.65); the odds of women reporting concurrent sexual partnerships were reduced by 45% (95%CI 0.19, 1.04; p = 0.06); and the odds of reporting recent HIV testing were 1.6 and 1.9 times higher in men and women, respectively.

CONCLUSIONS

We identified potential health benefits of cohesion across three HIV-related health behaviors in one region with higher overall evidence of group cohesion. There may be a minimum level of cohesion required to yield positive health effects.

Alcohol use and intimate partner violence among women and their partners in sub-Saharan Africa

BACKGROUND

Alcohol use is a well-documented risk factor for intimate partner violence (IPV); however, the majority of research comes from high-income countries.

METHODS

Using nationally representative data from 86 024 women that participated in the Demographic and Health Surveys, we evaluated the relationship between male partner alcohol use and experiencing IPV in 14 countries in sub-Saharan Africa (SSA). Using multilevel mixed-effects models, we calculated the within-country, between-country, and contextual effects of alcohol use on IPV.

RESULTS

Prevalence of partner alcohol use and IPV ranged substantially across countries (3-62 and 11-60%, respectively). Partner alcohol use was associated with a significant increase in the odds of reporting IPV for all 14 countries included in this analysis. Furthermore, the relationship between alcohol use and IPV, although largely explained by partner alcohol use, was also attributable to overall prevalence of alcohol use in a given country. The partner alcohol use-IPV relationship was moderated by socioeconomic status (SES): among women with a partner who used alcohol those with lower SES had higher odds of experiencing IPV than women with higher SES.

CONCLUSIONS

Results of this study suggest that partner alcohol use is a robust correlate of IPV in SSA; however, drinking norms may independently relate to IPV and confound the relationship between partner alcohol use and IPV. These findings motivate future research employing experimental and longitudinal designs to examine alcohol use as a modifiable risk factor of IPV and as a novel target for treatment and prevention research to reduce IPV in SSA.