A Multi-Country Study of Harms to Children Because of Others' Drinking

Risk of severe mood and anxiety disorders in the adult children of parents with alcohol use disorder: a nationwide cohort study

BACKGROUND

Growing up with parental alcohol use disorder (AUD) is a risk factor for psychiatric disorders. This study investigated the risk of mood disorders and of anxiety disorders in the adult children of parents with AUD, adjusted for sociodemographic factors.

METHODS

Individual-level register data on the total population were linked to follow children of parents with AUD from 1973 to 2018 to assess their risk of mood disorders and of anxiety disorders. AUD, mood disorders and anxiety disorders were defined with International Statistical Classification of Diseases and Related Health Problems codes from the National Patient Register. HRs of outcomes were calculated with Cox regression. Model 1 was adjusted for the child's sex, parental education and death of a parent. Model 2 was adjusted for those factors and parental diagnosis of mood or anxiety disorder.

RESULTS

Those with ≥1 parent with AUD (99 723 of 2 421 479 children) had a higher risk of mood disorder and of anxiety disorder than those whose parents did not have AUD (HR mood 2.32, 95% CI 2.26 to 2.39; HR anxiety 2.66, 95% CI 2.60 to 2.72). The risk remained elevated after adjustment for sociodemographic factors and parental psychiatric diagnosis (HR mood 1.67, 95% CI 1.63 to 1.72; HR anxiety 1.74, 95% CI 1.69 to 1.78). The highest risks were associated with AUD in both parents, followed by AUD in mothers and then in fathers.

CONCLUSION

Adult children of parents with AUD have a raised risk of mood and anxiety disorders even after adjustment for sociodemographic factors and parental mood or anxiety disorder. These population-level findings can inform future policies and interventions.

Potential factors affecting the impact of community reinforcement and family training. Secondary analysis of an RCT

BACKGROUND

In addition to increasing the quality of life among concerned significant others (CSOs), Community Reinforcement and Family training (CRAFT) aim at helping CSOs motivate treatment-refusing identified patients (IPs) into treatment through a positive reinforcement process. The aim of the present study was to investigate if the following factors, measured at baseline, have an influence on IP future treatment engagement (1) Type of relation between CSO and the IP (2) The amount of time the CSO spend with the IP (3) if the IP knows that the CSOs seeks help, and (4) The CSO's own alcohol use.

METHODS

A secondary analysis from the Danish CRAFT study. CSOs completed a self-administered questionnaire at baseline, after three months, and six months. To investigate the relationship between the four variables and treatment engagement, logistic regression was used.

RESULTS

CSO's relation to the IP, the frequency of contact between the CSO and the IP, and the CSO's AUDIT score at the time of the baseline interview were not associated with the IP's treatment engagement. If CSO at baseline had informed the IP that the CSO participated in CRAFT, odds for IP treatment engagement were significantly higher (adjusted OR [(CI)] = 2.29 [1.13; 4.63] (p < 0.05), relative to if IP not being informed.

CONCLUSIONS

CRAFT has a higher impact on the likelihood for treatment seeking, if the CSOs inform the IP about his or her own help seeking in order to change the situation. The underlying mechanism behind this is needs further investigations.

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.

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.

A Framing Analysis of Consultation Submissions on the WHO Global Strategy to Reduce the Harmful Use of Alcohol: Values and Interests

BACKGROUND

In response to the magnitude of harms caused by alcohol, the World Health Organization (WHO) Global Strategy to Reduce the Harmful Use of Alcohol (GAS) was endorsed in 2010. We analysed submissions to the 2019 WHO consultation on the implementation of the GAS to identify how different stakeholders frame alcohol use and control; and to assess how stakeholders engage with the consultation process, with possibly harmful consequences for public health policy.

METHODS

All submissions from WHO Member States, international organisations, non-governmental organisations (NGOs), academic institutions and private sector entities were identified and used as data for an inductive framing analysis. This involved close reading and data familiarisation, thematic coding and identifying emergent framings. Through the analysis of texts, framing analysis can give insights into the values and interests of stakeholders. Because framing influences how issues are conceptualised and addressed, framing analysis is a useful tool to study policy-making processes.

RESULTS

We identified 161 unique submissions and seven attachments. Emerging frames were grouped according to their function: defining the problem, assigning causation, proposing solutions, or justifying and persuading. Submissions varied in terms of the framing they deployed and how this was presented, eg, how the problem was defined. Proposed policy solutions also varied. Targeted solutions emphasising individual responsibility tended to be supported by industry and some Member States. Calls for universal regulation and global mobilisation often came from NGOs and academia. Stakeholders drew on evidence and specific value systems to support the adoption of certain problem and solution ideas and to oppose competing framing.

CONCLUSION

Alcohol control is a contested policy field in which different stakeholders use framing to set the agenda and influence what policy solutions are considered legitimate. WHO should consider which interests are served by these different framings and how to weigh different stakeholders in the consultation process.

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.

A multi-country analysis of informal caregiving due to others' drinking

The burden of caring for drinkers is seldom articulated as a social concern, or integrated in service planning or alcohol policy. This study aims to examine prevalence and predictors of informal caregiving due to others' drinking cross-nationally by surveying 20,728 respondents (18-64 years) in 11 countries. The outcome variable was respondent-reported informal caregiving due to others' drinking, analysed by socio-demographic factors and drinking pattern using logistic regression and meta-analysis. Estimated overall prevalence of informal caregiving due to others' drinking ranged from 9% in Nigeria to 47% in Thailand. In most countries, females reported a higher rate than males of caring for children and other dependents, but males reported a higher rate of driving family or friends somewhere or picking them up. Logistic regression analysis found differences between high-income countries and low- and middle-income countries in the relationship of caregiving with employment and household composition. Respondent's own drinking was positively correlated with the prevalence of caregiving in 10 out of 11 countries. In general, younger adults and those who are themselves risky drinkers are more likely to have had caring responsibilities. Although problematic drinking is concentrated in specific subpopulations, the burden of care for others' drinking extends widely across the population.

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.

Harms to children from the financial effects of others' drinking

BACKGROUND

Many children live with parents who drink and experience little impact, but risky or heavy drinking by caregivers can result in a range of harms to children. Alcohol-related financial harms which directly impact children's needs in general populations have been seldom studied.

OBJECTIVE

The study aims to identify the prevalence and correlates of financial harms from others' drinking affecting children's needs in nine lower- and middle-income (LMICs) and high-income countries (HICs).

METHODS

Participants (n = 7,669) from Brazil, Chile, Ireland, Lao PDR, Nigeria, Sri Lanka, Thailand, USA and Viet Nam were aged 18-64 years and living with children. Logistic regression and meta-analyses explored differences in financial harm affecting children among LMICs and HICs, adjusting for gender, education, rurality and drinking pattern.

RESULTS

In around one-tenth to a third of households in the nine countries, children lived with people who drank riskily. Less than 1% to 8% of respondents reported that their children's needs had not been met because of financial harm from others' drinking. Women reported significantly greater harm to children due to the financial effects of others' drinking than men in the USA, Nigeria and Viet Nam. When the participant reported drinking riskily, and particularly when families included someone who drank heavily, increased odds of financial harm from others' drinking affecting children were identified.

CONCLUSION

That children's needs were not met due to financial harm from others' drinking was reported by three percent (<1 to 8%) of caregivers across the nine countries, representing a problem for large numbers of children, particularly in the low and middle-income countries studied. When a person's drinking was reported to be heavy or harmful within the family, the risk that children's needs were affected by the financial impacts of others' drinking was significantly greater.

Parental risk constellations and future alcohol use disorder (AUD) in offspring: A combined HUNT survey and health registries study

OBJECTIVE

We examined the risk of developing a future alcohol use disorder (AUD) among offspring of families with different constellations of parental risk factors.

METHOD

We analyzed a sample of 8,774 offspring (50.2% male) from 6,696 two-parent families who participated in the Nord-Trøndelag Health Study in Norway when offspring were 13-19 years old in 1995-1997 or 2006-2008. Based on population registry information and parental Nord-Trøndelag Health Study self-reports, families were classified via Latent Profile Analysis into fiver risk constellations reflecting parents' education, drinking quantities and frequencies, and mental health. Information about AUD-related diagnoses, treatments, and prescriptions for all offspring in the period between 2008 and 2016 was obtained from 3 national health registries and pooled to reflect any AUD. The likelihood of AUD in offspring was examined with a set of nested logistic regression models.

RESULTS

Registry records yielded 186 AUD cases (2.1%). Compared with the lowest-risk constellation, offspring from two constellations were more likely to present with AUD in unadjusted analyses. After adjusting for all covariates, including offspring's alcohol consumption and witnessing parental intoxication during adolescence, AUD risk remained elevated and statistically significant (adjusted odds ratio = 2.34, 95% confidence interval = 1.14, 4.85) for offspring from the constellation characterized by at least weekly binge drinking, low education, and poor mental health in both parents.

CONCLUSION

Weekly binge drinking by both parents was associated with future AUD risk among community offspring in Norway when clustered with additional parental risks such as poor mental health and low educational attainment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Parental alcohol intoxication and adverse health outcomes among offspring. A 4-year follow up HUNT study among 2399 Norwegian adolescents

This study aimed to investigate whether experience of parental alcohol intoxication was associated with adverse health outcomes among adolescents four years later. A population-based Norwegian cohort study of 2399 adolescents who participated in the Young-HUNT1 Survey 1995-97 (T1, 13-15 years old) was followed up four years later (T2) in 2000 (Young-HUNT2, 17-19 years old). Measures were based on adolescent self-report of exposure to parental alcohol intoxication, self-rated general health, mental distress (SCL-5) and lifetime hospital admission. Multivariable logistic regression analyses, adjusted for gender, age and parental education were applied. Results show that half of the adolescents (51%) had seen parents intoxicated at age 13-15 years. Four years later, those who had reported parental alcohol intoxication at T1 had increased odds of admission to hospital with odds ratios ranging from OR1.3; CI 1.0-1.7 to OR 2.2; CI 1.3-3.9, poorer self-rated health (odds ratio ranging from 1.8;1.2-2.6 to 2.0;1.1-3.7) and more mental distress (odds ratio ranging from 1.7;1.1-2.5 to 1.9;1.0-3.6). Furthermore, the increased frequency of experience of parental alcohol intoxication are associated with higher prevalence of admission to hospital and mental distress and lower levels of self-rated health. Findings from this large, representative population of Norwegian adolescents indicate that adverse health outcomes among adolescents in a general population are related to relatively common heavy drinking behaviours among parents.

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.

Do gender differences in the relationship between living with children and alcohol consumption vary by societal gender inequality?

INTRODUCTION AND AIMS

To better understand the relationship between alcohol consumption and living with children, we assessed whether the association varied for men and women across diverse countries and whether this relationship was moderated by country-level gender inequality.

DESIGN AND METHODS

We used Hierarchical Linear Modelling to analyse data from 32 surveys conducted in 27 countries. Measures included whether the participant was a drinker versus abstainer in past 12 months, annual number of drinks consumed, whether the respondent lived with children, gender (male/female) and age of respondent, and country-level gender inequality measured using the Gender Inequality Index.

RESULTS

Annual drinks consumed was significantly lower for women living with children. Men living with children were generally more likely to be drinkers, and the relationship between annual consumption and living with children was moderated by cultural gender equality: specifically, men in countries with higher gender equality drank less if they lived with children while the association for men in lower equality countries was nonsignificant.

DISCUSSION AND CONCLUSIONS

Although lower alcohol consumption was found generally for women living with children, this relationship was found only for men in countries where there was more gender equality. Given the high risk of harm to children from heavy consumption by adults with whom they live, prevention efforts need to strengthen prevention of heavy consumption by parents and other who live with children, especially for men who live with children in low gender equality countries.

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.

Improving measurement of harms from others' drinking: A key informant study on type and severity of harm

Aims:

Survey items for measuring harms experienced from others' drinking (AHTO) have been developed primarily to measure type of harm and not severity. However, some type of harms may produce more negative effects than others. We aimed to compare the perceived severity of a comprehensive list of AHTO items to assess consistency in subjective ratings of severity, facilitate a more nuanced analysis and identify strategies to improve measurement of AHTO in epidemiological surveys.

Methods:

Thirty-six leaders of national alcohol surveys (conducted between 1997 and 2016) from 23 countries rated the typical severity of negative effects on the victim of each of 48 types of AHTO using a scale from zero (no negative effect) to 10 (very severe negative effect). The survey leaders were also asked to provide open-ended feedback about each harm and the severity-rating task generally.

Results:

Of 48 harm items, five were classified as extreme severity (mean rating ≥ 8), 17 as high (≥ 6 < 8), 25 as moderate (≥ 4 < 6), and one as low (≤ 4). We used two-way random effects models to estimate absolute agreement intraclass correlation coefficients (AA-ICC) and consistency of agreement intraclass correlation coefficients (CA-ICC). Results showed that there was fair to excellent absolute agreement and consistency of agreement among experts’ ratings of the severity of harms from others’ drinking (single measures CA-ICC = 0.414, single measures AA-ICC = 0.325; average CA-ICC = 0.940, average AA-ICC = 0.914). Harms to children, and harms causing physical, financial, practical, or severe emotional impacts were rated most severe.

Conclusions:

When designing new AHTO surveys and conducting analyses of existing data, researchers should pay close attention to harms with high perceived severity to identify effective ways to prevent severe AHTO and reduce the negative health and social impacts of AHTO. By inquiring into experts' views on survey items, this analysis involves a first scoping of the sort of questions that should be taken into consideration. In-depth analyses of specific sub-sets of harms and qualitative interviews with victims of severe AHTO are likely to help along this work in the future.

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.

Trends in inequalities of alcohol-related harms among Thai households: 2007-2017

BACKGROUND

To estimate and compare the socio-economic inequities in alcohol-related harms among households in Thailand between 2007 and 2017 adjusted for socioeconomic status with the proportions of current and binge drinkers in each household.

METHODS

A secondary data analysis of the 2007 and 2017 National Cigarette and Alcohol Consumption Survey was conducted. The unit of analysis was household-level. Concentration index (CI) was used to measure household income-based inequalities in alcohol-related harms (i.e., workplace, domestic, non-domestic, financial, and drinking-and-driving) in the previous 12 months.

RESULTS

Based on data from two waves of survey (n = 66,776 in 2007 and 39,630 in 2017), the prevalence of households that had at least one member who had an alcohol-related harm event was 21.8% and 26.2% in 2007 and 2017, respectively. The highest prevalence was the drinking-and-driving domain (about 20%). The prevalence increased between 2007 and 2017 with an annual rate of change ranged from 1.2 to 4.4%. All of the CI values were negative for both survey waves, except the drink-and-driving domain in 2007. The CI values for all domains in 2017 had a larger magnitude than in 2007, except the domestic domain. For any alcohol-related harm, the CI value was not significant at +0.002 (Standard error [SE] 0.004) in 2007, but significant at -0.014 (SE 0.004) in 2017. So, the index changed around -0.016.

CONCLUSIONS

The poor households had a slightly greater tendency to incur harms from alcohol and there existed more inequality in the prevalence of harms in 2017 compared with 2007.

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.

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.

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

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

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

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

Safe, funny and frightening drinking situations from children's viewpoint: Comparing recalled childhood stories about others' drinking in Scandinavia

The article analyzes retrospective childhood stories related to others' drinking (N = 336). The stories have been told in a focus group context in Finland and Sweden. Hence, they are stories about the past that have been constructed in the present. The retrospective childhood stories are analyzed from the perspective of emotions, seen as relational and situational sociocultural constructions, by paying attention to what kind of contact and emotional responses children develop to others' drinking in specific situations. The analysis demonstrates how in an intoxicated-oriented drinking culture the presence of alcohol may signify something outside the bounds of everyday life, in the case of which children develop an ambiguous contact with drinking in which many kinds of positive or negative emotions can emerge, such as love, fun, fear, shame or curiosity. In the Finnish narratives, children's emotional socialization to drinking is regulated by situations of heavy domestic drinking, festive drinking and moderate routine drinking at home. In the Swedish narratives, children's emotional socialization to drinking is governed by festive situations, moderate routine drinking at home and meal drinking. Fear dominates the Finnish participants' recalled childhood stories, whereas fun is the most common emotion in the stories from Sweden. The differences between Finnish and Swedish emotions recalled from childhood in relation to drinking may reflect differences in these culture's drinking practices and/or social interaction norms. The article demonstrates how adults' childhood memories on drinking provide an important 'indirect' source to get knowledge on children's ways of experiencing and responding to others' drinking in various situations.

Disclosure of alcohol-related harm: Children's experiences

Objectives:

(1) to learn to whom children disclose experiences of harm caused by their parents’ or carers’ substance abuse, (2) to show whether professionals enable children to disclose this harm, and (3) to highlight what kind of assistance they provide after disclosure of harm.

Methods:

The study is based on in-depth semi-structured interviews with children living with alcohol-abusing caregivers in Lithuania. Twenty-three children, aged from 8 to 18 years, from social risk families participated in this study.

Results:

Children suffer not only from the maltreatment itself, but also from the associative stigma of the caregivers’ drinking. They prefer to disclose their troubles in informal settings because professionals often do not help children to disclose harm and may even ignore it.

Conclusion:

The analysis shows that when children reveal parental alcohol problems, there is no inquiry, follow-up, or management of the children’s problems related to the caregivers’ drinking. And yet, protective factors such as social support and positive experiences may enhance children’s resilience in adverse conditions. Policy-makers should reduce barriers to disclosure and refocus their strategies from risk identification to identification of protective factors. Professionals need to develop an understanding about how they can support children to disclose harms related to the caregivers’ drinking so that harms to children can be managed sensitively and well.

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.

Child injury deaths linked with adult alcohol consumption: A time series analysis

OBJECTIVE

This paper aims to quantify the population-level associations between child injury deaths and adult (aged 15+ years) per capita alcohol consumption (PCC) and between child injury deaths and the impact of major alcohol and safety policy changes in Australia.

METHODS

All child deaths due to external causes during 1910-2013, and child deaths due specifically to road crashes, assaults, suicide and other external causes, were obtained from the Australian Institute of Health and Welfare. Child (0-14 year) mortality rates were analysed in relation to PCC using an Autoregressive Integrated Moving Average model.

RESULTS

A positive association between PCC and overall child external mortality was identified. The estimated coefficient was 0.326 (p = .002), indicating that a 10% decrease in PCC was associated with a 3.3% reduction in child injury mortality. A positive association was identified for road traffic and other child injury mortality, but not assault injuries. The introduction of compulsory seatbelt legislation in combination with random breath testing was associated with a reduction in overall injury and road traffic child mortality. Decreasing the legal drinking age was associated with an increase in the rate of other external-cause child mortality.

CONCLUSION

Reducing PCC in Australia is likely to result in a small but significant reduction in the injury mortality rate of children aged 0-14 years.

Alcohol-related child maltreatment: Reports to the Child Rights Protection Service in Kaunas municipality

Aim

To increase understanding of alcohol-related child maltreatment on the basis of child protection cases in Lithuania. The study is based on a document content analysis of 203 case records of families at social risk. It identifies the prevalence of alcohol-related harm by analysing associations between types of drinkers and child maltreatment. It also maps the distribution of people who typically report this maltreatment. Both qualitative and quantitative analytical approaches are employed.

Results

Child neglect was the most prevalent type of child maltreatment and was usually reported together with other types of child maltreatment. Child maltreatment was typically mentioned in the context of a caregiver's heavy drinking. In 85.7% (174) of the cases, the family had at least one problem drinker. More than one problem drinker was detected in as many as a third of all cases. At least one form of child maltreatment was detected in families with a drinking mother in 60% of the cases (χ² = 4.825, p < 0.05), with a drinking father in 36% of the cases (p > 0.05), and in 15% of the cases (p > 0.05) when there was a drinking partner in the family. The most common source of reporting by the authorities was the police (26.6%), and the most typical non-official source was the child's relatives (16.3%).

Conclusions

Alcohol-related child maltreatment needs special attention if issues of child safety in Lithuania are to be disclosed, evaluated, and responded to. Further research on this topic is needed.