Alcohol’s Harms to Others: Multinational Cultural Contexts and Policy Implications

Funding: NIAAA R01AA023870

Project MPIs: ARG’s Dr. Thomas K. Greenfield, Professors Sharon Wilsnack (of the University of North Dakota, School of Medicine & Health Sciences), and Kim Bloomfield (of Aarhus University, Centre for Alcohol and Drug Research, Copenhagen Denmark)

These ARG UND and Aarhus senior investigators are responsible for project direction of this 4-year project, for which the acronym is GENAHTO (Gender and Alcohol’s Harms to Others).  The new project extends earlier NIAAA-supported cross-national GENACIS project (Gender, Alcohol and Culture: an International Study) and like that now-completed project, the new study involves a large team of international scientists working together on harms to others analyses involving 36 countries.

Project sites and co-investigators are located at major research institutions in the US, Australia, Canada, Denmark and Switzerland.  At the ARG site, Dr. Greenfield is joined by co-investigator Katherine Karriker-Jaffe, as well as Drs. Priscilla Martinez and Libo Li, serving as key biostatistician.

Worldwide, most research on alcohol’s harms has focused on how heavy drinking harms the drinker since alcohol intake can cause significant acute and chronic harms and premature death. However, recent research has noted that alcohol not only adversely affects the drinker but can also inflict harm on others—family members, friends, acquaintances, and strangers. Only a few types of harms to others (e.g., drink-driving, fetal alcohol effects, intimate partner violence) have been well studied. There is a dearth of knowledge about alcohol’s broader harms to others (H2O; also known as alcohol’s second-hand effects). Initial studies in a few high-income countries (Australia, New Zealand, and the US) show that heavy drinking can hurt families, create financial burdens, reduce quality of life, and engender fears and injuries. These second-hand effects may double the social costs directly incurred by harms to drinkers themselves.

The study combines surveys from 21 countries of the GENACIS Project (Gender, Alcohol and Culture: An International Study) with surveys from 16 other countries (countries in the WHO-Thai Health collaboration plus separately-funded surveys in additional countries, including the US). The GENACIS surveys provide detailed data on characteristics of drinkers who report causing harms to others, and the WHO-Thai Health and related surveys provide equally detailed data from the victims (both drinkers and nondrinkers) of alcohol-related harms from other heavy drinkers.

Within a multilevel social ecological framework, the project uses these unique data to test hypotheses about individual and contextual factors associated with persons who report having experienced H2O as well as persons who report having caused H2O; regional differences in conditions within countries that may modify individual risks of H2O; and how regional variations in drinking cultures may interact with alcohol policies to prevent or promote harms caused by heavy drinkers. The analyses take advantage of hierarchical linear modeling (including multilevel interaction effects), risk curve analyses and, where appropriate, propensity scoring methods. The analyses provides the most detailed multinational findings available to date on the individual, social, and cultural influences that may increase or reduce alcohol’s H2O. The findings help to identify opportunities for better-focused interventions and policies to reduce alcohol’s second-hand effects under a range of environmental conditions, including important new knowledge with direct relevance to the US.

This project is the first to assess the types, severity, and individual and contextual correlates of harms from others’ heavy drinking in a wide range of societies with greatly varying drinking cultures and policies. Studying alcohol’s harms to others in a multinational, public health framework parallels the role that data on second-hand smoking harms played in making the case for tobacco regulations. The study applies new metrics, including reduced quality of life and other costs, to estimate the severity of second-hand impacts of alcohol. By studying comprehensively how individual, social, and economic influences within regions and societies may affect heavy drinkers’ harms to families, friends, and strangers, the research informs prevention planning and alcohol policy development aimed at abating these harms in varying cultural contexts.