International Journal of Alcohol and Drug Research

Alcohol prevention research and policy development in LMICs: New perspectives, insights and recommendations

Monica Swahn — 2024-08-17

Organizational structure, capacity and reach of organizations involved in alcohol prevention: An assessment of stakeholders across five countries in East Africa

Gina Raderalazasoa — 2024-04-07

Aims: East African countries, classified as low- and middle-income countries (LMICs), are disproportionately harmed by alcohol consumption, and many countries lack strategies to address and prevent alcohol harm. This study draws on community input from stakeholders involved in alcohol harm prevention in five East African countries to identify organizational structures, capacity and outreach, and strategies for capacity building to address the high burden of alcohol harm more systematically.

Design/Setting/Participants: A cross-sectional survey was distributed from October to December 2020 by the East Africa Alcohol Policy Alliance to their member alliances and stakeholders across five countries in East Africa (i.e., Burundi, Kenya, Rwanda, Tanzania and Uganda). Analyses were based on 171 persons from 171 organizations completing the survey.

Measures: The East Africa Alcohol Policy Alliance Capacity Assessment Survey (EAAPACAS) included organizational size and funding, research capacity, priorities, and perceptions related to alcohol prevention and harm locally and nationally.

Results: The types of organizations, funding structures, and functions dedicated to alcohol prevention vary widely across countries, indicating great diversity and heterogeneity of organizations working on alcohol prevention and advocacy in East Africa. Most organizations rely on volunteer staff. Additionally, 51% reported that they did not know, or could not meet their program goals, with the available operational funds.

Conclusion: These organizations rely primarily on volunteers and face significant barriers to achieving their goals with their current budget, primarily derived from foundations and private donations. Overall, these findings indicate that the infrastructure for alcohol prevention is weak and fragmented in countries where national initiatives are limited or underfunded.

Community awareness and engagement to prevent alcohol related harm: Stakeholder priorities in West Africa

boi-Jeneh Jalloh — 2024-08-02

Aims: West Africa is disproportionately harmed by alcohol consumption. However, limited information is available about the alcohol prevention strategies used by stakeholders in West Africa. In addition, there is scant awareness of health consequences from alcohol use among the communities with which stakeholders engage in alcohol prevention.

Design/Setting/Participants: A cross-sectional survey was distributed in 2020 by the West African Alcohol Policy Alliance to their member alliances and stakeholders across nine countries. Analyses were computed based on 171 persons/organizations completing the survey.

Measures: The West Africa Alcohol Policy Alliance Capacity Assessment Survey (WAAPACAS) included questions about programs and service delivery, alcohol prevention strategies used, and community knowledge of alcohol as a risk factor for a range of health concerns.

Results: In terms of addressing alcohol-related harm, non-governmental organizations (NGOs) and community-based organizations (CBOs) across West Africa engage primarily in community outreach and health promotion activities. Even so, awareness of alcohol as a risk factor for key health conditions remains relatively low, and varies by country and acute versus longer term consequences.

Conclusion: Leveraging the outreach and engagement by NGOs/CBOs will be critically important for addressing alcohol-related harm in West Africa. However, NGOs/CBOs will need additional capacity and information to convey that alcohol is a key risk factor for several health outcomes to ensure communities are more informed about the range of alcohol-related harms.

Who is marketing alcohol in the slums of Kampala? A closer look at marketing types, content and brands

Joseph Madden — 2024-08-13

Objective: To understand alcohol marketing strategies used in an urban slum, photographs of street-level (defined as being seen while walking along the streets) alcohol advertisements were assessed to determine the marketing types, content, and brands in Kampala, Uganda. The content of these photographs was categorized and analyzed to understand the strategies implemented in marketing alcoholic beverages at the street-level in the community.

Methods: We collected pilot data in May 2019 of the content and placements of alcohol advertisements in urban slums using smart phones. Three teams of researchers walked a set route of four stretches of 100 meters surrounding the boda boda (motorcycle) taxi stand in the urban retail center in three selected areas in Makindye in Kampala, Uganda. After the data collection, the photographs were reviewed, categorized, and simple, descriptive statistics were computed.

Results: Across three locations, 181 photos of alcohol advertisements were taken with 129 of the photos meeting the criterion for analysis. The most common marketing message was focused on the product itself with quality, taste, and national pride being the top three sub-categories. Overall, 80% of the advertisements were posters found outside bars, restaurants, or supermarkets. Of the products advertised, 75% of the products were produced by one of two companies: Diageo or AB InBev.

Conclusions: The approach for capturing and coding alcohol marketing in urban slums can be refined and used in future research. Also, the approach can be instrumental for characterizing the alcohol environment at a specific time or for continuous monitoring of marketing to inform and evaluate intervention strategies aimed at reducing alcohol advertisement exposure.

Crowdsourcing alcohol billboards in Kampala, Uganda: Examining alcohol advertisement violations

Monica Swahn, Ph.D. — 2024-08-11

Despite high levels of alcohol use in Uganda, there is a scarcity of research on alcohol marketing, its placement and content. In this field study we evaluated the content of alcohol billboards across Kampala, Uganda using the Alcohol Marketing Assessment Rating Tool (AMART). Of the 27 unique alcohol advertisements evaluated, the nine-member review panel found that 23 contained at least one violation yielding a violation rate of 85%. Given the high number of violations, our recommendation is that future alcohol billboard advertisements within Kampala be reviewed and approved by a governing body for compliance with alcohol advertisement standards.

Tobacco and alcohol co-use among people with HIV (PWH) in Nairobi, Kenya

Jonathan Shuter — 2024-04-28

Introduction: Although the majority of people living with HIV (PWH) in the world reside in sub-Saharan Africa, little is known about the syndemic of tobacco and alcohol use among PWH in that region. The purpose of this study was to describe tobacco and alcohol co-use behaviors among PWH in Nairobi, Kenya.

Methods: Between June and November 2021, 50 PWH with concurrent tobacco and alcohol use in Nairobi were assessed with a structured interview. Women were intentionally oversampled in order to constitute 50% of the group. Participants completed structured interviews administered by trained research assistants using standardized, culturally appropriate, tobacco and alcohol use questionnaires.

Results: Fifty PWH completed the study. All identified as African with a mean age of 40.3 years. All participants were engaged in HIV care and were receiving antiretroviral therapy (ART). Mean cigarettes smoked per day was 8.2, and 57% reported moderate/high cigarette dependence. The mean alcohol use disorder identification test (AUDIT) score was 18.6, and 84% reported drinking amounts in the hazardous range. Preferred alcoholic beverages were clear spirits (48%), beer (32%), and changaa (12%), a traditional home-brewed liquor made from millet, corn, or sorghum. Cigarette dependence was not significantly associated with higher AUDIT score in any of the two linear regression models that were tested. In Model 1 younger age (β = -0.37, p = 0.002) and higher depression score (β = 0.49, p = 0.02), and in Model 2, younger age (β = -0.31, p = 0.01) and higher anxiety score (β = 1.05, p = 0.003) were significantly associated with higher AUDIT scores.

Conclusions: Tobacco and alcohol co-use in PWH in Nairobi, Kenya is common. This syndemic may require culturally appropriate and tailored treatment approaches, especially those targeting younger health strata and those with comorbid mental illness, to improve health outcomes.

Newsprint representation of the alcohol sales bans during the COVID-19 pandemic in South Africa: A mixed methods analysis

Marieke Theron — 2023-10-23

Aims: Content analysis of newspapers covering the alcohol sales bans during Covid-19 in South Africa.

Methods: Mixed method content analysis of the highest circulated, paid for, English language newspapers published by four newspaper outlets in South Africa, between 26 February to 26 September 2020 (seven months).

Setting: South African Bibliographic Information Network (Sabinet) and Arena Holdings Media databases were used.

Participants: 317 newspaper articles were identified for analysis from four newspapers: Sunday Times (Arena Holdings), Daily Sun (Naspers), The Star (Independent Media) and the Mail and Guardian (Media Development Investment Fund).

Measures: Qualitative data: a structured coding frame was used to identify themes. Quantitative data: date, agency, placement/page number in the newspaper, number of graphics, words in heading and in article and whether the article was based on opinion or fact. The media vectors: framing, responsibility and newspaper media exposure were calculated.

Findings: Articles were predominantly unfavourable toward the alcohol sales bans, indicated that government should take responsibility for prevention of harmful alcohol use, and focused mainly on the negative economic impact of the alcohol sales bans.

Conclusions: News agencies should make a concerted effort to ensure balanced reporting on matters of health and put measures in place to prevent undue influence on journalists by large corporations, such as the alcohol industry.

Alcohol’s impact on the health and wellbeing of women in low- and middle-income countries: An integrative review

Anne-Marie Laslett — 2024-05-15

In lower- and middle-income countries (LMICs), alcohol poses significant challenges to the health, well-being, and safety of women. This integrative review builds upon a previous rapid assessment conducted by Laslett and Cook in 2019, delving into the specific impacts of alcohol on women's health in LMICs while also shedding light on research gaps across different global regions. We advocate for further research endeavours and policy initiatives aimed at addressing these deficiencies. Additionally, we prompt discussions regarding the necessity of establishing distinct priorities for alcohol research, monitoring, policy, and evaluation tailored to women's needs in LMICs, as compared to those for men or the general population, particularly in high-income countries (HICs).

Alcohol use, economic development and health burden: A conceptual framework

Jürgen Rehm, Ph.D. — 2024-02-03

Economic development has been identified as an important contributor to life expectancy: wealthier countries with better living conditions generally have different causes of death and show overall lower all-cause mortality rates. Economic development also impacts on alcohol consumption: upper-middle and high-income countries, on average, have higher levels of consumption and less abstention. Thus, there are two influencing factors on alcohol-attributable mortality, acting in opposite directions. This often leads to a paradoxical situation whereby, for some low- and middle-income countries (LMICs), increases in alcohol consumption may be associated with decreases in alcohol-attributable mortality rates due to the impact of improved living conditions outweighing the impact of higher alcohol consumption. Without any change in alcohol consumption, both alcohol-attributable and all-cause mortality are substantially improved with economic development—but an increase in consumption diminishes these benefits. Thus, increases in consumption diminish the potential benefits of economic development. Two case examples from Thailand and Vietnam are presented to illustrate this phenomenon, where failure to implement alcohol control policies in Vietnam led to marked increases of alcohol attributable mortality despite an overall decreasing rate of all-cause mortality.