Alcohol marketing in Africa: not an ordinary business

Alcohol was the cause of nearly five million deaths globally in 2010, an increase of over one million deaths recorded ten years earlier. It was the leading risk factor for disease in southern sub-Saharan Africa (SSA), fifth in the East and West, and sixth in the Central African region. Several factors account for the increasing harm associated with alcohol in Africa among which are the availability of a wide variety of alcoholic beverages, rising urban populations, more disposable income to purchase alcohol, and unrestrained marketing and promotion of alcohol. Using a variety of strategies, producers of alcohol target young people and women with aspirational messages and other exhortations in an unprecedented onslaught of marketing and promotion which is increasingly being recognized as detrimental to public health and social welfare. Missing in the discussion on alcohol in most African countries is a clear understanding that alcohol marketing is not an ordinary economic activity and that the business of alcohol (an addictive substance with high potential for harm) can subvert the rights of individuals and the principles of democracy which many African societies are struggling to enthrone. This paper discusses these issues with particular attention to the harms caused by alcohol (to drinkers and non-drinkers alike), the potential for far-reaching harms to individuals and the society at large if the present scenario continues, and how these harms can be averted or minimized with the implementation of evidence-based policies.Key words: Alcohol marketing, alcohol promotion, Africa, alcohol advertisin

Perception of alcohol availability, promotion and policy by Nigerian university students

As a follow-up to the Monitoring Alcohol Marketing and Promotion in Africa (MAMPA) project conducted in Nigeria and three other countries in Africa, a survey of Nigerian students was conducted to assess their perceptions of alcohol promotion and policy in the country. Nearly five hundred students drawn from five faculties in the University of Uyo, Nigeria completed a perception of alcohol policy survey, in which they indicated their levels of agreement with statements on alcohol policy. The sample consisted of 265 (53.9%) male and 227(46.1%) female students; with age range of 16-37 years (mean of 24.8 years). Findings revealed that respondents were in support of policy options that sought to reduce availability of alcohol (in terms of access and cost). They also agreed with statements on alcohol as the cause of health and social problems; supported strong laws against drunk-driving; and agreed with the statement that the industry flouts self-imposed code on alcohol advertising. Chi-square analyses of data however confirmed the hypothesis that drinkers will significantly differ from non-drinkers in their perception of alcohol policy in Nigeria. The implications of these findings were discussed in the context of the development of effective alcohol control policy in Nigeria and other low and middle-income countries.Key Words: Perception, alcohol policy, alcohol advertising, university student

Volume of alcohol consumption, patterns of drinking and burden of disease in sub-Saharan Africa, 2002

The aim of this study was to provide an overview of the volume of alcohol consumption, type of beverage, patterns of drinking and alcohol-attributable burden of disease among adults in sub- Saharan Africa (SSA) for the year 2002. Exposure data were taken from surveys, the World Health Organization (WHO) Global Status Report on Alcohol and the WHO Global Alcohol Database. Mortality and disability data were obtained directly from WHO. The results showed that adult per capita alcohol consumption (population15 years and above) in SSA was higher than the global consumption rate (7.4 L vs. 6.2 L) and that alcohol consumption per adult drinker was 42% higher than the global rate. Alcohol was responsible for a considerable disease burden: 2.2% of all deaths and 2.5% of all DALYs could be attributed to this exposure. Intentional and unintentional injuries accounted for 53% of all alcohol-attributable deaths and almost 57% of alcohol-attributable disease burden. Among men 70% of all alcohol-attributable injury deaths occurred among 15-44 year olds (52% among women). This first attempt to quantify the health burden attributable to alcohol in SSA provides evidence of the direct health costs associated with drinking in the continent. In light of known effective and cost-effective measures, there is urgent need to implement interventions aimed at reducing levels of risky drinking and the high burden of alcohol-related harm in African countries. KEY WORDS: alcohol consumption, patterns of drinking, sub-Saharan Africa, burden of diseas

“Your drinking is my problem”: recording alcohol’s harm to others in Nigeria

The negative consequences of alcohol consumption on the drinker are well documented. Alcohol is the cause of many physical and mental health conditions and is associated with social problems affecting the drinker, the family and the society at-large. Nondrinkers also experience the impact of other people’s drinking though the extent of this experience is not well documented. This paper presents preliminary data from the WHO/Thai Health project on the harm to others from drinking. A sample of 16 health, security and social welfare agencies in Akwa Ibom State of Nigeria was selected and a nominated key informant in each agency was approached for information using a qualitative interview schedule. The information sought from respondents included types of harms to others seen at the agency, the frequency of such cases, how information about the cases are recorded and handled, and whether regular records are kept at the agency on harm to others from alcohol. Findings show that few agencies collected data on harm to others from drinking but several reported seeing people affected by the drinking of others, with most cases reported by social welfare agencies. Almost all the agencies contacted expressed interest in collecting relevant data and being involved more in addressing the problem. The reported low levels of awareness and action on harm to others from drinking have potentially serious implications in a society with a rapidly growing rate of alcohol consumption.Key words: Alcohol, harm to others, Nigeria, drinking problem

The politics of alcohol policy in Nigeria: a critical analysis of how and why brewers use strategic ambiguity to supplant policy initiatives

The global call by the World Health Assembly (WHA) to control the rising alcohol-related problems caused by harmful consumption through policy became necessary in 2005 due to the recognition of the fact that many countries did not have alcohol policies. This gave rise to the adoption of a ten-point policy strategy by the World Health Organization (WHO) Member States in 2010. Against this backdrop, many countries adopted alcohol policies to reduce harmful alcohol consumption. Nigeria was one of the WHO Member Countries that adopted the resolution. Nigeria is among the 30 countries with the highest per capita consumption and alcohol-related problems, yet has not formulated alcohol policy to date. This paper draws on Eisenberg’s Strategic Ambiguity Model to explore the role of brewers in supplanting alcohol policy initiatives in Nigeria. It argues that the leading alcohol producers in Nigeria have been the main reason alcohol policies have not been formulated. The article focuses on why their campaigns for responsible drinking, promotions, sponsorships and ‘strategic social responsibilities’ may have increased since the WHA made the call and the WHO adopted the resolution in 2010. It concludes by arguing that there is an urgent need to formulate policies drawing from the WHO resolution to curtail the activities of these brewers and reduce harmful consumption

Packages of Care for Alcohol Use Disorders in Low- And Middle-Income Countries

In the fourth in a series of six articles on packages of care for mental disorders in low- and middle-income countries, Vivek Benegal and colleagues discuss the treatment of alcohol use disorders

The downward spiral of mental disorders and educational attainment: a systematic review on early school leaving.

BACKGROUND: Most psychiatric disorders present symptom patterns that cause severe impairment on the emotional, cognitive and social level. Thus, adolescents who suffer from a mental disorder risk finding themselves in a downward spiral caused by the reciprocal association of psychological symptoms and negative school experiences that may culminate in early school leaving. In addition to previous collective work that mainly focused on school refusing behaviour among children and was presented as an expert's opinion, the following systematic review fills the knowledge gap by providing a structured overview of the bidirectional association between mental health and secondary school dropout based on a sound methodology and with a particular focus on mediating factors. METHODS: Four electronic databases were searched from January 1990 until June 2014. Selected references were assessed for study details, main results, mediating factors and methodological limitations. Standardized risk of bias assessment was conducted. RESULTS: Mood and anxiety disorders seemed to have a less consequential direct effect on early school leaving than substance use and disruptive behaviour disorders. The association between externalizing disorders and educational attainment was even stronger when the disorder occurred early in life. On the other hand, internalizing disorders were reported to develop as a consequence of school dropout. Only few studies had addressed gender differences, with discrepant results. Socio-economic background, academic achievement and family support were identified as significant mediating factors of the association between mental disorders and subsequent educational attainment. CONCLUSIONS: Findings suggested a strong association between mental health and education, in both directions. However, most studies focused on mediating factors that could not be targeted by intervention programs

Self-reported drunkenness among adolescents in four sub-Saharan African countries: associations with adverse childhood experiences

<p>Abstract</p> <p>Background</p> <p>Consumption of alcohol is associated with acute and chronic adverse health outcomes. There is a paucity of studies that explore the determinants of alcohol use among adolescents in sub-Saharan Africa and, in particular, that examine the effects of adverse childhood experiences on alcohol use.</p> <p>Methods</p> <p>The paper draws on nationally-representative data from 9,819 adolescents aged 12-19 years from Burkina Faso, Ghana, Malawi, and Uganda. Logistic regression models were employed to identify correlates of self-reported past-year drunkenness. Exposure to four adverse childhood experiences comprised the primary independent variables: living in a food-insecure household, living with a problem drinker, having been physically abused, and having been coerced into having sex. We controlled for age, religiosity, current schooling status, the household head's sex, living arrangements, place of residence, marital status, and country of survey. All analyses were conducted separately for males and females.</p> <p>Results</p> <p>At the bivariate level, all independent variables (except for coerced sex among males) were associated with the outcome variable. Overall, 9% of adolescents reported that they had been drunk in the 12 months preceding the survey. In general, respondents who had experienced an adverse event during childhood were more likely to report drunkenness. In the multivariate analysis, only two adverse childhood events emerged as significant predictors of self-reported past-year drunkenness among males: living in a household with a problem drinker before age 10, and being physically abused before age 10. For females, exposure to family-alcoholism, experience of physical abuse, and coerced sex increased the likelihood of reporting drunkenness in the last 12 months. The association between adverse events and reported drunkenness was more pronounced for females. For both males and females there was a graded relationship between the number of adverse events experienced and the proportion reporting drunkenness.</p> <p>Conclusions</p> <p>We find an association between experience of adverse childhood events and drunkenness among adolescents in four sub-Saharan African countries. The complex impacts of adverse childhood experiences on young people's development and behavior may have an important bearing on the effectiveness of interventions geared at reducing alcohol dependence among the youth.</p

Doing masculinity, not doing health? a qualitative study among dutch male employees about health beliefs and workplace physical activity

<p>Abstract</p> <p>Background</p> <p>Being female is a strong predictor of health promoting behaviours. Workplaces show great potential for lifestyle interventions, but such interventions do not necessarily take the gendered background of lifestyle behaviours into account. A perspective analyzing how masculine gender norms affect health promoting behaviours is important. This study aims to explore men's health beliefs and attitudes towards health promotion; in particular, it explores workplace physical activity in relation to masculine ideals among male employees.</p> <p>Methods</p> <p>In the Fall of 2008, we interviewed 13 white Dutch male employees aged 23-56 years. The men worked in a wide range of professions and occupational sectors and all interviewees had been offered a workplace physical activity program. Interviews lasted approximately one to one-and-a-half hour and addressed beliefs about health and lifestyle behaviours including workplace physical activity, as well as normative beliefs about masculinity. Thematic analysis was used to analyze the data.</p> <p>Results</p> <p>Two normative themes were found: first, the ideal man is equated with being a winner and real men are prepared to compete, and second, real men are not whiners and ideally, not vulnerable. Workplace physical activity is associated with a particular type of masculinity - young, occupied with looks, and interested in muscle building. Masculine norms are related to challenging health while taking care of health is feminine and, hence, something to avoid. Workplace physical activity is not framed as a health measure, and not mentioned as of importance to the work role.</p> <p>Conclusions</p> <p>Competitiveness and nonchalant attitudes towards health shape masculine ideals. In regards to workplace physical activity, some men resist what they perceive to be an emphasis on muscled looks, whereas for others it contributes to looking self-confident. In order to establish a greater reach among vulnerable employees such as ageing men, worksite health promotion programs including workplace physical activity may benefit from greater insight in the tensions between health behaviours and masculinity.</p