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

Some types of harms experienced because of others' drinking (AHTO) may produce greater negative effects than other harms. However, AHTO survey items were developed to measure type, not severity, of harm. 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. 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. 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. 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. In-depth analyses of specific sub-sets of harms and qualitative interviews with victims of severe AHTO may prove useful

Alcohol's harm to others and subjective well-being: Cross-sectional studies in Lao People's Democratic Republic and Thailand

Introduction and Aims Previous studies have confirmed that the number of heavy drinkers in a household negatively correlates with the subjective well‐being of individuals in the household. However, limited studies have investigated the experiences of alcohol's harm to others (HTO) and subjective well‐being, particularly in low‐ and middle‐income countries. The purpose of this study was to investigate the associations between experiences of HTO and subjective well‐being in two selected low‐ and middle‐income countries. Design and Methods We analysed population survey data on 1205 and 1491 individuals aged 18–64 years from Lao People's Democratic Republic (Lao PDR) and Thailand, respectively. The respondents' experiences of HTO and their subjective well‐being were measured using face‐to‐face interviews. The association between experiencing HTO and subjective well‐being was investigated using Tobit regression models. Results A significant association between experiencing HTO and subjective well‐being was found in Thailand, but not in Lao PDR. Those who had ever experienced HTO had a 2.77‐point lower score of subjective well‐being than those who had never experienced HTO (95% confidence interval −4.67, −0.88; P ‐value <0.05) in Thailand. In Lao PDR, the physical harm dimension showed the strongest association with subjective well‐being compared to other types of harm, while in Thailand, financial harm was the dimension most strongly associated with the outcome. Discussion and Conclusions There was a significant association between HTO and subjective well‐being, particularly physical harm in Lao PDR and financial harm in Thailand. The study suggests that services to mitigate the impacts of HTO on well‐being should focus on physical harm in Lao PDR and financial harm in Thailand

Harm from others’ drinking-related aggression, violence and misconduct in five Asian countries and the implications

© 2018 Elsevier B.V. Background: Harm from alcohol-attributable aggression and violence is linked to diminished personal safety and reduced physical and mental health and wellbeing in many countries. But there has been limited evidence on these harms in low- and middle-income countries (LMICs). This study measured harm from others’ drinking-related aggression, violence and misconduct in five Asian LMICs (Thailand, Sri Lanka, India, Vietnam, and Lao PDR), aiming to compare the magnitude and pattern of harm across countries by gender, age group, educational level, rurality, and country-level indicators. Methods: Data from 9832 respondents from the WHO/Thai Health International Collaborative Research Project on the Harm from Others’ Drinking undertaken between 2012 and 2014 were analysed. Findings: 50–73% of respondents from five countries reported being harmed at least once in the past year. Public disorder and feeling unsafe due to someone else's drinking was frequently reported, followed by harassment, assaults and threats, traffic harm, and property damage. In most countries, men were more likely than women to report traffic harms, property harm, and assaults, whereas women were more likely to report feeling unsafe in public. Being young, less educated, living in urban areas, and one's own drinking were significant predictors of more harm from others’ drinking for both genders. Conclusions: This study revealed a consistently high prevalence of alcohol-related aggression and violence in the five Asian countries. Patterns of harm within countries and populations at most risk for different forms of harms were identified. Alongside services for those affected, efforts to strengthen alcohol policies are needed in each society

Seeking Help for Harm from Others' Drinking in Five Asian Countries: Variation Between Societies, by Type of Harm and by Source of Help

Aims: This study aims to measure the prevalence rates and patterns of help-seeking behavior as a consequence of being harmed by drinkers in five Asian countries (India, Sri Lanka, Vietnam, Lao PDR and Thailand).Methods: A total of 9832 respondents aged 18-65 years from the WHO/ThaiHealth Collaborative Project were surveyed between 2012 and 2014 about their experiences of being negatively affected due to another's drinking, and whether and where they sought help, focusing on four adverse aspects of harms from others' drinking.Results: The prevalence of seeking help from any source in the past year due to harm from others' drinking ranged from 7% to 20%. The most common service used by those who were affected by other people's drinking was asking for help from friends, followed by calling the police and using health-related services. The largest proportion of help-seeking was among those reporting property harm, followed by those being harmed physically and sexually by drinkers.Conclusion: Given a wide range of harms from others' drinking in the general population and different needs of those affected, prevalence rates for help-seeking behavior due to others' drinking in South and South East Asian countries were low and the help sought was often informal. There is a large knowledge gap in our understanding of the mechanisms of help-seeking behavior and the pathways for access to help among those affected. Further studies are important for enhancing the social response services available and making these more accessible to those who need help

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

Harm from Known Others&#039; Drinking by Relationship Proximity to the Harmful Drinker and Gender: A Meta-Analysis Across 10 Countries

Background: Drinking is a common activity with friends or at home but is associated with harms within both close and extended relationships. This study investigates associations between having a close proximity relationship with a harmful drinker and likelihood of experiencing harms from known others&#039; drinking for men and women in 10 countries. Methods: Data about alcohol&#039;s harms to others from national/regional surveys from 10 countries were used. Gender-stratified random-effects meta-analysis compared the likelihood of experiencing each, and at least 1, of 7 types of alcohol-related harm in the last 12 months, between those who identified someone in close proximity to them (a partner, family member, or household member) and those who identified someone from an extended relationship as the most harmful drinker (MHD) in their life in the last 12 months. Results: Women were most likely to report a close male MHD, while men were most likely to report an extended male MHD. Relatedly, women with a close MHD were more likely than women with an extended MHD to report each type of harm, and 1 or more harms, from others&#039; drinking. For men, having a close MHD was associated with increased odds of reporting some but not all types of harm from others&#039; drinking and was not associated with increased odds of experiencing 1 or more harms. Conclusions: The experience of harm attributable to the drinking of others differs by gender. For preventing harm to women, the primary focus should be on heavy or harmful drinkers in close proximity relationships; for preventing harm to men, a broader approach is needed. This and further work investigating the dynamics among gender, victimperpetrator relationships, alcohol, and harm to others will help to develop interventions to reduce alcohol-related harm to others which are specific to the contexts within which harms occur

Alcohol's harm to others and subjective well‐being: Cross‐sectional studies in Lao People's Democratic Republic and Thailand

Introduction and Aims Previous studies have confirmed that the number of heavy drinkers in a household negatively correlates with the subjective well‐being of individuals in the household. However, limited studies have investigated the experiences of alcohol's harm to others (HTO) and subjective well‐being, particularly in low‐ and middle‐income countries. The purpose of this study was to investigate the associations between experiences of HTO and subjective well‐being in two selected low‐ and middle‐income countries. Design and Methods We analysed population survey data on 1205 and 1491 individuals aged 18–64 years from Lao People's Democratic Republic (Lao PDR) and Thailand, respectively. The respondents' experiences of HTO and their subjective well‐being were measured using face‐to‐face interviews. The association between experiencing HTO and subjective well‐being was investigated using Tobit regression models. Results A significant association between experiencing HTO and subjective well‐being was found in Thailand, but not in Lao PDR. Those who had ever experienced HTO had a 2.77‐point lower score of subjective well‐being than those who had never experienced HTO (95% confidence interval −4.67, −0.88; P ‐value <0.05) in Thailand. In Lao PDR, the physical harm dimension showed the strongest association with subjective well‐being compared to other types of harm, while in Thailand, financial harm was the dimension most strongly associated with the outcome. Discussion and Conclusions There was a significant association between HTO and subjective well‐being, particularly physical harm in Lao PDR and financial harm in Thailand. The study suggests that services to mitigate the impacts of HTO on well‐being should focus on physical harm in Lao PDR and financial harm in Thailand

Alcohol’s harm to others: An international collaborative project

Aims: This paper outlines the methods of a collaborative population survey project measuring the range and magnitude of alcohol’s harm to others internationally. Setting: Seven countries participating in the World Health Organization (WHO) and ThaiHealth Promotion Foundation (ThaiHealth) research project titled “The Harm to Others from Drinking,” along with two other countries with similar studies, will form the core of a database which will incorporate data from other countries in the future. Measures: The WHO-ThaiHealth research project developed two comparable versions of a survey instrument, both measuring harm from others’ drinking to the respondent and the respondent’s children. Design: Surveys were administered via face-to-face methods in seven countries, while similar surveys were administered via computer-assisted telephone interviews in two additional countries. Responses from all surveys will be compiled in an international database for the purpose of international comparisons. Discussion: Harms from the alcohol consumption of others are intertwined with the cultural norms where consumption occurs. The development of this database will make it possible to look beyond reports and analyses at national levels, and illuminate the relationships between consumption, harms, and culture. Conclusions: This database will facilitate work describing the prevalence, patterning, and predictors of personal reports of harm from others’ drinking cross-nationally

Addiction research centres and the nurturing of creativity: The Centre for Alcohol Policy Research (CAPR), Melbourne: A decade on

Established in 2006, the Centre for Alcohol Policy Research (CAPR) is Australia's only research centre with a primary focus on alcohol policy. CAPR has four main areas of research: alcohol policy impacts; alcohol policy formation and regulatory processes involved in implementing alcohol policies; patterns and trends in drinking and alcohol problems in the population; and the influence of drinking norms, cultural practices and social contexts, particularly in interaction with alcohol policies. In this paper, we give examples of key publications in each area. During the past decade, the number of staff employed at CAPR has increased steadily and now hovers at approximately 10. CAPR has supported the development of independent researchers who collaborate on a number of international projects, such as the Alcohol's Harm to Others study which is now replicated in approximately 30 countries. CAPR receives core funding from the Foundation for Alcohol Research and Education, and staff have been highly successful in securing additional competitive research funding. In 2016, CAPR moved to a new institutional setting at La Trobe University and celebrated 10 years of operation

Scoping response system management of alcohol&#039;s harm to others in lower middle income countries

AIMS - As part of the WHO Harm from others&#039; drinking project, Thailand, Sri Lanka, India, Chile, Nigeria and Vietnam undertook scoping studies to examine: which service agencies in low and middle income countries responded to people affected by others&#039; drinking; how commonly key informants from these agencies indicated alcohol was part of the problems they managed; and whether any routine reporting systems collected information on alcohol&#039;s harm to others (AHTO) and the types and examples of harms experienced across the six countries. METHODS - Researchers synthetised within country peer-review literature, reports, news and agency website information. Additionally, researchers interviewed key informants to investigate current structures, functions and practices of service agencies, and in particular their recording practices surrounding cases involving others&#039; drinking. RESULTS - 111 key informants agreed to participate from 91 purposively selected agencies from health, social protection, justice and police, and &#039;other&#039; sectors. National and provincial level data, as well as state-run and civil society agency data were collected. Diverse service response systems managed AHTO in the different countries. A large range in the percentage of all cases attributed to AHTO was identified. Case story examples from each country illustrate the different responses to, and the nature of, many severe problems experienced because of others&#039; drinking. CONCLUSIONS - AHTO was a major issue for service systems in LMIC, and significantly contributed to their workload, yet, very few recording systems routinely collected AHTO data. Recommendations are outlined to improve AHTO data collection across multiple sectors and enable LMIC to better identify and respond to AHTO