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Cross-sectional surveys of financial harm associated with others’ drinking in 15 countries: Unequal effects on women?

https://doi.org/10.1016/j.drugalcdep.2020.107949Get rights and content

Highlights

  • Two percent of respondents in high-income countries reported financial harm due to others’ drinking.

  • In contrast, fourteen percent of respondents reported financial harm from others' drinking in low- and middle-income countries.

  • Financial harm from others’ drinking was notably high 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.

Abstract

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.

Introduction

Women suffer more from a partner’s drinking while men experience harm more commonly from strangers’ drinking (Laslett et al., 2011). Consequently, women are likely to be more impacted by financial harm as this generally occurs in the family context. For women, problems associated with a partner’s drinking have long been studied in the US, Australia and Europe (Laslett et al., 2015), and include economic abuse – a form of domestic violence that affects the financial wellbeing of victims and includes controlling behaviours (Kutin et al., 2017). Less information is available on the financial harm from others’ drinking in low- and middle-income countries (LMIC). In Thailand (data also used in the present study), Waleewong (Waleewong, 2019) found that around one-fifth of the Thai population was affected financially by others’ drinking for a variety of reasons, including because they have paid for the costs associated with traffic crashes, property damage and/or ruined clothes or belongings caused by others’ drinking; household finances have been diverted; they need to pay for health care costs; or they had money stolen from them by a drinker. In a qualitative study in India, family members, mostly spouses, of 50 men with alcohol dependence were interviewed (Chand and Chaturvedi, 2010). Family members of these patients reported excessive spending and disturbances of the peace at home as stressful. More severe problems, including situations where the spouse was not working and earning money for the family because of their drinking, were considered very stressful. Studies among populations displaced by conflict, in Kenya, Liberia, Uganda and Thailand, identified widespread use of alcohol following this displacement (Ezard et al., 2011). For instance, in Uganda, “household financial problems, resulting from indebtedness and trading family rations and other goods for alcohol, left families short of food and children hungry” (p.6, Ezard et al., 2011). In Rwanda, among HIV-infected clinical populations, alcohol use was significantly associated with food insufficiency (Sirotin et al., 2012). In a 2010 study exploring the role of intimate partner violence in household food insecurity for women in Brazil, socioeconomic position, demographic characteristics, the degree of women's social support and partner alcohol misuse were identified as key factors (de Moraes et al., 2016).

In sum, there is evidence that individual drinking can cause and exacerbate financial harm not only for the drinker themselves but also for other family members. It is probable that people in LMIC may be more adversely affected as families in these countries often have less disposable income, and few social services are available to supplement family incomes. Previous research has found that a range of alcohol-related harms to drinkers differ according to both individual- and country-level socioeconomic differences (Grittner et al., 2012). Whether harms (and especially financial harms) from other drinkers affect respondents with different income and education levels (and other measures of social advantage) differentially has been seldom studied in surveys, and where it has few differences have been identified (Laslett et al., 2017; Room et al., 2019).

This study aims to assess the extent to which persons from 15 diverse high-income countries (HIC) and LMIC have experienced the financial impacts of others’ drinking and compare the prevalence and correlates (gender, age, education, rurality and respondent drinking pattern) of financial harm arising from someone else’s drinking. We hypothesise that women will be more affected than men, that participants with lower education will be more affected than those with higher education and participants from LMIC will be more affected than participants from HIC.

Section snippets

Setting, participants and data

The Gender and Alcohol’s Harm to Others (GENAHTO) project (Wilsnack et al., 2018) includes survey data from 16 countries of which 15 include items on financial harm (Switzerland, Denmark, Sweden, Australia, US, Ireland, New Zealand, Chile, Brazil, Thailand, Sri Lanka, Nigeria, Vietnam, Lao People’s Democratic Republic (Lao PDR) and India). The participants were 17,670 men and 20,947 women aged 18−64 years. The samples and differences in survey methods are shown in Table 1, listed in order of

Dependent variables

Experiencing any financial harm from a drinker was defined as a positive response to at least one of the following two questions on financial harm occurring in the past 12 months: a) Have you experienced financial trouble or problems due to others’ drinking? and b) Have you had less money for household expenses due to others’ drinking? Question b) was asked only of people who indicated in response to a prior question that they had experienced harm from a “known person.” In Switzerland, Denmark

Results

Sample sizes reported in Table 1 are unweighted but percentages are drawn from weighted samples. All surveys under-represented men except for the Nigerian and Vietnamese surveys. Across the different countries the weighted percentages were largely similar in terms of age distribution, apart from the Brazilian sample, which had a higher proportion of participants aged 18–29 years, contrary to Thailand and Vietnam which both had a lower proportion of this age group. Differences in education were

Gendered findings on financial harm

Both men and women in LMIC were more likely to experience financial harms from others’ drinking than were men and women in HIC (as shown in meta-analysis – 12 % vs. 2% for men and 11 % vs. 3% for women). This finding is consistent with research showing that trouble per litre experienced by drinkers is greater in poorer than in richer countries (Room et al., 2011). Moreover, while living in HIC is protective of financial harm, women in HIC, who on average earn lower incomes than men (The World

Conclusions

This study is the first of its kind to produce cross-national comparable estimates of financial harm from others’ drinking. In 13 countries financial harm from others’ drinking was common. Financial harm inequitably affected women and was more prevalent in LMIC than in HIC. In LMIC women and participants who themselves drank more, were more likely to report financial harms in the household from drinking and financial trouble, whereas in HIC only gender and age were associated with greater

Contributors

AML wrote the first draft of the text; HJ conducted all analyses; SK, SW, OS & TKG and KG advised on analysis; ES, OW and KB conducted, analysed and contributed to the interpretation of country-level data. All authors made substantial contributions to numerous drafts and the final paper.

Role of funding source

None.

Declarations of competing interest

None.

Acknowledgements

The data used in this study are from the GENAHTO Project (Gender and Alcohol’s Harm to Others), supported by NIAAA Grant No. R01 AA023870 (Alcohol’s Harm to Others: Multinational Cultural Contexts and Policy Implications). GENAHTO is a collaborative international project affiliated with the Kettil Bruun Society for Social and Epidemiological Research on Alcohol and coordinated by research partners from the Alcohol Research Group, Public Health Institute (USA), University of North Dakota (USA),

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