Harmful health behaviours among conflictaffected populations in Georgia: The case of harmful alcohol use

Bayard Roberts
London School of Hygiene and Tropical Medicine

www.hitt-cis.net/
Improving health worldwide www.lshtm.ac.uk

Background
Alcohol and conflict Harmful alcohol use a leading risk factor for disease and mortality globally among adults. Costly to individuals, families, communities and societies. Alcohol use and conflict: form of coping with trauma exposure, poor mental health, daily stressors. Limited evidence globally on patterns of harmful alcohol use among conflict-affected civilian populations

Aim and Objectives

Aim: To examine the patterns of harmful alcohol use among conflict-affected persons in Georgia.

Objectives: 1. To measure the prevalence of harmful alcohol use. 2. To identify individual-level risk-factors for harmful alcohol us 3. To identify community level risk-factors for harmful alcohol use.

Methods
Data sources: Individual-level survey data: consumption (wine, spirits, beer). Community-level data: alcohol outlets; advertisements for wine, beer, spirits; alcohol formally available 24 hours a day; and sum of cheapest mean cost of beer, wine and spirits. Key measures: Frequency of alcohol consumption. Mean volume of pure alcohol consumption per year (litres). Key outcome 1: Alcohol use disorder (AUDIT instrument). Key outcome 2: Episodic heavy drinking (60 grammes of pure alcohol per drinking session at least once a week).

Analysis: Factor analysis community variables to produce alcogenic factor. Multivariate logistic regression analysis.

Results: frequency of use

Frequency of alcohol consumption, by gender (N=3600)
90
80 70 60 50 % 40 30 20 10 0 10 2 0 Everyday 23 35 28 18 2 Once a month or less Never Men Women 80

2 0

4 times a 2-3 times a 2-4 times a week week month

Results: volume consumed

Mean volume of pure alcohol consumption per year (litres), by alcohol type and gender (current drinkers only, N=1387) 14 12 Mean volume (litres) 10 8 6 3.36 Beer Spirits Wine 6.99 0.32 0.54 0.97 Men Women 2.77

=13.12 litres

4
2 0

=1.83 litres

Results: alcohol use disorder

Alcohol use disorder (AUDIT), by gender (current drinkers only, N=1387)
100 90 80 70 60
% 25.70

Require treatment (score 20+)

98.96

50 40 30 20
72.18

Counselling suggested (score 16-19) Require advice (score 8-15) No alcohol problem (score <8)

10
0 Men Women

Results: episodic heavy drinking

Proportion of current drinkers reporting episodic heavy drinking*, by gender (current drinkers only, N=1387) 14 12 10 % 8 6 4 2 0 Men Women 2 12

* Episodic heavy drinking: 60 grammes of pure alcohol per drinking session at least once a week

Results: Risk-factors
Probability of having alcohol use disorder (AUDIT score 8), current drinking men only, N=912)*
3 2.5 Odds ratio 2 1.5 1 0.5 0
65+ years Experienced serious injury
Trauma event

2.63 2.36

2.67

2.73

2.65

1.4

0.16
1 event 2 events 3 events 4+ events Depression**

Age

Cumulative trauma events

Mental health

*Odds ratios adjusted for other significant effects in multivariate regression model. All results statistically significant at P<0.05. ** Depression is PHQ score of 10.

Results: Risk-factors
Probability of episodic heavy drinking, current drinking men only, N=912)*
3 2.6

2.5
Odds ratio

2.34 1.66 1.27

2
1.5 1 0.5 0 30-39 years 40-49 years

Experienced serious injury Trauma event

Alcogenic factor

Age

Community influences

*Episodic heavy drinking: 60 grammes of purealcohol per drinking session at least once a week Odds ratios adjusted for other significant effects in multivariate regression model. All results statistically significant at P<0.05.

Discussion: limitations
Cross-sectional survey: problems of causation, temporality. Sample size limitations Under reporting of alcohol use?

Discussion
Contributions of the study: Most comprehensive study on harmful alcohol use among conflictaffected civilian populations (globally). Highlights the role of community-level influences on heavy episodic

drinking.
Highlights association between depression and alcohol use disorder. Combined treatment interventions?

Acknowledgements
Adrianna Murphy (London School of Hygiene and Tropical Medicine)

www.hitt-cis.net/