Alcohol, Gender and Drinking Problems

241 Pages·2006·2.6 MB·English

Alcohol, Gender and
Drinking Problems
Perspectives from Low and Middle Income Countries
Edited by
Isidore S. Obot & Robin Room
Department of Mental Health and Substance Abuse, Geneva
WHO Library Cataloguing-in-Publication Data
Alcohol, gender and drinking problems: perspectives from low and middle income
countries.
1. Alcohol drinking - adverse effects 2. Alcoholic intoxication - epidemiology 3.
Sex factors 4. Socioeconomic factors 5. Multicenter studies 6. Developing
countries I. World Health Organization II. GENACIS.
ISBN 92 4 156302 8 (NLM classification: WM 274)
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C
ONTENTS
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .v
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix
Chapter 1: Why study gender, alcohol and culture? . . . . . . . . . . . .1
Richard W. Wilsnack, Sharon C. Wilsnack & Isidore S. Obot
Chapter 2: Social consequences of alcohol consumption
in Argentina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
Myriam I. Munné
Chapter 3: Differences in drinking patterns between
men and women in Brazil . . . . . . . . . . . . . . . . . . . . . .49
Florence Kerr-Corrêa, Andrea M. Hegedus,
Alessandra F. Sanches, Luzia A.Trinca, Ligia R. S.
Kerr-Pontes, Adriana M. Tucci & Tricia M. F. Floripes
Chapter 4: Alcohol, gender and partner aggression: a study
in the Greater Metropolitan Area of Costa Rica . . .69
Julio Bejarano-Orozco
Chapter 5: Women and alcohol in India . . . . . . . . . . . . . . . . . . . . . .89
Vivek Benegal, Madhabika Nayak, Pratima Murthy,
Prabha Chandra & G. Gururaj
Chapter 6: Alcohol consumption in Mexican women:
implications in a syncretic culture . . . . . . . . . . . . . . .125
Martha Romero Mendoza, Maria Elena Medina-Mora,
Jorge Villatoro & Ana Durand
Chapter 7: The contexts of alcohol consumption by men and
women in Nigeria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .143
Akanidomo J. Ibanga, Adebola V. Adetula,
Zubairu Dagona, Haruna Karick & Ochiyna Ojiji
Chapter 8: Gender and alcohol in Sri Lanka . . . . . . . . . . . . . . . . .167
Siri Hettige & Dharmadasa Paranagama
Chapter 9: Gender and the major consequences of alcohol
consumption in Uganda . . . . . . . . . . . . . . . . . . . . . . . . . .189
Nazarius Mbona Tumwesigye & Rogers Kasirye
Chapter 10:Problems from women's and men's drinking
in eight developing countries . . . . . . . . . . . . . . . . . . . .209
Robin Room & Klara Hradilova Selin
Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .221

F
OREWORD
In the year 2000 the Department of Health of the Government of
Valencia, Spain, received a proposal from the Department of Mental
Health and Substance Dependence (now Substance Abuse) of the World
Health Organization for technical cooperation and financial support for
several projects on alcohol programmes and policy. The projects suggested
in the proposal included data gathering, management of alcohol problems
through dissemination of brief intervention, the development of global
alcohol policy initiatives, and support for technology transfer in the field of
substance abuse in general.
The reason behind this request for cooperation was a recognition of the
growing role of alcohol in global public health, especially in developing
countries, and the need for more funding to continue some of the World
Health Organization's outstanding work on alcohol. For example, though
WHO projects on screening and brief intervention (SBI) in primary heath
care settings had been recognized as an effective strategy in reducing
harmful and hazardous alcohol consumption in several developed
countries, the strategy had not been tested in developing countries. The
proposal also recognized the need for dependable and comparable data on
gender and alcohol issues, including differences between men and women
in patterns of drinking and related problems.
Data from a variety of sources, especially WHO's Global Alcohol
Database (GAD) and the annual world health reports, support the
contention that alcohol indeed has become a major risk factor for disease
and disability in many countries across the world. That this risk is
increasing in, for example, the low-mortality developing countries of Asia
and South America where alcohol is often the highest contributor to
disease burden.
Considering its interest in global public health, the Valencian
Government was pleased to approve the signing of a cooperative
agreement with WHO in 2001 and the agreement has been renewed every
year since then. The agreement focused on work in the following areas:
gender and alcohol, alcohol policy, and knowledge transfer through
training. One of the first activities in the agreement was a meeting of
experts to discuss the implications of alcohol marketing to young people's
drinking which took place in Valencia in March 2002. The product of that
meeting is expected to serve as a major resource in our understanding of
the role of alcohol marketing and promotion in youth drinking behaviours.
Support provided through the agreement has also been used by WHO
to fund projects on brief intervention for alcohol problems in Brazil and
South Africa. It has also led to this book which is the product of the gender
and alcohol project in seven countries on four continents (namely,
Argentina, Costa Rica, India, Kazakhstan, Nigeria, Sri Lanka and Uganda).
I am indeed pleased to contribute the foreword to this book which
publishes contributions on gender and alcohol from six of the countries
funded through the Valencia-WHO cooperative agreement and two other
countries. The book will go a long way in enhancing our appreciation of
gender issues in alcohol research and in the management of alcohol-
related problems not only in primary care but in other settings, e.g.,
prenatal clinics and the workplace. I am sure that the book will contribute
to the development of alcohol policy and the provision of service to men
and women with alcohol-related problems not only in the countries in the
reports but all around the world. The Government of Valencia, through the
Department of Health, is happy to be associated with WHO's commitment
to reducing alcohol problems globally and will continue to support its
efforts in achieving this goal.
Dr Bartolomé Pérez Gálvez
Director General, Drug Dependence
Department of Health
Autonomous Government of Valencia
Spain
vi
P
REFACE
This book presents data and addresses significant issues on gender and
alcohol in eight low and middle income countries where such data are often
not available. The book is a product of the multinational collaborative
project on "Gender, Alcohol and Culture: an International Study"
(GENACIS). GENACIS was funded by the European Commission, the U.S.
National Institute on Alcoholism and Alcohol Abuse (NIAAA), the Swiss
Office of Education and Science, the German Federal Ministry of Public
Health, the World Health Organization, government agencies and other
sources in individual countries.
The study was conceived by the International Research Group on
Gender and Alcohol (IRGGA), a group of researchers affiliated with the
Kettil Bruun Society for Social and Epidemiological Research on Alcohol
(KBS). Beginning with a few countries in 1999, GENACIS grew to include
projects in more than thirty countries and 50 researchers, all united by a
common interest in seeking greater understanding of gender and alcohol
issues.
GENACIS uses a centralized data analysis and standardized measures
to assess the differences between men and women within and across
cultures in the following areas:
• patterns and contexts of drinking;
• prevalence of alcohol problems;
• the experience of drinking-related violence in close relationships;
• how social inequalities and social roles influence drinking and
heavy alcohol consumption;
• the relationship of societal-level factors (e.g., gender equality,
drinking culture norms) to drinking and alcohol-related problems.
The study grew out of earlier projects in Europe and the U.S. and seeks
to clarify further the factors associated with men's and women's drinking
and alcohol-related problems.
GENACIS is truly an international project; participating countries are
drawn from all parts of the world, especially from countries where harmful
use of alcohol poses a threat to public health and social welfare. Funding
provided to WHO by the Government of Valencia, Spain, made it possible
for countries in low and middle income countries to participate in the
project. These countries are Argentina, Costa Rica, India, Kazakhstan,
Nigeria, Sri Lanka and Uganda. There are also ongoing WHO-funded
projects in three countries in the region of the Americas.
The papers published in this book report data from six of these
countries and from two other countries (Brazil and Mexico) participating
in GENACIS. Each paper addresses a particular issue of relevance to the
country and provides a general overview of drinking and alcohol problems.
All papers evolved through a series of revisions after consultations with
and reviews by a team of experts associated with the project. These experts
and lead authors participated in group discussions held in Berlin, Krakow,
and Helsinki during GENACIS steering committee meetings or the annual
conference of the Kettil Bruun Society.
GENACIS is one of several projects on alcohol by the Department of
Mental Health and Substance Abuse that are designed to enhance our
understanding of alcohol problems and provide the basis for effective
interventions. This product from the GENACIS project will serve as a
valuable resource to researchers, service providers, policy-makers,
students and all those engaged in work on alcohol and public health, and
contribute to shaping a global response to the harmful consequences of
alcohol.
Dr Benedetto Saraceno
Director
Department of Mental Health and Substance Abuse
viii
A
CKNOWLEDGEMENTS
The preparation and publication of this book would not have been
possible without the generous financial contribution of the Autonomous
Government of Valencia, Spain, to the World Health Organization for
projects on Alcohol and Public Health. This support started in 2001 with a
grant for work in three related areas — gender and alcohol, screening and
brief intervention for alcohol problems, and alcohol policy. The grant made
it possible for WHO to sponsor the participation of researchers from low
and middle income countries in the multinational project on Gender,
Alcohol and Culture: an International Study (GENACIS).
Special thanks are due to Dr Bartolomé Pérez Gálvez, Director General
for Drug Dependence, Department of Health, Autonomous Government of
Valencia, for his exceptional commitment to the GENACIS project and his
overall interest in working with WHO to reduce alcohol related problems
in developing countries. Several staff of the Department of Health in
Valencia, especially Dr José Martinez-Raga, also contributed in various
ways to the success of the projects funded by their office.
The participation of contributors in project meetings (in Berlin,
Krakow and Helsinki) was made possible by grants from the U.S. National
Institute on Alcohol Abuse and Alcoholism/National Institutes of Health
(R01AA04610 and R21AA12941), and the European Union's Fifth
Framework Research Programme (contract QLG4-CT-2001-01496).
Grateful thanks are due to the principal investigators in these grants
(Sharon Wilsnack and Kim Bloomfield, respectively), and to Arlinda
Kristjanson, Stephanie Kramer, and Friedericke Froehner for facilitating
the participation of contributors in these meetings in various ways.
Richard Wilsnack and Sharon Wilsnack reviewed the papers in this
volume and provided guidance to contributors during the preparation of
the manuscripts, and Gerhard Gmel provided advice on data management
and statistical analysis. Their contributions greatly enhanced the quality of
the papers published in this volume.
The WHO-GENACIS project was initiated by Maristela Monteiro and
continued under the coordination of Vladimir Poznyak. Both of them
provided the support and encouragement needed at different stages of the
project, including the publication of this book.
Tess Narciso and Mylene Schreiber provided invaluable secretarial
support for all activities related to the WHO/GENACIS project. Isidore
Obot had overall responsibility for the implementation of the project in the
seven WHO funded countries and represented WHO in the steering
committee of the multinational research initiative.