Illicit alcohol, existing outside legal frameworks, lacks safety standards and may contain harmful substances. In Africa, the illicit alcohol market is pervasive, contributing to significant public health challenges. The state in Zambia may not be so different where abuse of alcohol was associated to unintended injuries, suicidal ideation and physical fights that in some cases lead to death. This mirrors these challenges; according to the Zambia Stepwise Survey for Non-Communicable Diseases (NCDs) Risk Factors (2017), 21.7% of adults consume alcohol, with urban areas experiencing higher rates of illicit production. The study aimed to assess the public health risk implications associated with the production and retail of illicit alcohol based on the hygiene and sanitation of these premises. A quantitative approach was employed in Livingstone, Lusaka, and Ndola. We employed a quantitative approach was conducted in Livingstone, Lusaka, and Ndola. A hygiene and sanitation observation tool obtained from the Lusaka City Council was adapted and utilized to evaluate the conditions of these premises. The study found that Livingstone exhibited the highest rate of unavailability of water supply at illicit alcohol production sites, with 18% lacking access to water, while Lusaka had 13% without water supply of the zones selected, all sites in Ndola had water supply. Given the growing trend of consuming illicit alcohol in such unsanitary environments, urgent interventions are warranted. The study recommends the implementation of enforcement of regulations, including regular inspections and enhanced enforcement mechanisms, to ensure hygienic and sanitary production practices.

Illicit alcohol consumption is prevalent globally, particularly in low- and middle-income countries where formal regulatory systems are weak or less enforced. Consumption of illicit alcohol has serious consequences, both immediate and long-term. The objective of this study was to examine the socio-demographic and behavioral factors associated with the consumption of illicit alcohol among the patrons in selected urban and peri-urban areas in Zambia. This was a cross-sectional study. Illicit alcohol consumption status, socio-demographics and behavioral factors were assessed. Of the 416 patrons who participated, 71.2% consumed illicit alcohol (Men, 75.3% vs. women 54.7%). More than 66.8% reported needing a drink first thing in the morning, 50.2% have had problems with friends due to alcohol and 19% did indicate having visited the hospital due to a drinking problem. Our findings underscore the high prevalence of illicit alcohol consumption among the patrons. Addressing illicit alcohol consumption requires a multifaceted set of interventions that consider the various factors contributing to alcohol misuse, and focuses on prevention, education, support, and community engagement.

Illicit alcohol consumption is a major public health problem in Zambia and many other countries in Sub-Saharan Africa. This study aimed to determine drivers of illicit alcohol consumption among at-risk populations, such as youths, in selected urban areas in Zambia, using the social-ecological model as a lens to understand these drivers. Through a qualitative approach, we conducted semi-structured interviews with 12 key stakeholders from the Ministry of Health, Zambia Revenue Authority, local council public health departments, and rehabilitation centers. We also interviewed 30 alcohol consumers who frequent alcohol retail settings such as bars or liquor stores. Participants were purposively selected based on their knowledge of illicit alcohol consumption. Social demographic factors such as age and sex were identified as key drivers. Adolescents as young as 10 years old initiated illicit consumption, with males constituting the majority of consumers. Limited job opportunities and recreational facilities in communities encouraged young people to consume illicit alcohol; this is worsened by the availability of alcohol in their social circles. Peer influence was also found to be a major driver of illicit alcohol consumption, as cultural norms normalized alcohol use. Lack of productive activities and economic disparities were also found to drive consumption among this group. Low-income individuals sought cheaper alternatives, such as home-distilled spirits or fermented alcohol, due to their affordability and availability in disadvantaged neighbourhoods. Social norms, such as the consumption of homemade alcoholic beverages during social gatherings such as weddings, were also significant drivers. Despite policies and state agencies banning illicit alcohol sale and production, the sale of alcoholic beverages to young people and weak enforcement of regulations across the country, especially in urban areas increases young people’s risk of consuming illicit alcohol. Applying the social-ecological model emphasizes the need for multi-level interventions. These interventions should target individuals, communities, and policy levels. Specifically, they should aim to regulate alcohol consumption, disrupt the social environments that promote illicit alcohol consumption, and ultimately facilitate positive behavior change among young people.

The objective of this study was to compare drink driving and related road safety issues in 2 urban areas of 6 countries and develop an equation for estimating the rate of crash underreporting to the police in urban areas of countries that lack this information. This study is a secondary analysis of 1 to 2 waves of surveys in pairs of matched medium-sized cities in Belgium, Brazil, China, Mexico, South Africa, and Ohio, United States; the surveys supported evaluation of local alcohol harm reduction efforts. Data were from 2017 to 2019 except 2023 for Mexico. Mailed surveys in Ohio and household interviews elsewhere of quota samples matched to census data yielded 23,240 completed interviews. Relevant questions covered drinking, driving under the influence of alcohol (DUI), DUI enforcement, and, except in South Africa, road crashes. GLM regression provided an equation for estimating police reporting rates of urban injury and no-injury crashes from a country’s purchasing-power parity–adjusted gross domestic product (GDP) per capita. Our equation more closely approximates urban police crash reporting rates than prior studies that assumed that they matched U.S. data. DUI enforcement is weak/ineffective in urban Ohio. With suggested adjustments, our survey questions should be usable in other international road safety and DUI studies.

Low- and middle-income countries bear disproportionate burdens from excessive alcohol consumption, yet have fewer resources to identify and intervene with risky drinkers. Low-cost screening and brief intervention (SBI) models offer a tool for addressing this health problem and reducing disparities. In this mixed-methods study, trained pseudo-patients visited health clinics in Zacatecas, Mexico, where a novel SBI model was used with trained nonmedical health educators (HEs) conducting SBI in waiting areas. Pseudo-patients, who provided responses to the AUDIT-C screening items designed to trigger a brief intervention (BI), waited for HEs to engage them in an SBI encounter. Data on HEs’ behaviors, SBI components provided, and contextual characteristics were coded from audio recordings of the encounters using an SBI checklist and from pseudo-patient interviews. Quantitative analyses examined the consistency in pseudo-patients’ targeted AUDIT-C scores and those documented by HEs as well as the frequency of delivery of SBI components. Across 71 interactions, kappas between HEs’ scores and the targeted AUDIT-C scores ranged from 0.33 to 0.45 across AUDIT-C items; it was 0.16 for the total AUDIT-C. In 41% of interactions, the HEs recorded total AUDIT-C scores that accurately reflected the targeted scores, 45% were below, and 14% exceeded them. Analyses of checklist items and transcripts showed that HEs demonstrated desired interpersonal skills (attentive, empathetic, professional) and provided general information regarding risks and recommendations about reducing consumption. In contrast, personalized BI components (exploring pseudo-patients’ personal challenges and concerns about reducing drinking; making a plan) occurred much less frequently. Pseudo-patient interviews revealed contextual factors (noise, lack of privacy) that may have negatively affected SBI interactions.

Studies have revealed that approximately half of driving while intoxicated (DWI) offenders had their last alcoholic drink at a licensed bar or restaurant. Sales and service of alcohol to underage youth and those already intoxicated contributes to many causes of injuries. The objective of this study was to conduct a comprehensive literature review and synthesis of responsible beverage service (RBS) training effectiveness and to document the various measures of effectiveness. This review was conducted to understand the effects of RBS training on various alcohol measures of harm and in particular reducing alcohol-impaired driving. The review included both peer-reviewed and grey literature resources. Professional association websites were also searched in an effort to seek information on the effectiveness or ineffectiveness of RBS training as a strategy to reduce alcohol-related harms. Twenty-four articles found RBS training to be effective in reducing some measure of alcohol harm. Six articles could not find an effect for RBS training and eleven articles only described the implementation process of RBS training programs. Successful RBS training programs had effects on at least ten measures of alcohol harm (e.g., sales to pseudo-intoxicated patrons (decreased); DWI arrests coming from bars (decreased); and assault injuries treated at the emergency department (decreased) as examples). Reasons for RBS training being ineffective included (a) lack of buy-in by managers and owners, (b) no incentive for servers to deny service, (c) no enforcement of illegally serving underage or visibly intoxicated patrons and (d) poor implementation of the training program. There are strong indications that RBS training, when implemented correctly, when sustained, when owners and managers buy into the strategy and when implemented in coordination with other interventions, can substantially reduce a number of harms due to risky alcohol consumption.

Especially in middle-income countries, crash intervention and burden analyses/policymaking often rely on assumptions supported by data from the United States (US). Using survey data, to compare driver behavior and crash characteristics in the US, Belgium, Brazil, China, Mexico, and South Africa. In each country, we conducted face-to-face interviews with the same highway safety questions (translated into six languages) using stratified samples of 1300 to 6000 adult respondents spread across two mid-sized cities, except the US survey was by mail. The survey primarily focused on alcohol consumption patterns. Survey dates: 2018/19 or 2023. Survey data weighted to match local censuses. Differences between countries assessed with Fishers exact test, t-tests, logit regression. Driving without a license was rare except in Mexico (30%) and a Brasilia exurb (26%). Among those who drove, self-reported alcohol-impaired driving rates were: 15% Belgium, 20% Brazil, 5% China, 9% Mexico, 20% South Africa, 14% US. The percentage of those who drove drunk in the past year who police stopped for drunk driving varied widely: 53% Belgium, 21% Brazil, 60% China and Mexico, 93% South Africa, 3% (sic) in the US. Drivers passing through a sobriety checkpoint were: 27% Belgium, 53% Brazil and China, 38% Mexico, 5% US. Use of an app or social media to avoid police when driving after drinking was most common in Brazil (17% of drivers) and South Africa (13%), lowest in the US (1%). The percentage of respondents riding with someone they thought was intoxicated in the past year was: 26% Belgium, 9% China. 18%-19% Brazil and Mexico, 12% US. Crash data were not collected in South Africa. The surveys yielded data on 380 crashes. Police crash reporting rates were: 56% Brazil , 69% US, 61%-63% elsewhere. The percentage of crashes involving death or injury was: 16% US, 24% Mexico, 31%-34% elsewhere. Perceived crash alcohol involvement rates were: 19% Belgium, 32% Brazil, 41% China, 57% Mexico, 13% US. US data are poor surrogates for driving parameters elsewhere, notably urban police crash reporting. US impaired driving enforcement is far worse than in these comparison countries.

Youth alcohol use (AU) is a major global health problem. Tomando Buenas Decisiones (TBD), an adapted family-based prevention program based on the existing Guiding Good Choices program, was piloted and tested in Zacatecas, Mexico. We examined the effects of the TBD program on reducing family risk for youth AU. We used a quasi-experimental design comprising a sample of 268 parents with children 8 to 16 years. All participants were working actively in one of five Zacatecan private companies. Inverse probability weighting based on intervention status, along with censoring propensity scores, was used to estimate the difference in risk levels between intervention participants and wait-listed controls. Latent growth curve modeling was used to analyze the intervention impact on three first-order risk factors (i.e., positive attitudes for drug use, family conflict, poor family management) and a combined measure of general family risk (i.e., a second-order factor using the three first-order risk factors) at baseline, post-intervention, and 3-month follow-up. Relative to wait-listed controls, the TBD program was efficacious in reducing positive attitudes for drug use, family conflict, poor family management, and general family risk levels. However, at the 3-month follow-up, effects on positive attitudes toward drug use were no longer significant. Findings from this study address a gap in establishing efficacious preventive interventions for youth AU in Latin America. We anticipate that our study’s findings could help inform prevention efforts to reduce leading youth alcohol-related harms such as drunk driving, and domestic violence among Mexican adolescents and their families.

South Africa presents one of the riskiest patterns of alcohol consumption, with per capita consumption above the African regional average. Globally, there has been an increased focus on the potential of appointing lay counsellors to administer alcohol intervention strategies in resource-limited contexts. Given the increasing need for relevant and efficient intervention strategies in response to high-risk alcohol consumption, screening instruments such as the AUDIT-C have gained increased attention. This paper explores the experiences of 15 lay counsellors in response to the training received on how to administer the AUDIT-C instrument, as well as provide interventions such as brief advice or an appropriate referral, in the resource-limited South African township of Alexandra, Johannesburg. A focus group was facilitated for this purpose and, thereafter, a thematic content analysis was applied to identify the themes most central to the lay counsellors’ experiences. The research findings suggest that the lay counsellors perceived the training to be adequate in preparing them for administrating the AUDIT-C and for providing any relevant interventions, and that their confidence in administering the instrument developed as the project progressed. However, recruitment and administration challenges were experienced in primary healthcare and community settings, and lay counsellors perceived home visits to be more appropriate with respect to issues related to confidentiality and stigmatisation. Overall, while lay counsellors feel that the training they received on the tool and the tool itself is useful for effectively implementing the AUDIT-C in low-resource communities, the availability and efficiency of alcohol treatment services in Alexandra Township need to be improved.

Unhealthy alcohol use is a leading contributor to premature death and disability worldwide. The World Health Organization’s Global Status Report on Alcohol and Health ranked South Africa as having one of the riskiest patterns of alcohol consumption, which calls for intervention. Recognising the need for effective primary care interventions, particularly in the absence of appropriate alcohol-related harm reduction policies at national and local levels, this paper highlights the opportunities and challenges associated with a two-pronged, community-centered approach to the identification of unhealthy alcohol use and interventions. This approach included the use of the Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) as a means of screening to identify individuals at moderate (score of 5–7) to high risk (score of 8 +) alcohol use, raising awareness, and investigating the potential utility of brief advice and referrals as a means of reducing risk. Of the 54,187 participants, 43.0% reported engaging in moderate-risk alcohol consumption, with 22.1% reporting high-risk alcohol consumption. Resistance to brief advice was observed to increase with higher AUDIT-C scores. Similarly, participants engaging in high-risk alcohol consumption were resistant to accepting treatment referrals, with fewer than 10% open to receiving a referral. While men were most likely to report patterns of high-risk alcohol consumption, they were more resistant to accepting referrals. Additionally, participants who were willing to receive brief advice were often resistant to taking active steps to alter their alcohol use. This study highlights the need to consider how to prevent harmful patterns of alcohol use effectively and holistically, especially in low socioeconomic settings through primary health care and community services.

Adolescent alcohol use is a significant public health concern, particularly in Latin America where rates are high. Despite the increasing use of evidence-based interventions in this region, there is a need for further research to understand how and for whom the programs work best. This study examines at how motivation and self-efficacy affected an alcohol prevention intervention among students in Zacatecas, Mexico. We tested whether motivation mediated the relationship between alcohol use risk and the success of the intervention, and whether self-efficacy moderated this relationship. We analyzed data from 5,955 middle school students using correlation and mediation analyses to assess the indirect effects of motivation. We then conducted a moderated mediation analysis to see if the indirect effect differed between students with low and high self-efficacy. Students with higher motivation had lower risk for alcohol use and were more successful in achieving the intervention outcome. Motivation was a stronger mediator in the high self-efficacy group compared to the low self-efficacy group. This study deepened our understanding of the mechanisms of change for the program and emphasized the importance of personal self-efficacy in targeting motivation. It also highlights the need for testing mechanisms in Latin America.

Due to the ongoing COVID-19 pandemic, efforts to promote health and well-being by reducing harms related to alcohol misuse are likely to be adversely affected by changing sales and policy environments, as well as social distancing requirements imposed to halt virus transmission. In response, the AB InBev Foundation adapted an initiative originally developed to reduce harmful alcohol drinking in five global “City Pilot” demonstration sites that sponsored partnerships between local coalitions and public institutions to reduce alcohol-related harms. Little is known about the effects of a prolonged pandemic on access to alcohol, alcohol misuse and related harms, and ongoing interventions designed to prevent or mitigate these harms. Participants in Community Steering Committees (SteerCos) associated with each City Pilot provided information about the history of the project and the context of implementation during the COVID-19 pandemic. We found that, where feasible, the City Pilots adapted their in-person prevention strategies for online delivery. They also modified the purpose of a Foundation-sponsored fund that was originally intended to support community-based alcohol harm prevention efforts. As repurposed, this fund financed local COVID-19 prevention and emergency response efforts and generated goodwill with community partners.

This study examined the prevalence of screening and brief intervention (SBI) for alcohol use disorder (AUD) risk in samples of adult drinkers in three middle-income countries (Brazil, China, South Africa), and the extent to which meeting criteria for AUD risk was associated with SBI. Cross-sectional survey data were collected from adult samples in two cities in each country in 2018. Survey measures included past-year alcohol use, the CAGE assessment for AUD risk, talking to a health care professional in the past year, alcohol use screening by a health care professional, receiving advice about drinking from a health care professional, and sociodemographic characteristics. The prevalence of SBI was determined for past-year drinkers in each country and for drinkers who had talked to a health care professional. Logistic regression analyses were conducted to examine whether meeting criteria for AUD risk was associated with SBI when adjusting for sociodemographic characteristics. Among drinkers at risk for AUD, alcohol use screening rates ranged from 6.7% in South Africa to 14.3% in Brazil, and brief intervention rates ranged from 4.6% in South Africa to 8.2% in China. SBI rates were higher among drinkers who talked to a health care professional in the past year. In regression analyses, AUD risk was positively associated with SBI in China and South Africa, and with brief intervention in Brazil. Although the prevalence of SBI among drinkers at risk for AUD in Brazil, China, and South Africa appears to be low, it is encouraging that these drinkers were more likely to receive SBI.

Little research has examined how pandemics affect residents in under-resourced communities. This study investigated how COVID-19 and lockdown policies affected residents of Alexandra, one of Johannesburg, South Africa’s lowest-income townships. We conducted a telephone survey May 11–22, 2020, while the lockdown and alcohol ban were in effect, of a spatially stratified sample of 353 adult Alexandra residents drawn randomly from voter registration, credit card application, and prior studies’ sampling frames. We examined economic consequences; health experiences, including COVID-19 exposure and mental health symptoms; alcohol use; and personal experiences with violence. Respondents were aged 18 to 89 and 47% female. About 70% of those employed before the lockdown were no longer working. Over half of households lost at least one source of income. About 50% of respondents reported stockpiling food. A majority reported price rises and declines in availability of food. Smaller percentages reported such changes for other items. Over 80% reported stress or anxiety, or depression due to the pandemic. The prevalence of past-week alcohol use fell from over 50% before the lockdown to less than 10% during the lockdown. Self-reported physical violence victimization increased.

Beginning in 2016, the Anheuser-Busch InBev Foundation (ABIF) provided funding to six pilot cities to implement evidence-based interventions to reduce the harmful use of alcohol and its deleterious consequences such as alcohol-impaired driving. The cities receiving funding are Alexandra Township in Johannesburg, South Africa; Brasilia, Brazil; Columbus, Ohio, United States; Jiangshan, China; Leuven, Belgium; and Zacatecas, Mexico. Four of the city pilot coalitions are implementing a wide array of interventions to deter Driving Under The Influence (DUI). Columbus made efforts to get more judges to apply Ohio’s alcohol ignition interlock law and implemented and evaluated a Safe Rides program. Brasilia increased the number of roadside checkpoints and planned an educational campaign about the dangers of impaired driving to be delivered at bars by firefighters and paramedics. Alexandra expanded and upgraded the Metropolitan Police Department’s Alcohol Evidence Center (AEC). In Zacatecas, among other interventions, a new Driving While Intoxicated (DWI) facility is being constructed to expedite case processing and adjudication. In Columbus, the evaluation of the Safe Rides program showed an estimated reduction of 2.9 impaired driving crashes but also an average increase of 0.4 alcoholic drinks per program participant. There was a reduction in harmful alcohol use of .02% in 2017 associated with the Safe Rides campaign, but with no carryover to 2018. In Brasilia, the combined effect of the road safety measures and other factors resulted in a 35% decrease in traffic deaths between 2016 and 2019. In Alexandra, there were 46 fatal crashes over the Easter weekend in 2018, 25 fatal crashes in 2019 (46% reduction), and 3 fatal crashes in 2020 (88% reduction from 2019).

Alcohol use represents a global health problem, especially for Latin American youth. As part of the Global Smart Drinking Goals campaign, a family-based preventive intervention was adapted and piloted in Mexico based on an existing evidence-based program, Guiding Good Choices. In this study, we explored the malleability and session-specific mean-level changes in protective and risk factors targeted by the adapted family intervention as related to the prevention of underage alcohol use and abuse. The sample consisted of 177 parents working at four private local companies who had children between the ages of 8 and 16. Data were collected before and after each program session. Linear mixed-effects models were used to examine growth trajectories and session-specific mean differences for selected etiologic factors. Significant effects on protective and risk factors were found. Among protective factors, positive family involvement showed the most considerable linear growth over time, while clear standards for youth showed the largest within-session increase. The greatest linear decrease in risk was observed for family conflict, which also showed the greatest pre-, and post-session reduction. Our findings suggest that the adapted program helped families develop protection against, and reduce risk of, alcohol use in their adolescent children. Results from this exploratory pilot study provide support for further rigorous evaluation and dissemination of the adapted intervention for Hispanic families.

The purpose of this study is to develop and implement a community-based prevention initiative to prevent youth alcohol use and abuse in Zacatecas, Mexico.

Underage drinking represents a major global health problem. Given the crisis that underage drinking represents, Tomando Buenas Decisiones, a family-based prevention program, was adapted and piloted in Mexico based on the existing Guiding Good Choices program. Although family-based interventions in the USA are promising for preventing underage drinking, little is known about how adapted versions of these interventions may work in low-middle income countries, such as in Latin America. The present study examined whether baseline individual, familial, and cultural factors predict participants’ engagement and attendance in an adapted program for preventing underage drinking in Zacatecas, Mexico. The study was conducted with a sample of 178 parents who participated in the adapted program and were employed at local private companies. Latent growth curve modeling was used to analyze (a) change in engagement, (b) predictors of engagement, and (c) predictors of attendance. Results indicated that perceived engagement evidenced a significant linear increase throughout the intervention. Participants’ familism values, such as perceived family as referents and family support, at baseline predicted both initial levels of and change in engagement. Perceived familial obligation also predicted change in engagement. Attendance was negatively predicted by male gender, by perceived stress, and by perceived familial obligations among women only. Poor family management, and perceived familial obligations among men, positively predicted attendance. Our findings have important implications for the conceptualization of engagement and attendance in family-based preventive interventions for underage drinking among Hispanics. Researchers interested in implementing interventions in Latin America can use these findings to better comprehend how and for whom adapted family-based preventive interventions work.

As part of the Global Smart Drinking Goals campaign launched in 2018 in 6 “City Pilots” around the world, the Businesses That Care (BTC; Empresas Que se Cuidan in Spanish) prevention system was developed and implemented in Zacatecas, Mexico. BTC is a private business sector adaptation of the Communities That Care prevention system. BTC is designed to address underage alcohol use through a combination of a company-led prevention system, an adapted family-based prevention program with parents employed at participating companies, and environmental prevention strategies for company employees. BTC was designed to be congruent with other health and safety efforts in the region (e.g., media campaign, road safety, and school prevention efforts). This study presents the feasibility and adoption of the BTC system in Zacatecas. Process implementation measures indicated successful participant recruitment, retention, and adherence to intervention protocols. The first 4 stages of BTC implementation were completed within 14 months, with Stage 5 being interrupted by the COVID-19 pandemic. BTC Prevention Committee members, made up of employees from BTC participating companies, received 9 out of 10 BTC trainings/workshops during this time. Results provide evidence of the acceptability and feasibility for private companies to implement a prevention system approach for reducing youth alcohol use.

This study examined the relative contribution of alcoholic beverage types to overall alcohol consumption and associations with heavy alcohol use and alcohol-related harms among adults. Cross-sectional survey data were collected from adult samples in two cities involved in the Global Smart Drinking Goals (GSDG) initiative in each of five countries (Belgium, Brazil, China, South Africa, United States). Survey measures included past-30-day consumption of beer, wine, flavored alcoholic drinks, spirits, and homemade alcohol; past-30-day heavy drinking; 14 alcohol-related harms in the past 12 months; and demographic characteristics. Within in each country, we computed the proportion of total alcohol consumption for each beverage type. Regression analyses were conducted to estimate the relative associations between consumption of each alcoholic beverage type, heavy alcohol use, and alcohol-related harms, controlling for demographic characteristics. Beer accounted for at least half of total alcohol consumption in GSDG cities in Belgium, Brazil, the U.S., and South Africa, and 35% in China. Regression analyses indicated that greater beer consumption was associated with heavy drinking episodes and with alcohol-related harms in the cities in Belgium, Brazil, South Africa, and the U.S. Significant increases in heavy drinking and alcohol-related harms were also consistently observed for spirits consumption. Beer accounts for the greatest proportion of total alcohol consumption in most of the GSDG cities and was consistently associated with more heavy drinking episodes and alcohol-related harms. Reducing beer consumption through evidence-based interventions may therefore have the greatest impact on hazardous drinking and alcohol-related harms.

Globally, increased domestic violence against women during the 2020 Covid-19 lockdowns concerned researchers, policymakers, governments and the civil society. In South Africa, an increased risk for gender-based domestic violence against women during the lockdown period was reported by various sources including the national gender-based violence call centre (GBVCC), the South African Police Service (SAPS) and the civil society. Covid-19 lockdown encouraged spatial distance: a public health measure. This measure inadvertently created social distance and social disconnection. Public life, which is frequently a coping mechanism and an escape for some women and girls at risk of domestic violence, was curtailed by the lockdown rules that forbade movements. Informal sources of help for victims of abuse were limited due to closed economic activities, and community-based helping services for domestic violence were not permitted to open. Some victims of domestic violence struggled with public transportation to access informal help, visit the police, social workers and other sources of help. Some organisations offered online and telephone services. The increased risk of gender-based domestic violence during the lockdown is indicative of poly-violence that women are exposed to. The risk of the domesticated poly-violence during crisis periods could be averted by focussing on risk reduction for all forms of violations against women.

Underage drinking is a major global health problem. Given the crisis that underage drinking represents, Tomando Buenas Decisiones (TBD), a family-based prevention program based on the existing Guiding Good Choices program, was adapted and piloted in Northern Mexico. Although family-based interventions in the U.S. are efficacious for preventing underage drinking, little is known about how their adapted versions work in low-middle income countries, such as in Latin America. In light of this, the current dissertation: (1) explored the malleability, and session-specific mean-level changes in etiologic factors targeted by TBD; (2) examined whether baseline individual, familial, and cultural factors predicted participants’ engagement and attendance during program delivery; and (3) tested the effects of TBD for reducing family risk for underage drinking in Zacatecas, Mexico. Findings suggest that TBD helped families develop protection against and reduce the risk of alcohol use in their children. Also, that participants’ engagement significantly increased throughout the intervention. Moreover, different familism subscales predicted both participants’ engagement and attendance. However, pre-intervention individual and familial characteristics such as perceived stress, sex (i.e., male), and poor family management only predicted attendance. Finally, results indicated that TBD was efficacious in reducing family conflict, poor family management, and general family risk relative to our wait-listed comparison group at post-intervention and 3-months post-intervention. This dissertation provides support for further rigorous evaluation and dissemination of the TBD program for Hispanic families. These findings can be used to comprehend better how and for whom adapted family-based preventive interventions work in Latin America.

Research on the effects of restricting bar opening hours and alcohol sales in middle-income countries is very limited. We assessed compliance with and possible effects of a law enacted in Zacatecas, Mexico on December 30, 2017 and implemented in 2018 and 2019 that established a 2 AM  bar closing time and 10 PM cut-off for alcohol sales by off-premises stores.

Monthly observations of bars and off-premises stores and alcohol mystery shopping visits from 2018 to early 2020 were conducted to assess compliance with the law. Breath tests were conducted in 2018 and 2019 with samples of pedestrians in the nighttime entertainment districts of Zacatecas and a comparison city (Aguascalientes). Surveys of bar owners/managers and staff, emergency medical personnel (EMP), and police officers were conducted in Zacatecas in 2018 and 2019 to assess awareness and support of the law and possible effects of the law on alcohol-related problems such as violence and injuries. Monthly observations indicated that a substantial percentage of bars and off-premises package stores did not comply with the law. Pedestrian breath tests in 2018 and 2019 indicated significant reductions in blood alcohol concentration and heavy drinking among pedestrians in Zacatecas from 11 PM to 2 AM compared to Aguascalientes, but not after 2 AM. Surveys of bar owners/managers indicated that most were aware and supportive of the law. EMP surveys indicated reductions in incidents of physical fighting and drunk or injured customers during the annual September fair in Zacatecas.

This study suggests that restricting bar opening hours and alcohol sales may not result in full compliance by bars and off-premises stores, but may help to reduce excessive alcohol use and related harms in a middle-income country. A more rigorous evaluation with pre-intervention data is needed, however, to fully address this latter question.

Primary healthcare-based Early Identification and Brief Intervention (EIBI) for hazardous and harmful alcohol use is both a clinically relevant and cost-effective strategy to reduce heavy drinking. Unfortunately, it remains poorly implemented in daily practice. Multiple studies have shown that training and support (T&S) programs can increase the use of EIBI. Nonetheless, gains have only been modest and short-term at best. Suggestions have been made to rely more on multicomponent programs that simultaneously address several barriers to the implementation of EIBI. The PINO-project aims to evaluate the added value of such a multicomponent program to improve EIBI delivery in daily practice. A quasi-experimental three-arm implementation study in Flanders (Belgium) will assess the effects of tailored T&S to General Practitioners (GPs) with or without community mobilisation on EIBI delivery in general practice. The study lasts 18 months and will take place in three comparable municipalities. In municipality 1 and 2, GPs receive a tailored T&S program. The T&S is theoretically founded and tailored to the GPs’ views, needs and practice characteristics. Furthermore, community actions will be embedded within municipality 1 providing additional, contextual, support. In municipality 3, GPs are offered a minimal intervention to facilitate data collection. The primary outcome is the proportion of adult patients screened for hazardous and harmful alcohol use at the end of an 18-month implementation period. The secondary outcome is the scaling up activity at municipal level in screening rates, as assessed every 3 months, and the proportion of patients who received an additional brief intervention when necessary. Furthermore, the correlation between the opinions and needs of the GP’s, their practice organisation and their EIBI performance will be explored.

Reducing youth alcohol use is a public health priority that can be addressed by implementing evidence-based preventive interventions (EBPIs) with high fidelity. However, when EBPIs are delivered in a new geographical setting, lack of contextual fit might interfere with expected effects. The purpose of our study was to understand the contextual fit of the family preventive program, Guiding Good Choices (GGC), to inform its future adaptation in Zacatecas, Mexico. Four focus groups were conducted with parents of children aged 9–14 years (N = 43) from four private companies. After transcribing audiotaped sessions, we used a general inductive approach to obtain codes and derive themes. Parents expressed a high level of interest in program content, highlighting its potential to decrease underage drinking in Mexico. Surface-structure modifications of program audiovisual materials (e.g., new videos with Mexican actors and locations) and delivery methods were recommended by parents to maximize participant acceptability and engagement. Participant definitions of family and perception of family dynamics both support the cultural relevance of the program modules and activities related to this content. Underage drinking was acknowledged by parents as a major problem in Zacatecas. Our findings suggest a need for incorporating an extra session that focuses on addressing low alcohol literacy levels and parents’ positive alcohol expectancies. Machismo was not considered a cultural factor that could affect attendance and program activities. In fact, we observed an opportunity to use local masculinity to ensure practice of parental skills at home. Due to the needs expressed by participants and the apparent compatibility and fit of the curriculum contents with the new context, we conclude that GGC could be an adequate EBPI for preventing underage drinking in Mexico.

Hazardous alcohol use significantly affects health and wellbeing in society. General practitioners (GPs) are uniquely positioned to address this problem by integrating early identification and brief intervention (EIBI) in daily practice. Unfortunately, EIBI implementation remains low. Community-oriented strategies (COS), defined as public health activities directed to the general population, are suggested to address this implementation gap. COS aim to increase the understanding, engagement and empowerment within the population to facilitate EIBI delivery. However, no consensus on what COS should contain exists. To obtain insight in the stakeholders’ perspectives and create consensus with them on COS with the highest potential to facilitate EIBI delivery. Four nominal group sessions were conducted with 31 stakeholders representing 12 different stakeholder groups from Leuven (Belgium). Stakeholders generated ideas, reflected on them in group and prioritised them anonymously, creating four separate lists. Merging these lists with their relative scores resulted in a master list, which was checked for accuracy through a member check. Qualitative content analysis on the stakeholder’s notes provided an in-depth exploration of their perspectives. Twenty-one strategies were identified, nine of which were COS. Highlighting the GPs’ proactive role was considered most relevant. Other foci included creating awareness on the effects of alcohol use and normalising discussing alcohol use within the community. A holistic approach, exceeding the sole focus on COS, combining community, healthcare and government was accentuated. Stakeholders emphasise addressing the proactive role of GPs as most promising COS, though it should be delivered within a holistic multi-component approach.

Social Development Goal 3.5.2 calls for a 10% reduction in harmful alcohol use. We began evaluating efforts to achieve this goal in Alexandra, South Africa; Brasilia, Brazil; Columbus, Ohio; Jiangshan, China; Leuven, Belgium; and Zacatecas, Mexico by estimating baseline harm. Following the Global Burden of Disease (GBD), we measured alcohol-attributable burden in Years of Healthy Life (YHLs) lost. GBD estimates harmful alcohol use from a jurisdiction’s alcohol consumption and diagnosis-specific relative risk distributions. We assessed alcohol consumption and alcohol-involved violence through surveys of 1500 adults per city and, except in Columbus, 1500 youth. We combined those data with GBD’s relative risk curves and accessible police-reported road crash data to estimate the baseline. We incorporated the financial effects of health problems into the baseline by converting them to YHL-equivalents. For use in conversion. we defined a standardized YHL as the average year of life expectancy lost to a crash death or homicide. Violence – physical assault, sexual assault, drink-driving crashes, and suicide — comprised 84% of the burden in Alexandra, 74% in Zacatecas, 65% in Leuven, and 56%-59% elsewhere. Physical and sexual assault alone comprised 32%-72%. Drink-driving comprised 10%-21%. Achieving this SDG goal will require creating effective violence prevention programs. Our physical assault estimates greatly exceed GBD’s estimates. GBD’s assault incidence sets a high severity threshold for qualifying cases. Its alcohol-attributable fractions for physical assault average one third of the estimates in widely respected multi-national studies. GBD 2017 also attributed no sexual violence to harmful alcohol use.

Little is known about adults in China who drink homemade alcohol, and whether they are at elevated risk of harms relative to those who drink alcohol from commercial sources. Purpose: We describe and contrast adults in China who regularly consume either homemade or commercially available alcohol, or both. Methods: Household-based in-person interviews were conducted in 2018 with adults in Jiangshan and Lanxi. We examined the characteristics of 833 adults who had consumed alcohol within the previous 30 days, comparing those who drank commercial alcohol only with those who drank homemade alcohol only and alcohol from both sources. Results: Regression analyses revealed that drinkers of both homemade and commercial alcohol consumed more drinks and were more likely to report heavy drinking than did drinkers of commercial or homemade alcohol only and were also more likely to meet criteria for alcohol use disorder. We also found that homemade-only alcohol drinkers were at elevated risk for this disorder. Conclusions: Drinkers of both homemade and commercial alcohol in China may be at risk for alcohol-related problems and constitute a little understood population for whom further research is needed.

We report the results of a quasi-experimental evaluation of a mystery shopper intervention in Zacatecas and Guadalupe, Mexico. Underage youth attempted to purchase beer at 50 Modelorama stores and 32 Oxxo stores (intervention groups), and at 19 comparison convenience stores in March, July, and August 2018. After each attempt, intervention store operators were informed if a sale was made. Modelorama operators also received training and were warned that repeated sales to minors could jeopardize their franchise. Average sales rates to minors were 63.8% at Modeloramas, 86.5% at Oxxo stores, and 98.2% at comparison stores. The findings suggest that mystery shopper interventions with training, feedback to store operators, and sanctions after repeated sales to underage youth may reduce sales to minors in low- and middle-income countries.

Studies assessing awareness and knowledge of alcohol-attributable causes of death and disease have been conducted across the globe to develop and evaluate public information campaigns to increase alcohol health literacy. Because of variation in measurement, the results of these studies cannot be easily compared to determine relative rates of high versus low alcohol health literacy across countries or regions. This review catalogs the samples and survey items that have been used and presents recommendations for how to improve alcohol health literacy survey research. Searches for studies surveying general populations for knowledge of the associations between alcohol and nine alcohol-related health harms—fetal alcohol syndrome, liver cirrhosis, cancer, pancreatitis, tuberculosis, epilepsy, cardiovascular disease, lower respiratory infections, and conduction disorders—were conducted in PubMed and Embase. Survey results published between January 2007 and April 2018 were reviewed for eligibility. Of 791 studies initially identified, 76 were included in the final analysis. Survey items varied substantially in the types of response options used (e.g., yes/no, agree/disagree, Likert scales, multiple choice); terminology for drinking behavior (e.g., alcohol consumption vs. alcohol abuse), risk-factor framing (e.g., cause vs. association), and health harms (e.g., cardiovascular disease vs. stroke); and how their results were presented (e.g., numbers and/or percentages of respondents vs. odds ratios). Very few studies used probability samples. The current state of the research literature makes it impossible to identify patterns of alcohol health literacy globally or even to compare intra-country studies across time. We recommend that a database of standard, validated questions for assessing knowledge about the relationship between alcohol and several key health outcomes be assembled and made available to the research community.

No economic evaluations exist of free or subsidized ridesharing services designed to reduce impaired driving. To evaluate the effects and economics of a 17-weekend program that provided rideshare coupons good for free one-way or round trips to/from the hospitality zones in Columbus, Ohio, coupled with a modest increase in enforcement and a media campaign that used messaging about enforcement to promote usage. Web surveys of riders and intercept surveys of foot traffic in the hospitality zones yielded data on the reduction in driving after drinking and the change in alcohol consumption associated with coupon use. We estimated crash changes from trip data using national studies, then confirmed with an ARIMA analysis of monthly police crash reports. Costs and output data came from program and rideshare company records. 70.8% of 19,649 responding coupon redeemers said coupon use reduced the chance they would drive after drinking. An estimated 1 in 4,310 drink-driving trips results in an alcohol-attributable crash, so the coupons prevented an estimated 3.2 crashes. Consistent with that minimal change, the ARIMA analysis did not detect a drunk-driving crash reduction. Self-reports indicated alcohol consumption rose by an average of 0.4 drinks per coupon redeemer, possibly with an equal rise among people who rode with the redeemer. The program cost almost $650,000 and saved an estimated 1.8 years of healthy life. Across a range of discount rates and values for a year of healthy life, it cost $366,000 to $791,000 per year of healthy life saved. Its estimated benefit-cost ratio was between 0.31 and 0.59, meaning it cost far more than it saved.

Ridesharing, coupled with a media campaign and increased enforcement, was not a cost-effective drunk-driving intervention. Although it reduced drink-driving crashes and saved years of healthy life, those savings were modest and expensive. Moreover, the self-reported increase in participant drinking imposed countervailing risks. Even sensitivity analyses that potentially overestimate the benefits and underestimate the costs indicate a significant imbalance between program costs and savings. Any funding devoted to ridesharing would divert scarce resources from interventions with benefit-cost ratios above 1. Thus, our evaluation suggests that governments should not devote energy or resources to ridesharing programs if their primary objective is to reduce drink-driving or harmful alcohol use.

Studies have shown that approximately half of arrested intoxicated drivers had their last alcoholic drink at a licensed bar or restaurant. Current efforts to prevent intoxicated patrons from leaving licensed establishments and driving home have been only partially successful. Since a high proportion of drinkers drive to their drinking destination, promoting the use of alternative transportation (AT) – including safe ride shuttles, free or subsidized taxi and ridesharing services, voluntary or paid designated driver programs, and more accessible public transportation – is an important strategy for preventing impaired driving. The primary goal of this study was to review and synthesize the findings of research studies designed to test the effectiveness of AT programs in reducing alcohol-impaired driving. A secondary goal was to report if using AT has led to any unintended consequences, in particular greater alcohol consumption. We identified relevant academic articles, new articles, government reports, and other documents (English only) through the University of Chicago library, Google Scholar, and Google Search. We also included published articles recommended by peers. Key search terms included: alternative transportation; safe rides; designated driver; alcohol-impaired driving; alcohol consumption, cost effectiveness; and reduce drunk driving. Initially, we identified 168 potentially relevant sources, of which only 57 were academic articles. After a thorough review, we narrowed down the number of relevant articles to 125 including some background articles and government reports. Some AT programs produced reductions in one or more of the following outcomes: (1) impaired driving; (2) impaired driving crashes; (3) driving under the influence (DUI) arrests; and (4) traffic crashes in general, but others were not shown to be effective. A few programs resulted in greater self-reported alcohol use, but there were no significant findings indicating that drinking when using AT led to an increase in alcohol-related harms such as public intoxication, assaults, or other alcohol-related crime. Of the studies that conducted a cost-benefit analysis, most showed that AT programs yielded a positive benefit, but these studies did not include a sufficient number of variables to be considered true cost-benefit analyses. There is mixed evidence regarding the effectiveness of AT programs. Evaluations with more rigorous quasi-experimental and experimental designs are needed to identify which types of AT programs work best for different types of communities and target groups.

Alcohol remains readily available to youth in most countries. We examined the associations between both the on- and off-premises commercial availability of alcohol to youth and their alcohol use, heavy episodic drinking, and alcohol-related harms. We conducted the study using data from a survey of a sample of 594 students in central Mexico between 12 and 17 years of age in 2016. Both the perceived availability of alcohol and the purchasing of alcohol at an off-premises establishment were positively related to past-30-day alcohol use and heavy episodic drinking, as well as to alcohol-related harms in the past year. Consumption at on-premises establishments was also positively associated with alcohol-related harms. Preventive efforts to reduce the availability of alcohol at off- and on-premises establishments, by such strategies as mystery shopper and responsible beverage service programs, are imperative.

Prior lethality analyses of suicide means have historically treated drug poisoning other than alcohol poisoning as a lumped category. Assessing risk by drug class permits better assessment of prevention opportunities. This cross-sectional study analyzed censuses of live emergency department and inpatient discharges for 11 US states from January 1, 2011, to December 31, 2012, as well as Healthcare Cost and Utilization Project national live discharge samples for January 1 to December 31, 2012, and January 1 to December 31, 2016, and corresponding Multiple Cause of Death census data. Censuses or national samples of all medically identified drug poisonings that were deliberately self-inflicted or of undetermined intent were identified using diagnosis and external cause codes. Data were analyzed from June 2019 to January 2020. Distribution of drug classes involved in suicidal overdoses. Logistic regressions on the state data were used to calculate the odds and relative risk (RR) of death for a suicide act that involved a drug class vs similar acts excluding that class.

We describe the rationale for and design of an independent evaluation of the Global Smart Drinking Goals (GSDG) program. The primary purpose of this program, supported by the AB InBev Foundation, is to reduce harms associated with alcohol use by 10%. Our evaluation focuses on the effects of prevention strategies sponsored by the Foundation that are being implemented in six city pilots located in as many countries. These strategies are designed to reduce heavy episodic drinking, underage drinking, drink driving, and alcohol-related violence. Each city pilot has been matched with a comparison city in which the GSDG program will not be implemented. In this quasi-experimental community trial, we will assess each city pilot’s progress toward reaching its harm reduction goals, relative to its comparison city, by means of annual adult and youth surveys. We will then supplement these analyses with the use of pertinent local archival data, where available. We discuss several challenges related to this evaluation and its quasi-experimental design. These include operating in a fluid and unpredictable environment in regard to the implementation, adaptation, and (on occasion) abandonment of the prevention strategies selected by each city pilot. We also discuss issues concerning our decision to accept funding from the alcohol industry and the measures we have taken to ensure the independence of our evaluation.

Background: The World Health Organization (WHO) 2017 Global Conference in Montevideo, Uruguay, was dedicated to promoting successful cases and best practices in fighting and preventing noncommunicable disease (NCDs). The global effort undertaken by WHO aims to reduce road traffic deaths in order to meet goal number 3.4 of the sustainable development goals. Objectives: To describe two Brazilian road safety prevention programs, presented at the WHO 2017 Global Conference: São Paulo Traffic Safety Movement (Movimento Paulista de Segurança no Trânsito) and Safe Life Program of Brasília (Programa Brasília Vida Segura), along with their governance structures, models and results. Design and setting: This was a descriptive case study conducted in São Paulo and Brasilia from 2015 to 2018. These programs aimed to reduce the number of deaths caused by road accidents to 8.3 deaths per 100,000 inhabitants in São Paulo by 2020 and in Brasília by 2016; and to reduce harmful use of alcohol by 10% by 2020. Methods: These two initiatives were designed, managed and operated to bring together government and civil society, i.e. industry, academia, non-governmental organizations (NGOs), etc., around the common goal of saving lives. They were collaborative and guided by sharing of best practices, learning and information, thereby making it possible to attain more and better results. Their format enables reproduction in cities across all Brazilian regions. Results: The results attest to the efficacy of the programs implemented in these two cities. In Brasília, the initiative helped reduce the number of traffic-related deaths by 35% (2017). In the same year in the state of São Paulo, 7,600 deaths were avoided. Conclusion: Both programs are innovative public policies that deal with health issues caused by the external agents that ultimately account for the rapid increase in days lost to disability. Prevention of external causes of deaths and injuries, such as traffic violence, strongly correlates with changes in habits and actions, especially excessive consumption of alcohol, and with NCDs in Brazil.