This study determined the associations between alcohol use exposures, marketing, education, and problem drinking and drunkenness among youth living in the slums of Kampala. This cross-sectional study of youth was conducted in 2011 to quantify and describe high-risk behavior and exposures in a convenience sample ( ) of urban youth living in the slums, 14–24 years of age, who were participating in a drop-in center for disadvantaged street youth. Logistic regression analyses were computed to determine associations between alcohol use exposures, marketing exposures, alcohol education, and problem drinking and drunkenness while controlling for possible confounders. Among participants, 30.2% reported problem drinking and 32.8% reported drunkenness. In multivariate analyses, obtaining free drinks was associated with problem drinking (AOR: 2.47; 95% CI？=？ 1.23–4.96) and drunkenness (AOR: 2.40; 95% CI？=？1.22–4.70) after controlling for potential confounders. Alcohol education measures were not significantly associated with either problem drinking or drunkenness in multivariate analyses. There are important associations between alcohol marketing and drinking among these youth. Moreover, the findings underscore the need for additional research related to the impact of alcohol marketing among vulnerable youth and also the need for policy regulations that restrict alcohol marketing that involve providing free alcohol directly to youth. 1. Introduction Alcohol use is the most commonly used psychoactive substance in the world and is one of the leading causes of death and disability worldwide [1]. Alcohol abuse causes 3.2% (1.8 million) of all deaths worldwide annually and also accounts for 4.0% of the global disease burden each year [2]. Research has shown that alcohol use is associated with alcohol addiction [3], other drug use [4], unintentional injuries [5, 6], physical fighting [7], criminal activity [4], suicidal ideation and attempts [8–10], and increased risk of human immunodeficiency disease (HIV) [11, 12]. In order to address this global public health issue, the World Health Organization (WHO) recently prioritized the global reduction of the harmful use of alcohol with a particular focus on monitoring and technical support [13]. Even with limited data, it is still evident that low-income and middle-income countries, and vulnerable populations within, bear an increased burden of disease and injury due to increasing alcohol consumption and limited or nonexistent public health and prevention policies and programs [1]. In sub-Saharan Africa, alcohol use has been
References
[1]
J. Rehm, C. Mathers, S. Popova, M. Thavorncharoensap, Y. Teerawattananon, and J. Patra, “Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders,” The Lancet, vol. 373, no. 9682, pp. 2223–2233, 2009.
[2]
World Health Organization, “Global status report on alcohol and health,” 2011, http://www.who.int/substance_abuse/publications/global_alcohol_report/msbgsruprofiles.pdf.
[3]
R. W. Hingson, T. Heeren, and M. R. Winter, “Age at drinking onset and alcohol dependence: age at onset, duration, and severity,” Archives of Pediatrics and Adolescent Medicine, vol. 160, no. 7, pp. 739–746, 2006.
[4]
P. L. Ellickson, J. S. Tucker, and D. J. Klein, “Ten-year prospective study of public health problems associated with early drinking,” Pediatrics, vol. 111, no. 5, pp. 949–955, 2003.
[5]
R. W. Hingson, T. Heeren, A. Jamanka, and J. Howland, “Age of drinking onset and unintentional injury involvement after drinking,” Journal of the American Medical Association, vol. 284, no. 12, pp. 1527–1533, 2000.
[6]
R. Hingson, T. Heeren, R. Zakocs, M. Winter, and H. Wechsler, “Age of first intoxication, heavy drinking, driving after drinking and risk of unintentional injury among U.S. college students,” Journal of Studies on Alcohol, vol. 64, no. 1, pp. 23–31, 2003.
[7]
R. Hingson, T. Heeren, and R. Zakocs, “Age of drinking onset and involvement in physical fights after drinking,” Pediatrics, vol. 108, no. 4, pp. 872–877, 2001.
[8]
H. Cho, D. D. Hallfors, and B. J. Iritani, “Early initiation of substance use and subsequent risk factors related to suicide among urban high school students,” Addictive Behaviors, vol. 32, no. 8, pp. 1628–1639, 2007.
[9]
M. H. Swahn, R. M. Bossarte, and E. E. Sullivent, “Age of alcohol use initiation, suicidal behavior, and peer and dating violence victimization and perpetration among high-risk, seventh-grade adolescents,” Pediatrics, vol. 121, no. 2, pp. 297–305, 2008.
[10]
M. H. Swahn and R. M. Bossarte, “Gender, early alcohol use, and suicide ideation and attempts: findings from the 2005 youth risk behavior survey,” Journal of Adolescent Health, vol. 41, no. 2, pp. 175–181, 2007.
[11]
D. Baliunas, J. Rehm, H. Irving, and P. Shuper, “Alcohol consumption and risk of incident human immunodeficiency virus infection: a meta-analysis,” International Journal of Public Health, vol. 55, no. 3, pp. 159–166, 2010.
[12]
J. C. Fisher, “Can we engage the alcohol industry to help combat sexually transmitted disease?” International Journal of Public Health, vol. 55, no. 3, pp. 147–148, 2010.
[13]
World Health Organization, “Global strategy to reduce the harmful use of alcohol,” 2010, http://www.who.int/substanceabuse/msbalcstragegy.pdf.
[14]
M. H. Swahn, B. Ali, J. Palmier, et al., “Early alcohol use and problem drinking among students in Zambia and Uganda,” Journal of Public Health in Africa, vol. 2, no. 2, pp. e20–e23, 2011.
[15]
M. E. Coldiron, R. Stephenson, E. Chomba et al., “The relationship between alcohol consumption and unprotected sex among known HIV-discordant couples in rwanda and Zambia,” AIDS and Behavior, vol. 12, no. 4, pp. 594–603, 2008.
[16]
S. C. Kalichman, L. C. Simbayi, M. Kaufman, D. Cain, and S. Jooste, “Alcohol use and sexual risks for HIV/AIDS in sub-saharan Africa: systematic review of empirical findings,” Prevention Science, vol. 8, no. 2, pp. 141–151, 2007.
[17]
S. Siziya, A. S. Muula, L. N. Kazembe, and E. Rudatsikira, “Harmful lifestyles' clustering among sexually active in-school adolescents in Zambia,” BMC Pediatrics, vol. 8, article 6, 2008.
[18]
S. D. Weiser, K. Leiter, M. Heisler et al., “A population-based study on alcohol and high-risk sexual behaviors in Botswana,” PLoS Medicine, vol. 3, no. 10, Article ID e392, pp. 1940–1948, 2006.
[19]
J. Mayeya, R. Chazulwa, P. N. Mayeya et al., “Zambia mental health country profile,” International Review of Psychiatry, vol. 16, no. 1-2, pp. 63–72, 2004.
[20]
S. Hassan, W. M. Macharia, and J. Atinga, “Self reported alcohol use in an urban traffic trauma population in Kenya,” East African Medical Journal, vol. 82, no. 3, pp. 144–147, 2005.
[21]
P. L. Ellickson, R. L. Collins, K. Hambarsoomians, and D. F. McCaffrey, “Does alcohol advertising promote adolescent drinking? Results from a longitudinal assessment,” Addiction, vol. 100, no. 2, pp. 235–246, 2005.
[22]
S. Q. Hurtz, L. Henriksen, Y. Wang, E. C. Feighery, and S. P. Fortmenn, “The relationship between exposure to alcohol advertising in stores, owning alcohol promotional items, and adolescent alcohol use,” Alcohol and Alcoholism, vol. 42, no. 2, pp. 143–149, 2007.
[23]
A. C. McClure, S. Dal Cin, J. Gibson, and J. D. Sargent, “Ownership of alcohol-branded merchandise and initiation of teen drinking,” American Journal of Preventive Medicine, vol. 30, no. 4, pp. 277–283, 2006.
[24]
L. B. Snyder, F. F. Milici, M. Slater, H. Sun, and Y. Strizhakova, “Effects of alcohol advertising exposure on drinking among youth,” Archives of Pediatrics and AdolescentMedicine, vol. 160, no. 1, pp. 18–24, 2006.
[25]
S. Vantamay, “Alcohol consumption among university students: applying a social ecological approach for multi-level preventions,” Southeast Asian Journal of Tropical Medicine and Public Health, vol. 40, no. 2, pp. 354–369, 2009.
[26]
M. H. Swahn, B. Ali, J. B. Palmier, G. Sikazwe, and J. Mayeya, “Alcohol marketing, drunkenness, and problem drinking among zambian youth: findings from the 2004 global school-based student health survey,” Journal of Environmental and Public Health, vol. 2011, Article ID 497827, 8 pages, 2011.
[27]
M. H. Swahn, R. M. Bossarte, D. M. Elimam, E. Gaylor, and S. Jayaraman, “Prevalence and correlates of suicidal ideation and physical fighting: a comparison between students in Botswana, Kenya, Uganda, Zambia and the USA,” International Journal of Public Health, vol. 2, no. 2, pp. 195–206, 2010.
[28]
World Health Organization, “Monitoring alcohol marketing in Africa: MAMPA Project,” 2011, http://www.afro.who.int/en/clusters-a-programmes/hpr/health-risk-factors/diseases-surveillance/highlights/3032-monitoring-alcohol-marketing-in-frica.html.
[29]
P. Anderson, D. Chisholm, and D. C. Fuhr, “Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol,” The Lancet, vol. 373, no. 9682, pp. 2234–2246, 2009.
[30]
K. Fleming, E. Thorson, and C. K. Atkin, “Alcohol advertising exposure and perceptions: links with alcohol expectancies and intentions to drink or drinking in underaged youth and young adults,” Journal of Health Communication, vol. 9, no. 1, pp. 3–29, 2004.
[31]
A. Wyllie, J. F. Zhang, and S. Casswell, “Positive responses to televised beer advertisements associated with drinking and problems reported by 18 to 29-year-olds,” Addiction, vol. 93, no. 5, pp. 749–760, 1998.
[32]
N. O. A. Kwate and I. H. Meyer, “Association between residential exposure to outdoor alcohol advertising and problem drinking among African American Women in New York City,” American Journal of Public Health, vol. 99, no. 2, pp. 228–230, 2009.
[33]
J. B. Unger, C. A. Johnson, and L. A. Rohrbach, “Recognition and liking of tobacco and alcohol advertisements among adolescents: relationships with susceptibility to substance use,” Preventive Medicine, vol. 24, no. 5, pp. 461–466, 1995.
[34]
K. E. Pasch, K. A. Komro, C. L. Perry, M. O. Hearst, and K. Farbakhsh, “Outdoor alcohol advertising near schools: what does it advertise and how is it related to intentions and use of alcohol among young adolescents?” Journal of Studies on Alcohol and Drugs, vol. 68, no. 4, pp. 587–596, 2007.
[35]
D. Jernigan, Global Status Report: Alcohol and Young People, World Health Organization, Geneva, Switzerland, 2001, http://whqlibdoc.who.int/hq/2001/who_msd_msb_01.1.pdf.
[36]
D. Jernigan, I. Obot, and N. Jos, “Thirsting for the African market,” African Journal of Drug and Alcohol Studies, vol. 5, no. 1, pp. 57–70, 2006.
[37]
D. H. Jernigan, “The extent of global alcohol marketing and its impact on youth,” Contemporary Drug Problems, vol. 37, no. 1, p. 57, 2010.
[38]
Alcohol Justice, “Tactics: Advertising and Promotion,” 2012, http://alcoholjustice.org/big-alcohol/industry-tactics/24-tactic-advertising-and-promotions.html.
[39]
M. H. Swahn, J. B. Palmier, R. Kasirye, and H. Yao, “Correlates of suicide ideation and attempt among youth living in the slums of Kampal,” International Journal of Environmental Research and Public Health, vol. 9, no. 2, pp. 596–609, 2012.
[40]
M. H. Swahn, L. Gressard, J. B. Palmier, R. Kasirye, C. Lynch, and H. Yao, “Serious violence victimization and perpetration among youth living in the slums of Kampala, Uganda,” Western Journal of Emergency Medicine, vol. 13, no. 3, pp. 253–259, 2012.
[41]
Uganda Youth Development Link, 2012, http://www.uydel.org/.
[42]
Center for Disease Control and Prevention, “Youth Risk Behavior Surveillance System (YRBSS),” 2012, http://www.cdc.gov/HealthyYouth/yrbs/index.htm/.
[43]
Centers for Disease Control and Prevention (CDC), “Global School-based Student Health Survey,” 2012, http://www.cdc.gov/GSHS/.
[44]
E. W. Austin, M. J. Chen, and J. W. Grube, “How does alcohol advertising influence underage drinking? The role of desirability, identification and skepticism,” Journal of Adolescent Health, vol. 38, no. 4, pp. 376–384, 2006.
[45]
W. Ngwenya, “Advertising in Zambia—Who is Targeted?” Lusaka Times, 2009, http://www.lusakatimes.com/?p=17511.
[46]
S. Casswell and T. Thamarangsi, “Reducing harm from alcohol: call to action,” The Lancet, vol. 373, no. 9682, pp. 2247–2257, 2009.
[47]
K. Capell, “SABMiller’s plan for cheaper African beer,” BusinessWeek, 2009, http://www.businessweek.com/globalbiz/content/apr2009/gb2009048046722.htm.
[48]
Zambian Government Bans Some Alcohol Sales, Zambia Reports, 2012, http://zambiareports.com/2012/04/16/zambian-government-bans-some-alcohol-sales/.
[49]
C. Parry, N. H. Burnhams, and L. A. London, “A total ban on alcohol advertising: presenting the Public Health Case,” South African Medical Journal, vol. 102, no. 7, pp. 602–604, 2012.
[50]
Guide to Community Preventive Services, “Preventing excessive alcohol consumption: electronic screening and brief intervention (e-SBI),” 2012, http://www.thecommunityguide.org/alcohol/eSBI.html/.
