Social disparities in alcohol’s harm to others: evidence from 32 European countries
Research Paper
Abstract
Background
Alcohol can cause harm not only to the person who consumes it but also to others. Prior research has found that these alcohol-attributable harms to others differ across socioeconomic groups, though several findings have been contradictory.
The aim of this contribution was to study the role of individual-level and population-level income inequalities in alcohol’s harm to others among women and men.
Methods
Logistic regression analysis of cross-sectional survey data from 2021, covering 39,629 respondents from 32 European countries.
Second-hand harm due to alcohol was defined as
- experiences of physical harm,
- involvement in a serious argument, or
- involvement in a traffic accident, due to another person’s alcohol use, within the past year.
The researchers examined the association of individual-level income and country-specific income inequality (Gini index) with harms from a known person’s or a stranger’s alcohol use, adjusting for the respondent’s age, daily alcohol use levels, and at least monthly high risk single-occasion alcohol use.
Results
At the individual level, people with lower incomes had 21% to 47% increased odds of reporting harms from a known person’s alcohol use (women and men) or stranger’s alcohol use (men only) than their same-gender counterparts in the highest income quintile.
At the national level, countries with higher income inequality showed increased risks of harms from a known person’s alcohol use among women, while among men the risk of harm from strangers’ alcohol use decreased with higher income inequality.
These associations with income inequality were observed among respondents from all but the lowest income groups.
Conclusion
Alcohol can cause harm to others, with women and people with low incomes being disproportionally exposed to these harms.
Alcohol control policies targeting high consumption levels, especially among men, as well as upstream policies to reduce inequalities, are needed to lower the health burden of alcohol beyond those who consume it.
Background
Alcohol is a major contributor for health and social harms, affecting the person consuming alcohol as well as others.
In this study, researchers focus on alcohol’s harm to others (AHTO), which includes a wide range of health and social harms caused by other’s alcohol use, from vomiting in public or property damage under the influence of alcohol, to emotional and physical interpersonal violence or road accidents.
According to a pan-European survey from 2015 (Moskalewicz and Room, 2016), more than three in five adults have had experienced any AHTO in the past year, most frequently from a known person’s alcohol use. Estimates other than these are so far missing for Europe, as AHTO is not routinely covered in cross-national health surveys. The Standardised European Alcohol Survey carried out in the DEEP SEAS project represents the second large-scale assessment of AHTO in Europe, providing comprehensive and comparable data across 33 European countries, 32 of which are presented in this contribution.
The costs of AHTO are similar to those of harms to the alcohol user, but are largely underestimated in the public health agenda. Understanding the second-hand harm of alcohol, and identifying populations most affected, will help to adapt clinical settings (e.g., awareness of and resources for victims of these harms) and policies (e.g., regarding driving under the influence of alcohol).
AHTO, also called ‘second-hand effects of alcohol’, is a complex phenomenon including diverse roles, such as that in the family, the public, as a worker, or friend, and may be composed of more than 20 dimensions (e.g., verbal insults, financial problems, serious arguments).
This research article focuses on three severe and well-defined situations that someone can experience because of another person’s alcohol use:
- physical harm,
- being involved in a serious argument, and
- being involved in a traffic accident.
Although anyone can be exposed to second-hand harms due to alcohol, AHTO were found to cluster within specific sociodemographic groups. For example:
- Women are at higher risks of harms from a partner’s and other known person’s alcohol use.
- Men are more likely to report harms arising from strangers’ alcohol use.
- Young adults have higher risks of experiencing AHTO.
- A person’s socioeconomic status (SES) is also associated with experiences of AHTO, although the patterns found are more contradictory, with higher risks being reported both among individuals with low and high SES.
- As with gender, it is likely that the relationship between the individuals involved is key to understanding these contradictory findings.
- For example, high-SES women were found to be at increased risk for harms from stranger’s alcohol use, while those with low-SES were more likely to experience harm from a known person’s alcohol use.
- Such findings highlight the role of gender and the victim-aggressor relationship in studying AHTO, and are also likely to be linked to the alcohol consumption context.
- For example, a Northern European study found that the likelihood of being verbally abused, physically harmed, or involved in a serious argument with a person who was under the influence of alcohol, was higher among those who reported consuming alcohol frequently in on-premise consumption sites or outdoors.
Cross-national research further suggests that socioeconomic disparities in AHTO extend beyond the individual level and are also apparent at the population level, as has been reported with violence in general. Specifically, variations in the prevalence of AHTO have been found to be associated with income inequality, with higher prevalence for both women and men being observed in countries with higher inequalities. Little is known, however, about the interactions of AHTO with both individual-level SES and population-level income inequality, although inequality research points to an amplification of individual-level health disparities as income inequality increases.
In this paper, the researchers examine the interaction of individual-level income as indicator for SES and income inequality on experiencing harms from known persons’ or strangers’ alcohol use.
Based on the existing literature on this topic, the researchers propose three hypotheses (preregistered, Kilian, 2022):
- At the individual level, low incomes are associated with higher risks of harms from known persons’ alcohol use, while the risk of harms from strangers’ alcohol use is increased among individuals with high incomes.
- At the population level, higher income inequality is associated with higher levels of AHTO irrespective of the victim-aggressor relationship.
- There is an interaction between individual-level income and population-level income inequality, with individual-level income inequalities in reporting harms from known persons’ and strangers’ alcohol use increasing as population-level income inequalities increase.