“We Cannot Avoid Drinking”: Alcohol Use among Female Entertainment Workers in Cambodia

Figures & data

Table 1. Number of focus group discussions by type of entertainment venues.

Type and participants of FGDs	Number of FGDs
Pilot FGDs	5
Karaoke bar	5
Massage parlor	5
Beer garden	5
On-call sex workers	3
Parenting (included FEWs across venues who were mothers)	2
Street-based sex workers	2
Total	27

Figure 1. Conceptual model of alcohol decision-making continuum of volition.

Table 2. Themes, codes, definition and sample quotes related to alcohol use among FEWs.

Theme	Codes	Definition	Sample Quote
1. Pressured or Coerced Alcohol Use	Pressure to drink from clients	Descriptions of feeling pressured to drink alcohol by clients at entertainment establishments	“If they want us to finish up the drinks, we have to or else they will be chasing us out of the room.”
	Pressure to drink from managers	Descriptions of feeling pressured to drink alcohol by employers or supervisors at entertainment establishments	“When we say we can’t drink, our (supervisors) will just ask us why we work as EWs if we can’t drink. If we did not drink, we would be fired.”
2. Economically rational alcohol use	Job Requirement	Descriptions of drinking as a known and understood requirement of the job	“Karaoke is a place not only for singing but also for service alcohol and entertaining with women. The boss hires us to drink with clients.”
	Economic Survival	Descriptions of drinking alcohol to earn extra money due to economic hardship or economic shock	“We have to drink since we don’t have any money. We are poor and we need money, so we must drink for money.”
3. Socially Rational Alcohol Use	Pressure to drink alcohol from peers	Descriptions of feeling pressured to drink alcohol by coworkers or peers at entertainment establishments	“We must help drink from the big round table, because we get the same bill. If we don’t help drink, other women would be jealous. So we must drink.”
	Drinking in response to stress in life	Descriptions of choosing to drink beer to cope with daily life and the pressures and stress of their life.	“We are not happy, we think a lot and we can’t help. So the beer helps us not to think a lot.”
4. Voluntary Alcohol Use	Drinking for enjoyment and fun	Descriptions of drinking because they enjoy it	[Alcohol] encourages us to tell jokes, to relieve the suffering, when there is reunion, we drink and we laugh. Whenever I drink with my family, all the worry will be gone."
5. Perceived impacts of alcohol use	Physical Health	Descriptions of how women perceive alcohol impacting their physical health.	“When I drink, I will suffer vaginal discharge. When I don’t drink, I feel recovered. Drinking alcohol can cause a discharge.”
	Mental Health	Descriptions of how women perceive alcohol impacting their mental health.	“Alcohol use makes us forgetful.”
	Drinking while on Medication	Descriptions of how women handle drinking while on medication.	“If we take an [antibiotic], we can tell the boss or supervisor to give us a week off because we need to take medicine and then they help us."
	Economic Cost of Drinking	Descriptions of treatments for hangovers that cost money	“Sometimes I get hangover the next morning after drinking and I have to spend money on treatment such as IV fluid injection.”
6. Strategies to manage the drinking environment	Avoiding Alcohol	Women talk about ways they avoid drinking alcohol at work.	“Sometimes if we do not want to drink, we pretend to vomit and they would not force us anymore.”
	Preparing for Drinking	Descriptions of how women prepare for night of drinking in ways that may mitigate the effects of the alcohol.	“We have to have lots of rice before drinking so that it also won’t damage our health (stomach and intestine as well). We also have lots of snacks during drinking.”
	Failed tactics	Descriptions of coping mechanisms that don’t always work.	“Sometimes I say that I am sick and cannot drink but my clients told me that if I was sick I should drink in little amount. We cannot avoid drinking.”
7. Intersections of violence and alcohol use	Partner violence	References violence against FEW from partner when partner is drunk	“Because of her husband’s drunkenness, she was hit by her husband sometimes even with black eyes.”
	Client violence	References violence against FEW from client when client is drunk	“Since boys are gentleman only when they are not drunk. When they’re drunk, they become forgetful.”
	Condom use and alcohol	References the impact of alcohol on condom negotiation ability among FEWs	“Apart from being drunk, they [clients] are easy to talk to about condoms.”