A Multilevel Analysis of Regional and Gender Differences in the Drinking Behavior of 23 Countries

Abstract

Introduction: Drinking behavior differs not only among countries, but also among regions within a country. However, the extent of such variation and the interplay between gender and regional differences in drinking have not been explored and are addressed in this study. Methods: Data stem from 105,061 individuals from 23 countries of the GENACIS data set. The outcomes were heavy drinking (10/20 g or more of pure ethanol per day for women/men), and risky single occasion drinking (RSOD) (5+ drinks per occasion) at least monthly. Analyses used binary logistic mixed models. Variance at specific levels was measured by the intra-class correlation coefficient (ICC). Gender differences in outcomes were measured using gender ratios. Results: Country-level ICC was 0.13 (95% CI: 0.09–0.18) for heavy drinking and 0.16 (95% CI: 0.10–0.26) for RSOD. Within-country regional-level ICC for heavy drinking and RSOD was 0.02 (95% CI: 0.009–0.05; 0.01–0.04, respectively), implying that 2% of variation in heavy drinking and RSOD was explained by regional variation. Variance in drinking indicators was larger for women compared to men across countries. Gender ratios were higher in low- and middle-income countries. Conclusions: Regional variations in risky drinking were more often present in low- to middle-income countries as well as in a few higher-income countries, and could be due to cultural and demographic differences. Variations in gender differences were larger on the country level than on the regional level, with lower-income countries showing larger differences. These results can help to better identify specific high-risk groups for prevention strategies.

Keywords:

• Alcohol consumption
• gender
• region
• international

Acknowledgements

GENAHTO is a collaborative international project affiliated with the Kettil Bruun Society for Social and Epidemiological Research on Alcohol and coordinated by research partners from the Alcohol Research Group/Public Health Institute (USA), University of North Dakota (USA), Aarhus University (Denmark), the Center for Addiction and Mental Health (Canada), the Center for Alcohol Policy Research at La Trobe University (Australia), and the Addiction Switzerland Research Institute (Switzerland). Support for individual country surveys was provided by government agencies and other national sources. National funds also contributed to collection of all of the data sets included in WHO projects. Study directors for the survey data sets used in this articles have reviewed the article in terms of the project’s objective and the accuracy and representation of their contributed data. (GENAHTO survey information at https://genahto.org/abouttheproject/.)

Declaration of interest

The authors declare that they have no conflict of interest. The authors alone are responsible for the content and writing of the article.

Additional information

Funding

The data used in this paper are from the GENAHTO Project (Gender and Alcohol’s Harm to Others), supported by NIAAA Grant No. R01 AA023870 (Alcohol’s Harm to Others: Multinational Cultural Contexts and Policy Implications). GENAHTO is a collaborative international project affiliated with the Kettil Bruun Society for Social and Epidemiological Research on Alcohol and coordinated by research partners from the Alcohol Research Group/Public Health Institute (USA), University of North Dakota (USA), Aarhus University (Denmark), the Centre for Addiction and Mental Health (Canada), the Centre for Alcohol Policy Research at La Trobe University (Australia), and the Addiction Switzerland Research Institute (Switzerland). Support for aspects of the project has come from the World Health Organization (WHO), the European Commission (Concerted Action QLG4-CT-2001-0196), the Pan American Health Organization, the Thai Health Promotion Foundation (THPF), the Australian National Health and Medical Research Council (NHMRC Grant No. 1065610), and the U.S. National Institute on Alcohol Abuse and Alcoholism/National Institutes of Health (Grants R21 AA012941, R01 AA015775, R01 AA022791, R01 AA023870, and P50 AA005595). Support for individual country surveys was provided by government agencies and other national sources. National funds also contributed to collection of all of the data sets included in WHO projects. Study directors for the survey data sets used in this paper have reviewed the paper in terms of the project’s objective and the accuracy and representation of their contributed data. The study directors and funding sources for data sets used in this report are: Switzerland (Gerhard Gmel, Swiss Federal Office for Education and Science Contract 01.0366, Swiss Federal Statistical Office), Austria (Irmgard Eisenbach-Stangl, Boltzmann Institute), Germany (Ludwig Kraus (Germany Federal Ministry of Health and Institute for Therapy Research Munich), France (Francois Beck, National Institute of Prevention and Health Education), Spain (Antonio Vidal, Dirección General de Atención a la Dependencia, Conselleria de Sanidad, Generalitat Valenciana, Comisionado do Plan de Galicia sobre Drogas, Conselleria de Sanidade, Xunta de Galicia, Dirección General de Drogodependencias y Servicios Sociales, Gobierno de Cantabria), Sweden (Karin Bergmark (Ministry of Social Affairs and Health Sweden), Finland (Pia Mäkelä, National Research and Development Centre for Welfare and Health Finland), Denmark (Kim Bloomfield, Sygekassernes Helsefond, Danish Medical Research Council), Czech Republic (Ladislav Csemy, Ministry of Health of Czech Republic, Grant Number: MZ 23752), Hungary (Zsuzsanna Elekes, Ministry of Youth and Sport Hungary), Ireland (Ann Hope, Department of Health and Children Ireland), USA (Thomas Greenfield, National Institute on Alcohol Abuse and Alcoholism / National Institute of Health, Grant AA05595), Canada (Kathryn Graham, Canadian Institute of Health Research), Mexico (Martha Romero, Ministry of Health, Mexico, Office of Antinarcotics Issues; U. S. Embassy in Mexico, National Institute of Psychiatry, National Council Against Addictions, General Directorate of Epidemiology and Subsecretary of Prevention and Control of Diseases, Ministry of Health, Mexico), Costa Rica (Julio Bejarano, WHO), Belize (Claudina Cayetano, Pan American Health Organization), Nicaragua (Jose Trinidad Caldera, Pan American Health Organization), Uganda (Nazarius, Mbona Tumwesigye, WHO), Nigeria (Akanidomo Ibanga, WHO), India (Vivek Benegal, WHO), Sri Lanka (Siri Hettige, WHO), Australia (Paul Dietze, Robin Room, National Health and Medical Council, Grant 398500), New Zealand (Jennie Connor, Otago University Research Grant). Opinions are those of the authors and do not necessarily reflect those of the National Institute on Alcohol Abuse and Alcoholism, the National Institutes of Health, the WHO, and other sponsoring institutions. (GENAHTO survey information at https://genahto.org/abouttheproject/).