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Original research
Improving estimation of the association between alcohol use and intimate partner violence in low-income and middle-income countries
  1. M Claire Greene1,2,
  2. Lori Heise3,4,
  3. Rashelle J Musci2,
  4. Andrea L Wirtz5,
  5. Renee Johnson2,
  6. Jeannie-Marie Leoutsakos2,6,
  7. Milton L Wainberg1,
  8. Wietse A Tol2,7
  1. 1Psychiatry, Columbia University, New York, New York, USA
  2. 2Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  3. 3Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  4. 4School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
  5. 5Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  6. 6Psychiatry and Behavioral Sciences, Johns Hopkins Medicine, Baltimore, Maryland, USA
  7. 7Peter C. Alderman Program for Global Mental Health, HealthRight International, New York, New York, USA
  1. Correspondence to Dr M Claire Greene, Psychiatry, Columbia University, New York, NY 10032, USA; claire.greene{at}nyspi.columbia.edu

Abstract

Background Alcohol use is a consistent correlate of intimate partner violence (IPV) in low-income and middle-income countries (LMICs). However, the magnitude of this association differs across studies, which may be due to contextual and methodological factors. This study aims to estimate and explore sources of heterogeneity in the association between alcohol use and IPV in 28 LMICs (n=109 700 couples).

Methods In nationally representative surveys, partnered women reported on IPV victimisation and male partner’s alcohol use. We estimated the relationship between alcohol use and IPV using logistic regression and full propensity score matching to account for confounding. Country-specific ORs were combined using a random-effects model. Country-level indicators of health and development were regressed on ORs to examine sources of variability in these estimates.

Results Partner alcohol use was associated with a 2.55-fold increase in the odds of past-year IPV victimisation (95% CI 2.27 to 2.86) with substantial variability between regions (I2=70.0%). Countries with a low (<50%) prevalence of past-year alcohol use among men displayed larger associations between alcohol use and IPV. Exploratory analyses revealed that colonisation history, religion, female literacy levels and substance use treatment availability may explain some of the remaining heterogeneity observed in the strength of the association between alcohol use and IPV across countries.

Conclusion Partner alcohol use is associated with increased odds of IPV victimisation in LMICs, but to varying degrees across countries. Prevalences of male alcohol use and cultural factors were related to heterogeneity in these estimates between countries.

  • violence
  • alcohol
  • low-middle income country
  • gender
  • epidemiology

https://doi.org/10.1136/injuryprev-2019-043433

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    Footnotes

    • Funding This work was supported by the National Institute on Drug Abuse (T32DA007292) and the National Institute of Mental Health (T32MH096724).

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Ethics approval The ICF International Institutional Review Board (IRB) and a local IRB from each participating country approved all DHS procedures. The ICF International IRB adheres to protection of human subjects regulations provided by the US Department of Health and Human Services (45 CFR 46).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available. Data may be requested from the Demographic and Health Survey program (https://dhsprogram.com/data/).