Demographic disparities in the limited awareness of alcohol use as a breast cancer risk factor: empirical findings from a cross-sectional study of U.S. women.

BACKGROUND: Alcohol use is an established yet modifiable risk factor for breast cancer. However, recent research indicates that the vast majority of U.S. women are unaware that alcohol use is a risk factor for breast cancer. There is limited information about the sociodemographic characteristics and alcohol use correlates of awareness of the alcohol use and breast cancer link, and this is critically important for health promotion and intervention efforts. In this study, we assessed prevalence of the awareness of alcohol use as a risk factor for breast cancer among U.S. women and examined sociodemographic and alcohol use correlates of awareness of this link. METHODS: We conducted a 20-minute online cross-sectional survey, called the ABLE (Alcohol and Breast Cancer Link Awareness) survey, among U.S. women aged 18 years and older (N = 5,027) in the fall of 2021. Survey questions assessed awareness that alcohol use increases breast cancer risk (yes, no, don't know/unsure); past-year alcohol use and harmful drinking via the Alcohol Use Disorders Identification Test (AUDIT); and family, health, and sociodemographic characteristics. We conducted multivariate multinomial regression analysis to identify correlates of awareness that alcohol use increases breast cancer risk. RESULTS: Overall, 24.4% reported that alcohol use increased breast cancer risk, 40.2% reported they were unsure, and 35.4% reported that there was no link between alcohol use and breast cancer. In adjusted analysis, awareness of alcohol use as a breast cancer risk factor, compared to not being aware or unsure, was associated with being younger (18-25 years old), having a college degree, and having alcohol use disorder symptoms. Black women were less likely than white women to report awareness of the alcohol use and breast cancer link. CONCLUSIONS: Overall, only a quarter of U.S. women were aware that alcohol use increases breast cancer risk, although 40% expressed uncertainty. Differences in awareness by age, level of education, race and ethnicity and level of alcohol use offer opportunities for tailored prevention interventions, while the overall low level of awareness calls for widespread efforts to increase awareness of the breast cancer risk from alcohol use among U.S. women.

Community voices on alcohol harm in Sierra Leone: Perceptions of prevention needs.

Objective: The research purpose is to determine alcohol prevention needs in Sierra Leone. Methods: We analyzed a cross-sectional survey from fall 2020, distributed by the West African Alcohol Policy Alliance to their partners across nine West African countries. The survey included questions on perceptions of alcohol harm, research priorities, and capacity and reach of the organizations represented. Only participants from Sierra Leone were included (n = 33). Results: When asked if they thought measures taken to prevent alcohol-related harm in their country have been adequate, 66% answered inadequate (n = 32). Asked if heavy drinking of commercial alcohol is a concern in their community, 96% said yes (n = 25), and 92% said heavy drinking of traditional brew or distilled spirits is a concern in their community (n = 24). Finally, 91% said that their organization would be interested in implementing an alcohol counter-marketing campaign (n = 23). Conclusions: Based on the perception of survey participants, efforts to prevent alcohol-related harm thus far are inadequate in Sierra Leone where heavy drinking is a critical concern. CBOs and NGOs already engaged in alcohol harm prevention are eager to support and adopt new strategies. Innovation: This is the first research to seek direct input from CBOS and NGOs about alcohol harm prevention in Sierra Leone.

Acceptability of Primary Care Counseling and Brief Educational Messages to Increase Awareness about Alcohol and Breast Cancer Risks among Bisexual and Lesbian Women.

This research had two aims: (1) to assess how often bisexual and lesbian women self-report screening and counseling for alcohol use in primary care settings; and (2) understand how bisexual and lesbian women respond to brief messages that alcohol increases breast cancer risk. The study sample consisted of 4891 adult U.S. women who responded to an online, cross-sectional Qualtrics survey in September-October 2021. The survey included the Alcohol Use Disorders Identification Test (AUDIT), questions about alcohol screening and brief counseling in primary care, and questions assessing awareness of the link between alcohol use and breast cancer. Bivariate analyses and logistic regression were conducted. Bisexual and lesbian women had higher odds of harmful drinking (AUDIT score ≥ 8) than heterosexual women (adjusted odds ratio [AOR] = 1.26, 95% confidence interval [CI] = 1.01-1.57 for bisexual women; AOR =1.78, 95% CI = 1.24-2.57 for lesbian women). However, bisexual and lesbian women were no more likely than heterosexual women to be advised about drinking in primary care. In addition, bisexual, lesbian, and heterosexual women had similar reactions to messages highlighting that alcohol is a risk factor for breast cancer. Women across all three sexual orientations who are harmful drinkers more often agreed to search for more information online or talk to a medical professional compared to non-harmful drinkers.

Developing an alcohol harm prevention research agenda in West Africa: a mixed methods approach.

Research on alcohol use and its associated harm is scarce in West Africa. To mitigate the knowledge gap and to build momentum for future research, we determined research priorities for alcohol prevention among stakeholders across nine countries in West Africa. We analyzed a cross-sectional survey conducted in the fall of 2020, distributed by the West African Alcohol Policy Alliance (WAAPA). Respondents represented members of the WAAPA, members of intra-country alliances on alcohol and other stakeholders reached by snowball sampling. Quantitative and qualitative survey measures, adapted from the WHO's readiness assessment for the prevention of child maltreatment or developed by the research team, assessed research priorities, awareness of alcohol-related harm, risk factors and data availability. We mapped the qualitative answers into general themes and conducted descriptive analysis on the quantitative responses. Participants outlined two general themes to focus on: (i) alcohol use among children and youth and (ii) the health-related impact of alcohol. The most commonly listed types of alcohol-related harms pertained to acute consequences, such as gender-based violence, injuries, traffic crashes and child maltreatment. Risk factors for alcohol-related harm included limited enforcement of alcohol policies, cheap alcohol, and limited knowledge. Strengthening the capacity for addressing these research priorities will be key in reducing alcohol-related harm in West Africa. The goal of these research priorities is to drive research that informs advocacy, programs and policy. In addition to research, an awareness campaign of the health effects of alcohol is urgently needed.

Preventing Alcohol-Related Harm in East Africa: Stakeholder Perceptions of Readiness across Five Countries.

OBJECTIVE: While alcohol-related harm is a recognized public health priority, the capacity to address and mitigate its harm is lacking, primarily in low-income countries. Recent developments including new tools that can assess readiness for preventing alcohol-related harm, specifically in low-resource settings, can be used to determine strengths and opportunities for supporting, planning, and resource allocation. In this study, we determined the perceptions of readiness and capacity for the prevention of alcohol-related harm across East Africa among stakeholders engaged in such work. METHODS: We conducted a cross-sectional survey in 2020, distributed by the East Africa Alcohol Policy Alliance to their member alliances and stakeholders across five countries in East Africa (i.e., Burundi, Kenya, Rwanda, Tanzania, and Uganda). The survey included modified measures from the Readiness Assessment for the Prevention of Child Maltreatment (RAP-CM) short form, organizational size and funding, research capacity and priorities, and perceptions related to alcohol prevention and harm both locally and in the region. Analyses were computed based on 142 persons/organizations completing the survey. RESULTS: In terms of general readiness, the overall adjusted aggregate score for East Africa was 39.70% (ranging from 30.5% in Burundi to 47.0% in Kenya). Of the 10 domains assessed (on a 0-10 scale), across all countries, knowledge of alcohol prevention (8.43), institutional links and resources (6.15) and legislation, mandates and policies (5.46) received the highest scores. In contrast, measures pertaining to resources (i.e., material, human, technical, and informal) received the lowest score. CONCLUSIONS: Our results demonstrate substantial variability in the readiness to address alcohol-related harm across East Africa. The highest capacity was noted for knowledge towards alcohol prevention, institutional links, and legislative mandates and policies. However, important gaps were noted in terms of attitudes towards alcohol prevention, the will to address the problem, as well as material, human, and informal resources, which need to be urgently addressed to strengthen capacity for addressing and mitigating the significant toll of alcohol-related harm in the region.

Barriers to breast cancer screening in Atlanta, GA: results from the Pink Panel survey at faith-based institutions.

PURPOSE: Our research sought to describe barriers to mammography screening among a sample of predominantly Black women in metropolitan Atlanta, Georgia. METHODS: The Pink Panel project convened community leaders from faith-based institutions to administer an offline survey to women via convenience sampling at fourteen churches in Atlanta in late 2019 and early 2020. With the COVID-19 pandemic, the research team switched to an online survey. The survey included seven questions about breast cancer awareness, barriers to breast cancer screening, and screening status. We used residence information to attain the 9-digit zip code to link to the Area Deprivation Index at the Census Block Group neighborhood level. We report results as descriptive statistics of the barriers to mammography screening. RESULTS: The 643 women represented 21 counties in Georgia, predominantly from metropolitan Atlanta, and 86% identified as Black. Among women aged 40 and older, 90% have ever had a mammogram. Among all women, 79% have ever had a mammogram, and 86% indicated that they would get a mammogram if offered in their neighborhood. The top barriers to mammography screening were lack of health insurance and high cost. Barriers to mammography screening did not differ substantially by Area Deprivation Index. CONCLUSION: Among metropolitan Atlanta women aged 40+ , nearly all reported ever having a mammogram. However, addressing the barriers, including lack of health insurance and high cost, that women reported may further improve mammography screening rates.

Research Capacity and Needs for Alcohol-Related Harm Prevention in West Africa: Findings From a Cross-Sectional Survey of Stakeholders.

OBJECTIVE: The purpose of this study was to determine capacity and resource needs for alcohol prevention research among stakeholders across nine countries in West Africa. METHOD: We analyzed a cross-sectional survey conducted in the fall of 2020, distributed by the West African Alcohol Policy Alliance to their member alliances and stakeholders across nine countries in West Africa. Fifteen survey questions assessed research capacity and priorities related to alcohol prevention and harm locally and in the region. Overall, 140 persons participated in the survey, predominantly representing community-based organizations (CBOs) and nongovernmental organizations (NGOs). RESULTS: Only 42% of the respondents reported that their organizations have conducted research with a university or a research institution (with percentages ranging from 13% in Burkina Faso to 68% in Nigeria). The survey respondents indicated greater capacity for "upstream" research tasks (e.g., monitoring and evaluation, online survey tools, and data collection) compared with "downstream" research tasks (e.g., data analyses, translating research for community use, and preparing policy briefs and briefing decision makers). Less than half (48%) of the respondents were familiar with the World Health Organization (WHO) SAFER initiative. CONCLUSIONS: Given the low proportion of stakeholders in alcohol-related work who have worked with universities and research institutions, a clear priority is to facilitate and strengthen future collaborations. In addition, improving capacity for downstream research tasks is needed to inform policy. Finally, increasing familiarity with SAFER among key stakeholders involved in alcohol harm prevention in the region is a tangible short-term priority.

Impact of the COVID-19 Pandemic on Alcohol Treatment Access and Harm Prevention in West Africa: Reports from NGOs and Community-Based Organizations.

BACKGROUND: Recent research highlights how the COVID-19 pandemic has significantly impacted alcohol consumption patterns, yet research thus far has largely overlooked the experience in West Africa. Research also has not addressed how the COVID-19 pandemic has affected access to alcohol treatment, support, and alcohol harm prevention. This study addresses this research gap in West Africa, a low-resource setting with a very high burden of alcohol harm. OBJECTIVES: To understand the impact of the COVID-19 pandemic on alcohol use, access to alcohol, treatment access, and alcohol harm prevention activities in West Africa. METHODS: This study analyzed data from a cross-sectional online survey conducted in August and September of 2020 and distributed by the West Africa Alcohol Policy Alliance to their member alliances and stakeholders across nine countries (N = 140 participants) to understand their perceptions on COVID-19 and alcohol-related topics. RESULTS: Our findings convey a significant adverse impact on alcohol-focused NGOs and community-based organizations in West Africa. Overall, 94% of participants indicated that the COVID-19 pandemic adversely impacted their organizations' work. In addition, 71% of participants reported reduced access to alcohol treatment or support in their communities. Lastly, 44% of the respondents indicated that people in their community drank less alcohol than usual, and only 33% answered that they perceived it to be harder to get alcohol. CONCLUSIONS: These data underscore the significant impact of the COVID-19 pandemic across West Africa with respect to accessing alcohol treatment and organizational capacity to address alcohol harm. With the lack of infrastructure to address alcohol harm, this impact could exacerbate the high level of alcohol use and harm in the region.

A readiness assessment for the prevention of alcohol-related harm in West Africa: A new methodological approach to inform practice and policy.

OBJECTIVE: Alcohol-related harm is a growing concern globally and particularly in West Africa. However, tools for assessing the readiness for prevention of alcohol-related harm in low-resource settings have been lacking. We modified the WHO tool, the Readiness Assessment for the Prevention of Child Maltreatment Short Form (RAP-CM), to assess readiness for the prevention of alcohol-related harm across West Africa. METHODS: We conducted a cross-sectional survey in the fall of 2020, distributed by the West Africa Alcohol Policy Alliance to their member alliances and stakeholders, predominantly community-based organizations (CBOs) and non-governmental organizations (NGOs), across 7 countries in West Africa (N = 140). The survey included modified measures from the RAP-CM short form. RESULTS: In terms of general readiness, the overall adjusted aggregate score for West Africa was 45.0% (ranging from 42.9% in Liberia to 52.7% in Senegal). Of the ten domains assessed (on a 0-10 scale), across all countries, knowledge of alcohol-related harm prevention (8.3) and legislation, mandates, and policies (6.7) received the highest readiness scores. The lowest readiness scores were observed for human and technical resources (2.5), attitudes toward preventing alcohol-related harm (2.7), and the will to address the problem (2.9). CONCLUSIONS: Our results demonstrate substantial variability across domains in the readiness to address alcohol-related harm with clear strengths and limitations for future priority setting and capacity building. The barriers to progress include attitudes toward alcohol-related harm prevention, lack of willingness to address the problem, and limited human and technical resources available. These barriers need to be mitigated to address the high burden of alcohol-related harm in the region and to inform both practice and policy.