Alcohol stigma as it relates to drinking behaviors and perceptions of drink drivers: A mixed method study in Moshi, Tanzania.

BACKGROUND: Alcohol is a leading risk factor for road traffic injury in low- and middle-income countries, such as Tanzania. This research seeks to explore the drinking patterns, perceptions, and stigma of drink driving behavior of injury patients at Kilimanjaro Christian Medical Center in Moshi, Tanzania. METHODS: This mixed methods study incorporated the Perceived Alcohol Stigma (PAS), an additive Likert scale, and the Alcohol Use Disorders Identification Test (AUDIT). Results are reported as medians with IQRs. Additionally, focus groups with injury patients, their families, and community members (n = 104) were conducted and analyzed in pairs using an inductive thematic content analysis approach. RESULTS: Those who self-reported driving after ingesting 3 or more alcoholic drinks had a median AUDIT score (median = 11.0) significantly higher than those who denied drink driving (median = 5.5, p < 0.01). The PAS showed a high overall stigma against those who use alcohol but differed for drink drivers, drinkers, and abstainers (median = 20.8, 23.9, 34.9, p < 0.01). Thematic content analysis highlighted a 'disapproving of drink drivers', that 'problematic drinking is a drinking behavior which negatively affects others', and a 'passiveness toward drinking and drink driving'. CONCLUSIONS: Stigma against those who use alcohol is present in Tanzania. Perceived stigma is significantly lower among those who drink drive than those who do not. Overall, there appears to be a community-wide disapproval of drinking and driving, which is coupled with feeling unable to change this risky behavior.

Perceptions of alcohol use among injury patients and their family members in Tanzanian society.

Alcohol is one of the leading causes of death and disability worldwide. Rates of alcohol abuse in Moshi, Tanzania, are about 2.5 times higher than the Tanzanian average. We sought to qualitatively assess the perceptions of alcohol use among injury patients in Moshi, including availability, consumption patterns, abuse, and treatments. Participants were Emergency Department injury patients, their families, and community advisory board members. Participants were included if they were ≥18 years of age, a patient or patient's family member seeking care at the Kilimanjaro Christian Medical Center Emergency Department, Moshi, Tanzania, for an acute injury, clinically sober at the time of enrollment, medically stable, able to communicate in Swahili and consented to participate. Focus group discussions were audiotaped, transcribed, translated, and analyzed in parallel using an inductive thematic content analysis approach. Resultant themes were then reanalyzed to ensure internal homogeneity and external heterogeneity. Fourteen focus group discussions, with a total of 104 participants (40 patients, 50 family members, 14 community advisory board members), were conducted. Major themes resulting from the analysis included: 1) Early/repeated exposure; 2) Moderate use as a social norm with positive attributes; 3) Complications of abuse are widely stigmatized; and 4) Limited knowledge of availability of treatment. Our findings suggest that, among our unique injury population and their families, despite the normalization of alcohol-related behaviors, there is strong stigma toward complications stemming from excess alcohol use. Overall, resources for alcohol treatment and cessation, although broadly desired, are unknown to the injury population.