Alcohol use and internal migration in Nepal: a cross-sectional study.

BACKGROUND

Alcohol use is a leading cause of disease. Although low- and middle-income countries (LMICs) have lower per capita alcohol consumption, the alcohol-attributable disease burden is high in these settings with consumption increasing. LMICs are also experiencing unprecedented levels of internal migration, potentially increasing mental stress, changing social restrictions on drinking, and increasing alcohol availability. We assessed the relationship between internal migration, opportunity to drink, and the transition from first use to regular alcohol use and alcohol use disorders (AUD) in Nepal, a low-income, South Asian country.

METHODS

A representative sample of 7435 individuals, aged 15-59 from Nepal were interviewed in 2016-2018 (93% response rate) with clinically validated measures of alcohol use and disorders and life history calendar measures of lifetime migration experiences. Discrete-time hazard models assessed associations between migration and alcohol use outcomes.

RESULTS

Net of individual sociodemographic characteristics, internal migration was associated with increased odds of opportunity to drink (OR 1.32, 95% CI 1.14 to 1.53), onset of regular alcohol use given lifetime use (OR 1.29, 95% CI 1.13 to 1.48) and AUD given lifetime use (OR 1.24, 95% CI 0.99 to 1.57). The statistically significant association between internal migration and opportunity to drink was specific to females, whereas the associations between migration and regular use and disorder were statistically significant for males.

CONCLUSIONS

Despite high rates of internal migration worldwide, most research studying migration and alcohol use focuses on international migrants. Findings suggest that internal migrants are at increased risk to transition into alcohol use and disorders. Support services for internal migrants could prevent problematic alcohol use among this underserved population.

Informations de copyright

© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.

Déclaration de conflit d'intérêts

Competing interests: DG, FC, SH and WA report support from the National Institute of Mental Health (grant number R01MH110872); WA, DG and SH report support from a Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) centre grant to the Population Studies Center (PSC) at the University of Michigan (grant number P2CHD041028) during the conduct of the study. DG is also the Director of the Institute for Social and Environmental Research-Nepal (ISER-N), which collected the data for the research reported here. DG’s conflict of interest management plan is approved and monitored by the Regents of the University of Michigan. CB reports support from the National Institute of Mental Health and the Fogarty International Center (grant number R01MH120648).