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Abstract
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.
- ALCOHOLISM
- HUMAN MIGRATION
- DEMOGRAPHY
- MENTAL HEALTH
Data availability statement
Data are available on reasonable request. The data used in this study come from the Chitwan Valley Family Study (CVFS). Deidentified CVFS data and documentation are archived at the Inter-university Consortium for Political and Social Research (ICPSR). For more information on using CVFS data, please go to https://cvfs.isr.umich.edu/. The mental health data presented here are available upon request and will be archived at ICPSR soon. They will be available to the scientific community following ICPSR protocols for restricted-use data.
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Data availability statement
Data are available on reasonable request. The data used in this study come from the Chitwan Valley Family Study (CVFS). Deidentified CVFS data and documentation are archived at the Inter-university Consortium for Political and Social Research (ICPSR). For more information on using CVFS data, please go to https://cvfs.isr.umich.edu/. The mental health data presented here are available upon request and will be archived at ICPSR soon. They will be available to the scientific community following ICPSR protocols for restricted-use data.
Footnotes
Contributors All authors contributed to the study conception and design. WA and DG direct the Chitwan Valley Family Study, including the mental health and life history calendar data collection analyzed here. DG is the guarantor and led the data analysis, with support from FC. CB and SH contributed to the data analytical plan, interpretation and communication of results. DG wrote the first draft of the manuscript and all authors made significant contributions and revisions to subsequent versions of the manuscript.
Funding This study was supported by the National Institute of Mental Health (grant number R01MH110872) and 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). The authors are grateful to the staff of the Institute for Social and Environmental Research-Nepal for collecting the data reported here; the staff of the Survey Research Operations unit of the University of Michigan’s Survey Research Center for the development and support of the technical systems that made the fieldwork possible; and the World Mental Health Consortium staff at Harvard University for their input into the design and all subsequent steps of collecting and analyzing these data. The authors thank the respondents of the Chitwan Valley Family Study, whose participation made this work possible.
Disclaimer These sponsors did not directly play a role in data collection, analysis, conceptualisation or manuscript preparation. The authors are solely responsible for any errors or omissions in this manuscript.
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).
Provenance and peer review Not commissioned; externally peer reviewed.