University of New England, (SMG, JM), Biddeford, Maine.
Division of Emergency Medicine, Duke University Medical Center (SMG, JRNV, CS), Durham, North Carolina.
Alcohol Clin Exp Res. 2020 Aug;44(8):1700-1707. doi: 10.1111/acer.14402. Epub 2020 Aug 9.
Each year, alcohol use causes 3.3 million deaths globally and accounts for nearly 30% of injuries treated at Kilimanjaro Christian Medical Center (KCMC) in Moshi, Tanzania. Prior research found significant stigma toward patients reporting alcohol use in general and among healthcare providers for this population.
This mixed-methods study aimed to identify sex-based perspectives of stigma among injury patients, family members, and local community advisory board (CAB) members. Injury patients from the emergency room at KCMC were asked to complete surveys capturing consumption of alcohol, perceived stigma, and consequences of drinking. Patients who completed the survey, their family members, and members of a CAB were also recruited to take part in focus groups led by a trained bilingual research nurse. Data were analyzed using multiple linear regression and Wilcoxon rank sum tests with alpha level set at 0.05.
Results showed that sex was a significant predictor of perceived discrimination (p = 0.037, Standard Error (SE) = 1.71 (0.81)) but not for perceived devaluation (p = 0.667, SE = -0.38 (0.89)). Focus groups revealed there were global negative perceptions of the amount of alcohol consumed as well as negative perceptions toward disclosure of alcohol use to healthcare providers. Sex differences in stigma emerged when participants were specifically asked about women and their alcohol consumption.
The findings of this study suggest there is an underlying sex difference, further stigmatizing women for alcohol use among the injury patient population at KCMC. Tanzanian women suffer from unequal access to health care, and the stigmatization of alcohol use likely increases this disparity.
每年，酒精使用在全球范围内导致 330 万人死亡，占坦桑尼亚莫希基督教学术医疗中心（KCMC）治疗的创伤患者的近 30%。先前的研究发现，一般来说，报告酒精使用的患者以及该人群的医疗服务提供者都存在显著的耻辱感。
这项混合方法研究旨在确定创伤患者、家庭成员和当地社区咨询委员会（CAB）成员中基于性别的耻辱感观点。KCMC 急诊室的创伤患者被要求完成调查，调查内容包括酒精消费、感知耻辱感和饮酒后果。完成调查的患者、他们的家人和 CAB 的成员也被招募参加由一名受过双语培训的研究护士领导的焦点小组。使用多元线性回归和 Wilcoxon 秩和检验分析数据，α 水平设为 0.05。
结果表明，性别是感知歧视的显著预测因素（p=0.037，标准误（SE）=1.71（0.81）），但不是感知贬值的预测因素（p=0.667，SE=-0.38（0.89））。焦点小组揭示了对饮酒量的普遍负面看法，以及对向医疗服务提供者披露饮酒的负面看法。当参与者被特别问及女性及其饮酒行为时，耻辱感出现了性别差异。
这项研究的结果表明，存在潜在的性别差异，进一步对 KCMC 的创伤患者群体中女性的酒精使用产生污名化。坦桑尼亚妇女在获得医疗保健方面存在不平等，对酒精使用的污名化可能会加剧这种差异。
