Matenga Tulani Francis L, Zyambo Cosmas, Phiri Masauso Moses, Zulu Richard, Mukupa Musawa, Mabanti Kumbulani, Hainze Anna, Menda Dhally M, Rizzo Angela, Ogwell Ahmed, Goma Fastone M, Achoki Tom
Department of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia.
Centre for Primary Care Research, Lusaka, Zambia.
Front Public Health. 2025 Apr 1;13:1444334. doi: 10.3389/fpubh.2025.1444334. eCollection 2025.
Illicit alcohol consumption is a major public health problem in Zambia and many other countries in Sub-Saharan Africa. This study aimed to determine drivers of illicit alcohol consumption among at-risk populations, such as youths, in selected urban areas in Zambia, using the social-ecological model as a lens to understand these drivers.
Through a qualitative approach, we conducted semi-structured interviews with 12 key stakeholders from the Ministry of Health, Zambia Revenue Authority, local council public health departments, and rehabilitation centers. We also interviewed 30 alcohol consumers who frequent alcohol retail settings such as bars or liquor stores. Participants were purposively selected based on their knowledge of illicit alcohol consumption.
Social demographic factors such as age and sex were identified as key drivers. Adolescents as young as 10 years old initiated illicit consumption, with males constituting the majority of consumers. Limited job opportunities and recreational facilities in communities encouraged young people to consume illicit alcohol; this is worsened by the availability of alcohol in their social circles. Peer influence was also found to be a major driver of illicit alcohol consumption, as cultural norms normalized alcohol use. Lack of productive activities and economic disparities were also found to drive consumption among this group. Low-income individuals sought cheaper alternatives, such as home-distilled spirits or fermented alcohol, due to their affordability and availability in disadvantaged neighbourhoods. Social norms, such as the consumption of homemade alcoholic beverages during social gatherings such as weddings, were also significant drivers.
Despite policies and state agencies banning illicit alcohol sale and production, the sale of alcoholic beverages to young people and weak enforcement of regulations across the country, especially in urban areas increases young people's risk of consuming illicit alcohol. Applying the social-ecological model emphasizes the need for multi-level interventions. These interventions should target individuals, communities, and policy levels. Specifically, they should aim to regulate alcohol consumption, disrupt the social environments that promote illicit alcohol consumption, and ultimately facilitate positive behavior change among young people.
非法饮酒是赞比亚及撒哈拉以南非洲其他许多国家的一个主要公共卫生问题。本研究旨在以社会生态模型为视角，确定赞比亚部分城市地区高危人群（如年轻人）非法饮酒的驱动因素，以了解这些驱动因素。
通过定性研究方法，我们对来自赞比亚卫生部、赞比亚税务局、地方议会公共卫生部门和康复中心的12名关键利益相关者进行了半结构化访谈。我们还采访了30名经常光顾酒吧或酒类商店等酒类零售场所的饮酒者。参与者是根据他们对非法饮酒的了解有目的地挑选出来的。
年龄和性别等社会人口因素被确定为关键驱动因素。年仅10岁的青少年就开始非法饮酒，男性占消费者的大多数。社区中有限的就业机会和娱乐设施促使年轻人饮用非法酒精饮料；他们社交圈子中酒精的可得性使情况更加恶化。同伴影响也被发现是非法饮酒的一个主要驱动因素，因为文化规范使饮酒行为常态化。缺乏生产性活动和经济差距也被发现促使这一群体饮酒。低收入者寻求更便宜的替代品，如自酿烈酒或发酵酒，因为它们在贫困社区价格实惠且容易获得。社会规范，如在婚礼等社交聚会上饮用自制酒精饮料，也是重要的驱动因素。
尽管有政策和国家机构禁止非法酒精销售和生产，但向年轻人销售酒精饮料以及全国尤其是城市地区监管不力，增加了年轻人饮用非法酒精饮料的风险。应用社会生态模型强调需要进行多层次干预。这些干预应针对个人、社区和政策层面。具体而言，它们应旨在规范酒精消费，扰乱促进非法酒精消费的社会环境，并最终促进年轻人的积极行为改变。
