Alcohol consumption in adolescent homicide victims in the city of Johannesburg, South Africa Lu-Anne Swart1, Mohamed Seedat1 & Juan Nel2 Institute for Social and Health Sciences, University of South Africa, Johannesburg, South Africa and Medical Research Council/University of South Africa Violence, Injury and Peace Research Unit, Tygerberg, South Africa1 and Department of Psychology, University of South Africa, Pretoria, South Africa2
Aims To describe the blood alcohol concentration (BAC) of adolescent homicide victims in Johannesburg, South Africa and to identify the victim and event characteristics associated with a positive BAC at the time of death. Design Logistic regression of mortality data collected by the National Injury Mortality Surveillance System (NIMSS). Setting Johannesburg, South Africa. Participants A total of 323 adolescent (15–19 years) homicide victims for the period 2001–9 who had been tested for the presence of alcohol. Measurements Data on the victims’ BAC level, demographics, weapon or method used, scene, day and time of death were drawn from NIMSS. Findings Alcohol was present in 39.3% of the homicide victims. Of these, 88.2% had a BAC level equivalent to or in excess of the South African limit of 0.05 g/100 ml for intoxication. Multivariate logistic analysis showed that a positive BAC in homicide victims was associated signiﬁcantly with the victim’s sex [male: odds ratio (OR) = 2.127; 95% conﬁdence interval (CI) = 1.012–4.471], victim’s age (18–19 years: OR = 2.364; CI = 1.343–4.163); weapon used (sharp instruments: OR = 2.972; CI = 1.708–5.171); and time of death (weekend: OR = 3.149; CI = 1.842–5.383; night-time: OR = 2.175; CI = 1.243–3.804). Conclusions Excessive alcohol consumption is associated with a substantial proportion of adolescent homicides in Johannesburg, South Africa, and is more prevalent among male and older adolescent victims and in victims killed with sharp instruments over the weekends and during the evenings. Keywords
Adolescents, alcohol, blood alcohol concentration, homicide, South Africa.
Correspondence to: Lu-Anne Swart, Institute for Social and Health Sciences, University of South Africa, Johannesburg, South Africa and Medical Research Council/University of South Africa Violence, Injury and Peace Research Unit, Tygerberg, South Africa. E-mail: [email protected]
Submitted 9 June 2014; initial review completed 25 July 2014; ﬁnal version accepted 1 December 2014
INTRODUCTION Per capita alcohol consumption patterns are correlated with homicide rates [1–4], and this correlation is pronounced in countries with intoxication-orientated drinking patterns [1,3]. A substantial proportion of homicides also involve alcohol use by participants [5–8]. A multi-country review revealed that 33–66% of offenders and 40–50% of victims were affected by alcohol at the time of the homicide . South Africa has one of the highest adult (≥15 years) per capita alcohol consumption levels (12.4 l) globally . Drinking large amounts per occasion or drinking to intoxication is common [10,11]. The National Injury Mortality Surveillance System (NIMSS) shows that approximately 58% of homicide victims have positive blood alcohol concentrations (BACs) [12,13]. The South African Youth Risk Behaviour Survey (SAYRBS) 2008  highlights the intoxication-orientated drinking pattern among © 2015 Society for the Study of Addiction
adolescents: 33.5% of male and 23.7% of female secondary school learners reported binge drinking (ﬁve or more drinks per occasion) in the past month. NIMSS data showed that 50–54% of adolescent (15–19 years) homicide victims had positive BACs . Interpersonal violence is a leading cause of death among adolescents and young adults [12,13,16], accounting for the majority (52.4%) of injury deaths among 15–24-year-olds in South Africa . Therefore, research concerning the alcohol and interpersonal violence nexus is important for informing violence preventive strategies. The alcohol–violence nexus Pharmacological effects of alcohol play a role in the alcohol–violence nexus. Increased psychomotor stimulation, reduced anxiety and ability to notice inhibitory cues, increased emotional sensitivity, impaired cognitive Addiction, 110, 595–601
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functioning and inability to interpret information accurately and communicate effectively increases the likelihood of violent responses in conﬂict situations [17–20]. Adolescents’ developing physiology and inexperience renders them vulnerable to the pharmacological effects of alcohol . Alcohol-related violence is the result of the pharmacological effects of alcohol in interaction with a number of variables, such as the characteristics of the individual drinker (e.g. age, gender, drinking pattern), the situational context in which drinking occurs (e.g. locations characterized by a concentration of intoxicated peers and low levels of monitoring and guardianship) and the socio-cultural environment (e.g. tolerance of violence in situations of intoxication) [22,23]. While the patterns of intoxicationorientated drinking  may partly explain the high levels of alcohol-related homicide among South African adolescents the role of other factors, including demographic characteristics and event circumstances, must also be considered [24–26]. Victim, event and offender characteristics Although not focusing speciﬁcally on adolescents, studies from different countries [26–31] have shown that victim, event and offender characteristics are associated with a higher probability of alcohol consumption at the time of the homicide. Male victims are signiﬁcantly more likely to have consumed alcohol at the time of the killing than female victims [28,30,31]. Adolescent and adult homicide victims are also more likely to have positive BACs than children (60 years) victims [30,31]. Studies with respect to the victims’ race appear to be inconclusive. Whereas an United States study found that black victims were more likely than white victims to have consumed alcohol at the time of the homicide , a meta-analysis of alcohol toxicology drawing on 61 studies (most from the United States) found no association between victims’ race and BAC levels . A comparison of the weapons shows that sharp instrument homicides have a strong association with alcohol [29–31]. Homicides occurring in public places, such as recreational venues or streets, appear more likely to involve alcohol [29,31], while homicides taking place in residential locations are less likely to be alcohol-related . This association is related to the social context in which drinking occurs, and may differ across cultures and countries. A study conducted in Russia, where drinking is likely to occur in private settings, found no signiﬁcant relationship between event location and alcohol-related homicides [26,32]. Despite differences in location, studies from various countries have reported consistently that homicides occurring at the weekends and in the evenings are more © 2015 Society for the Study of Addiction
likely to involve alcohol than those homicides occurring at other times [26,29–31]. With respect to offender characteristics, a number of studies show that homicides committed by friends/acquaintances are more likely to involve the use of alcohol [27,31] than those committed by strangers [26,31]. However, an Australian study found that homicides committed by friends/acquaintances or strangers were equally likely to involve alcohol . As to the motive or precipitating circumstance, studies are generally consistent—homicides occurring in the context of arguments are more likely to involve alcohol compared to homicides related to robberies or instrumental crimes [26–28,31]. Considered together, the victim, event and offender characteristics of alcohol-related homicides appear to have much in common with ‘male honour contests’  and confrontational homicides [34,35] that arise from relatively trivial disagreements between friends/acquaintances or strangers, which tend to occur in scenes of leisure activity or public settings where there is a concentration of young males and easy access to alcohol. However, research on the characteristics of alcoholrelated homicide in South Africa is scarce. One study focusing on alcohol use and femicide in the Western Cape, South Africa, found that characteristics such as the victims’ age (