|Year : 2014 | Volume
| Issue : 2 | Page : 128-132
Alcohol consumption practices amongst adult males in a rural area of Haryana
Sandeep Sachdeva1, Mukesh Nagar1, Ajay K Tyagi1, Ruchi Sachdeva2, Bharti1
1 Department of Community Medicine, Pt B. D. Sharma PGIMS, Rohtak, Haryana, India
2 Department of TB and Respiratory Medicine, Pt B. D. Sharma PGIMS, Rohtak, Haryana, India
|Date of Web Publication||4-Feb-2014|
Department of Community Medicine, Pt B. D. Sharma PGIMS, Rohtak - 124 001, Haryana
Source of Support: None, Conflict of Interest: None
Objective: To assess alcohol consumption practices amongst adult males in a rural block area. Materials and Methods: Using multi-stage random sampling frame, at least 12 households were identified from selected anganwadi centers (n = 27), and one resident adult male from each household was interviewed in confidence using pre-designed, pre-tested, semi-structured interview schedule after seeking informed consent. In households with more than one adult male respondent, the elder member was recruited. For operational purpose, a drinker was defined as a person who had consumed at least one alcoholic drink in 1 year immediately preceding the survey. Results: A total of 345 adult males were covered with a mean age of 46.6 (±14.2) years. Nearly 64.6% had 5 years of schooling, 46.4% were farmers, 54.2% lived in joint family system and 59.7% had monthly family income up to Rs 10,000. Nearly 150 (43.5%) subjects had some correct knowledge regarding adverse effects of alcohol consumption. Of all the study subjects, 326 (94.4%) males had consumed at least one alcohol-based drink and of which 66.3% consumed country liquor. Nearly 239 (73.3%) drank at either their respective homes or their friends' homes. Two hundred and eighty-one (86.2%) procured alcohol from a shop within the village; average expenditure per month was Rs 500-900 for 132 (40.5%) respondents; and 38.3% subjects did not consume any snacks with alcohol intake. Drinking had become a habit for 194 (59.5%) males; however, based on self-assessment, 131 (40.2%) considered alcohol consumption as a problem and intended to stop drinking. Conclusion: Within study limitations, high prevalence of alcohol consumption was noted in this study, which may not only eventually lead to health/social issues but also adversely influence the younger generation for easy and early uptake of alcohol.
Keywords: Behavior, beverages, practices, social
|How to cite this article:|
Sachdeva S, Nagar M, Tyagi AK, Sachdeva R, Bharti. Alcohol consumption practices amongst adult males in a rural area of Haryana. Med J DY Patil Univ 2014;7:128-32
| Introduction|| |
Alcohol consumption has been an accepted social practice since time immemorial. However, its abuse is considered as world's third largest risk factor for disease and disability. It is a causal factor in 60 types of diseases, injuries, and a component cause in 200 other entities.  Globally, 6.2% of all male deaths are attributable to alcohol, compared to 1.1% of female deaths.  Worldwide, the per capita consumption of alcoholic beverages in the year 2005 equaled 6.13 l of pure alcohol consumed by person aged 15 years or older. Based on the adult per capita consumption, estimates show that the highest consumption is in developed nations (12.18-8.65 l), followed by South African region, and the least consumption is in South East Asia (2.20 l) and East Mediterranean region (0.65 l).  It has been estimated that about one-half of the total adult population worldwide used alcohol. The proportion of users varied across countries, from 18% to 90% among males and from 1% to 81% among adult females. 
In India, the available data for the year 2000-2001 indicated that there were 62.5 million alcohol users (62.5/1000 population) in the country, of which 17% were dependent users.  According to National Family Health Survey (NFHS)-3 (2005-2006), nearly one-third of the males (33% rural and 31% urban) drank alcohol. It has been estimated that alcohol use has been linked to 15-20% of absenteeism, 40% of accidents at work, 15-20% of traumatic brain injuries, 20% of domestic violence, and a similar proportion of all hospital admissions. ,, The risks related to alcohol are linked to the pattern of drinking and the amount of consumption.  In view of the public health importance of harmful use of alcohol related consequences, it is important to regularly analyze the pattern and trend of alcohol consumption. With this background, a study was carried out to assess the common alcohol consumption pattern and practices amongst adult resident males from a rural block of Haryana.
| Materials and Methods|| |
The study was carried out in Lakhanmajra, a rural block in district Rohtak (Haryana) with approximately 100,000 agrarian population. The area is served by three Primary Health Centers (PHCs) and 20 subcenters, and comprises 24 villages with 124 anganwadi centers (AWCs). The area is well connected by all-season motorable roads and situated around 35 km from the government medical college.
Study Instrument and Operational Definition
Data was collected using pre-designed, pre-tested, semi-structured interview schedule. A 100-ml cup was used as the reference to determine the amount of alcohol consumed. For operational purpose, a drinker was defined as a person who had consumed at least one alcoholic drink in 1 year immediately preceding the survey.
Sample Size, Sampling Strategy, and Data Collection
Sample size was calculated to be 300 considering the prevalence of current alcohol consumption among males as 24.6%  with confidence level of 95% and 20% allowable error (using the formula n = 4pq/l 2 , where p is prevalence, q = 1 − p, and l is the allowable error). Multistage random sampling was used by including all three PHCs of the rural block. Under each PHC, the subcenters were classified into near and far based on the distance (< or >3 km) from the headquarters, following which one (near) and two (far) subcenters were randomly selected from each category. From each subcenter, three AWCs were further selected using the above-mentioned criteria of distance (< or >1.0 km).
From each AWC, atleast 12 households were identified randomly from the survey register maintained by the AWC. One adult (>18 years) male from each household (excluding any guest) was interviewed at his residence in confidence after building rapport and seeking informed consent. In the households with more than one adult male respondent, the available ambulatory (excluding sick/bedridden) elder member was interviewed to assess the common alcohol consumption practices. Only one visit was made to the selected household, and in the event of non availability (8.0%) of a male member, the next household adjacent to the listed house was chosen. By the end of the survey, we were able to cover 345 (more than 3 × 3 × 3 × 12 = 324) adult male members from the community during the period October-December 2011. Data analysis was done using statistical package (SPSS ver. 16) to calculate descriptive statistics and chi-square test which was considered significant at P < 0.05.
| Results|| |
[Table 1] depicts the background profile of the study subjects. A total of 345 adult males were covered in the present survey with a mean age of 46.6 (±14.2) years. Nearly 64.6% had up to 5 years of schooling, 46.4% were farmers, 54.2% were living in joint family system, 29.6% did not own any drought animal, and 59.7% had monthly family income up to Rs 10,000. A large number of 326 (94.4%) males had consumed alcohol as per the operational definition used in the present study. Nearly 150 (43.5%) subjects had some correct knowledge (at least one of the extempore mentioned responses) regarding the adverse effects of regular alcohol consumption on health. The extempore responses ranged from gastritis, cancer, liver diseases, depression and body aches. In contrast, 174 (50.4%) subjects had some correct knowledge (at least one of the extempore mentioned responses) regarding adverse effects of tobacco consumption on health. The extempore responses ranged from asthma, cough, respiratory diseases, cancer lung, and tuberculosis.
[Table 2] depicts the usual consumption pattern and practices amongst the alcohol users (n = 326). Nearly 66.3% consumed country liquor (dessi). Majority of them [121 (37.1%)] and 90 (27.6%) males drank for 1-2 times/month and 3-4 times/week, respectively. Also, 239 (73.3%) drank at either their respective homes or their friends' homes. One hundred and fifty (46.0%) and 145 (44.5%) consumed alcohol during evening and night, respectively. Two hundred and eighty-one (86.2%) procured alcohol from a shop within the village. Average expenditure in a month was Rs 500-900 for 132 (40.5%) and at least Rs 1000 for 110 (33.7%) respondents. Drinking had become a habit for 194 (59.5%) males. One hundred and twenty-five (38.3%) subjects did not consume any snacks with alcohol intake and 217 (66.6%) subjects slept without any social issue following alcohol consumption. Based on self-assessment, 131 (40.2%) considered alcohol consumption as a problem and intended to stop drinking.
| Discussion|| |
A cross sectional descriptive study was undertaken to assess alcohol consumption practices among adult male members from a rural block of Haryana. The perception of local heath workers in the study block was that there was none of the household wherein a male does not consume alcohol, and this corroborated well with the high prevalence figure of alcohol (94.4%) consumers noticed in the present study, i.e. a person who had consumed an alcoholic drink at least once in the preceding 1 year of the survey. This apparently high prevalence figure of alcohol consumption could be due to increased social acceptance, easy access to alcohol (each village in the block has at least one liquor shop), seasonality, and/or sampling issues with a limitation of non-generalizability of the study findings.
There is a spectrum of use among those who consume alcohol according to the cited literature, which ranges from one-time use, occasional use, regular (at least three drinks/week), hazardous use, and harmful use (a pattern of alcohol use that is damaging to health) to a level of dependence with a cluster of adverse cognitive, physiological, and behavioral phenomena wherein consumption becomes overall a compelling priority.  While persons with alcohol dependence are most likely to incur high levels of harm, the bulk of harm associated with alcohol occurs among people who are not dependent, because of their presence in large numbers  though various meta-analysis studies have proved light alcohol drinking to be protective.  The World Health Organization (WHO) recommended low-risk drinking level as no more than 20 grams of alcohol per day and 5 days a week (recommending two non-drinking days).  But whether this recommendation is applicable per se to Indian citizen with variable body structure, genetic constituent and poor dietary practices may require larger discussion, debate and validation. A study found that the concentration of pure ethanol in Indian beverages is 5.0% in beer, 12-15% in wine, 42.8% in Indian Made Foreign Liquor (IMFL), and 40-70% in country liquor, whereas the "peg" is a standard measure of liquor across India and the amount of pure ethanol consumed via peg varies by region-specific beverage and the poured volume of the peg (13-28 g pure ethanol).  Drinking at home is likely to involve larger pour sizes than that at alcohol outlets, and hazardous drinking has indeed been noted to occur, especially at homes in North India. ,
Studies reporting relatively high prevalence of alcohol consumption among males show the rates as 65.8%, 64.2%, 62.4%, 60.0%, 49.0%, and 42.2% in Kolkata (slums), Arunachal Pradesh (hills), Tamil Nadu (rural), Punjab (rural), Goa (rural), and Dehradun (rural), respectively. ,,,,, In the Bangalore study, 46% households had consumed alcohol in the year preceding the survey; 62% users were long-term consumers (>10 years) and nearly one-third consumed alcohol every day; 63% consumed at homes in rural areas, while 52% drank to induce sleep.  In our study, 165 (50.61%) subjects had been consuming for at least 10 years and one-fifth (21.8%) were daily users. This is in contrast to a study (1997) carried out in urban Rohtak (Haryana) among >14-year-old males that revealed 19.7% prevalence of alcohol users only. 
India is one of the largest producers of alcohol in the world. In the South Asian region, it contributes to 65% of production and nearly 7% of imports.  According to the estimate of Associated Chambers of Commerce and Industry (ASSOCHAM) of India, alcohol consumption in the country will cross 19,000 million liters by 2015 from the current level of 6700 million liters, registering a growth of about 30% on a year-on-year basis.  A significant proportion (40.2%) of the study sample considered their drinking habit as a problem and, therefore, were in need of professional help including social and family support. Under these circumstances, greater preventive role can be played at primary/secondary health care level including dissemination of health education at schools and colleges. Nearly 46.6% (161/345) were regular (≥3 drinks/week) consumers of alcohol, indicating the need of health specialists in the future due to eventual health requirements of these high consumers. The Government of India along with stakeholders has taken some commendable measures to control tobacco menace during the last decade and its positive impact would be visible in the next two decades. On the contrary, there is willful reluctance to contain the propelling graph of alcohol production and consumption as it is considered as one of the promising revenue-generating sectors for taxation purpose. In conclusion, high prevalence of alcohol consumption was noted in this study, which may not only eventually lead to health and social issues but also adversely influence younger generations by promoting easy uptake and lifelong habituation.
| Acknowledgements|| |
Staff from the Department of Community Medicine, PGIMS, Rohtak, Haryana.
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[Table 1], [Table 2]
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