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Indian Journal of Community Medicine

Letters to the Editor: Epidemiological determinants of regular alcohol use

Author(s): Dr. Jagjit Singh

Vol. 25, No. 4 (2000-10 - 2000-12)

Prof. S.P.M., H.No. 32, Ajit Nagar, Patiala-147001.*

Sir,

It refers to the article, "A comparative study of prevalence of alcohol users....." by Singh et al1. We had a discussion in our department over this article and appreciated its contents. This is a good attempt to fill up the existing gaps in the epidemiology of alcohol use. Authors have rightly taken into the account only the regular alcohol users to study as occasional alcohol use or what people call "Social drinking" is very common and socially acceptable. Further, it does not have so many social or medical implications, which warrants its study. It has brought out the rural and urban differences very well, such as regular alcohol use is more in rural areas while the casual use is more in urban areas. The regular alcohol use in rural males between 40-59 years is very high and if we add the figures of casual use then alcohol use seems to be almost universal in this group. It also defines the alcohol use, which is very vital to understand and quantify the problems. However, while going through the study, we came across several conceptual flaws, which deserve attention.

  1. The definition of regular alcohol use "Consumption of 200 ml or more alcohol daily for four days or more in a week for last five years" is quite a comprehensive one. But it fails to take into consideration a large number of individuals who consume 1-2 bottles of beer (equating with the volume of 750-1500 ml of 3-7% alcohol) every day. Such population is quite large and is on an increase especially amongst youngsters and middle aged urbanites from upper and middle social class.
  2. Using this definition, there were 48 and 69 regular alcohol users in urban and rural areas respectively. But when we look into the table VII, we find 2 and 3 out of same 48 and 69 regular alcohol users respectively who do not fulfill the definition.
  3. Prevalence was calculated in the population aged 10 years and above and it is interesting to know that not a single person between 10-19 year age was an alcohol user. Apart from a true finding, this can also result from the method employed to seek this information. Persons of this age may not confess of their alcohol use if inquired using the same proforma or asked in front of other elder family members. Further, if the prevalence in 10-19 years is zero, it is logical to reduce the denominator also to 19 years and above only. Accordingly it will result into the higher prevalence of regular alcohol users i.e. 13.8% in urban (48 out of 346 and not 446) and 17.9% in rural areas (69 out of 386 and not 405). The fact that not a single boy between 10-19 was an alcohol user assumes importance when we look into the Table III. Here we find that 11 out of 48 and 21 out of 69 current regular users started taking alcohol when they were aged between 10-19 year old. It may signify the change in the habits of the people in the recent past.
  4. We object to the way percentages have been calculated in this table (No. III). Denominators and numerators are not related at all. For e.g. in the first row of same Table, 11 need not to be the part of 100. Ideally to derive the true information in this regard, mean or median age to start first drink (for rural and urban areas) should have been calculated. Such parameters would have been of much practical use to suggest the target age group for starting the IEC intervention.
  5. Lastly, while referring to the Table IV, no attempt should be made to identify the marital status as determinant for alcohol use as the pattern of marital status in the community is not known. It is just the distribution and profile of regular alcohol users under study. Authors very rightly have not drawn any conclusion from the Table V showing the educational status of alcohol users. In general, the rural, urban background and the age in themselves, are important determinants of marital and educational status than the alcohol use status. The statement "Percentage of alcohol users was more in married persons, both in urban and rural areas, may be partly due to the age factor and partly due to the increased family responsibilities of married life" is not true. On the contrary a system of marriage may provide a social support system which can keep a person away from the regular alcohol use. Accordingly, unmarried and divorcee persons may have more alcohol users in them as such people either being lonely (unmarried) or socially maladjusted (divorcee) are more likely to indulge in alcohol use. Most of the alcohol users in the study are married because most people of their age are also married.

Reference:

1. Singh Jagjeet, Singh Gurmeet, Mohan V, Pada AS: A comparative study of prevalence of regular alcohol users among the male individuals in an urban and rural areas of District Amritsar, Punjab. Indian Journal of Community Medicine. 2000; XXV(2): 73-8. Thanking You,

Yours Sincerely,
Pradeep Kumar, Smita J. Kapadia
PSM Deptt. Govt. Medical College, Surat-395001*

Response of the author to the queries:

Sir,

Thanks for publishing the article "A comparative study of prevalence rate of regular alcohol users is an urban and rural area of distt. Amritsar, Punjab, published in April-June, 2000 issue of IJCM. I also welcome the observations made and queries raised by some of the readers, which is definitely pointing towards the healthy discussion. The clarification of the same is as under:

  1. About 750-1500 ml of beer with 3-7% alcohol, when complied with all the criteria of definition of regular alcohol user, has been included in the study.
  2. I agree with the next observation. In fact, two regular users in urban and three in rural area were not to be included in the list of regular users as per its definition. But, the fact was that one regular user in urban and two in rural area were taking more than 200 ml of alcohol, at least on alternate days and most of the times the frequency was more; for the last 8-10 years. While one case each in urban as well as in rural area was such that by them the alcohol was being taken regularly at weekends, but more often than not, the frequency was 3-4 times or sometimes even more, in a week, for the last 7-8 years. So considering these points; 5 individuals were counted as regular users. I also agree with this that it would have been better when the same would have been mentioned in discussion also.
  3. Maximum efforts were made that exact information should be recorded. In the 10-19 years age group no regular alcohol user was found. This may be there that some persons in this age group might be taking alcohol quite frequently, but they did not conform to the definition of regular alcohol users. But as these persons were interviewed and there would have been some possibility that one or the other might be regular user; so these were included in the denominator. However, inference can also be made and discussed by excluding them from the denominator, as the reader has rightly done the samething.
  4. In Table No. III, the percentage was calculated by keeping in mind, that in which age group maximum number of persons were there or which was the most vulnerable age group, in which the first drink was taken by the regular alcohol users; as 40.1% of the total regular users were in the 20-29 years age group, in which some specific or more IEC activities can be targeted. However, the observation of the reader knowing about the mean or median age, to start the first drink, so as to target the IEC intervention, is an important observation.
  5. As per Table IV 93.75% of the alcohol users were married persons, two were widowers and only one was unmarried. The observations made were only with respect to regular users, as the marital status in the community was not ascertained. Similarly, reasons thereof, were expressed by the regular users only and as the number of married persons was more, the reasons expressed by them, carried the high percentage. While, it cannot be denied that lonely or socially maladjusted/illadjusted (divorcee), as observed by the reader, are more likely to indulge in alcohol use.
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