“PREVALENCE AND SOCIAL FACTORS ASSOCIATED WITH ALCOHOL USE AMONG MEN IN THIRUVATTAR” Dissertation Submitted to THE TAMILNADU Dr. M.G.R MEDICAL UNIVERSITY In partial fulfilment of the requirements for the award of the degree of M.D COMMUNITY MEDICINE Branch XV May 2019 CERTIFICATE This is to certify that this dissertation entitled “Prevalence And Social Factors Associated With Alcohol Use Among Men In Thiruvattar” is a bonafide record of the work done by Dr.M.S.Praythiesh Bruce during the period 2016-2019. This has been submitted in the partial fulfilment of the award of M.D. Degree in Community Medicine [Branch-XV] by the Tamilnadu Dr. MGR Medical University Chennai. Dr.Rema.V.Nair.M.D., D.G.O. Dr.M.C Vasantha Mallika.M.D.,DPH. Director Professor and Head Sree Mookambika Institute of Department of Community Medicine Medical Sciences Sree Mookambika Institute of Kulasekharam Medical Sciences Kanyakumari District Kulasekharam Tamil Nadu -629161 Kanyakumari District Tamil Nadu -629161 CERTIFICATE This is to certify that this dissertation entitled “Prevalence And Social Factors Associated With Alcohol Use Among Men In Thiruvattar”hereby submitted by Dr. M.S.Praythiesh Bruce for the M.D. Degree in Community Medicine [Branch-XV] in the Tamilnadu Dr. MGR Medical University is a record of bonafide research work carried out by him under our guidance and supervision during the period 2016-2019. Dr.M.C Vasantha Mallika.M.D.,DPH. Dr.Austoria A.J.M.D. Professor and Head [Co-guide] Department of Community Medicine Assistant Professor Sree Mookambika Institute of Department of Community Medicine Medical Sciences Sree Mookambika Institute of Kulasekharam Medical Sciences Kanyakumari District Kulasekharam Tamil Nadu -629161 Kanyakumari District Tamil Nadu -629161 DECLARATION I Dr. M.S.Praythiesh Bruce hereby submit the dissertation titled “PREVALENCE AND SOCIAL FACTORS ASSOCIATED WITH ALCOHOL USE AMONG MEN IN THIRUVATTAR” done in partial fulfilment for the award of the degree M.D Community medicine [Branch-XV] in Sree Mookambika Institute of Medical Sciences, Kulasekharam. This is an original work done by me under the guidance and supervision of Dr. M.C.Vasantha Mallika M.D., DPH. and Dr. Austoria A.J.M.D. Dr. M.C. Vasantha Mallika.M.D., DPH. Dr.M.S.Praythiesh Bruce Professor and Head Postgraduate Department of Community Medicine Department of Community Sree Mookambika Institute of medicine Medical Sciences Sree Mookambika Institute of Kulasekharam Medical Sciences Kanyakumari District Kulasekharam Tamil Nadu -629161 Kanyakumari District Tamil Nadu -629161 ACKNOWLEDGEMENT My foremost thanks goes to the God Almighty who has blessed me abundantly with His grace, for giving me the strength that I needed to complete this thesis. I extend my sincere heartfelt thanks to Dr. Velayuthan Nair, Chairman and Dr. Rema. V. Nair, Director, for providing facilities to accomplish my dissertation work. I also thank the Principal of the Institution Dr. Padmakumar and vice principal Dr.Mookambika R.V and Deputy Medical Superindent Dr. Vinu Gopinath for their valuable support extended to me. I express my sincere thanks and gratitude to my professor, mentor and guide Dr.M.C Vasantha Mallika, Head of the Department, for her valuable and constant guidance, supervision and support throughout the study. Her constant motivation has helped me to overcome all the challenges and difficulties that I came across during this research work. I am very much grateful to my co-guide Dr. Austoria .A.J., Assistant Professor, for her tremendous help, valuable support and guidance in carrying out the study. Her constant encouragement helped me to overcome obstacles during the study. I wish to express my sincere thanks to Dr.Sudhir Ben Nelson Assistant Professor, for his help and valuble suggestions during the study period I wish to express my sincere thanks to Dr.Vishnu.G.Ashok Assistant Professor, for his help and valuble suggestions during the study period. I also thank Dr.Priya, Assistant Professor, for the help during the study period. I humbly thank Ms.Jossy John, Lecturer in Statistics, Department of Community Medicine, for the support, guidance and help at each stage of my dissertation work. I also thank my Junior Post Graduates for their help and support. I am very grateful for the support, encouragement and care given by parents and friends whenever I needed most. Mrs. Ambika Kumari deserves special mention for her help and cooperation. DEDICATED TO MY PARENTS, BROTHER, SISTER, TEACHERS, FRIENDS, COLLEGUES & MY DEAR WIFE Without whom I would have never reached to this stage of life. CONTENTS SL.NO TITLE PAGE NO. 1 INTRODUCTION 1 2 AIMS & OBJECTIVES 4 3 REVIEW OF LITERATURE 5 4 MATERIALS & METHODS 33 5 RESULTS 40 6 DISCUSSION 76 7 SUMMARY & CONCLUSION 90 8 LIMITATIONS 91 9 RECOMMENDATIONS 92 10 REFERENCES - 11 ANNEXURES - LIST OF TABLES Prevalence of alcohol use among Men in states and union territories in India 11 Table 1: Distribution of study population based on age 41 Table 2: Distribution of study population based on religion 42 Table 3: Distribution of study population based on marital status 42 Table 4: Distribution of study population based on educational qualification 43 Table 5: Distribution of study population based on occupation 44 Table 6: Distribution of study population based on income 44 Table 7: Distribution of study population based on Modified Kuppuswamy socio 45 economic classification Table 8: Alcohol use among the study population 46 Table 9: Distribution of ever alcohol users 46 Table 10: Alcohol use disorder according to AUDIT category 47 Table 11: Dependence category for current alcoholics 48 Tables 12: Frequency of alcohol use among ever and current alcohol users 49 Table 13: AUDIT score among current alcohol users (n = 232) 50 Table14: Age of initiation of alcohol and awareness about it. 50 Tables 15: Place of alcohol use among ever and current alcohol users 51 Tables 16: Company for alcohol use among ever and current alcohol users 52 Tables 17: Type of alcohol use among ever and current alcohol users 53 Table 18: Reason for Starting Alcohol among Ever and Current Alcohol user 54 Table19: Reason for continuing alcohol use in ever and current alcohol user. 55 Table 20: Efforts to stop alcohol use among ever and current alcohol users 56 Table 21: Factors Associated with alcohol use among ever and never alcohol users 58 Table 22: Factors Associated with alcohol use among ever and never alcohol 61 users-Odds (95%CI) Table 23: Factors associated with alcohol use among current alcohol users 64 Table 24: Factors associated with alcohol use among current alcohol users- 67 Odds(95%CI) Table 25: Factors associated with alcohol dependence among current 70 Table 26: Factors associated with alcohol dependence among current users- 74 Odds(95%CI) LIST OF FIGURES Figure 1 Total alcohol per capita(15+ years) consumption; in liters 7 of pure alcohol, 2010 Figure 2 Proportion (%) of recorded alcohol per capita (15+) 29 years consumption consumed in the form of beer, wine, spirit and other beverages by WHO region and world Figure 3 Flow chart depicting the prevalence of alcohol use 40 among men in Thiruvattar block aged 18 and above 1. INTRODUCTION Alcoholic beverages have been consumed from the beginning of the recorded history of human society1. Both the developed and underdeveloped countries have been suffering from the abuse of alcohol2. As per World Health Organization[WHO] Global status report 76.3 million are diagnosed with alcohol use disorders in 2 billion people consuming alcohol3. Due to harmful use of alcohol 5.9 % of all deaths that occur worldwide. Globally, 3.3 million deaths occur every year. Alcohol is a causal factor in more than 200 disease and injury conditions. Overall 5.1 % of the global burden of disease and injury are due to Alcoholism, as measured in disability-adjusted life years (DALYs). Death and disability occur early in life and it is mainly seen in 20-39 years and 25 % of the total deaths among this age group are attributable to alcohol. There is a causal relationship between the harmful use of alcohol and a range of mental and behavioural disorders and other non-communicable diseases and injuries. Harmful use of alcohol brings significant social and economic losses to individuals and society4. Some countries in the South-East Asia Region are moving to a higher level of alcohol use in the last decade. The globalization of the economies in the South-East Asia Region (SEAR) is increasing and so it leads to increase alcohol consumption which leads to abuse/harmful use and also addiction (dependence) . The alcohol industry is expanding hugely in the Region. In the period between 1993-94 the total annual estimated alcohol production was 642 million litres and it has doubled to 789 million litres in 2 years during 1994-1995 5 . In 2006 – 2007 in Tamilnadu 13.6% of the total state revenue was generated through the sale of alcohol. Tamil Nadu Government took over the retail sales of alcohol in a policy change in 2003. Illicit alcohol trade was wiped out through a series of measures. The Tamil Nadu State Marketing Corporation (TASMAC) was the sale outlets, apart from a few high- end bars and hotels. An increase of 40.34% in turnover was noted and an additional revenue of Rs. 15.64 billion was generated in the first 11 months when retail alcohol sales were taken over by the Government6 The revenue earned through a special fee on imported foreign liquor sales was increased in TASMAC from 1.86 crores [2010-2011] to 10.80 crores in [2016-17 ]6.The export of beer from Tamilnadu to other states has been increased from 1,15,00[2015-16] to 1,27,150 cases [2017-18]7.