|
 
 |
| ORIGINAL ARTICLE |
|
| Year : 2022 | Volume
: 17
| Issue : 1 | Page : 59-68 |
|
Knowledge, attitude, and practice related to alcohol use among undergraduate students
Kudupudi Punyavathi Poojitha, Syam Kumar Addepalli
Department of Pharmacology, GITAM Institute of Medical Sciences and Research, GITAM University, Visakhapatnam, Andhra Pradesh, India
| Date of Submission | 03-Dec-2021 |
| Date of Decision | 06-Jan-2022 |
| Date of Acceptance | 16-Feb-2022 |
| Date of Web Publication | 25-Jul-2022 |
Correspondence Address:
Dr. Kudupudi Punyavathi Poojitha
Department of Pharmacology, GITAM Institute of Medical Sciences and Research, GITAM University, Visakhapatnam, Andhra Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jdmimsu.jdmimsu_443_21
Background: The increasing production, distribution, and promotion of alcohol have seen drink-related problems emerging as a major public health concern in India, especially in college-going young adults. The percentage of the population drinking alcohol aged less than 21 years has increased from 2% to more than 14% in the past 15 years as revealed by Alcohol and Drugs Information Centre India. Objective: The objective is to evaluate knowledge about alcohol intake, attitude and practice methods toward alcohol consumption in undergraduates. Materials and Methods: A total of 500 undergraduates from engineering and medical streams were included in the study. Undergraduates were given a validated Student Alcohol Questionnaire. Information given by the students was analyzed. Results: 93% of students believe that many people drink to escape from problems, loneliness, and depression. 54% of students think that responsible drinking can result in relaxation, enhanced social interactions, and feeling of well-being. 74% of students' opinion is that many people drink because of peer group pressures and to gain adult status. About 76% of students agreed to the statement that approximately 10% of fatal highway accidents are alcohol related. Only 22% of students are aware of the fact that blood alcohol content of 0.1% is the legal definition of alcohol intoxication in driving. Alcohol was consumed by 31% of males and 17% of females at least once in their lifetime. 70% of boys and 64% of girls of those who consumed alcohol had experienced vomiting and hangover. Twenty (4%) students reported that they drove car after having several drinks or involved in a fight at least once in their lifetime. Conclusion: There is a necessity for more studies to evaluate the reason for increasing inclination of students toward the consumption of alcohol.
Keywords: Alcohol, drinking pattern, hangover, intoxication, knowledge on alcohol consumption, peer pressure, undergraduates
How to cite this article:
Poojitha KP, Addepalli SK. Knowledge, attitude, and practice related to alcohol use among undergraduate students. J Datta Meghe Inst Med Sci Univ 2022;17:59-68 |
How to cite this URL:
Poojitha KP, Addepalli SK. Knowledge, attitude, and practice related to alcohol use among undergraduate students. J Datta Meghe Inst Med Sci Univ [serial online] 2022 [cited 2022 Aug 16];17:59-68. Available from: http://www.journaldmims.com/text.asp?2022/17/1/59/352241 |
| Introduction | |  |
The prevalence of current use of alcohol in INDIA ranges from 7% in Gujarat to 75% in Arunachal Pradesh. Alcohol misuse has been implicated in over 20% of traumatic brain injuries and 60% of all injuries.[1] Alcohol contributes to 25% of all deaths in the age group of 20–39 years.[2]
The increasing production, distribution, and promotion of alcohol have seen drink-related problems emerging as a major public health concern in India. The studies done by Alcohol and Drugs Information Centre India has revealed that the percentage of the drinking population aged <21 years has increased from 2% to more than 14% in the past 15 years.[3]
It is observed that almost four in every five college students drink alcohol, and two in every five engage in heavy episodic drinking which is the consumption of five or more drinks in a row.[4] College students are more being engaged in heavy episodic drinking when compared to the same-age peers who do not attend college.
Binge drinking is also very frequently encountered with the young generation. About 15% of young Australians[5] and about one-third of students in Denmark, Ireland, Poland, and the United Kingdom are involved with binge or heavy drinking.[6] The most common adverse consequences of binge drinking in young people include the physiological effects of excessive alcohol such as blackouts, hangovers, and behavioral problems.[7] Alcohol-related disorders are most prevalent among young adults when compared to their prevalence in adults.[8] In India, the processes of industrialization, urbanization, and migration have led to loosening of the traditional methods of social control rendering an individual more vulnerable to the stress of modern life as well as increased exposure to the substances of abuse. It is estimated that about 50% of the boys have tried at least one of the substances of abused nature by the time they reach the ninth grade.[9] A study reported that in Uttar Pradesh, the most populous state in India, 22.8/1000 were dependent on alcohol. Many studies revealed that alcohol was the most common substance abused (60%–98%) followed by cannabis.[10]
The present study evaluates the knowledge about alcohol, its consumption, and consequences in male and female undergraduates from a university located in Visakhapatnam, Andhra Pradesh, India.
Aims and objectives
- To evaluate knowledge about alcohol consumption in undergraduate students
- To evaluate attitude and practice methods toward alcohol consumption in undergraduate students.
| Materials and Methods | | |
This study was conducted at a university located in Andhra Pradesh, INDIA. The study was done after taking approval from the Institutional Ethics Committee [Annexure – I]. The study was undertaken in students pursuing graduation in different streams who volunteered to participate in the study. The students were selected randomly for inclusion in the study irrespective of their status with regard to alcohol intake. A brief introduction about the study was given to the students and they were assured about the confidentiality of the information given by them. Informed consent [Annexure – II] was taken from the students after interaction with the student individually. The psychological status of the student was assessed during interaction with them. The students were given a validated Student Alcohol Questionnaire (SAQ) [Annexure– III] which was used in few alcohol awareness studies.[11] One hard copy printed material of SAQ was given to each student. Questions were given regarding knowledge about alcohol, attitude toward alcohol use, and their practice methods. Filled-in forms were collected back to generate data for analysis. There was no time limit. This was done during working hours within the college and in multiple sessions for each stream. Hence, students attending college participated in the study. The forms were given number codes and data were collected.
Study design
Prospective observational questionnaire-based study.
Study population
Students pursuing graduation under various streams.
Sample size
The total sample size was 500 students.
A pilot study was conducted among 30 students. SAQ was given to them and the results were analyzed. Knowledge was found to be 78%. The sample size was calculated as 456 based on the following formula. Hence, the sample size is taken as 500.
α = 0.01, P = 0.78, d = 0.05;
Study period
Conducted over a period of 3 months from January 2020 to March 2020.
Descriptive statistics are used for demographic data and to analyze results.
Criteria of subject selection
Inclusion criteria
- Boy and girl students pursuing graduation aged 19–25 years
- Students staying in hostel as well as day scholars.
Exclusion criteria
- Students aged more than 25 years
- Students suffering from psychiatric illness.
| Results | | |
In the present study, out of 500 students, 267 (53%) are boys and 234 (47%) are girls as shown in [Figure 1]. The assessment of knowledge about alcohol gave the following results. 93% (465) of students believe that many people drink to escape from problems, loneliness and depression and this is shown in [Figure 2] and [Figure 3] is showing the percentage of students who think that responsible drinking can result in relaxation, enhanced social interactions, and feeling of wellbeing that is 54% (270). 74% (370) of students' opinion is that many people drink because of peer group pressures and to gain adult status. These data are represented in [Figure 4]. | Figure 2: Student's opinion on “many people drink to escape from problems, loneliness, and depression”
Click here to view |
 | Figure 3: Student's opinion on “Drinking can result in relaxation, enhanced social interactions, and feeling of wellbeing”
Click here to view |
 | Figure 4: Student's opinion on “People drink because of peer group pressures and to gain adult statuses”
Click here to view |
The fact that table wines contain 2%–12% alcohol is not known to 66% of the students. 48% of students do not know that distilled liquors like whiskey and vodka contain 15%–20% of alcohol by volume. 54% of students do not know that beer contains 2%–12% alcohol by volume.
[Figure 5] is representing the data “Approximately 10% of fatal highway accidents are alcohol related” – 76% (380) of students agreed to this statement. Only 22% (110) of students are aware of the fact that blood alcohol content of 0.1% is the legal definition of alcohol intoxication in driving and these data are displayed in [Figure 6]. About 66% (330) of students believe that moderate consumption of alcoholic beverages is generally not harmful to the body as depicted in [Figure 7]. | Figure 5: Student's opinion on fact “10% of fatal highway accidents are alcohol related”
Click here to view |
 | Figure 6: Percentage of students aware of the fact that blood alcohol content of 0.1% is the legal definition of alcohol intoxication
Click here to view |
 | Figure 7: Student's opinion on “Moderate consumption of alcoholic beverages is generally not harmful to the body”
Click here to view |
Information regarding alcohol practice methods in the students, alcohol was consumed by 31% (84) of boys as shown in [Figure 8] and 17% (40) of girls as shown in [Figure 9] at least once in their lifetime. 70% (58) of boys and 64% (25) of girls had experienced vomiting and hangover after taking alcohol. This is represented in [Figure 10] and [Figure 11], respectively, for boys and girls. The rate of alcohol intake is more in boys as compared to girls. Most of these students consume alcohol in the form of beer or table wine at least once a week but not every day. They also cut a class or missed a class because of hangover. About 1% of those who have consumed alcohol at least once in their lifetime drove car or involved in a fight at least once in their lifetime after having several drinks. | Figure 8: Percentage of boys who consumed alcohol at least once in their life time
Click here to view |
 | Figure 9: Percentage of girls who consumed alcohol at least once in their life time
Click here to view |
 | Figure 10: Boys who consumed alcohol and had experienced vomiting and hangover
Click here to view |
 | Figure 11: Girls who consumed alcohol and had experienced vomiting and hangover
Click here to view |
| Discussion | | |
The present study is done to assess the knowledge about alcohol, attitude of students toward usage of alcoholic beverages, and their implications for the young adults. Students belonging to medical as well as engineering streams were considered. SAQ is used in this study and is given in Annexure. It was developed during 1973–1974 academic years. It contains questions concerned with drinking patterns, problems related to alcohol, and alcohol knowledge. It was subjected to face validity by a panel of experts and by college students. The Alcohol Attitude Scale developed by the second author (Hanson, 1972) was added to this and the two authors began their collaborative study of college student drinking patterns in 1981.[11]
Kaur et al. conducted knowledge, attitude, and practices study about alcohol consumption in adolescents that is 17–20-year-old students in Amritsar, India. They used a pretested pro forma as a tool for their study. They reported that 31.6% of the study population had consumed alcohol on different occasions. In places, such as weddings, farewell parties, or birthdays, 76.9% of students had consumed alcohol. 55.7% of students said that they were initiated into drinking by friends and 17.8% by cousins. About 91.3% of the adolescents did not know about the quantity permissible for driving.[12] They concluded that peer pressure and family environment certainly played very important role in determining the inclination and initiation of alcohol consumption in students. The results of our present study though conducted in the southern part of India are also in similar lines with the previous study. Alcohol was consumed on various occasions by 31% of males and 17% of females who participated in our study. Only 22% of students from our study knew the legal blood alcohol content for intoxication. 74% of students who participated in our study opined that many people drink because of peer group pressures and to gain adult status.
A questionnaire-based cross-sectional study was conducted in 8 medical colleges from all over India regarding alcohol practices. They administered pretested questionnaire to assess the prevalence, the knowledge and attitudes toward alcohol and tobacco use among undergraduates and post graduate medical residents. They revealed that the prevalence of alcohol consumption for UG students and PG students was 16.6%, and 31.5%, respectively. The description of occasions when they consumed alcohol or tobacco was like – for the highest number of participants it was “with close friends” followed by “during parties.”[13] In the present study, 74% of students' opinion is that many people drink because of peer group pressures and to gain adult status. Both the studies reported more prevalence of alcohol consumption in males compared to females.
According to the review published by Martin P Daroven,[14] the patterns of alcohol consumption differ between continents and countries. During 2014–2015, the figures from the World Health Organisation (WHO) demonstrated that the European Region is the heaviest drinking region in the world.[15] Research suggests that students today drink more, with increasing emphasis on binge drinking and drunkenness when compared to earlier generations.[16]
A study conducted at the University of Leeds, United Kingdom, aimed to assess the alcohol and drug habits of a group of medical students. They used personally administered questionnaire for alcohol use and Hospital Anxiety and Depression Scale to assess the levels of anxiety and depression experienced by the students.[17] 86% of students reported drinking alcohol, 83% men and 88% women which is very high when compared to the present study. This variation may be attributed to the regional differences in the lifestyle of students. The recommended safe weekly limits for alcohol consumption (21 units for men and 14 units for women, per week) were exceeded by 52.6% of drinking men and 50.6% of drinking women.
The limitations of the study are, the personal information given by the students, especially regarding their practice methods towards alcohol consumption is being considered as base for the study irrespective of the actual facts. There is a chance for manipulation of the data by the student regarding his/her personal information. Care was taken to encourage the students to provide accurate data. Confidentiality of the collected information was maintained.
The future directions for the study can be on the evaluation of ratio of students who have experienced hangover or consumed alcohol and those who got addicted to alcohol. The impact of alcohol consumption on the academic performance and successful completion of the course can be focused in the future studies in this area. The impact of alcohol use on future planning and personality development of the individual can also be studied.
We acknowledge the faculty, heads of the departments and the students from the university belonging to the different streams that co-operated for us. There are no conflicts of interest during the conduct of the study. There was no financial support extended for the conduct of this study from any external body.
| Conclusion | | |
The high prevalence of alcohol consumption in students from professional courses is need of hour to be looked on. There is a need for educational and preventive awareness programs at individual, family, and community level to tackle the growing menace of substance abuse. This is to ensure the safety of upcoming generations. Substance dependence and abuse in the younger generation will hamper the economic development of their family as well as the country as a whole. There is a need to identify the problem in the budding stage and remove it in the early stages from society.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| Annexure– I | | |
| Annexure– II | | |
INFORMED CONSENT FORM
Title-“Knowledge, attitude and practice related to alcohol use among undergraduate students”
Investigator-Dr. K. P. Poojitha
Co-investigator-Mr. A. Syam Kumar
I was given explanation about the study and my participation in this survey is voluntary. I may refuse to take part in the research or exit the survey at any time. I am free to decline to answer any particular question I do not wish to answer for any reason. I was assured that information collected will remain confidential. I would like to participate in this study.
Student name-
Age–
Gender-
Signature-
| Annexure– III | | |
THE STUDENT ALCOHOL QUESTIONNAIRE (SAQ)
We are conducting a study of college students' behaviors and knowledge concerning alcohol and hope that you will volunteer to complete this questionnaire. DO NOT write your name on this questionnaire as we wish to retain your anonymity.
FILL IN THE NUMBER WHICH APPLIES TO YOU IN THE BOX BESIDE THE QUESTION
1. Your Gender: 1. Male 2. Female
2. Your age: (write in)
3. Study course & year:
WE WOULD LIKE TO ASK ABOUT YOUR DRINKING PATTERNS
4. Let's take beer first. How often, on the average, do you usually have a beer? (If you do not drink beer at all go to question 6.)
1. every day
2. at least once a week but not every day
3. at least once a month but less than once a week
4. more than once a year but less than once a month
5. once a year or less
5. When you drink beer, how much, on the average, do you usually drink at any one time?
1. more than one six pack (6 or more cans or tavern glasses)
2. 5 or 6 cans of beer or tavern glasses
3. 3 or 4 cans of beer or tavern glasses
4. 1 or 2 cans of beer or tavern glasses
5. less than 1 can of beer or tavern glass
6. Now let's look at table wine. How often do you usually have wine?
1. every day
2. at least once a week but not every day
3. at least once a month but less than once a week
4. more than once a year but less than once a month
5. once a year or less
7. When you drink wine, how much, on the average, do you usually drink at any one time?
1. over 6 wine glasses
2. 5 or 6 wine glasses
3. 3 or 4 wine glasses
4. 1 or 2 wine glasses
5. less than 1 glass of wine
8. Next we would like to ask you about liquors and spirits (whiskey, gin, vodka, mixed drinks, etc.). How often do you usually have a drink of liquor? (If you do not drink liquor at all, skip questions 8 and 9.)
1. every day
2. at least once a week but not every day
3. at least once a month but less than once a week
4. more than once a year but less than once a month
5. once a year or less
9. When you drink liquor, how many drinks, on the average, do you usually drink at any one time?
1. over 6 drinks
2. 5 or 6 drinks
3. 3 or 4 drinks
4. 1 or 2 drinks
5. less than 1 drink
The following are common results that other students have reported. If you have never had a drink at all, go to question 28. If you currently drink or have ever drunk in the past, put the number corresponding to the frequency of the occurrences in the box beside it.
1. at least once in the past two months and at least one additional time during the past year.
2. at least once within the past two months but not during the rest of this past year.
3. not during the past two months but at least once during the past year.
4. has happened at least once in my life but not during the past year.
5. has not happened to me.
10. had a hangover
11. Gotten nauseated and vomited from drinking
12. driven a car after having several drinks
13. driven a car when you knew you had too much to drink
14. driven a car while drinking
15. come to class after having several drinks
16. “cut a class” after having several drinks
17. missed a class because of a hangover
18. arrested for DWI (Driving While Intoxicated)
19. been criticized by someone you were dating because of your drinking
20. had trouble with the law because of drinking
21. lost a job because of drinking
22. got a lower grade because of drinking
23. gotten in trouble with school administration because of behavior resulting from drinking too much
24. gotten into a fight after drinking
25. thought you might have a problem
26. damaged property, pulled a false fire alarm, or other such behavior after drinking.
27. participated in a drinking game
28. How often on the average do you smoke cigarettes?
1. every day
2. at least once a week
3. at least once a month
4. at least once a year
5. less than once a year or not at all
29. When you smoke, how many cigarettes do you smoke per occasion? (write in)
WE WOULD NOW LIKE TO ASK YOU FOR SOME INFORMATION ABOUT ALCOHOL
The questions will either be True or False. If you do not know the answer to the question, DO NOT GUESS. Mark a “0” in the box.
If you think the answer is TRUE, write “1” for true. If you think the answer is FALSE, write “2” for false. If you do not know the answer, write “0” in the box.
30. Drinking milk before drinking an alcoholic beverage will slow the absorption of alcohol into the body.
31. Wines are mad by fermenting grains.
32. Alcoholic beverages do not provide weight-increasing calories.
33. In America, drinking is usually considered an important socializing custom in business,
for relaxation and for improving interpersonal relationships.
34. Gulping of alcoholic beverages is a commonly accepted drinking pattern in this country.
35. Alcohol is usually classified as a stimulant.
36. Alcohol is not a drug.
37. A blood alcohol content of 0.1% is the legal definition of alcohol intoxication in most states, in regards to driving.
38. Approximately 10% of fatal highway accidents are alcohol related.
39. Alcohol was used for centuries as a medicine in childbirth, for sedation and surgery.
40. Table wines contain from 2 to 12% alcohol by volume.
41. It is estimated that approximately 85% of the adult Americans who drink misuse or abuse alcoholic beverages.
42. Many people drink to escape from problems, loneliness and depression.
43. Liquor mixed with soda pop will affect you faster than liquor drunk straight.
44. The most commonly drunk alcoholic beverage in the united States are distilled liquors (whiskey, gin, vodka).
45. A 150 pound person, to keep his blood alcohol concentration below the legally intoxicated level, would have to drink fewer than 3 beers in an hour.
46. A person cannot become an alcoholic by just drinking beer.
47. To prevent getting a hangover, one should sip one's drink slowly, drink and eat at the same time, space drinks over a period of time, and not drink over one's limit.
48. Responsible drinking can result in relaxation, enhanced social interactions, and a feeling of well-being.
49. Distilled liquors (whiskey, gin, vodka, etc.) Usually contain about 15-20% alcohol by volume.
50. Moderate consumption of alcoholic beverages is generally not harmful to the body.
51. It takes about as many hours as the number of beers drunk to completely burn up the alcohol ingested.
52. An ounce of whisky contains about 60 calories.
53. Many people drink for social acceptance, because of peer group pressures, and to gain adult status.
54. A blood alcohol concentration of. 02% causes a person to be in a stupor.
55. Liquors such as gin, scotch and whiskies are usually distilled from mashes made from Fermenting grains.
56. Proof on a bottle of liquor represents half the percent of alcohol contained in the bottle.
57. The United States lacks a national consensus on what constitutes the responsible use of alcoholic beverages.
58. There is usually more alcoholism in a society that accepts drunken behavior than in a society that frowns on drunkenness.
59. Beer usually contains from 2 to 12% alcohol by volume.
60. Eating while drinking will have no effect on slowing down the absorption of alcohol in the body.
61. Drinking coffee or taking a cold shower can be an effective way of sobering up.
62. Wines throughout history have been commonly drunk at religious ceremonies and family gatherings.
63. Drinking of alcoholic beverages has been common in the U. S. A. since the Puritans first settled here.
64. Alcohol has only been used in a very few societies throughout history.
65. Liquor taken straight will affect you faster than liquor mixed with water.
| References | | |
| 1. | Benegal V. India: Alcohol and public health. Addiction 2005;100:1051-6.  |
| 2. | Ganavadiya R, Chandrashekar BR, Singh P, Gupta R, Rana PT, Jain S. Knowledge, attitude, and practice among tobacco and alcohol addicts before and after psychological intervention in a de-addiction center at Madhya Pradesh, India. Ind Psychiatry J 2018;27:27-40. [ PUBMED] [Full text] |
| 3. | Prasad R. Alcohol use on the rise in India. Lancet 2009;373:17-8. |
| 4. | Wechsler H, Nelson TE, Lee JE, Seibring M, Lewis C, Keeling RP. Perception and reality: A national evaluation of social norms marketing interventions to reduce college students' heavy alcohol use. J Stud Alcohol 2003;64:484-94. |
| 5. | Australian Institute of Health and Welfare (AIHW) 2001 National Drug Strategy Household Survey. First Results. Report No. AIHW Cat. No. PHE. 35. Canberra: Australian Institute of Health and Welfare; 2002. |
| 6. | |
| 7. | Shanahan P, Hewitt N. Developmental Research for a National Alcohol Campaign. Canberra: Commonwealth of Australia; 1999. |
| 8. | Bonomo YA, Bowes G, Coffey C, Carlin JB, Patton GC. Teenage drinking and the onset of alcohol dependence: A cohort study over seven years. Addiction 2004;99:1520-8. |
| 9. | Ramachandran V. The prevention of alcohol-related problems. Indian J Psychiatry 1991;33:3-10. [ PUBMED] [Full text] |
| 10. | Dubé KC, Handa SK. Drug use in health and mental illness in an Indian population. Br J Psychiatry 1971;118:345-6. |
| 11. | Engs RC, Hanson DJ. The Student Alcohol Questionnaire: An updated reliability of the drinking patterns, problems, knowledge, and attitude subscales. Psychol Rep 1994;74:12-4. |
| 12. | Kaur N, Chaudhary RK, Gupta P, Devgun P, Khurana BS. Alcohol in teenagers of Amritsar District: A KAP study. J Indian Acad Forensic Med 2015;37:152-4. |
| 13. | Goel N, Khandelwal V, Pandya K, Kotwal A. Alcohol and tobacco use among undergraduate and postgraduate medical students in India: A multicentric cross-sectional study. Cent Asian J Glob Health 2015;4:187. |
| 14. | Davoren MP, Demant J, Shiely F, Perry IJ. Alcohol consumption among university students in Ireland and the United Kingdom from 2002 to 2014: A systematic review. BMC Public Health 2016;16:173. |
| 15. | World Health Organization. Global Status Report on Alcohol and Health-2014. Switzerland: World Health Organization; 2014. |
| 16. | Murphy F, Murphy M. The Use of Social Marketing Messages to Reduce Binge Drinking Among Irish Third Level Female Students. In: Academic Public Administration Studies Archive-APAS; 2010. |
| 17. | Pickard M, Bates L, Dorian M, Greig H, Saint D. Alcohol and drug use in second-year medical students at the University of Leeds. Med Educ 2000;34:148-50. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11]
|
Search Pubmed for