Prevalence & predictors of alcohol use among college students in Ludhiana, Punjab, India.
Article Type: Letter to the editor
Subject: Drinking of alcoholic beverages (Research)
College students (Alcohol use)
Prevalence studies (Epidemiology)
Authors: Khosla, Vishal
Thankappan, K.R.
Mini, G.K.
Sarma, P.S.
Pub Date: 07/01/2008
Publication: Name: Indian Journal of Medical Research Publisher: Indian Council of Medical Research Audience: Academic Format: Magazine/Journal Subject: Biological sciences; Health Copyright: COPYRIGHT 2008 Indian Council of Medical Research ISSN: 0971-5916
Issue: Date: July, 2008 Source Volume: 128 Source Issue: 1
Topic: Event Code: 310 Science & research
Product: Product Code: E197500 Students, College
Geographic: Geographic Scope: India Geographic Code: 9INDI India
Accession Number: 186950594
Full Text: Sir,

Alcohol consumption is a major public health problem in most parts of the world (1), responsible for 3.2 per cent of deaths (1.8 million) and four per cent of the disability-adjusted life years (DALYS, 58.3 million) lost (2). Alcohol remains one of the widely used drugs among college students (3). Earlier initiation of alcohol has been reported to be associated with increased risk for alcohol-related problems (4). According to the National Family Health Survey (NFHS-II) 1998-99 in Punjab, prevalence of alcohol use among men was 28.3 per cent and women 0.2 per cent in the age group of 15 yr and above (5).

We conducted this study to find the prevalence, pattern and predictors of alcohol consumption among college students in Ludhiana district of Punjab. There were a total of 35 colleges (3 professional and 32 non professional) located in the city or towns in the district. Of these, nine colleges (two professional and seven non-professional colleges) were randomly selected for the present study. The professional colleges included one medial college and one engineering college. We approached all the final year students from the selected colleges. Of the total 610 students, 536 (60.6% male) present on the day of the survey participated in the study. The response rate was 87.9 per cent. Information on socio-demographic details, family history of alcohol consumption, knowledge of health effects of alcohol consumption, frequency and quantity of alcohol consumption, age at initiation, reason for initiation and pattern of drinking and information on tobacco use was collected using an anonymous structured, and self-administered questionnaire. The questionnaire was developed by the authors and pre-tested on a few college students in Ludhiana. Data were collected during the months of June--August, 2005. Verbal permission was taken from the principals of the colleges and written informed consent was obtained from all the participants of the study. The confidentiality was maintained by emphasizing not to report their personal identifiers in the questionnaire. Data were entered and analyzed using SPSS version 11.5 (SPSS Inc. Chicago, Illinois, USA).

Mean age of the students was 21 [+ or -] (SD 1.15) yr. The overall prevalence of ever alcohol use was 31.9 per cent (95% CI: 28.0-34.8); 49.2 per cent (95% CI 43.8-54.7) among male students and 5.2 per cent (95% CI 2.2-8.2) among female students. Ever use was significantly higher among male students (P< 0.001) compared to females. Ever use of alcohol among males in our study was more than the figures reported from a recent study among school students aged 12 to 18 yr in Delhi; 30.1 per cent boys were ever alcohol users (6). The mean age of initiation of alcohol consumption was 18.7 yr for males and 19.2 yr for females, which was lower than that reported from the results of a recent study conducted in Punjab (7). Three-fourth of the respondents tried their first use with friends. Among males the reasons for trying the first drink were encouragement from friends (38.8%), curiosity (25.0%), for fun (20.0%), for celebrations (10.6%) and during depressed mood (5.6%). Among females the main reasons for trying the first drink were curiosity (54.5%), celebrations (27.3%), for fun (9.1%) and encouragement by friends (9.1%).

Current use of alcohol (8) was reported only by male students. Prevalence of current use among males was 31.1 per cent (95% CI: 26.0-36.1). The preferred drinks were beer (47.3%), whisky (37.9%), wine (5.9%), rum (5.3%), vodka (3.0%) and gin (0.6%). The most preferred places of drinking were hostel (44%), bar (39%) and friend's place (17%). Among the current users, most of them (91.1%) drank with their friends and the remaining 8.9 per cent with their family members.

Forty seven per cent of the male students consumed alcohol two to three times in the month preceding the survey, 43 per cent of them consumed only once in the last month, and the remaining 10 per cent consumed once in a week. On the day when the students drank, 42.6 per cent of them consumed three to four standard drinks (9) on an average. Close to one third of current drinkers (32.7%) consumed 1-2 drinks and 24.8 per cent resorted to binge drinking ([greater than or equal to] 5 standard drinks). This reported binge drinking was higher than that reported earlier (10). Among the binge drinkers, 48 per cent reported only once in the preceding month, 32 per cent two to three times and 20 per cent more than three times.

Only 12 per cent of the students reported that their parents were aware of their drinking and 23 per cent of the students were not sure of their parents' awareness on their drinking and the rest of them (65%) reported that their parents were not aware of their drinking.

Multiple responses were obtained from the students related to the practices after drinking. Around 67 per cent students enjoyed more after drinking, 60 per cent reported to be happier after drinking to be part of a gathering, 59 per cent reported that they were able to take their mind off from their personal problems after drinking, 52 per cent felt easier to open up with people and 26 per cent told that they could do some complex task after drinking which they found difficult without drinking.

Among those who knew driving, 34 per cent had driven vehicles after drinking alcohol. This high risk behaviour can lead to accidents since in 2001, 51 per cent of the traffic deaths among the United States individuals aged 18-24 yr were alcohol related (11). Eight per cent of the users reported having a fight and another eight per cent faced accident after drinking. Around nine per cent of the users missed their classes due to the effect of drinking and four per cent were told by their friends to control the use of alcohol. This is an important issue since it has been reported that alcohol consumption was high among low performers in schools (12,13).

About two-third of the students believed that unprotected sex was higher under the influence of alcohol and that boys might indulge in eve-teasing or harassment of girls after drinking. These types of behavioural consequences were reported more by non users than users of alcohol in our study.

Around 16 per cent of the respondents reported the experience of sitting behind a drunken driver and seven per cent had disturbed sleep as a result of another person who was drunk. Even in countries such as the United States where law enforcement is much better, over two of the eight million college students drove under the influence of alcohol and over three million rode with a drunken driver (14) pointing to the need for stricter regulation and enforcement of law to control drunken driving. About six per cent reported that they were forced by friends to drink. Eight per cent reported that they met with an accident because of a drunken driver. Nine per cent respondents reported having a fight with a drunken person and someone who was drunk harassed 8.2 per cent.

Approximately 90 per cent were aware of the health effects of alcohol related to liver disease, 18 per cent heart disease, 25 per cent mental illness, 20 per cent cancer and 23 per cent impotence. Two per cent were aware of the linkages between alcohol consumption and all the above diseases.

Around 46 per cent of the participants reported positive use of alcohol. This positive perception towards alcohol use was reported more by ever users and current users of alcohol compared to their counterparts (ever users: 91.8%, non users: 23.8%, P<0.001; current users: 98.0%, non users: 33.3%, P<0.001). The reported positive attributes were 'good to be a part of gathering' (56.2%), helps to enjoy more (48.0%), remove strain (43.0%), relaxation (42.6%) and easier to approach opposite sex (27.5%).

In the step-wise logistic regression analysis of ever use of alcohol, students who reported a family history of alcohol use were five times more likely, current tobacco users were four times more likely and those who had access to pocket money were four times more likely to use alcohol compared to their counterparts. Similar finding on ever use of alcohol and access to pocket money was reported from an earlier study (15).

With regard to predictors of current use of alcohol in the step-wise logistic regression analysis, access to pocket money emerged as the major predictor. Students who had access to pocket money were seven times more likely to be current alcohol users, those with family history of alcohol consumption were six times more likely, professional students were two times more likely and students belonging to the Sikh religion were two times more likely to be current alcohol users compared to their counterparts (Table). Family history of alcohol was the second major predictor for current alcohol consumption. This has been reported in a pervious study also (16).

Our findings underscore the importance of controlling alcohol consumption among college students in the State of Punjab. The results of this study suggest that students receiving pocket money, those with a family history of alcohol consumption, professional students and those belonging to the Sikh religion must be targeted for intervention strategies. Priority attention needs to be given to those who resort to binge drinking since they are at a higher risk. Implementation of alcohol related public policies such as increasing the minimum drinking age and stricter enforcement of alcohol related traffic policies are likely to result in significant reduction of alcohol consumption among college students and related risky behaviours.

Vishal Khosla, K.R. Thankappan * G.K. Mini & P.S. Sarma

Achutha Menon Centre for Health Science Studies Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram 695 011 Kerala, India

* For correspondence:


(1.) Lowenfels AB. Epidemiologic studies of alcohol-related disease in the 20th century. J Epidemiol Biostat 2000; 5: 61-6.

(2.) World Health Organization. Quantifying the selected major risks to health. World Health Report 2002-reducing risks, promoting healthy life. Geneva: World Health Organization; 2002. p. 66.

(3.) Kaplan MS, Patterns of alcoholic beverage use among college students. J Alcohol Drug Educ 1979; 24: 26-40.

(4.) DeWit DJ, Adlaf EM, Offord DR, Ogborne AC. Age at first alcohol use: a risk factor for the development of alcohol disorders. Am J Psychiatry 2000; 157: 745-50.

(5.) International Institute for Population Sciences (IIPS) and ORC Macro.2000. National Family Health Survey (NFHS-2), 1998-99: India, Mumbai: IIPS: p. 44-5.

(6.) Singh AK, Maheshwari A, Sharma N, Anand K. Lifestyle associated risk factors in adolescents. Indian J Pediatr 2006; 73: 901-6.

(7.) Chavan BS, Priti A, Bhargava R, Singh GP. Prevalence of alcohol and drug dependence in rural and slum population of Chandigarh: A community survey. Indian J Psychiatry 2007; 49: 44-8.

(8.) World Health Organization. WHO STEPS Surveillance Manual: The WHO STEPwise approach to chronic disease risk factor surveillance, Geneva: World Health Organization; 2005, Fact sheet analysis guide WHO 2005: 6-3B-1.

(9.) World Health Organization: Regional Office South-East Asia. Prevention of harm from alcohol use: Spectrum of alcohol use and abuse in society. Available from: http:/ LinkFiles/Facts_and_Figures_ch3.pdf (accessed on May 15, 2007).

(10.) Wechsler H, Lee JE, Kuo M, Seibring M, Nelson TF, Lee H. Trends in college binge drinking during a period of increased prevention efforts. Findings from 4 Harvard School of Public Health College Alcohol Study surveys: 1993-2001. J Am Coll Health 2002; 50: 203-17.

(11.) Hingson R, Heeren T, Winter M, Wechsler H. Magnitude of alcohol-related mortality and morbidity among U.S. College Students ages 18-24: changes from 1998 to 2001. Annu Rev Public Health 2005; 26: 259-79.

(12.) Miller PM, Plant M. Drinking, smoking, and illicit drug use among 15 and 16 year olds in the United Kingdom. BMJ 1996; 313: 394-7.

(13.) Soldera M, Dalgalarrondo P, Corea Filho HR, Silva CA. Heavy alcohol use among elementary and high-school students in downtown and outskirts of Campinas city-Sao Paulo: prevalence and related factors. Rev Bras Pisquiatr 2004; 26: 174-9.

(14.) Hingson RW, Heeren T, Zakocs RC, Kopstein A, Wechsler H. Magnitude of alcohol-related mortality and morbidity among U.S. college students ages 18-24. J Stud Alcohol 2002; 63: 136-44.

(15.) van Reek J, Adriaanse H, Knibbe R. Alcohol consumption and correlates among children in the European community. Int J Addict 1994; 29: 15-21.

(16.) Chuang YC, Ennett ST, Bauman KE, Foshee VA. Neighborhood influences on adolescent cigarette and alcohol use: mediating effects through parent and peer behaviors. J Health Soc Behav 2005; 46: 187-204.
Table. Predictors of alcohol use among male students: Results
from step-wise logistic regression analysis

Variables             OR        CI       P value

Ever use:

Pocket money:
  No                 1.00
  Yes                4.10   1.84-9.12      0.001
Tobacco use:
  No                 1.00
  Yes                4.31   1.63-11.35     0.003
Family history:
  No                 1.00
  Yes                5.38   3.28-8.83     <0.001

Current use:

  Hindus             1.00
  Sikh               1.81   1.06-3.09      0.030
  Non-professional   1.00
  Professional       2.11   1.23-3.59      0.006
Pocket money:
  No                 1.00
  Yes                6.51   1.87-22.60     0.003
Family history:
  No                 1.00
  Yes                5.58   3.21-9.72     <0.001

OR, Odds ratio; CI, Confidence Interval

Other variables included in the model but subsequently dropped in
the step-wise analysis were age, religion, course of study and
place of stay for ever use and age, place of stay and tobacco
use for current use
Gale Copyright: Copyright 2008 Gale, Cengage Learning. All rights reserved.