Alcohol Use and its Determinants among Youth Attending Mental Health Promotion Clinics in India: a State-Wide Case Record Analysis

Article Information

Gautham Melur Sukumar1, Aravind Banavaram1 , Pradeep Banandur S2, Shubhi Nema3, Vaishali Dagar3, Sathya Velu4, , Vani Naik4, Virupaksha Hasiruvalli Gangappa4, Mutharaju Arelingaiah5, Lavanya Garady6

1Additional Professor, Department of Epidemiology, Center for Public Health, NIMHANS, Bengaluru

2Professor and Head, Department of Epidemiology, Center for Public Health, NIMHANS, Bengaluru 560029, Karnataka, India

3Master of Public Health Scholar, Department of Epidemiology, Center for Public Health, NIMHANS, Bengaluru 560029, Karnataka, India

4Ph.D (Psychiatric Social Work), NIMHANS

5Department of Psychiatric Social Work, NIMHANS, Bengaluru 560029, Karnataka, India

6International Centre for Public Health Innovations, M S Ramaiah, Bengaluru 560054, Karnataka, India

*Corresponding Author: Pradeep Banandur S, Professor and Head, Department of Epidemiology, Center for Public Health, NIMHANS, Bengaluru 560029, Karnataka, India.

Received: 30 May 2023; Accepted: 09 June 2023; Published: 27 June 2023

Citation:

Gautham Melur Sukumar, Aravind Banavaram , Pradeep Banandur S, Shubhi Nema, Vaishali Dagar, Sathya Velu, , Vani Naik, Virupaksha Hasiruvalli Gangappa, Mutharaju Arelingaiah, Lavanya Garady. Alcohol Use and its Determinants among Youth Attending Mental Health Promotion Clinics in India: a State-Wide Case Record Analysis. Journal of Psychiatry and Psychiatric Disorders. 7 (2023): 52-59.

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Abstract

Background: Alcohol consumption is one among the emerging public health concerns among youth. We estimated prevalence of alcohol use among youth and the factors associated with it among beneficiaries attending YMHPCs (Yuva Spandana Health Promotion Clinics) across Karnataka.

Methods: The cross-sectional case record analysis was performed among 10,340 beneficiaries attending youth mental health promotion clinics named Yuva spandana kendras (YSKs) between 2017 and 2020 across Karnataka (a state in southern India)

Results: Overall, the prevalence of alcohol drinking among beneficiaries was 4 %. The risk of alcohol drinking was significantly high among beneficiaries who were male, married, reported sleep issues, low self- awareness, issues related to goal setting, relationship issues with parents and feeling lonely. On the other hand, education status, beneficiaries reporting education and academic issues and having average relationship status with friends were found to be protective against alcohol drinking. Among the factors associated with high risk of alcohol consumption, beneficiaries having relationship issue with parents had highest odds (~6 times) followed by those reporting sleep issues (5 times), male beneficiaries (3.5 times), being married (2 times), had issues related to goal setting (1.9 times) and feeling lonely (1.6 times) compared to their respective counterparts

Conclusion: Triad of health education, health promotion and appropriate interventions like Yuva Spandana aiming at observed interaction of alcohol drinking and its determinants can be a useful way to identify youth at risk of alcohol use and intervene early.

Keywords

Alcohol use; Prevalence; Youth; Yuva Spandana; Substance abuse; Health promotion; Sleep issue Mental health

Alcohol use articles; Prevalence articles; Youth articles; Yuva Spandana articles; Substance abuse articles; Health promotion articles; Sleep issue Mental health articles

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Article Details

1. Introduction

Youth play pivotal role in growth and development of any country. India comprises around 253 million youth population, which is largest in the world [1].The expansion in socio political and economic sectors is been linked to them [2]. Karnataka being the sixth largest Indian state, shares the same picture. 39% youth constitute the critical segment of its total population [3]. This age is among the most crucial stages for laying the foundation of good health [4].Substance use in adolescents and youth is serious worry for health authorities. Alcohol consumption is one among the emerging public health concerns [5]. Alcohol misuse affects the health of millions and leading cause of death and disabilities [6]. Globally, approximately 3 million deaths per year are attributed to alcohol drinking [6] and 5.1% of the global burden of disease, equivalent to 139 million disability adjusted life years (DALYs) is attributed to it [7]. Alcohol use is on the rise in many developing countries [8] and India is no exception. A recent national representative survey revealed that approximately 18% and 16.5% men aged 15 years and above consume alcohol in India and Karnataka respectively [9,10].Existing literature throws light on rising trends of alcohol in females as well [11]. According to Indian National Mental Health Survey, the prevalence of alcohol use disorder was found to be 4.6% which is considerably high [12]. According to experts, the rapidly shifting pattern of alcohol consumption especially among younger age group impose huge health and economic burden on families and country [13]. It is estimated that between 2011 and 2050, health system will be bearing a burden of INR 3127 billion (US$ 48.11 billion) for the treatment of health conditions induced by alcohol [13]. Almost double i.e. INR 121,364 billion (US$ 1867 billion) is the estimated cost for social burden inclusive of health system cost, out of pocket expenditure and productivity loss [13]. Hence, by addressing the alcohol misuse not only millions of lives will be saved but also the government can divert that expenditure to other developmental projects of the country. Excessive alcohol drinking can have short term as well as long term health risks [14]. Short term ill effects of alcohol include injuries such as falls, motor vehicle crashes, violence (sexual/ homicide), miscarriage and still birth among pregnant women among others [15]. Chronic health issues like high blood pressure, cancer, learning and memory problem like dementia, alcohol use disorders are some of the long term health risks of alcohol drinking [15]. Relationship between alcohol and mental health is a complex one. Detangling this association is vital for making appropriate intervention and policy for alcohol regulation and use. In Karnataka (a state in southern India), measures are undertaken to put mental health at fore front. ‘Yuva Spandana’ is one such unique community-based mental health promotion programme, implemented across all districts of the state by the Department of Youth Empowerment and Sports, Government of Karnataka with technical support by Department of Epidemiology, Centre for Public Health, NIMHANS.[16] It is a unique initiative of Karnataka youth policy launched with a focus to provide behavioural, mental, and psychological support and guidance to youth having issues at ‘Yuva Spandana Kendras’[16]. These YSKs serve as mental health promotion clinics providing counselling and referral services situated out of every district stadium in Karnataka. Evidence related to alcohol use among youth in India is limited. The United Nations, SDG 3.5 aims to “strengthen prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol” [17], the first and prime step to achieve this target is to fill the gap of knowledge regarding the determinants of alcohol use among youth. Data from clinic visits under programme Yuva Spandana provides this opportunity to understand determinants of alcohol use amongst youth and thus provide evidence to formulate interventions and appropriate public health action at state as well as country level. Our objective was to estimate the prevalence of alcohol use among youth and assess factors associated with alcohol use among beneficiaries attending YMHPCs across Karnataka.

2. Methods

This cross-sectional case record analysis was performed utilising registration and visit form data collected from 10,340 beneficiaries attending youth mental health promotion clinics named Yuva spandana kendras (YSKs) between 2017 and 2020 across Karnataka. Methods adopted for data collection and analysis in this study is similar to the methodology detailed elsewhere(18,19).To understand the determinants of alcohol drinking among youth of Karnataka, we developed a conceptual framework ( Ref Figure.1) depicting interrelation between different variables. This was developed based on literature review and expert opinion. According to which, there are broadly 5 domains which influence the habit of alcohol use. These include: Sociodemographic profile, behaviour changes, relationship with people around, emotional status and personal issues. Although, most of these domains are interlinked to each other, for sound clarity we have looked at each domain separately.

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Figure 1: Conceptual framework of hypothesized exposure variables affecting alcohol use among beneficiaries attending Yuva Spandana Kendras in Karnataka – 2017 to 2020

Fig.1. Bold arrow ( ) represents the interaction between dependent and domains of independent variables; dotted arrow (----) represents the interaction among independent variables

2.1 Statistical analysis

Multiple logistic regression analysis was performed with beneficiaries reporting ever consumed alcohol as outcome and other hypothesized variables as exposure using a conceptual framework (Fig 1). Those variables that were significant in univariate model (p < 0.10) were included as eligible variables into the multivariate model using a forward stepping process. Independent variables having significance level of 5% and those changing the measure of effect (exposure odds ratio) of at least one preceding variable by 10% were retained in the final model. The significance of addition of each exposure variable into the model was tested using likelihood ratio test with appropriate degrees of freedom comparing the nested model with the previous model. Goodness of fit for the final model was tested using estat gof command in STATA 12.0 software for WINDOWS followed by fitting area under the curve using lroc command.

  • Ethical consideration

Ethical approval was obtained from the Institutional Ethics Committee at NIHMANS, Bangalore vide letter No. NIMH/DO/ETHICS COMMITTEE MEETING/2018, Dated 10th January 2019. Informed consent was sought from all participant at time of registration.

3. Results

The total beneficiaries visiting Yuva Spandana Kendras during study period were 10,340 (Table1). More than half of them were aged between 15 to 19 years (54.3%) and males (55.7%). The overall prevalence of alcohol drinking among beneficiaries was 4%. Large subset of beneficiaries was unmarried (90.2%), belonged to rural areas (67.5%), students (71%), consumed predominantly non-vegetarian (65.9%) diet and junk food (69.3%).

All socio-demographic and behavioural characteristics were significantly associated (p<0.05) with alcohol drinking except for beneficiaries who were aged 20-24 years, unemployed and were separated/divorced/widowed in univariate analysis. (REF- Table 1)

Table 1: Socio-demographic & behavioural characteristics of beneficiaries attending YSK in Karnataka between 2016-2020 (N=10,340)

Socio-Demographical and behavioral characteristics

Alcohol drinking

 

Yes

No

Total

OR [95% CI] a

p-valueb

n (%)

n (%)

N (%)

 

 

Age

15-19 years

191 (46.0)

5420 (54.6)

5611 (54.3)

Ref

 

20-24 years

88 (21.2)

2592 (26.1)

2680 (25.9)

0.96 [0.75-1.24]

0.776

25-29 years

72 (17.3)

1169 (11.8)

1241 (12.0)

1.74 [1.32-2.3]

<0.001

30-35 years

64 (15.4)

744 (7.5)

808 (7.8)

2.44 [1.82-3.27]

<0.001

Gender

Female

96 (23.1)

4483 (45.2)

4579 (44.3)

Ref

 

Male

319 (76.9)

5442 (54.8)

5761 (55.7)

2.73 [2.17-3.45]

<0.001

Occupation

Students

237 (57.1)

7109 (71.6)

7346 (71.0)

Ref

 

Unemployed

70 (16.9)

1800 (18.1)

1870 (18.1)

1.16 [0.88-1.53]

0.266

Business/Salaried

42 (10.1)

401 (4.0)

443 (4.3)

3.14 [2.22-4.42]

<0.001

Others

66 (15.9)

615 (6.2)

681 (6.6)

3.21 [2.42-4.28]

<0.001

Marital status

Unmarried

320 (77.1)

9011 (90.8)

9331 (90.2)

Ref

 

Married

92 (22.2)

869 (8.7)

961 (9.3)

2.98 [2.34-3.79]

<0.001

Separated/Divorced/Widowed

3 (0.7)

45 (0.4)

48 (0.5)

1.87 [0.58-6.07]

0.293

Level of education

Illiterate/ Less than primary complete

57 (13.7)

218 (2.2)

275 (2.7)

Ref

 

Primary complete/Middle incomplete

31 (7.4)

463 (4.6)

494 (4.8)

0.25 [0.16-0.4]

<0.001

Middle complete/secondary incomplete

48 (11.6)

1652 (16.6)

1700 (16.4)

0.11 [0.73-0.16]

<0.001

High school and above

279 (67.2)

7592 (76.5)

7871 (76.1)

0.14 [0.1-0.19]

<0.001

Place of residence

Urban

80 (19.3)

3282 (33.1)

3362 (32.5)

Ref

 

Rural

335 (80.7)

6643 (66.9)

6978 (67.5)

2.06 [1.61-2.64]

<0.001

Predominant diet consumed

Vegetarian

55 (13.3)

3340(33.7)

3395 (32.8)

Ref

 

Non-Vegetarian

351 (84.6)

6466 (65.1)

6817 (65.9)

3.29 [2.47-4.39]

<0.001

Junk food consumption

No

260 (62.7)

2767 (27.9)

3027 (29.3)

Ref

 

Yes

145 (34.9)

7021 (70.7)

7166 (69.3)

4.59 [2.21-9.51]

<0.001

Total

415 (4.0)

9925 (95.9)

10340 (100)

 

 

aOR- Odds Ratio; CI- Confidence Intervals; b p-value for significance of association in univariate logistic regression analysis Note: Some percentages may not add to 100% due to rounding

In univariate analysis, alcohol drinking was significantly associated (p<0.05) with beneficiaries reporting issues related to health and life style, relationship, education and academics and gender-based violence (REF- Table 2).

Table 2: Personal Issues of beneficiaries attending YSK in Karnataka between 2017- 2020 (N =10,340)

Personal issues

Alcohol drinking

 

Yes

No

Total

 

 

 

n (%)

n (%)

N (%)

OR [95% CI] a

p-valueb

Health & lifestyle

Sleep issues

283 (68.2)

1083 (10.9)

1366 (13.2)

17.5 [14.1-21.72]

<0.001

Physical illness

53 (12.8)

795 (8)

848 (8.2)

1.68 [1.24-2.26]

0.001

Psychological health

71 (17.1)

650 (6.5)

721 (7.0)

2.94 [2.25-3.84]

<0.001

Self-Development Issues

Low self-awareness

276 (66.5)

1570 (15.8)

1846 (17.9)

10.56 [8.55-13.04]

<0.001

Low self-esteem

98 (23.6)

927 (9.3)

1025 (9.9)

3.00 [2.36-3.8]

<0.001

Emotional issues

71 (17.1)

942 (9.5)

1013 (9.8)

1.96 [1.51-2.56]

<0.001

Lack of skills to handle negative emotions

11 (2.7)

306 (3.1)

317 (3.1)

0.85 [0.46-1.57]

0.617

Education & academic issues

Goal setting

282 (68.0)

3189 (32.1)

3471 (33.6)

4.47 [3.62-5.52]

<0.001

Concentration/ memory

77 (18.6)

3413 (34.4)

3490 (33.8)

0.43 [0.33-0.55]

<0.001

Time- management

66 (15.9)

2203(22.2)

2269 (21.9)

0.66 [0.5-0.86]

0.003

Exam-anxiety

29 (7.0)

1387 (14.0)

1416 (13.7)

0.46 [0.31-0.67]

<0.001

Education Stress/ fear of Failure

25 (6.0)

1690 (17.0)

1715 (16.6)

0.31 [0.2-0.46]

<0.001

Bullying/ ragging/ scare

2 (0.5)

207 (2.1)

209 (2.0)

0.22 [0.56-0.91]

0.038

Suicidality

Suicidal ideation/ attempts

17 (4.1)

290 (2.9)

307 (2.9)

1.14 [0.86- 2.33]

0.169

Family member attempting suicide

17 (4.1)

443 (4.5)

460 (4.4)

0.91 [0.55-1.49]

0.722

Friend attempting suicide

24 (5.8)

473 (4.8)

497 (4.8)

1.22 [0.8-1.87]

0.343

Gender sex & sexuality

Gender discrimination issue

6 (1.4)

70 (0.7)

76 (0.7)

2.06 [0.89-4.78]

0.09

Gender based violence

9 (2.2)

68 (0.7)

77 (0.7)

3.21 [1.59 -6.48]

<0.01

aOR- Odds Ratio; CI- Confidence Intervals; bp-value for significance of association in univariate logistic regression analysis

Alcohol drinking was found to be significantly associated (p<0.05) with beneficiaries reporting emotional experiences such as feeling anxious, feeling lonely, feeling worthless and those having average and not good relation with their friends compared to those who had good relations in univariate analysis (REF- Table 3).

Table 3: Relationship and emotional issues reported of beneficiaries attending YSK in Karnataka between 2017- 2020 (N =10,340)

 

Yes

No

Total

 

 

 

n (%)

n (%)

N (%)

OR [95% CI] a

p-valueb

Relationship issues

Relationship with Parents

274 (66.0)

745 (7.5)

1019 (9.9)

23.94 [19.28-29.73]

<0.001

Intergenerational issues

59 (14.2)

227 (2.3)

286 (2.8)

7.08 [5.21-9.6]

<0.001

Marital relationship/ romantic relationship

41 (9.9)

243 (2.4)

284 (2.7)

4.36 [3.08-6.17]

<0.001

Peer relationship

20 (4.8)

160 (1.6)

180 (1.7)

3.09 [1.92-4.97]

<0.001

Virtual relationship

6 (1.4)

55 (0.6)

61 (0.6)

2.63 [1.12-6.14]

0.025

Communication issues

28 (6.7)

179 (1.8)

207 (2.0)

3.93 [2.61-5.94]

<0.001

Relationship with

Family members

Good

390 (94.0)

9370 (94.4)

9760 (94.4)

Ref

 

Average

20 (4.8)

502 (5.1)

522 (5.0)

0.95 [0.6-1.51]

0.852

Not good

5 (1.2)

53 (0.5)

58 (0.6)

2.26 [0.9-5.7]

0.082

Relatives

Good

378 (91.1)

8998 (90.7)

9376 (90.7)

ref

 

Average

34 (8.2)

861 (8.7)

895 (8.7)

0.94 [0.65-1.34]

0.735

Not good

3 (0.7)

66 (0.7)

69 (0.7)

1.08 [0.33-0.34]

0.894

Friends

Good

395 (95.2)

9199 (92.7)

9594 (92.8)

ref

 

Average

15 (3.6)

690 (7.0)

705 (6.8)

0.5 [0.3-0.85]

0.01

Not good

5 (1.2)

36 (0.4)

41 (0.4)

3.23 [1.26-8.28]

0.014

Neighbours

Good

358 (86.3)

8707 (87.7)

9065 (87.7)

ref

 

Average

53 (12.8)

1093 (11.0)

1146 (11.1)

1.17 [0.87-1.58]

0.273

Not good

4 (1.0)

125 (1.3)

129 (1.2)

0.77 [0.28-2.11]

0.624

Emotional status

Feel anxious

112 (27)

2117 (21.3)

2229 (21.6)

1.36 [1.09-1.7]

0.006

Feel depressed

34 (8.2)

733 (7.4)

767(7.4)

1.11 [0.78-1.6]

0.539

Not interested to do any work

33 (8.0)

793 (8.0)

826(8)

0.99 [0.69-1.43]

0.978

Feel tired or helpless

34 (8.2)

865 (8.7)

899(8.7)

0.93 [0.65-1.33]

0.711

Worry about problems

30 (7.2)

786 (7.9)

816(7.9)

0.9 [0.62-1.32]

0.609

Feel like lost everything in life

18 (4.3)

418 (4.2)

436(4.2)

1.03 [0.63-1.67]

0.901

Incapable to make decisions

26 (6.3)

880 (8.9)

906(8.8)

0.68 [0.45-1.02]

0.068

Feel lonely

38 (9.2)

587 (5.9)

625(6)

1.6 [1.13-2.26]

0.007

Unable to trust anyone

17 (4.1)

275 (2.8)

292(2.8)

1.49 [0.93-2.47]

0.113

Forget things that just happened

11 (2.7)

325 (3.3)

336(3.2)

0.8 [0.43-1.47]

0.483

Difficulty in concentrating

12 (2.9)

338 (3.4)

350(3.4)

0.84 [0.47-1.51]

0.571

Feel like running away

12 (2.9)

170 (1.7)

182(1.8)

1.7 [0.94-3.09]

0.077

Feel like committing suicide

8 (1.9)

115 (1.2)

123(1.2)

1.67 [0.81-3.45]

0.161

Feels like it would have been good if I had died

6 (1.4)

114 (1.1)

120(1.2)

1.26 [0.55-2.88]

0.581

Angry with people around

16 (3.9)

388 (3.9)

404(3.9)

0.98 [0.59-1.64]

0.956

Failed in managing responsibilities

7 (1.7)

295 (3)

302(2.9)

0.56 [0.26-1.19]

0.133

Feel guilty

14 (3.4)

467 (4.7)

481(4.7)

0.7 [0.41-1.21]

0.09

Feel worthless

25 (6)

358 (3.6)

383(3.7)

1.71 [1.12-2.6]

0.012

aOR- Odds Ratio; CI- Confidence Intervals; bp-value for significance of association in univariate logistic regression analysis

In multivariate analysis, male beneficiaries had 3.4 times higher odds [aOR = 3.39, 95% CI=2.57- 4.45] of alcohol drinking as compared to female beneficiaries. Married beneficiaries had nearly twice the risk of alcohol drinking compared to those unmarried [95 % CI = 1.6-2.97]. Sleep issues increased the risk of alcohol drinking by almost 5 folds [95 % CI =3.6-6.62]. Increased odds of alcohol drinking were found in beneficiaries reported with low self-awareness [aOR =1.93, 95 % CI=1.39-2.68] and emotional status like feeling lonely [aOR =1.68, 95 % CI=1.13-2.52]. The odds of alcohol drinking were much higher [aOR =6.09, 95 % CI= 4.45-8.32] in beneficiaries having relationship issues with parents. Goal setting issue increase the odds of alcohol drinking by about 1.5 times [aOR =1.64, 95 % CI= 1.2-2.2]. Educational status including majority of the issues related to it except goal setting were in inverse relation with alcohol drinking habit. Average relationship with peers were found to be protective against alcohol drinking [aOR = 0.44, 95 % CI= 0.24-0.8] (REF- Table 4).

Table 4: Multivariate analyses of factors associated with alcohol drinking among beneficiaries attending YSK in Karnataka between 2017- 2020 (N =10,340)

Variables

Adjusted OR [95% CI] a

p-valueb

Gender

Female

Ref

 

Male

3.39 [2.57-4.45]

<0.001

Marital status

Unmarried

Ref

 

Married

2.18 [1.6-2.97]

<0.001

Separated/Divorced/Widowed

0.92 [0.23-3.65]

0.905

Education status

Illiterate /Less than primary complete

Ref

 

Primary complete/Middle incomplete

0.44 [0.24-0.81]

0.008

Middle complete/secondary incomplete

0.32 [0.19-0.53]

<0.001

High school and above

0.37 [0.24-0.56]

<0.001

Health & lifestyle

Sleep issues

4.88 [3.6-6.62]

<0.001

Self-development issues

Low self-awareness

1.93 [1.39-2.68]

<0.001

Education & academic issues

Goal setting

1.64 [1.2-2.23]

0.002

Concentration/ memory

0.47 [0.35-0.64]

<0.001

Time- management

0.41 [0.29-0.59]

<0.001

Exam-anxiety

0.55 [0.34-0.88]

0.012

Education Stress/ Fear of Failure

0.5 [0.31-0.8]

0.004

Relationship issues

Relationship issues with Parents

6.09 [4.45-8.32]

<0.001

Relationship with Friends

Good

Ref

 

Average

0.44 [0.24-0.8]

0.006

Not good

1.57 [0.47-5.26]

0.465

Emotional experiences

Feel lonely

1.68 [1.13-2.52]

0.011

aOR- Odds Ratio; CI- Confidence Intervals; bp-value for significance of association in univariate logistic regression analysis

4. Discussion

This cross-sectional case record analysis of 10,340 beneficiaries revealed the prevalence of alcohol consumption amongst youth attending YMHPCs across Karnataka as 4%. The results outlined in this paper indicates that the risk of alcohol drinking was significantly high among beneficiaries who were male, married, reported sleep issues, low self-awareness, issues related to goal setting, relationship issues with parents and feeling lonely. On the other hand, education status, beneficiaries reporting education and academic issues and having average relationship status with friends were found to be protective against alcohol drinking.

Among the factors associated with high risk of alcohol consumption, beneficiaries having relationship issue with parents have highest odds (~6 times) followed by those reporting sleep issues (5 times), male beneficiaries (3.5 times), being married (2 times), had issues related to goal setting (1.9 times) and feeling lonely (1.6 times) compared to their respective counterparts.

Compare and contrast findings

The prevalence of alcohol use among youth in our study is lesser compared to the prevalence of 6 % in Karnataka(20). This variation could be due to inclusion of broader age group (10- 75 years) while our beneficiaries were aged 15- 35 years. “For every one woman who consumes alcohol, there are 17 alcohol using men” the statement quoted by the recent report of Ministry of Social Justice and Empowerment [20] reflects the gender disparity in alcohol use in India similar to what is observed in our study. Interestingly, Married beneficiaries in this study were at higher risk of alcohol drinking. Evidence suggests that being widowed/separated/divorced has higher risk of alcohol use in contrast to this study [21,22]. The type of beneficiaries, their age distribution and them being clinic attendees makes the relationship between alcohol and marital status complex and calls for further exploration. Result of present study give out positive association between alcohol drinking and sleep issues which is line with the existing literature [23]. It is known that higher usage of alcohol is associated with low self-awareness [24]. Similar results were found in our study. Relationships are known to influence alcohol and substance use [24,25]. Relationship issues with parents among adolescents can act as a facilitator of substance use (25).although among youth, present study throws light on similar association with alcohol. Drinking along with friends (peer pressure) is one among the key influencer of alcohol use [26]. Similarly, this study reveals that good relationship with friends increases the odds of alcohol drinking compared to those who reported average relationship. Probable reason could be peer pressure. Larger and closer the circle of friends more are the chances of social drinking. Interestingly, the beneficiaries reported poor relationship with friends also had higher risk of alcohol drinking. Evidence suggest that break ups and poor relationship with friends are linked to feeling of loneliness thus makes one prone for alcohol drinking [27].Higher odds of alcohol drinking were found in beneficiaries reporting feeling of loneliness similar to other studies [28,29]. It is hard to ascertain temporality of feeling lonely and alcohol use due to lack of data related to onset. Lack of onset related information limits the understanding and highlights the need for further exploration. Education status is having inverse relation with alcohol drinking similar to other studies (30,31). Education widens individual’s knowledge regarding the ill effect of heavy drinking and help them build individual capacity to manage it [31]. We found education and academic issues such as exam anxiety, education stress, time management and memory issues to be protective against alcohol drinking. Studies have shown that anxiety can significantly reduce alcohol consumption provided appropriate social support, [32] however we did not include social support parameter in the current study. Time management and memory issues generally appears during exam times. A study done among college students revealed that alcohol drinking decreased during the last week of exams, because of better options (e.g. studying) to cope up with above mentioned issues were available to students [33]. This may also be indicative of exam anxiety. However, this requires further investigation. Despite being case record analysis, wide geographical coverage and large sample size are the biggest strengths of this study and has considerable scope for generalisability. Collection of information through a standardised real time CMIS along with quality processes inbuilt into the programme, assures overall quality of data used for the study. Assessing multiple potential variables for association with alcohol using a conceptual framework is another key strength of this study. The study provides fresh insights on some unique behavioural and infrequently inspected emotional factors. This gives a holistic perspective towards alcohol drinking and its determinants among youth. Our results should be interpreted within the context of certain study limitations. First is regarding the temporality of alcohol drinking to independent variables. It can’t be analysed due to the cross-sectional nature of the study. Second, self-report of sensitive information like alcohol drinking, emotional and behavioural factors might be influenced by social desirability. However, it is likely to be minimum as data was collected by trained personnel. However, such influences cannot be completely ruled out.

5. Recommendations and Conclusion

This study gives overall view on positive and negative relation of alcohol drinking with different behavioural and social determinants among youth. Alcohol contributes to the loss of skills, ability and even sometimes life of this productive age group (youth). It is of paramount importance to protect the youth from alcohol use. Triad of health education, health promotion and appropriate interventions like Yuva Spandana aiming at observed interaction of alcohol drinking and its determinants can be a useful way to identify youth at risk of alcohol use and intervene early.

Contributors

Conception/design, P.B.,G.M.,M.A. ;Data curation, P.B,G.M,A.B.,S.V., V.H.G.,M.A,L.G.; Formal analysis, P.B., G.M.,A.B.,S.V., Funding acquisition, P.B.,G.M.,A.B.,V.N.,V.H.G.,G.A.,L.G..; Investigation, P.B., G.M., A.B.; Methodology P.B., S.N.,V.D.,S.V.,V.N.,V.H.G.,M.A., L.G.; Project administration, P.B.,G.M.,S.V., V.N.,V.H.G.,M.A., L.G.; Supervision, P.B.,G.M.,A.B., S.V., V.N.,V.H.G.,M.A., L.G.; validation, P.B.,G.M., A.B., S.N.,S.V., V.H.G., V.N., M.A., L.G.; visualization, P.B.,G.M.,A.B,S.N.,V.D.; roles writing , P.B.,G.M.,A.B.,S.N. V.D.; original draft; Writing, P.B.,G.M.,S.N. and V.D.; review & editing, P.B.,G.M.,A.B.,S.N., V.D.,S.V., V.N.,V.H.G.,M.A., L.G. All authors have read and agreed to the published version of the manuscript.

Conflict of interest

All other authors declare no conflict of interest.

Funding

The primary data collection for Yuva Spandana is funded by Department of Youth Empowerment and Sports, Government of Karnataka. However, there was no funding for the preparation of this article. In addition, the funding agency has had no role in design of the study; the collection, analysis and interpretation of data; or in writing this article.

Data sharing statement

Not applicable

References

  1. United Nation Children’s Fund. Adolescent development and participation (2022).
  2. Malik BK. Youth development in India: does poverty matter? SpringerPlus 4 (2015): 613.
  3. Census of India Website: Office of the Registrar General & Census Commissioner, India (2022).
  4. Patton GC, Sawyer SM, Santelli JS, et al. Our future: a Lancet commission on adolescent health and wellbeing. Lancet Lond Engl 387 (2016): 2423–78.
  5. Esser MB, Jernigan DH. Multinational Alcohol Market Development and Public Health: Diageo in India. Am J Public Health 105 (2015): 2220–7.
  6. Geneva: World Health Organization (2018).
  7. Institute for Health Metrics and Evaluation (IHME). GBD Compare [Internet]. Seattle, WA: IHME, University of Washington (2015).
  8. A summary of Global Status Report on Alcohol [Internet]. Geneva: Management of Substance Dependence Non-Communicable Diseases (2001).
  9. International Institute of Population Sciences (IIPS) and ICF.2021. National Family Health Survey (NFHS-5) (2021).
  10. International Institute of Population Sciences(IIPS) and ICF. National Family Health Survey (NFHS-5) (2021).
  11. Prasad R. Alcohol use on the rise in India. The Lancet 373 (2009): 17–8.
  12. Gururaj G, Varghese M, Benegal V, et al. G. National Mental Health Survey of India [Internet]. Bengaluru: National Institute of Mental Health and Neuro Sciences, NIMHANS (2015).
  13. Jyani G, Prinja S, Ambekar A, et al. Health impact and economic burden of alcohol consumption in India. Int J Drug Policy 69 (2019): 34–42.
  14. Harmful use of alcohol [Internet]. Geneva: World Health Organization (WHO) (2021).
  15. Center for Disease Control. Alcohol and Public Health. U.S.: Department of Health & Human Services (2021)
  16. Banandur PS, Gururaj G, Garady L, et al. A youth mental health promotion model in India – Design, methods and progress. Indian J Public Health 65 (2021): 380.
  17. Take Action for the Sustainable Development Goals - United Nations Sustainable Development (2022).
  18. Banandur P, Kalpana G, Pai SG, et al. Correlates of relationship issues among youth: Findings from a large scale youth mental health promotion program in India (2021).
  19. Banandur P, Shahane S, Velu S, et al. Health and Lifestyle, Safety, Relationship and Personality Factors Influence Gender, Sex and Sexuality Issues among Youth—A Case Record Analysis from Youth Mental Health Promotion Clinics in Karnataka, India. Sexes 2 (2021): 483–94.
  20. Ambekar A, Agrawal A, Rao R, et al. on behalf of the group of investigators for the National Survey. Magnitude of Substance Use in India [Internet]. New Delhi: Ministry of Social Justice and Empowerment, Government of India (2019).
  21. Kendler KS, Larsson Lönn S, Salvatore J, et al. Divorce and the Onset of Alcohol Use Disorders: A Swedish Population-Based Longitudinal Cohort and Co-Relative Study. Am J Psychiatry 174 (2017): 451–8.
  22. Omary, A. Age and Marital Status Predictors of Binge Alcohol Use among Adults with Major Depressive Episode. J Psychiatry Neurosci JPN 4 (2020): 307–19.
  23. Stein MD, Friedmann PD. Disturbed Sleep and Its Relationship to Alcohol Use. Subst Abuse Off Publ Assoc Med Educ Res Subst Abuse 26 (2005): 1–13.
  24. Hull JG, Levenson RW, Young RD, et al. Self-awareness-reducing effects of alcohol consumption. J Pers Soc Psychol 44 (1983): 461–73.
  25. Kafka RR, London P. Communication in relationships and adolescent substance use: the influence of parents and friends. Adolescence 26 (1991): 587–98.
  26. Girish N, Kavita R, Gururaj G, et al. Alcohol Use and Implications for Public Health: Patterns of Use in Four Communities. Indian J Community Med Off Publ Indian Assoc Prev Soc Med 35 (2010): 238–44.
  27. Salvatore JE, Kendler KS, Dick DM. Romantic Relationship Status and Alcohol Use and Problems Across the First Year of College. J Stud Alcohol Drugs 75 (2014):580–9.
  28. Canham SL, Mauro PM, Kaufmann CN, et al. Association of alcohol use and loneliness frequency among middle-aged and older adult drinkers. J Aging Health 28 (2016): 267–84.
  29. Mushtaq R, Shoib S, Shah T, et al. Relationship Between Loneliness, Psychiatric Disorders and Physical Health? A Review on the Psychological Aspects of Loneliness. J Clin Diagn Res JCDR 8 (2014): 01–4.
  30. Crum RM, Helzer JE, Anthony JC. Level of education and alcohol abuse and dependence in adulthood: a further inquiry. Am J Public Health 83 (1993): 830–7.
  31. Murakami K, Hashimoto H. Associations of education and income with heavy drinking and problem drinking among men: evidence from a population-based study in Japan. BMC Public Health 19 (2019): 420.
  32. Stress, social support and health-related behavior: A study of smoking, alcohol consumption and physical exercise - ScienceDirect (2022).
  33. Noel NE, Cohen DJ. Changes in Substance Use during Times of Stress: College Students the Week before Exams: J Drug Educ (2022).

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