Urban – Rural differences

The place of residence and nature of population movement, in turn linked to availability issues, has a significant association with alcohol use. Despite

the lack of good studies, it is clear that the problem of alcohol use is significantly higher in rural areas, transitional towns and tribal areas.

The National Household Survey revealed that rural individuals were 1.5 times more likely to use alcohol compared with urban users (Ray, 2004a). This would probably be attributed to education, income, occupation and other social factors. Subramanian et al (2005) reanalyzed the data from the NFHS - 2 and observed that the prevalence of alcohol use among both men and women was significantly higher in towns and villages as compared to large and small cities. Nearly 22% and 17% of users were in towns and villages compared with 14.8% of users in larger cities. Analyzing the NSSO data, Neufield et al (2005), report that men were 10 times more likely to report regular alcohol use. They also observed a greater preponderance amongst rural populace, those without formal education, with low incomes especially those below the poverty line and belonging to disadvantaged groups (Neufield et al, 2005).

There are a few studies comparing alcohol use across different populations using standardized methodologies. As early as 1980, alcohol use rates were reported to be higher in rural India in a comparative survey of urban and rural areas. Some of the earlier studies have shown it to vary from 20 –50% in rural areas (Isaac, 1998). In the largest survey in rural Maharastra as early as 1991, Bang and Bang (1991) report that nearly 100,000 men in a population of 400,000 used alcohol, of whom 20% were addicted. In a survey of 32,400 people in rural areas near Bangalore by NIMHANS, the prevalence was observed to be 1% in the rural population (Benegal et al, 2003). Significantly higher use has been recorded among tribal, rural and lower socioeconomic urban sections (Ray and Sharma, 1994, Thimmiah, 1979). The WHO study of undocumented consumption recorded significantly higher prevalence of drinking

in rural areas compared to urban areas: with (61% vs. 39%) or without (52% vs. 48%) the inclusion of the tribal sample in the rural sector. Tribal areas had the highest prevalence of alcohol use in both men and women (Benegal et al, 2003).

In the GENACIS study undertaken in the state of Karnataka, the prevalence of drinking among men was 23% in rural areas and 41% in urban areas among men, while similar rates among women was 4.4% and 7% respectively (Benegal et al, 2005). The health behavior study undertaken by NIMHANS has reported the prevalence of alcohol use (in the previous 12 months) in urban, rural, slum and town population as 8%, 9.5%, 19.0% and 6%, respectively. Quite contrary to reported numbers, qualitative, focused group discussions revealed far higher numbers (every other male over 25 years drinks) (Gururaj et al, 2004a). In the study on socioeconomic impact of alcohol across 4 communities, the alcohol prevalence rates were 24%, 21% and 28% among adult men in urban, rural, slum and town population, respectively, while it was <3% among women (Gururaj et al, 2006a).

Residing in villages and brewing alcohol is significantly linked to alcohol use (John et al, 2009). In a rural sample of Vellore, one third used alcohol during the previous year, one fifth drank regularly and one sixth were hazardous alcohol users. Similarly, high rates of alcohol use have been observed in urban slums of India in several studies (Anand et al, 2007). NFHS-3 revealed that for either sex, proportions consuming alcohol were greater amongst those from rural than urban areas. Among females the ratio between urban to rural was 1:5 (0.6%: 3.0%).

5.11. Education, occupation and

income

The exact association of several socio- demographic correlates like education, occupation, income, marital status and others variables with

drinkers were more likely not to have completed school and were most likely to have an earlier age of onset of drinking.

Relationship with occupation has been examined in a very few studies. Ghulam et al (1996) in Rajasthan observed that upto 45% of the labor classes was involved in heavy drinking while Hazarika et al (2000) in an urban community noted that 51% of those employed in service and in business categories consumed alcohol. Chaturvedi et al (2003) from Arunachal Pradesh reported that a majority of self-employed men engaged in agriculture and other day-to-day activities were consuming more alcohol, possibly as a source of constant energy and relaxation. Recent studies indicate an upsurge of alcohol use among younger men and also in student communities (Kumar and Basu, 2000).

Income is one of the determining factors of alcohol use and consumption patterns. Due to difficulties in the definition and measurement of poverty and income levels in Indian society, establishing the association of alcohol use across different social economic groups is challenging. Despite the difficulties, NFHS 2 revealed that 24% of men in low income groups, 15% in the middle income and 10% in the higher income groups were alcohol users. The percentage of women across the same three groups were 4%, 2% and 0.3% respectively .

The NSSO revealed that 3.9% of those above the poverty line and 5.9% of those below the poverty line were regular alcohol users with an increased odds ratio of 1.5. The lowest quintiles had increased consumption of alcohol (NSSO, 2005). Bonu et al (2005) observe that there is a higher risk of borrowing or distress selling during hospitalization for individuals who use alcohol even after controlling for socio-demographic and economic factors. Using the data from the NSSO, it was observed that among people hospitalized, and using alcohol in alcohol use in India has not been clearly delineated

and interlinked. The findings from the NSSO reveal that respondents with no formal education were more likely to be regular users of alcohol (NSSO, 2005). The data from NFHS 3 revealed that a majority (78% females and 26% males) of the alcohol users were illiterate and belonged to the poorer sections of society. Several studies have revealed higher rates of alcohol use in urban slums and rural areas, where educational levels are correspondingly low (Anand et al, 2007, John et al, 2009).

Analyzing the data from the NFHS, Subramanian et al (2005) observed that the proportion of alcohol users was more than twice in the educationally deprived populations. Among women, those with secondary schooling levels and beyond were less likely to use alcohol; having no education was associated with a greater risk of alcohol consumption. Ghulam et al (1996), in Madhya Pradesh, noticed that drinking rates increased with education up to higher secondary levels and gradually decreased thereafter. Gupta et al (1995), in Rajasthan, observed that among those who consumed alcohol, 27% were illiterate and 17% were literate; graduates and above constituted 10% of the drinking population. Increased alcohol use to the extent of 47% was reported among illiterates in a community-based study in Arunachal Pradesh (Hazarika et al, 2000). Gupta et al (2003) from Mumbai observed that the current users and ever users of alcohol were higher by 20% among the illiterate population and those who had studied up to primary levels. Mohan et al (2002a) from Delhi observed that poor educational achievement was associated with the increased risk of alcohol disorders. Frequent drinking was more among the less educated (<8 years of formal education), with lower levels of income, in those who were married and in non-muslim categories (Benegal et al, 2005). Silva et al (2003) in Goa reported that hazardous