INTRODUCTION:

Alcohol abuse is a major health problem in India and world at large. For the past thirty to forty years alcohol consumption has increased tremendously. The problem of alcoholism until a few decades was considered a moral problem and a sign of social irresponsibility. After introduction of prohibition it was reined as an illegal act. Recently studies consider it as more complicated, chronic, and immensely costly disease than a type of deviant behavior. Rapid growth of alcohol consumption in developing countries is likely to be followed by a higher incidence of alcohol related problems.

In India people fail to understand alcoholism as a disease. The common man sees alcoholism as a weakness of character. The age at which people start drinking has also declined. Taking alcohol even once in a while leaves the possibility of a habit-forming phenomenon open and the drinker may start drinking frequently and in large quantity, which could have drastic effects on ones health.

The World Health Organization estimates that there are about 2 billion people worldwide who consume alcohol beverages and 76.3 million with diagnosable alcohol disorders. According to a study conducted by the All India Institute of Medical Science, Delhi, over the past 20 years, the numbers of drinkers have increased from one in 300 to one in 20. However, alcoholics comprise 5% while occasional drinkers account for 96%.The extent of alcohol consumption varies from state to state. For example, in Madhya Pradesh, production of country liquor, which was 4.7 lakh liters in 1986-1987, increased to 1.47 crore liters in 1990-91. The increase in revenue from sale of liquor increased from Rs.34crore in 1986-87 to Rs.922.7 crore in 1993-94, with arrack contributing Rs. 675.60 crore. Kerala State in India today stands first in the per capita consumption of liquor (8.3 liters) followed by Punjab (7.9 liters) against the National average of 5.7 liters. A survey conducted jointly by WHO and ADIC (Alcohol and Drug information Center) among the college students in Kerala, found that the age at, which they consumed liquor for first time is coming down from 19 in 1986, seventeen in 1990 and 14 in 1994. Similarly there was increase in the percentage of drinking population in different age groups. The increase in the drinking population from 1990 to 1994 was in the age group of 21-30 years (29% to 31%). However, in other age groups (31-40 years) there was a decrease from 38% in 1990 to 36% in 1994 and in the age group of 41-50 years, the decrease was from 24% to 22%. The decrease in people aged 50 years and above was 7% to 5%.

In 2000, approximately 30% of India’s population was aged 10 to 24 yr, that increased to 53 % when children younger than 10 were included. Adolescents is a stage when people have to negotiate a complex interplay of both personal and socio-economic changes in order to manoeuvre the ‘transition’ from dependence to independence, take effective control of their own lives and assume social commitments. Alcoholism is the base problem of more sophisticated issues among young adults and teenagers.

Alcohol associated problems may lead to extreme physical, psychiatric and emotional problems. Some of them may be anxiety, depression and personality disorder. Underage drinking is dangerous not only for the drinker but also for society as evident by the number of alcohol involved motor vehicle accidents, homicides, suicides, and other injuries. It is a widely established fact that problem of alcoholism is closely associated with lack of knowledge regarding alcoholism.

Present day alcoholic consumption in adolescents in India is not well documented. Among these problems alcoholism is becoming a major problem in India since each year approximately 5000 young people under 18 die as a result of underage drinking. The average age of first consumption of liquor has come down to below 13 years. Alcohol use shows a monotonic increase during adolescence and young adulthood, particularly during the transition out of high school. However, alcohol consumption decreases as young adults reach their mid-twenties. Alcoholism in adolescents is due to various factors like adolescents crisis, modernization, peer pressure, increased socio economic status, easy accessibility.

The major concern is that alcohol consumption is associated with certain other behaviors and long range consequences. For example, alcohol use is directly associated with smoking, substance abuse and risky sexual behavior. There is also a risk of excessive alcohol consumption, which can lead to life-long problems psychosocial distress and chronic diseases.

Primary prevention among adolescents is a particularly important issue in India, due to high population numbers and wide economic, social, and health disparities among its population. Focusing primary prevention efforts on children and young adolescents in order to improve the overall public health in the near and distant future can be justified for several interrelated reasons. One is that various risk behaviors, such as smoking, and alcohol and drug use, are often adopted in young adolescence. At the same time, it may be easier to inculcate healthy behaviors at a young age rather than to modify behaviors at later ages or after the onset of disease.

Thus this study would help the investigators to find out the knowledge and attitude of adolescents towards alcoholism. Also, the results from this study would provide a feedback or base to which will help health care workers to design and implement effective programs in reducing alcoholism among adolescents.

MATERIAL AND METHODS:

This quantitative, non experimental, descriptive survey was conducted in St.Thomas College H S S Thrissur a selected school of Thrissur district, Kerala during second week of July 2011.A total number of 100 students were selected using convenient sampling a method of non probability sampling technique. Both genders who were studying in 7^th, 8^th ,9^th classes in the age group of 14-18yrs and willing to participate were included in the study. But students who can’t give an adequate response were excluded from the study.

A demographic data sheet, knowledge assessment questionnaire which consisted of 30 multiple choice questions with 4 responses and a three point rating scale with 10 statements were used to assess the knowledge and attitude of students towards alcoholism, which were developed after thorough review of literature. Validity was established by seeking opinion of 5 experts from the field of nursing education psychiatry, community health. A pilot study was conducted among 10 students to establish the feasibility of study. No modifications were made in the tool or study protocol after the pilot study. Students took 20 minutes to complete the questionnaire. Collected data were analyzed by using descriptive and inferential statistics at .05 level of significance. Ethical clearance was obtained from the school authorities, and informed written consent was obtained from the students and parents.

RESULTS:

Table 1: Sample characteristics of adolescents

Sl.No	Variable		Percentage (%) distribution
1.	Age (yrs)	15	1
		16	30
		17	67
		18 and above	2
2.	Type of family	Nuclear family	89
		Joint family	8
		Extended family	3
3.	Religion	Hindu	32
		Christian	62
		Muslim	5
		Others	1
4.	Education of father	Illiterate	1
		Some school	32
		Graduate	44
		Post graduate	23
5.	Occupation of father	Business	31
		Government job	35
		Daily labor	12
		Others	22
6.	Monthly income (Rs)	<2000	5
		2001-5000	17
		5001-10000	36
		>10001	42
7.	Availability of alcohol nearby home	Yes	41
7.	Availability of alcohol nearby home	No	59
8.	Presence of alcoholic family member	Yes	30
8.	Presence of alcoholic family member	No	70
9.	Presence of alcohol induced illness in family	Yes	23
9.	Presence of alcohol induced illness in family	No	77

It was found that majority of adolescent were 17years old (67%), belonged to Nuclear family ( 89%) Christian (62%) religion, with a family income of Rs >10001.Adolescents fathers were mostly graduated (44%) and in government jobs (35%). Alcohol was available nearby home in 59% adolescent’s home while 70% of adolescent’s family members were nonalcoholic and 77% did not suffer any alcohol induced medical illnesses.

Study revealed that only 3% of adolescents had excellent knowledge regarding alcoholism while 21% had good, 58% had average and 18% had poor knowledge. Attitude towards alcoholism was found to be unfavorable in 26% of adolescents while 30% had favorable and only 44% had very favorable attitudes.

It also revealed that alcohol related knowledge was significantly positively associated with age and attitude towards alcoholism. Favorable attitude was found to be positively associated with consumption of alcohol by a family member.

DISCUSSION:

Knowledge of adolescents regarding alcoholism was found to be inadequate since most of them (58%) had just average level of knowledge which was found similar to the findings of studies done by vasumathi Gincy A.Similarly attitude was also found to be unfavorable, with only 44% had very favorable attitudes as similar to the finding of vasumathi, and Austin EW.

This finding urges all governments, the mass media, non-governmental organizations, schools, hospitals, and communities to engage in population based programmes for empowering adolescents with knowledge and skills to tackle alcoholism and its ill effects. Prevention programmes should have a multi-level focus, including the individual, the family, and other social institutions. Public health and behavioral epidemiologists should also plan and target appropriate and effective primary prevention lifestyle techniques to subgroups of adolescents and young adults with unique risk behaviors and psychological and behavioral problems so that prevention programmes may be developed to specifically target them.

REFERENCES:

Arora M. Alcohol in India. Available from: URL: http://apapaonline.org/data/National_Data/India/Alcohol_India_Globe2001.pdf

U.S. Census Bureau, International Database. International.Population Census for India, midyear 2000. Available at URL: http://www. census.gov/cgi-bin/ipc/idbsum?cty=IN.

National Institute of Health Research Port Polio Online reporting tools(report). Yesterday, Today Tomorrow Underage Drinking. Available at URL: http://report.nih.gov/nihfactsheets/ viewfactsheet.aspx?csid=21

Vasumathi. An explorative study to determine the relationship between knowledge and attitude towards alcoholism among pre University students in Mangalore [Masters Degree in Nursing]; Rajiv Gandhi university of Health Science; 2001.

Gincy. A study to assess knowledge and attitude of adolescence towards alcoholism in a selected community in Udupi District. [Masters Degree in Nursing]. University of Manipal; 1999

Received on 07.11.2012 Modified on 26.11.2012

Asian J. Nur. Edu. and Research 2(4): Oct-Dec. 2012; Page 212-214