Academic journal article Bulletin of the World Health Organization

Role of Socioeconomic Markers and State Prohibition Policy in Predicting Alcohol Consumption among Men and Women in India: A Multilevel Statistical Analysis

Academic journal article Bulletin of the World Health Organization

Role of Socioeconomic Markers and State Prohibition Policy in Predicting Alcohol Consumption among Men and Women in India: A Multilevel Statistical Analysis

Article excerpt


Approximately 2 billion people worldwide consume alcohol, an estimated 76 million of whom have been diagnosed with alcohol use disorders (1), Alcohol consumption is estimated to cause 1.8 million deaths per year (3.2% of all deaths) and to be responsible for 4,0% of the disability-adjusted life years lost per year worldwide (1, 2). Additionally, it is estimated that 20-30% of all motor vehicle accidents, homicides and intentional injuries are alcohol-related (3, 4). Studies have also found that high alcohol intake increases blood pressure (5, 6), and elevates the risk of stroke (7-10) and liver cirrhosis (11, 12).

It is, therefore, important to know if certain population groups are more susceptible to alcohol consumption. Moreover, health behaviours, such as alcohol consumption, tend to be influenced by the context within which they occur (13). Two individuals, despite being similar in a range of individual demographic and socioeconomic characteristics, may have differential probabilities of alcohol use that may be due to different residential environments, suggesting an underlying geography of alcohol consumption. "There is currently very little research examining the socioeconomic and geographical patterns of alcohol intake in developing countries. Consequently, in this study, we assessed the independent contribution of individual socioeconomic markers and geographical contexts on alcohol consumption among men and women in India.

Developing countries are thought to be dominated by abstainers, but the minority who do drink tend to do so heavily (14). In the Asian subcontinent, per capita alcohol consumption increased by over 50% between 1980 and 2000 (4), while India has experienced a 115% increase in per capita alcohol consumption by adults since 1980 (15). In India, as in other developing societies, alcohol addiction has adverse health and social consequences, ranging from shifting the use of resources away from basic necessities such as food and shelter, to acute consequences for the welfare of other members of the household (especially children and women) (16, 17).

A recent review of studies on alcohol use in India concluded that existing studies had little power to draw national patterns of alcohol consumption for contemporary India (18). Sex differences in alcohol use have been recognized, but socioeconomic differences remain under-researched (19). Specifically, the extent to which education, caste and material standard of living are independently predictive of alcohol consumption is unclear. Furthermore, the role of individual stares in India, as suggested by the variations in alcohol use shown in Fig. 1 (web version only, available at:, is likely to be important because the production and sale of alcohol are state, and nor federal, responsibilities. Two main policy perspectives dominate the regulation of alcohol consumption in India (20). The first relates to prohibition, i.e. a complete or partial ban on the production, sale and consumption of alcohol by particular states of India (15). Support for prohibition goes back to the struggle for independence launched by Mahatma Gandhi, and is mentioned in the Indian Constitution, as a stared, but not universally enforced, goal (21). The second policy perspective is to regulate alcohol use with increased tax rates on alcohol production and consumption (22), or by imposing age restrictions on the purchase of alcohol (20).

The aim of this study was to investigate the different demographic and socioeconomic axes along which alcohol consumption is stratified in India. Conditional on this distribution we estimated the extent to which the prevalence of alcohol consumption varied between localities, districts and states. In particular, we tested whether prohibitionist states tended to have lower level, of alcohol use, after adjusting for their socioeconomic composition.


Sources of data

The analysis used data from the 1998-99 Indian national family health survey (INF HS). …

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