In 2015, the use of alcohol resulted in about 2.3 million deaths globally, representing 4.1% of all deaths in that year.1–4 Based on disability-adjusted life-years, the estimated global burden of disease attributable to alcohol in 2015 had caused chronic liver diseases such as cirrhosis (43.5%), transport injuries (23.2%), self-harming activities and interpersonal violence (13.2%), mental disorders and substance abuse (6.9%), cancer (5.8%), unintentional injuries (5.2%), HIV/AIDs (4.4%), and cardiovascular diseases (2.5%),4 , 5 thereby making alcohol consumption an important risk factor for noncommunicable diseases, injuries, and violence.
In Vietnam, a recent community-based survey found that the self-reported prevalence of alcohol use at least once a week was greater than 70% among adult males (18 years and older) and greater than 10% among adult females.6 , 7 Several small-scale studies in Vietnam showed that the proportion of alcohol abuse is about 2.8% to 4.5% among males and 0.6% to 1% among adult females. Furthermore, males between 25 and 44 years of age are the highest alcohol heavy consumption group. Other studies also showed that the proportion of males between 25 and 60 years of age who drink every day ranges from 40% to 85%.8 , 9 Alcohol use also contributes to social and health problems including increasing the risk of noncommunicable diseases in Vietnam.10 , 11
In addition to noncommunicable diseases, alcohol is an important risk factor of road traffic injuries, which results in more than 10 000 deaths per year in Vietnam.12 Official statistics (2016) show that alcohol contributed to about 3% to 5% of all road traffic deaths, and an even larger proportion of road traffic injuries that require hospitalization.13 A recent study revealed that blood alcohol concentration was over the legal limit (0.00-0.05 g/dL) in 62% of road traffic injuries cases admitted to hospital.14 , 15 According to the ministry of police, in the past 5 years, about 30% of public order disturbances nationwide were caused by alcohol use, with about 27% of these involving young men aged 16 to 35 years. A recent study also found that there is an association between suicidal thoughts and alcohol consumption among adolescent boys and girls.16
Although the data and evidence on the harmful effects of alcohol consumption have improved in recent years in Vietnam, but there are still data-policy gaps that hamper the planning and implementation of harm reduction activities and advocacy campaigns such as slow process of promulgating alcohol harm reduction law, the difficulty of implementing age-restricted and limiting alcohol sales hours, and so forth. In this article, we aim to describe the prevalence of alcohol consumption and binge drinking in a representative sample of those 15 years of age and older who were part of the Chi Linh Health and Demographic Surveillance System (CHILILAB HDSS)17 in 2016. We also aim to quantify the association between sociodemographic characteristics and alcohol use.
The CHILILAB HDSS is based in Chi Linh district in the northern province of Hai Duong in Vietnam. The site was established in 2003 and is part of the International Network for the Demographic Evaluation of Populations and Their Health.18 It covers 16 019 households and 58 761 individuals and collects data on births, deaths, pregnancies, and migrations of household members using verbal autopsy instruments.17 , 19 This cross-sectional study was carried out from April to December 2016 in CHILILAB. A total of 5585 households were randomly selected on the basis of the list of households in CHILILAB to participate in the study. Predesigned questionnaires were integrated into tablets and were used to interview the study participants. The heads of households were interviewed using predesigned questionnaires to obtain information on the household as well as on all members in that household. A total of 5438 subjects 15 years of age or older were interviewed on issues related to health and health-related behaviors including alcohol use.
Assessment of alcohol consumption
The “STEPwise approach to surveillance of noncommunicable diseases” (STEPS) Questionnaire by the World Health Organization has a module on alcohol consumption which was used for data collection in this study.6 Data were collected to assess alcohol drinking status and patterns related to consumption of any type of alcoholic beverage. The questions use several reference periods to assess alcohol use: the participant's lifetime period, the previous 12 months, and the previous 30 days. Based on these reference periods, individuals were categorized into 4 groups: (a) lifetime abstainers (have never consumed alcohol), (b) ex-drinkers (have consumed alcohol but not in the previous year), (c) current drinkers (consumed at least 1 alcoholic beverage in the previous 12 months), and (d) binge drinkers (consumed ≥6 drinks for men and ≥4 drinks for women on 1 occasion in the last 30 days). For the analysis purpose, we also recoded binary variables: alcohol consumption (drinker vs abstainer/ex-drinker) and binge drinking (binge drinker vs current drinker). In this study, a standard drink is defined as any drink that contains about 12 g of pure alcohol. This definition has been previously used in other population-based studies conducted in Vietnam and other countries.6 , 20
We selected age group (15-29 years, 30-44 years, 45-49 years, and 60+ years), gender (male/female), place of residence (rural/urban), marital status (single, married, and other), occupation (government official, nongovernment official, freelance work, student, housework, retired, and others), education, and household social economic status (SES) index as social demographic measures in this study. While other variables were collected through interviews, the household SES index was constructed using the principle component analysis method based on household ownership of 15 selected assets including a radio, a telephone, a septic toilet, a refrigerator, a car, a motorbike, a washing machine, an air conditioner, a microwave, a gas stove, an electric generator, a computer, and Internet connection. The SES index categorized households into 5 quintiles, namely, poorest, poor, below average, average, and upper average.
All analysis was conducted using STATA version 13. Prevalence estimates with 95% confidence interval were computed for different alcohol consumption categories. Adjusted odd ratios (aOR) for current drinkers and binge drinkers were calculated using multiple logistics regression to estimate their association with sociodemographic characteristics, stepwise approach was used for model selection, and z-statistic and P value less than .05 were used to assess the significance of independent variables.
A sample of 5438 people 15 years of age and older currently living in CHILILAB as part of CHILILAB HDSS were included in this analysis. Males accounted for 44.9% of the sample. There were 11.4% adults between 15 and 29 years of age and an almost equal proportion of adults aged 30 to 49 years and 50 to 69 years. A majority (67.6%) resided in suburban areas, while 32.4% resided in rural areas. Most of the individuals were married (75.5%) and 9.5% were single while the remaining 15.0% were living with a partner or were widowed, divorced, or separated. A majority of them (46.2%) work freelance. Almost half of the individuals had received secondary education and almost half of the participants (47.2%) have a family income level that is average and above average (Table 1).
Table 2 displays the prevalence of alcohol use among lifetime abstainers, ex-drinkers, and current drinkers. Overall, there were 52.2% lifetime abstainers in the CHILILAB HDSS. However, this distribution is disproportionate among males and females; 75.6% of females had not had a drink in their lifetime while only 28.1% of males were lifetime abstainers. Around 5.9% of participants were ex-drinkers. Males (66.6%) drink currently while only 16.4% of females drink currently. There is a difference in the prevalence of current drinkers among rural and suburban male residents (76.4% of rural residents vs 67.8% of urban residents). The mean alcohol consumption among alcohol users was 6.9 standard drinks per week, which translates into an estimated consumption of pure alcohol per person per year of 6.1 L.
About 19.1% of male current drinkers consume alcohol daily. It was found that males consume alcohol roughly 1 to 4 times per week. The drinking pattern is very different among females than among males since more than 80% of females drink only 1 to 3 times per month. The proportion of binge drinking among participants (≥6 in males and 4 standard units of alcohol in females) is 31.7% as shown in the Figure. The proportion of males who engaged in binge drinking (≥6 drinks on 1 occasion) was higher than females (P < .05) in corresponding age groups. The binge drinking in urban areas (50.1%) was statistically significantly higher than in rural areas (33.9%) (P < .001). Among females, binge drinking in urban areas (27.8%) was 4.8 times higher than in rural areas (5.7%).
The findings from multiple logistic regression analysis conducted using the independent variables age group, gender, marital status, residence area, education, and family income are shown in Table 3. Models were developed for current drinkers and binge drinkers as outcome. The adjusted odds of current drinkers were 1.53 times for those between 30 and 44 years of age compared with the reference group. Female use of alcohol was much less than male use for both current drinkers (aOR = 0.07) and binge drinkers (aOR = 0.57). The associations between binge drinkers and marital status and education level were not statistically significant. However, after controlling for age group, gender, marital status, residence area, and family income, current drinkers with university-level education were found to be 3.32 times more likely to consume alcohol than those with only a primary level of education (P < .001). Both current drinkers (aOR = 2.33) and binge drinkers (aOR = 2.01) had significantly higher odds (P < .001) of being suburban residents than rural residents. There were no statistical differences between family income level and binge drinking. Among current drinkers, those with above average family income level were found to have higher adjusted odds (aOR = 2.29) of drinking than those with a poor family income level.
Out of a random sample of 5438 adults 15 years of age and older currently living in Chi Linh, Hai Duong, Vietnam, 52.2% are lifetime abstainers. This distribution is disproportionate among males and females; around a quarter of men reported having never used alcohol and two-thirds of males reported themselves to be current drinkers. These findings are similar to other alcohol studies conducted in Vietnam.6 , 7 , 21 Furthermore, the proportion of self-reported ex-drinkers was very small in our sample. We found that the overall prevalence of lifetime alcohol consumption was 48.2%, and the 12-month prevalence was 41.8% in our sample. Based on our results, the estimated consumption of pure alcohol per person per year was 6.1 L. This finding is similar to large surveys that were done in Vietnam recently.6 , 7 It is important to note that the alcohol production in Vietnam has increased by about 50% in the last decade. In 2002, the National Health Survey found that the 1-week prevalence of alcohol use was 46% among men and 2% among women.22 In 2016, the STEP survey reported the prevalence of alcohol use in the last 30 days to be 77.3% among men and 11.1% among women.6 The 2 surveys provide evidence that over the last 1.5 decades, the alcohol consumption has almost doubled in men and has increased by 6 times among women. This time frame also reported the highest growth in beer production in Vietnam, which had increased from 1.38 billion liters in 2005 to 4.67 billion liters in 2015, which constituted a 238% increase.23 It is not only the high prevalence of alcohol consumption that is a concern in Vietnam; binge drinking or excessive drinking is also a serious problem in low- and-middle-income countries including Vietnam. The prevalence of binge drinkers in our study was 31.7% (33.5% among men and 22.6% among women). This statistic is lower than the statistic found in other similar surveys conducted in Vietnam; that is, the International Alcohol Control study in 2014 reported that 52.9% of males binge drink,7 while the Vietnam STEP survey in 2016 reported that 44.2% of males binge drink. On the contrary, our result showed a 10% increase compared with the Vietnam STEP survey in 2010 (24.1% for males).6
This increase in alcohol use could be explained by the following reasons. The first reason is the lack of policies to reduce the harmful use of alcohol and the lack of effective implementation of existing regulations, for example, alcohol promotion and advertising and age restriction at point of sale.24 The second reason is the easy availability of alcohol at low cost in Vietnam. Over the last 10 years, the average annual increase in production of beer and other alcohol products was about 10%. In addition to that, Vietnam is among the top 10 global consumers of alcohol. Thus, there is seemingly parallel growth in alcohol production and consumption in the country.25 , 26 The final reason is the lack of public health interventions or health promotion programs to influence the behavior in relation to harmful alcohol consumption among the population.7
We also found a significant association between alcohol use and residence area, education, and family income level for current drinkers. These results are similar to the results of other study settings.21–24 The results from our study indicate that current drinkers and binge drinkers tend to be highly educated and belong to well-to-do families. In general, this might be because in Vietnam, people with higher education are more likely to have higher income and have a higher social status and tend to live in a rural area. As a result, they are more likely to be active in social interactions, which could lead to a higher risk of drinking and binge drinking. The same findings were also found in studies conducted in Vietnam and China.9 , 27
Implications for Policy & Practice
- The findings of this study show that alcohol consumption is more common in men than in women.
- People living in rural areas drink more than those in urban areas, but people living in urban areas tend to drink at a harmful level more.
- We have not found the evidence of relationship between family SES and alcohol consumption/binge drinking.
- The level of alcohol consumption in Vietnam is currently high and has been steadily increasing over the past 10 years.
- Alcohol consumption at harmful levels leads to several health and social problems and is a serious public health concern. The results of this study reaffirm the need for public health strategies, including the formulation of laws and policies to reduce the harmful effects of alcohol consumption in Vietnam.
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