1. VITAL SIGNS: BINGE DRINKING PREVALENCE, FREQUENCY AND INTENSITY AMONG ADULTS IN EASTERN CAPE, SOUTH AFRICA. EO Owolabi 1, DT Goon 1, E Seekoe 1 1 Department of Nursing, Faculty of Health sciences, University of Fort Hare, East London.

2. Outline Background Problem statement Objective Methodology Results Conclusion Implication for public health practice

3. BACKGROUND Alcohol is a mind-altering substance which has been in use for ages and by various cultures and is associated with varieties of health, social and economic burden (NIAAA, 2014:1). Alcohol use is the third leading modifiable risk factor for morbidity and mortality globally and the first leading risk factor in middle-income countries with a prevalence of 31% recorded globally (WHO, 2015). In 2012, alcohol was responsible for 3.3 million deaths (5.9%) worldwide and a cause of over 200 diseases and injuries (WHO, 2014).

4. South Africa is considered a hard-drinking country with the per-capital consumption rate of 5 billion litres a year which was among the highest recorded globally (Seggie, 2012:1; WHO, 2014b: 17). Alcohol is the leading risk factor for morbidity and mortality in South Africa (Pisa et al., 2010:S8). Alcohol use is a public health and development challenge in South Africa. South Africa suffers a great deal of burden of mortality and morbidity related to alcohol and is part of the highest recorded in the world (Herrick & Parnell, 2014: 1).

5. Alcohol use in South Africa is characterised by a hazardous form of drinking, basically binge drinking with a significant rise among females and a relatively stable rate among males (Morojele & Ramsoomar, 2016:1).

6. Binge drinking (BD) is a form of hazardous drinking. Binge drinking is the consumption of 4 or more alcoholic drinks among women or 5 or more alcoholic drink among men on a single occasion Binge drinking generally results in acute impairment and has numerous adverse health consequences. Binge drinking is also a risk factor for many health and social problems, including motor vehicle crashes, violence, suicide, hypertension, acute myocardial infarction, STIs, Unwanted pregnancy, fetal alcohol syndrome etc (USDHHS, 2010).

7. Some of the highest rate of alcohol misconduct, risky alcohol use and rates of violence and trauma related to the use of alcohol is found in South Africa (Evans, 2015:1). Although there exist an alcohol control regulations in the country, evidence however shows the ineffectiveness of the policy (Ramsoomar & Morojele, 2012:1).

8. Problem statement Binge drinking (BD) is a major risk factor for several diseases and disabilities yet scarcely investigated in Eastern Cape, South Africa (SA). Objective To determine the prevalence, frequency and intensity of binge drinking among adults attending out-patient clinic of health facilities in Buffalo city Metropolitan Municipality (BCMM), East London.

9. METHODOLOGY This was a cross sectional survey of 998 purposively selected adults in a tertiary hospital and two community health centres in BCMM. The study utilized the WHO STEPwise approach and questionnaire to obtain information on the demographic and behavioural characteristics of the respondents. Prevalence of BD was defined as consumption of four or five or more drinks on an occasion during the past 30days for women and men, respectively. Frequency of binge drinking was defined as the average of the number of episodes of BD Intensity of BD was defined as the average largest number of drinks consumed on an occasion. A descriptive analysis was done. Bivariate and multiple logistic regression analysis was done to determine the associated factors. Also, ANOVA was used to determine the variance of means.

10. RESULTS Of all the 998 adults (male=321, female=677) the overall prevalence of BD was 15.0%. However, 47% of participants that consume alcohol were binge drinkers. Frequency and intensity of BD were 5.4 episodes per month and 13.4 drinks on an occasion, respectively. Prevalence of BD was highest among males (24%), smokers (44%), students (23.2%), age group 18-25 (24.6%), never married participants (19.2%) and those earning between 2001and 5000 Rands (21.8%). Frequency was highest among males (6.4episodes), age group 36-45 (6.8 episodes), lower education (grade 8-12) (5.9 episodes), income above 5000 per month (7.1 episodes) and self-employed participants (7.8episodes). Only marital status (p=0.034) and age (p= 0.042) were significantly associated with intensity of BD.

11. VariableYesNoP-value Sex Male Female 146(45.9) 173(25.8) 172(54.1) 497(74.2) 0.000 Age (yrs) ≤25 26-35 36-45 46-55 56-65 ≥66 90(50.0) 99(44.8) 47(26.4) 49(29.3) 21(15.0) 13(12.7) 90(50.0) 122(55.2) 131(73.6) 118(70.7) 119(85.0) 89(87.3) 0.000 Demographic characteristics of the binge drinkers

12. Variables n(mean) SD p-value Age group (years) 18-2545(4.8)4.5 26-3545(5.6)4.9 36-4524(6.8)2.50.393 46-5525(4.6)4.0 56-658(6.2)6.9 ≥66 Total Sex Male Female Total 3(4.7) 150(5.4) 77(6.4) 73(4.3) 150(5.4) 0.6 4.2 5.2 2.4 4.2 0.002 Level of education No formal schooling27(4.6)1.2 Grade 1-714(5.5)3.60.226 Grade 8-1289(5.9)4.9 Tertiary Total 20(4.0) 150(5.2) 3.0 4.2 Mean distribution of frequency of binge drinking

13. Monthly income (Rands) No income73(5.3)5.3 R150-200032(4.9)2.70.658 R2001-500038(5.5)3.0 R5001and above Total 7(7.1) 150(5.2) 2.6 4.2 Marital status Never Married123(5.4)4.3 Ever Married Total 77(5.5) 150(5.2) 4.0 4.2 0.893 Smoker Yes66(5.9)4.7 No Total 84(4.9) 150(5.2) 3.7 4.2 0.154

14. Variable NMeanSDp-value Age Below 25 26-35 36-45 46-55 56-65 Above 65 45 24 25 8 3 11.8 15.7 16.0 10.0 15.8 4.7 7.7 12.5 9.2 6.0 8.2 0.6 0.042 Total15013.49.6 Sex Male Female 77 73 13.8 13.1 8.8 10.5 0.653 Total15013.49.6 Level of Education No formal schooling Grade 1-7 Grade 8-12 Tertiary 27 14 89 20 11.5 11.6 14.2 13.6 10.0 5.4 10.3 8.2 0.539 Total15013.44.1 Marital Status Never Married Ever Married 122 27 14.2 9.9 10.0 7.1 0.893 Total14913.49.6 Mean distribution of the intensity of binge drinking

15. Smokers Yes No 66 84 13.9 13.0 10.8 8.6 0.034 Total15013.49.6 Income Categories No income 150-2000 2001-5000 Above 5000 73 32 38 7 12.6 12.7 15.1 16.1 10.2 10.0 8.6 9.0 0.493 Total15013.49.64 Employment Government Non- government Self employed Student Unemployed Retired 9 47 9 23 60 3 13.4 13.5 18.1 14.0 12.5 13.0 8.1 7.6 15.0 8.5 10.8 9.9 0.741 Total15013.49.6

16. CONCLUSION The prevalence of BD among adult in these settings is alarmingly higher than previously documented national prevalence in SA. IMPLICATION FOR PUBLIC HEALTH PRACTICE There is a need for more wide spread implementation of interventions such as measures controlling the access to alcohol as well as price increase which could help in the reduction of frequency and intensity of BD and ultimately the prevalence and the associated health and social costs. Finally, health managers should encourage screening for alcohol abuse among patients.

17. ACKNOWLEDGEMENT  National Research Foundation  Health and Welfare Sector Education and Training Authority, South Africa  Faculty of Health Sciences, Department of Nursing science.

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