Heavy drinking and contextual risk factors among adults in South Africa: findings from the International Alcohol Control study
Original research, based on the International Alcohol Control study
Adults in South Africa consume more alcohol than adults in most other countries; previous research has shown this comes with high rates of fetal alcohol syndrome and is a driver of the country’s leading causes of death: sexually transmitted infections and interpersonal violence.
Now, the first study to look at contextual factors surrounding heavy alcohol use in South Africa, lead by the South African Medical Research Council in a collaboration with Johns Hopkins University, finds high-risk alcohol intake is common in the country, with larger container size emerging as the factor most associated with heavy alcohol consumption.
There is limited information about the potential individual-level and contextual drivers of heavy alcohol use in South Africa. This study aimed to identify risk factors for heavy alcohol use in Tshwane, South Africa.
A household survey using a multi-stage stratified cluster random sampling design. Complete consumption and income data were available on 713 adults. Heavy alcohol use was defined as consuming ≥120 ml (96 g) of absolute alcohol (AA) for men and ≥ 90 ml (72 g) AA for women at any location at least monthly.
53% of the sample were heavy alcohol users. Bivariate analyses revealed that heavy alcohol use differed by marital status, primary alcohol consumption location, and container size. Using simple logistic regression, only cider consumption was found to lower the odds of heavy alcohol intake. Persons who primarily consumed alcohol in someone else’s home, nightclubs, and sports clubs had increased odds of heavy alcohol use.
Using multiple logistic regression and adjusting for marital status and primary container size, single persons were found to have substantially higher odds of heavy alcohol use. Persons who consumed their primary beverage from above average-sized containers at their primary location had 7.9 times the odds of heavy alcohol intake as compared to persons who consumed from average-sized containers.
Some significant associations between heavy alcohol use and age, race, and income were found for certain beverages.
Heavy alcohol use is common among current alcohol users in South Africa, and heavy alcohol users consume most of the alcohol sold. Rates of heavy alcohol intake were higher than expected. Primary container size emerged as the most robust correlate of heavy alcohol use.
South Africa is currently contemplating alcohol policy reform, and this study underscores the importance of these draft policies and gives further impetus to various alcohol policy reforms under consideration in South Africa. The draft liquor amendment bill of 2016 proposes several evidence-based policies that could help reduce these heavy alcohol consumption occasions. Better labeling of the alcohol content of different containers is needed together with limiting production, marketing and serving of alcohol in large containers.
Rigorous monitoring of the heavy alcohol use environments may also serve to establish baseline data to evaluate the effects of any future policy changes.