Analysis of Unhealthy Alcohol Consumption

Harmful use of alcohol continues to be a global health issue that results in 3.3 million deaths (WHO, 2014). Alcohol consumption in developing countries is rising, as its increased risk of social harms, alcohol-related morbidity, and mortality persist (WHO, 2014). As a result, many countries make regulatory efforts to address the burdens of alcohol misuse. Alcohol policies that tend to be effective in developed countries need to be examined closely in low-income countries such as India. In the past three decades, India has undergone rapid urbanization along with the expansion of multinational alcohol markets.

India’s reputation as a country with a culture of inhibitions about alcohol is being replaced by a rapid proliferation of urban nightclubs and bars that make alcohol readily available, positioning drinking as a lifestyle choice. Sales of alcohol in India have seen rapid growth with significant changes in patterns and trends of alcohol use. Consequently, India has undergone a profound epidemiologic transition of alcohol use. There has been a striking increase in social and health issues related to alcohol misuse that are exacerbated in India, including liver and cardiovascular diseases, cancers, mental disorders, unintentional injuries, as well as violence such as intimate partner violence and suicide (Prasad, 2009). Illicit local homebrew, especially in the most impoverished areas, continues to cause significant death tolls and warrants legal intervention from the Indian government.

Overwhelming evidence from a growing body of literature suggests that unhealthy alcohol consumption is a predictor of intimate partner violence (IPV) among other negative consequences. IPV, as a form of violence against women, is a global public health and human rights concern. A growing number of studies suggest that IPV is prevalent in India, especially among certain social groups. Research from both more-developed and less-developed countries presents significant evidence that hazardous alcohol use by a male partner increases the prevalence of IPV (Bellis, Hughes, & Hughes, 2006). Consistent with findings from many different parts of the world, studies from India also show that alcohol misuse and dependence among husbands significantly relate to their wives experiencing IPV (Sabri et al., 2014; Kaur & Garg, 2010; Begum et al., 2015). With the current knowledge of alcohol abuse contributing to IPV, factors such as rural community-dwelling, educational level, occupation, and income level, are significant predictors for IPV. Studies in India show that excessive alcohol use by a male partner increases the prevalence of IPV against women, especially in rural areas and lower socioeconomic households (Pillai et al., 2013; Babu & Kar, 2010).

Effective alcohol policies are crucial for population intervention and prevention in reducing alcohol misuse and related harms. For the U.S., extensive studies have been conducted on the influence of alcohol policies and the causes of alcohol-related mortality (Xuan et al.). However, the literature on the effect of alcohol policies on underage consumption in India is sparse. Since India does not have a federal alcohol regulation, the state alcohol policies vary widely, ranging from prohibition and taxation to setting a minimum legal drinking age. While a few states enforce a complete prohibition of alcohol sales and consumption, other states limit alcohol availability and access through partial and complete bans. Findings from studies in India indicate that different alcohol policies, like prohibition and minimum legal drinking age, have diverse effects on alcohol consumption reduction and regulation (Mahal, 2000; Rahman, 2003). States like Bihar and Gujarat enforce a complete prohibition of alcohol consumption, while others limit alcohol availability through partial bans and increasing the legal drinking age.

Despite these policy efforts, there has been a drastic increase in alcohol consumption in India in both rural and urban areas (Poduthase & Vellappally, 2016; Murthy, Manjunatha, Subodh, Chand, & Benegal, 2010). According to nationwide studies on substance use prevalence, the trends from 1998 to 2006 surveys show an increase in alcohol use among men from 17% to 31%; women in India report a lower prevalence of alcohol consumption, with less than 3% in multiple national surveys (Murthy, Manjunatha, Subodh, Chand, & Benegal, 2010). Studies from India consistently show that alcohol misuse is more common in men from lower socioeconomic groups (Pillai et al., 2013). Unhealthy alcohol consumption includes misuse, dependence, and binge drinking, which leads to negative health and social effects associated with alcohol.

One study suggests that alcohol regulations, such as restrictions on alcohol availability, are effective policies to address the alarming negative health and socioeconomic burden linked to unhealthy consumption of alcohol (Mahal, 2000). However, other findings suggest that prohibition policies appear to have little effect on alcohol use by men (Subramanian, Nandy, Irving, Gordon, & Smith, 2005). Although the literature on the effect of alcohol policies in India is sparse, even more apparent gaps exist regarding the effects of alcohol policies on domestic violence outcomes. An in-depth exploration of alcohol policy in India is imperative to further understand its association with hazardous alcohol consumption and IPV against women.

To advance the understanding of the role of alcohol consumption in relation to intimate partner violence, this study combines individual-level data from national surveys with available state prohibition policies. The aim is to examine the alcohol prohibition policy differences across various states and union territories in India and assess their relationship with alcohol consumption and intimate partner violence among married couples.

This study utilizes data from the 2005-2006 and 2015-2016 waves of the India National Family Health Survey (NFHS). The Indian Demographic and Health Survey (DHS) collected data as part of a nationally representative household-based health surveillance system. NFHS provides information at the state and national level on various topics including alcohol consumption, domestic violence, and other socio-demographic factors. Alcohol regulations in each state are compared to relevant spousal violence and alcohol consumption data from NHFS to observe any relationships between state-level alcohol control policies and IPV in India.

The alcohol policies were collected from a comprehensive review of the existing literature and database. For this study, we identified the alcohol prohibition regulations by each state and union territory in India from the 1990s to 2016. The range of dates for alcohol policy covers the two waves of NFHS collection periods from 2005 to 2016. For each state and union territory, specific alcohol prohibition policies were collected and categorized into three domains: no alcohol ban, partial ban, and complete prohibition. For a comprehensive review, legal statutes and amendments pertaining to alcohol access and availability for all states and union territories were collected as part of the policy dataset. In addition to the independent policy review, the existing alcohol regulation report by the Public Health Foundation of India and previous literature were further examined and compared to increase reliability and validity (cite PHFI, Rahman, Mahar).

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