Culturally prevalent unrecorded alcohol consumption in Sikkim, North East India: cross-sectional situation assessment

Abstract

Introduction: India is a major producer and consumer of unrecorded alcohol, an under recognized public health problem. This situation assessment was conducted in Sikkim, a state in north east India with a strong culture of unrecorded alcohol, to describe patterns of consumption and possible alcohol problems.

Methods: This cross-sectional study combined primary and secondary information. About 395 participants with current unrecorded alcohol consumption completed a baseline assessment. Key informant survey enrolled 28 participants, who responded to a 23-item questionnaire on public health and social impact of unrecorded alcohol.

Results: Mean age of participants was 37.5 ± 11.4 years. This assessment did not detect underage regular drinking. Most unrecorded alcohol are home brewed chang (rice beer) and raksi (distilled from cereals). Early hour first drink and “no effect of alcohol today” signified alcohol problems. Key informants confirmed cultural use, household production, cheap price and alcohol problems; but did not approve commercial production and sale.

Conclusion: This study shows widespread unrecorded alcohol consumption in Sikkim. There was no evidence of underage drinking, but indications of alcohol problems were present. Stakeholders agreed that unrecorded alcohol is cultural, but accepted harmful effects and need for intervention and legal provisions. Community based outreach and screening for alcohol problems; licensing and quality control; and alternative livelihood are possible policy implications.

• Alcohol dependence
• baseline assessment
• key informant
• sikkim
• unrecorded alcohol

Acknowledgements

The authors acknowledge help and support of local administration and all field workers of Singtam, East Sikkim and Ravangla, South Sikkim during field work. The study consisted of only interviews and subsequent data analysis from questionnaires and did not involve any patient contact, medical, behavioral, therapeutic or instrumental intervention. The study commenced upon approval of the study protocol, questionnaires and informed consent process by the Research Protocol Evaluation Committee (RPEC) and Institutional Ethics Committee (IEC) of Sikkim Manipal Institute of Medical Sciences (SMIMS), Gangtok, India.

Declaration of interest

None declared. This study was supported by a research grant from International Center for Alcohol Policies (ICAP), Washington, DC. International Center for Alcohol Policies (ICAP) (www.icap.org) is a non-profit research organization, supported by leading producers of beverage alcohol. A.C. and T.K.R. designed and supervised the study; drafted the primary manuscript including data analysis and interpretation. B.S. and B.B.R. supervised the study, revised the manuscript and provided critical intellectual inputs.