title: Prevalence of and associations with papsak wine consumption among farm workers in the Western Cape Province, South Africa.
abstract: OBJECTIVE
  Until it was banned in 2007, inexpensive, atypically packaged wine, colloquially termed "papsak," was popular in poorer South African communities, which suffer a high burden of disease from alcohol. This study describes the prevalence of alcohol and papsak consumption, problem drinking (defined by a potentially problematic CAGE score of ≥2), and their associations among farm workers in the Western Cape Province.
  
  
  METHODS
  A cross-sectional analytical study was conducted in two farming areas using cluster sampling of farm worker households. Interview data from 347 male and 114 female respondents were analyzed.
  
  
  RESULTS
  Among respondents, 69% (95% CI [63.1, 74.3]) were current drinkers. Among drinkers, 50.6% (95% CI [41.9, 59.3]) preferred papsak and 73% (95% CI [65.5, 79.3]) had potentially problematic CAGE scores (CAGE ≥ 2). Papsak drinkers were more likely to have CAGE scores of 2 or more than drinkers of other alcoholic beverages (adjusted odds ratio = 2.8, 95% CI [1.4, 5.5]). Increasing levels of socioeconomic deprivation predicted both current drinking and preferred papsak consumption. Additional risk factors for preferring papsak were age 35 years or older, being married, being Coloured, and residing in the district in which papsak was produced.
  
  
  CONCLUSIONS
  Current drinking and symptoms of problem drinking were substantially higher in these farm workers compared with general provincial population levels. CAGE scores of 2 or more among female farm workers exceeded provincial estimates by 3.5 times. Problem drinking was strongly associated with papsak consumption, most likely because of affordability; however, the significant association between residence near papsak production and preferred papsak consumption highlights the consequence of easy access. Restrictions on papsak were warranted and may contribute to the prevention of alcohol-related harm in marginalized communities.
authors.affiliation: School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Jo-Ann
authors.initials: JA
authors.lastname: McLoughlin
authors.forename: Francesca
authors.initials: F
authors.lastname: Little
authors.forename: Chantel
authors.initials: C
authors.lastname: Mazok
authors.forename: Charles
authors.initials: C
authors.lastname: Parry
authors.forename: Leslie
authors.initials: L
authors.lastname: London
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000383:Agriculture; D000428:Alcohol Drinking / Q000191:economics / Q000453:epidemiology*; D019973:Alcohol-Related Disorders / Q000191:economics / Q000453:epidemiology*; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology; D014920:Wine / Q000191:economics / Q000600:supply & distribution; D055815:Young Adult