title: Epidemiological features of alcohol use in rural India: a population-based cross-sectional study.
abstract: OBJECTIVE
  We sought to estimate the proportion of adults in Sehore District, India, who consumed alcohol, and the proportion who had behaviours consistent with alcohol use disorders (AUDs), using the Alcohol Use Disorders Identification Test (AUDIT). Among men who drank, we identified individual-level, household-level and community-level factors associated with AUDIT scores. Men with AUDs (AUDIT score ≥ 8) reported on whether and where they had sought treatment, and about alcohol-related internal stigma.
  
  
  METHODS
  Population-based cross-sectional study.
  
  
  METHODS
  Rural villages and urban wards in Sehore District, Madhya Pradesh, India.
  
  
  METHODS
  n=3220 adult (≥ 18 years of age) residents of Sehore District.
  
  
  METHODS
  Score on the AUDIT.
  
  
  RESULTS
  Nearly one in four men (23.8%) had consumed alcohol in the past 12 months, while few (0.6%) women were consumers. Among drinkers, 33.2% (95% CI 28.6% to 38.1%) had AUDIT scores consistent with hazardous drinking, 3.3% (95% CI 2.1% to 5.1%) with harmful drinking and 5.5% (95% CI 3.8% to 8.0%) with dependent drinking. We observed that AUDIT scores varied widely by village (intraclass correlation=0.052). Among men who had recently consumed alcohol, AUDIT scores were positively associated with depression, having at least one child, high-quality housing, urban residence, tobacco use and disability. AUDIT scores were negatively associated with land ownership, out-of-pocket healthcare expenditure and participation in the national employment programme. While 49.2% of men with AUDs felt embarrassed by their problems with alcohol, only 2.8% had sought treatment in the past 12 months.
  
  
  CONCLUSIONS
  A need exists for effectively identifying and treating adults with AUDs. Health promotion services, informed by commonly-expressed stigmatised beliefs held among those affected by AUDs and which are targeted at the most affected communities, may be an effective step in closing the treatment gap.
authors.affiliation: Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Sujit D
authors.identifier: http://orcid.org/0000-0001-8783-7724
authors.initials: SD
authors.lastname: Rathod
authors.affiliation: Sangath, Goa, India.
authors.forename: Abhijit
authors.identifier: http://orcid.org/0000-0001-5832-5236
authors.initials: A
authors.lastname: Nadkarni
authors.affiliation: School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Arvin
authors.identifier: http://orcid.org/0000-0003-4235-0108
authors.initials: A
authors.lastname: Bhana
authors.affiliation: Centre for Mental Health, Public Health Foundation of India, New Delhi, India.
authors.forename: Rahul
authors.initials: R
authors.lastname: Shidhaye
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology*; D020751:Alcohol-Induced Disorders / Q000453:epidemiology* / Q000523:psychology*; D000437:Alcoholism / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D012424:Rural Population; D012720:Severity of Illness Index; D012737:Sex Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: EPIDEMIOLOGY; MENTAL HEALTH; PUBLIC HEALTH