title: Unrecorded Alcohol and Alcohol-Related Harm in Rural Sabah, Malaysia: A Socio-economically Deprived Region with Expensive Beer and Cheap Local Spirits.
abstract: OBJECTIVE
  To investigate recorded and unrecorded alcohol and the relation to alcohol-related harm in a region with high taxation, economic deprivation and cultural use of alcohol.
  
  
  METHODS
  Two participants per household were systematically sampled from 12 different villages chosen using stratified random sampling in the North of Sabah, Malaysia. Participants were asked about each type and amount of drink consumed; price paid, whether tax was paid, number of days sick in the last year and whether they had experienced various health problems. A brief screen for mental disorders (PHQ) and an alcohol disorder screening test (AUDIT) were completed. Village heads were also interviewed about alcohol-related problems at village level.
  
  
  RESULTS
  470 people were interviewed. The most commonly drunk beverages were beer and Montoku (a local distilled beverage), which had average prices of RM3.85 and RM0.48 per standard drink respectively. Montoku was more likely to be drunk by problem drinkers. Only 3.1% of alcohol drunk was believed by respondents to be taxed. Men with an AUDIT score of more than 15 were more likely to have had a sick day in the last year and have a female household member with symptoms of mental disorder on PHQ.
  
  
  CONCLUSIONS
  Change in the taxation structure needs to be considered to reduce alcohol-related harm. Most alcohol consumed in rural Sabah is smuggled or informal. The low price of local spirits is likely to be contributing to alcohol-related harm. Differential effects on minority populations need to be considered when designing alcohol policy.
authors.affiliation: Department of Community and Family Medicine, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia wshoesmith@ums.edu.my.
authors.forename: Wendy Diana
authors.initials: WD
authors.lastname: Shoesmith
authors.affiliation: Department of Community and Family Medicine, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia.
authors.forename: Naing
authors.initials: N
authors.lastname: Oo Tha
authors.affiliation: Department of Community and Family Medicine, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia.
authors.forename: Khin Saw
authors.initials: KS
authors.lastname: Naing
authors.affiliation: Department of Social Science, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia.
authors.forename: Roslee Bin Haji
authors.initials: RB
authors.lastname: Abbas
authors.affiliation: Department of Community and Family Medicine, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia.
authors.forename: Ahmad Faris
authors.initials: AF
authors.lastname: Abdullah
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects / Q000191:economics / Q000453:epidemiology; D019973:Alcohol-Related Disorders / Q000191:economics / Q000453:epidemiology*; D000434:Alcoholic Beverages / Q000191:economics / Q000706:statistics & numerical data*; D001515:Beer / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D011203:Poverty / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013660:Taxes