The Socio－cultural Factors of Alcohol Intake among undergraduate students and their KAP in China and Ghana

Ofori－Koree IsaacAizhong Liu Huaxian He

(1.Department Epidemiology and Health Statistics，School of Public Health，Central South University，Changsha，Hunan，P.R.China;2.Center for Disease Control and Prevention，Yueyang Municipality，Yueyang，Hunan，P.R.China)

Introduction

Intakes of alcohol are common in some cultures throughout the world as part of everyday meals or occasions of important benefits.

Drinking excessively creates many problems in the school settings，workplaces and some societies［1］.It can also cause severe harmful effect to the health of an individual more especially，the brain of a young person，thereby affecting the development of his/her brain［2，3］.

The prevalence of alcoholic intake and its problems are more severe in college or university than in the entire public population.Undergraduate stage in life is a period of transformation and transfiguration for many students.They live away from their parental care，thereby compelling them to involve themselves and experience new and risky behavior through peers and environment they belong.Researches have shown that among young adults，alcoholic intake varies greatly in different countries，regions，provinces，cultures and population groups as time goes by［4］.

Alcoholic intake among youths is an important issue worldwide.Undergraduate students are the future leaders of every country and any move on alcoholic intake can be detrimental to their health and the entire populace.

The literature provides a related publications and materials about alcoholism，effects of intake，risk factors associated with，reduction and interventions of alcohol intake and knowledge，attitude and practices of alcoholic intake among Chinese and Ghanaians.It focuses on students KAP towards alcoholic intake.The review points out the socio－cultural effects of alcohol intake and general use of alcohol among undergraduate students.

1.The history and current alcohol intake in China:China has a total area of 9.6 million sq kilometer and a population of approximately 1.4 billion，majority being the Han and 55 recognized minors.Alcohol has since antiquity been part of Chinese culture and widely employed at religious rituals，festivals，weddings，funerals，and other significant events.It is an important substance in many Chinese traditional medicine prescriptions.It is said that China is one of the earliest and oldest nations in alcoholic brewing in the world，evidence of alcohol intake and production in China dates back as far as 9000 years.Some Chinese believe alcoholic use is a practice associated with arts and poetry.The famous Chinese poet Li Bai is known as the‘saint of alcohol’.Distilled spirit is the primary beverage of choice for men，accounting for more than one－third of all drinks consumed［5］.Anecdotal saying depict some people in the northern part of China have higher levels of alcoholic intake than those in the south.Some groups，such as Tibetan and Mongolian are anecdotally described as having higher intake of alcoholics compared to the other ethics groups［6］.A study in Inner Mongolia suggested the quantity consumed at each drinking occasion，the Mongolian students drink significantly more than the Han students.Their drinking reflects their long－standing indigenous Mongolian cultural practices.Female non－alcoholics users listed societal restriction as the main reason for their abstinence，while non－drinkers males are concerned with the negative consequences for health and finances caused by drinking［7］.

The most common alcoholic drinks now in China are spirits，beer，grape wine，yellow wine，fruit wine，kumis and rice wine.Medicinal liquor believed to be good for health has been enjoyed since the Han Dynasty.It is used，particularly by men，as part of business meetings，to maintain good relations between supervisors and employees and to promote camaraderie among colleagues［8］.Chinese traditional way of living encourage alcohol intake in many ways.Cultural norms promote social drinking and discourage solitary drinking.Spring festival，mid － autumn festival，wedding and occasional meetings of colleagues，people donate well－ known brands of alcohol for friends as precious and important presents.Alcohol is regarded as showing and exhibiting happiness and hospitality and intake is therefore accepted for both sexes.Social drinking is aimed at establishing a joyful and good atmosphere.In drinkers’words，“drinking is a way to communicate，to establish and maintain relationships and bridges gaps between people”.

2.Alcohol Intake in Ghana:Ghana is located in West Africa.Its size is about the same as United Kingdom.Its current population is approximately 25，241，998(25 million)［9］.Alcohol consumption is a growing challenge in many African countries and Ghana in particular［10］.

Ghana has been listed among countries where alcohol consumption is high.International Center for Alcohol Policy，(ICAP)says the consumption of illicit or noncommercial alcohol is widespread in many countries worldwide and contributes significantly to the global burden of disease［11］.Alcoholic beverages such as palm wine(3%～5%)，pito，kasapreko bitters，brukutu(0.2.5% ～3.5%)，akpeteshie(40% ～50%)(all traditional)，beer(5% ～7%)，stout，Guinness，brandy，gin(40% ～ 50%)，white wine and red wine(imported)are served at functions，especially those associated with life events such as birth，marriage，death，and social gatherings［12］.There are a lot of misconceptions surrounding alcohol use in Ghana.

Notable among them is its’sexually potentiating properties.This is usually advertised on the screens as treatment for waist pains.It enters the brain and raises the user’s libido but decreases his performance and in the long term，causes impotence.Its use is increasingly being recognized as a key determinant of sexual risk behavior，and consequently，an indirect contributor to HIV transmission in Sub－ Saharan countries［13］.

Alcohol is believed to be an appetizer in Ghana hence consumers’drinks it before a meal to enable them eats well.In Ghana，the myth that makes people to drink alcohol is that，it is believed to have medicinal properties，such as the treatment of chickenpox.This is because alcohol interacts with the medication given during anesthesia.With the chronic use of alcohol，one is likely to be tipped into a state of life－threatening medical emergency called delirium in the first 48hours after the surgery.

3.Effects of Alcoholic Intake:Alcohol intake contributes to global disease，injury，disability and premature death more than any other risk factors in developing countries［11］.

Intoxication and long term alcoholic intake could have adverse effects on the central nervous system(CNS)，muscular system，liver，heart，blood cells，gastrointestinal system，respiratory system，reproductive system as well as the immune system.

Alcohol crosses the placenta and as a teratogen it may inhibit normal brain development leading to neurological problems that includes learning difficulties and reduction in Intelligence Quotient(IQ).These disorders may not be diagnosed until children are at school and they are often associated with increased risk of mental health problems，alcohol and drug use and other related psychosocial problems［1］.Different genotypes influence the effect of alcohol on the human brain and because the human brain continues to mature until the mid twenties，alcohol affects adolescents and adults differently.It has been found to affect memory development performance on attention－based activities and retrieval of verbal and nonverbal material.

The immediate effects of alcoholic intake include a lowering of inhibitions and impairment of gross motor，sensory and thought processes［14］.Excessive alcoholic intake is associated with increased risk of accident and injury，and even death，while the cumulative effects of unsafe drinking patterns are risk factors for morbidity and mortality associated with cardiovascular disease，diabetes，cancer，obesity and mental health disease［2］.Research under autopsies established that brains of people who are alcohol dependent are smaller，lighter and show greater atrophy than non－alcoholics.

Epidemiological research in developing countries has found a causal link between heavy alcohol consumption and pancreatitis attributed to alcoholic intake.The World Health Organization(WHO)Global Status Report on Alcohol WHO 2004 states，alcohol has a causal role in depression.According to Rocha － Silva and Stahmer，alcohol consumption sometimes promotes crime.Its intake can cost money which takes precedence over household needs or educational activities.Most people agree that higher rates of liver and esophageal cancer have been reported.Alcohol has been reported to be more likely to be associated with violent crime rather than property crime［15］.Drinking alcohol can also be linked to rape and housebreaking offences［16］.Most drinking require time，often spent drinking with colleagues as university students takes time for studies.

Undergraduate students are likely to have numerous effects from alcoholics.Some of these are:hangover，vomiting，cutting classes as a result of drinking，being criticized for drinking，having trouble with the law，receiving lower grade，problem with school administration，getting into fight with others，and damaging property.Physical injury to self，others，damage social relations and impaired academic performance are also some effects of alcohol to undergraduates.In 2011，3555 traffic accidents resulted from drunk driving in the entire nation of China，and out of these，1220 lives were lost.

Undergraduate alcohol consumption has been linked to depression［17］and suicide in both high school and college/university students.There is also effect of high－risk sexual activity and poor physical health.Alcohol is believed to enhance pleasure during moment of sex，causes drowsiness and weakness，precipitate defective memory，and impairs perception，serving as risk factor for most chronic diseases.Some research points out that some women think alcoholics are danger to children’s immature organs，deviant behavior and societal roles.These organs include liver，lungs，kidney，heart and brain.Alcohol may cause malfunction of the brain and could inhibit thinking processes causing misbehavior of the user and possibly destroying lives［18］.

4.Risk Factors Associated with Alcoholic intake:A number of factors contribute to high－risk alcohol use and alcohol related adverse events.Individual factors that may play a role in alcohol use and risk－taking behavior include a number of pre－college variables.The main risk factors are as follows:location of attending high school，college or university far from home determines.After the student leaves home to attend university or school，the increase in alcohol use develops quickly;living on campus，sorority or fraternity housing，drinking rate of student is highest.Living on campus dormitory has high rate of alcohol drinking.

Socially，peers affect drinking habits more often if a student aligns him/herself with close peer networks that are accepting drinking or youth drinking;“Fitting in”is reported as being a major motivating factor of beginning heavy drinking for college or university students.

Other factors include;family history of alcoholism，parental alcohol use，tobacco use in middle or high school，regular church attendance，personality factors，untreated depression，anxiety，bipolar disorders and posttraumatic stress disorder，alcohol and drug use among peers and the student’s home community［19］.

Other contributing factors of alcoholic intake in developing countries like China and Ghana include;rapid urbanization，changes in gender and age role，and high intensity mass marketing and promotion of alcoholic beverages by multi－ national corporations［20］.

5.Knowledge，attitudes and practices of Alcohol intake in China:Knowledge is formed through interaction with the surroundings where individuals themselves construct their understanding of the world through experience.It is the key to prevention，and education is the key to knowledge.Alcohol is taken to show strength and masculinity.Generally，young men or youth consume large amount of alcohol to indicate their strength，manliness and stature.Attitudes and practices as drinking more than any person or quickly than everybody are often regarded as admirable masculine characteristics.As gender role changes，some women also prove themselves with binge drinking patterns.Youth mainly males，usually consider alcohol intake as a state of adulthood characteristics to be admired and inspired.Alcohol consumption leads to a state of enjoyment from intoxication.

The attitude of westernization among youth and students has also contributed to high intake of alcohol.The development of brew pubs，usually joint ventures has attracted the young and students.The treat festival and parties as time of honoring occasions，and taste makes them drink alcohol.A number of people develop complicated palates for alcohols and sincerely appreciate good quality.Its intake helps to reduce tension of an impending or actual event.Differences include a family history of alcoholism，personality traits，self－ consciousness，cognitive functioning and gender［21］.

Youth may especially be pressurized to take in alcohols as a social norm.One is likely to be isolated if he/she is not involved in the practice.There is evidence that advertisement of role models such as famous sportsmen，attractive and strong people，and outdoor people who enjoy life，linked to advertisement，promote drinking attitudes and practices［20］.This makes young people feel that emulating this attitudes and practices makes one more like these models and advertisers.Additionally，some men say it gives them confidence，boost their ability to cope with social demands/stress，and helps to increase sexual performance，and for adolescents makes them more sociable with peers.Peer pressure from friends and classmates may promote alcohol intake.

The pattern of“normalization”or“ban”of drug use that has taken place over the past few years seems to be influencing attitudes and consumption pattern of alcoholic beverages by young people and students.Some observers think the more relaxed attitude towards drinking alcohol and drinking to intoxication are being fed by the values of international youth pop culture with some young people and students using alcohol to pursue a“buzz”.The alcohol industries are generally less regulated and are more aggressive with marketing than ever before［20］.The alcohol industry markets a range of“designer”or“fashion”drinks for youth and students create images that are attractive and target dance club scenes.

Alcohol makes students feel high and relaxed.Some undergraduate students drink alcoholics to relieve stress.Other students are influenced by their residential hall mates to drink.Some students who have friends that frequently drink are more likely to drink.Alcohol misuse is a health hazard to student in university environment.Male undergraduates consume more alcohol than female counterparts.Undergraduates take in beer and Chinese medicine wine more often than other alcoholics，and consumed them as tonic to increase virility and health［7］.

6.Knowledge，attitudes and practices of Alcohol intake in Ghana:In Ghana，there are several types of alcohol consumed.The locally brewed from millet is controlled by women.The drink is golden yellow to dark brown in color with taste varying from slightly sweet to sour.Some drinkers have the knowledge that it contains lactic acid，sugars，amino acids，2% －3%alcohol，some vitamins and proteins［12］.This makes people take in more with the knowledge of getting some vitamins and proteins while socializing with friends and well wishers.

Some drinkers in Ghana feel joyous and kind of connectedness and adolescents socialize with friends［13］. Other drinkers have knowledge that its intake can help them do away with shyness and help show their manliness.Some also say，with the presence of vitamin B complex in palm wine，taking it serves as medicine and appetite stimulant.

Some people think some amount of alcohol intake is good for the heart and treatment of chicken pox.Some drinkers say it gives them good sleep when consumed.Others also say they have knowledge that alcohol has an analgesic property，and as such relieves them from pain.

Some drinkers have knowledge that alcoholic intake leads to“hangovers”，addiction，accidents and deaths.Other drinkers have knowledge that alcoholic intake gives drivers and other users false courage，which affects one’s sense of judgment，propel drivers to over speed and cause accidents.It also makes people not to exercise restraint example，drivers over taking unnecessarily at dangerous portions of the road.

Some people say“we know the harmful effects of alcohol and the role it plays in causing accidents，therefore avoiding alcohol especially while driving will reduce our involvement in road traffic accidents［22］.A section of undergraduate students in Ghana have knowledge on alcoholic intake from their religion，and advice from superior.They are knowledgeable about alcohol as risk factor for most diseases.There was a myth that alcohol provides warmth，but majority of students did not accept this.Some undergraduate students have knowledge that alcohol can cause drowsiness，weakness，hangover and accident.

In some African countries and in Ghana in particular，access to alcoholic drinks and drinking alcohol are socially accepted.Alcoholic drinks are consumed at the time of mourning the departed soul，marriage and naming ceremonies for the new born.Some Ghanaian women show dislike for alcohol use and that there should be legislation to ban or prevent children and youth from buying alcoholic beverages.They show an attitude in support of discouraging and stopping adults from sending children to buy alcohol.Some people in Ghana dislike the idea of alcohol use among the youth.A section of parents in Ghana believe children and youth will be better off if they did not come into contact with alcohol.Most parents have the attitude and call for the ban from early alcoholic intake among the children and youth.They think using alcohols at an early age can cause many health and societal problems［23］.

Conclusion

Alcohol intake has a long history in both China and Ghana.Alcoholics result in many negative effects due to socio－cultural influences and the attitudes of alcoholic intake.A culture of sporadic heavy or binge drinking among young people or students is spreading from developed to the developing countries.Greater percentage of them assume alcohol gives them good sense of feeling and regard alcohol as an enhancer of moment of sex，while others have the knowledge that it can precipitate mental symptoms.To know the side－effects of alcoholic，make effective preventions to reduce the risk behavior and control violence resulting from alcoholic intake is the task for the whole society.

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