Bollettino epidemiologico nazionaleAlcohol-Related Behaviors in Future Health Workers
Margherita Canevari, Valentina Teglio, Agnello D’Alessandro, Giuseppe S. Badolati
Department of Health Sciences. – Section of Hygiene and Preventive Medicine- University of Genoa
Alcohol consumption in Italy, with its notable socio-cultural aspects and the sensations it provides, is extremely diffuse (1) and intimately linked with the Italian culture. In some cases, alcohol consumption becomes abuse, and as such, it represents one of the most common addictions in the country, albeit one that is not recognized by either the society or by the State. Indeed, the general consensus is that alcohol under most circumstances has positive health benefits, unlike most drugs (2).
To further evaluate the way in which alcohol is viewed and used by persons training in the health professions, we undertook a study in the Province of Genoa. The objective of the study was to determine the frequency and type of alcohol consumption, knowledge regarding alcohol abuse and its treatment, both psychological and pharmacological (3), and whether the students perceived themselves as playing a role in health education regarding alcohol use.
Three interviewers were identified who administered a structured, close-ended questionnaire to 149 medical students, 50 dentistry students, 52 physicians specializing in hygiene, and 73 specializing in other fields. The students in the first two groups were chosen by random sampling among those enrolled in the two faculties, while 100% sampling was used for the remaining two.
A high level of collaboration was achieved, with 100% of those contacted agreeing to participate. The persons interviewed were of similar ages, with a mean of 25 years, and 57% were female. A total of 83% consumed alcoholic beverages; of these 58% drank occasionally, 34% on the weekends, and only 7.2% on a daily basis. The majority of the interviewees reported usually consuming <200 ml (58%), while 26% consumed between 200 and 400 ml and 15% more than 400 ml.
Most of those interviewed (64%) drank hard liquor; 2% did so daily, 28% on weekends, and 70% occasionally. The quantities consumed were generally modest (< 50 ml) in 55%, between 50 and 200 ml in 33% and high (> 200 ml) in 12%, with an inverse relationship between frequency of consumption and volume; those who consumed the highest quantities were weekend drinkers. No differences were noted by sex with respect to either frequency or quantity of alcohol consumed.
Regarding the existence of psychologic and pharmacologic methods to assist with drinking cessation, only 35% knew of their existence. Another important finding concerned health education; although 94% realized its importance and approximately half were willing to become involved, the idea that they were role models for others was not sufficiently recognized.
In spite of the difficulties often encountered of obtaining accurate information in this type of survey, the students selected were highly cooperative with the peer interviewers and according to the interviewers, most were sincere and consistent in their responses.
In summary, this epidemiologic study permitted the gathering of data from a population that should have been highly sensitive to the problem of alcohol abuse, namely future health care workers. The data showed that the alcohol consumption in this group was high, especially compared with regional and national data (4), and was accompanied by a low level of knowledge. It is therefore necessary to improve the knowledge of future health workers, perhaps through specific health education efforts.
Editorial Note
Emanuele Scafato LEB, ISS
Laboratory of Epidemiology and Biostatistics and Director of the WHO Collaborating Cente for Research and Health Promotion on Alcohol and Alcohol-Associated Problems ISS, Rome
The survey conducted in Genoa offers a valuable opportunity to raise several important considerations on the elevated prevalence of at-risk behaviors (drinking in this specific case) in a target population of future health care workers who logically should have better knowledge than the general public regarding the prevention of alcohol abuse among themselves and how to recognize and treat it in others.
It is clear to all that the risk of alcohol varies based on the distribution, alcohol content of the beverages consumed, and on the frequency of consumption. Even in the absence of these details, which are needed for an accurate analysis of data regarding alcohol-related behaviors, it would have been useful in this study to also examine the data stratified by sex. In Italy, the male:female ratio in drinking behaviors is generally 2:1, but it is also important from the standpoint that females are more vulnerable to alcohol because of differences in the levels of the enzyme alcohol dehydrogenase between the two sexes.
The prevalence of alcohol consumption among interviewees in this study (83%) is higher than that obtained for the 18-24 year age group (77%) in the multipurpose national survey of 2000 done by ISTAT. The low frequency of daily consumption confirms the trend among the younger generation to move away from the traditional Mediterranean pattern of consumption whereby alcohol is consumed in a “family” context, with moderate consumption, usually of wine, and generally within the context of meals. The 15% of individuals in the study population who stated that they consume more than 400 ml of alcohol-containing beverages (presumably beer or wine) each day is also of concern when compared with ISTAT data, where in this same age group, the percentage stating that they drank 500 ml or more of beer or wine was 2% in males and 0.5% in females. The individuals who reported drinking hard liquor (64%) was double that of the ISTAT data, where 30% reported consuming hard liquor and 27% bitter digestifs. The relatively high pecentage (12%) who reported drinking more than 200 ml a day of hard liquor (which is the equivalent of 60 g of alcohol) and who may be consuming more in the form of other beverages as well, and the pattern of weekend drinking represents a group at serious risk for diseases and problems that are alcohol-related.
The fact that 50% were favorable to the idea of being involved in health education interventions may indicate a desire on their parts to have information useful to their own situation rather than for the sole purpose of educating others. These data unfortunately represent the sad reality concerning the lack of specific training about alcohol abuse during the training of health professionals. Article 5 of the Law 125/2001 specifically indicates the possibility of introducing changes in the curriculum of the health professions and those designed for persons going into social service and psychology careers to provide education in alcohol abuse. One year after the institution of this law, it appears that little has been done to change the situation.
BIBLIOGRAPHY
1) Badolati G. S., Vannucci A., Cartelli G., Risso D., Scarvaglieri S. Indagine epidemiologica sulla consuetudine alcolica in Liguria Editore Di.Sci.Pro.Co. Università di Genova 1992
2) Cottino A. L’ingannevole sponda. L’alcol fra tradizione e trasgressione. La Nuova Italia Scientifica. Roma 1991
3) Patussi V., Palvani S., Engelman K., Giunti F. Public services and the self-help movement for alcohol related problems in Italy: preliminary date. Paper presented at the 23rd Annual Alcohol Epidemiology Symposium Reykjavik Iceland. May 31st to June 5th 1997
4) Scafato E., Cicogna F., 1998. I consumi alcolici in Italia e in Europa e l’intervento previsto dal Piano Sanitario Nazionale.