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967
Bioscience Journal Original Article
Biosci. J., Uberlândia, v. 35, n. 3, p. 967-976, May/June 2019
http://dx.doi.org/10.14393/BJ-v35n3a2019-42481
ASSOCIATION BETWEEN ALCOHOLIC BEVERAGES CONSUMPTION
AND SOCIODEMOGRAPHIC CONDITIONS IN PEOPLE WITH LEPROSY
ASSOCIAÇÃO ENTRE CONSUMO DE BEBIDAS ALCOÓLICAS E CONDIÇÕES
SOCIODEMOGRÁFICAS EM PESSOAS COM HANSENÍASE
Giovanna de Oliveira Libório DOURADO
1
; Manoel Borges da SILVA JÚNIOR
2
;
Anderson Fuentes FERREIRA
3
, Daniela Costa SOUSA
4
; Francimar Sousa MARQUES
5
;
Lídya Tolstenko NOGUEIRA
6
1. Docente. Doutora em Enfermagem da Universidade Federal do Piauí-UFPI, PI, Brasil. giovannaliborio@ufpi.edu.br; 2. Enfermeiro
pela Universidade Federal do Piauí-UFPI, PI, Brasil; 3. Analista de Sistemas pela Faculdade de São Paulo-FSP, SP, Brasil; 4.
Enfermeira pela Universidade Federal do Piauí-UFPI, PI, Brasil; 5. Acadêmico de Enfermagem pela Universidade Federal do Piauí-
UFPI, PI, Brasil; 6. Docente. Pós-Doutora em Enfermagem pela Universidade Federal do Ceará, Brasil.
ABSTRACT: The objective of this article aimed was investigate the association between the
consumption of alcoholic beverages and sociodemographic conditions of people with leprosy. It is a cross-
sectional study, in which 347 people were addressed as people with leprosy, reported by Brazilian Health
Information System, between 2001 and 2014, in a city in Northeast of Brazil, classified as hyperendemic. 290
other people, above 15 years old, were included in the research. After answering all the instruments of study,
the exclusion criteria was having some cognitive deficit. The data were collected by a form with questions
about sociodemographic conditions, elaborated by the researchers, and the Alcohol Use Disorder Intention
Test (AUDIT). The participants were classified as low-risk and risk consumers. The low-risk consumers
(n=260) were 60 years old (and older) men, married, up to high-school educated, with individual income up to
$244,44. Among the risk consumers (n=60), there was a prevalence of 15-39 years old women, married, up to
high-school educated, with individual income up to $244,44. The gender and age range was statistically
significant with alcohol consumption (p-valor=0,012). Knowing the consumption risk and its relation to
sociodemographic conditions, the implementation of preventive actions and public policies should be
considered, since the consumption of alcoholic beverages deserves attention, because it affects treatment and
self-care.
KEYWORDS: Alcohol Drinking. Leprosy. Public Health.
INTRODUCTION
Leprosy is chronic infectious disease
present in tropical regions representing public
health problem (MOURA et al., 2017). Its
transmission is related to unfavorable aspects of
life, such as low family income, poor housing
conditions and lack of basic health conditions
(WHO, 2015). Such circumstances facilitate the
contamination and spread of the disease (LOPES;
RANGEL, 2014).
Despite the implementation of public
policies and advances in relation to the care of
patients with leprosy, the stigma is important factor
that leads to social exclusion. The late diagnosis
may prolong the leprosy transmission and increase
the risk of neural damage, in addition to
impairment, which may aggravate the stigma
(DADUN et al., 2017).
This is a disease what causes to physical
disabilities, which causes fear and rejection, which
can lead to barriers in the implementation of
efficient treatment (HASKER et al., 2017). The
withdrawal from the leprosy treatment is related to
personal factors associated with health care.
Personal factors include quality of life,
socioeconomic and cultural conditions, such as
alcohol consumption and health-related factors
involving adverse effects resulting from
medication, waiting time for health care and
distance from the home to the service (GIRÃO et
al., 2013).
Considering this context of unfavorable
conditions of life and stigmatization, the
consumption of alcoholic beverages can be an
important complicating factor in the treatment and
recovery of leprosy. The ingestion of alcoholic
beverages among people with leprosy is a concern,
since the consumption may interfere with the
therapeutic regimen and self-care, which may
influence the prevention of disabilities (SALES et
al., 2013).
The consumption of alcoholic beverages is
motivated by multiple factors, such as
Received: 18/05/18
Accepted: 05/12/18
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Association between alcoholic... DOURADO, G. O. L. et al
Biosci. J., Uberlândia, v. 35, n. 3, p. 967-976, May/June 2019
socialization, leisure, stress, anxiety, depression,
discrimination, and family problems. The harmful
use of alcoholic beverages acts as a detrimental
aspect to mental health, causing anxiety, stress,
depression and disorders resulting from its use
(NEVES; TEIXEIRA; FERREIRA, 2015).
Investigate the consumption of alcoholic
beverages is an opportunity for primary and
secondary prevention (WATSON et al., 2009). The
gap in international scientific production on the
consumption of alcoholic beverages among people
with leprosy should be highlighted. Among people
with leprosy, it is an important aspect, because the
consumption of alcohol, besides rising blood
pressure, it is one of the causes of anti-
hypertensive therapeutic resistance and the biggest
cardiovascular morbimortality (LUIS et al., 2018).
The alcohol consumption investigation can also
prevent nutritional problems, seizures,
hypoglycemia, neuropathy and other chronic
complications (SBD, 2016). Therefore, the
objective was to investigate the association
between alcoholic beverages consumption and
sociodemographic condition of people with
leprosy.
MATERIAL AND METHODS
This is cross-sectional epidemiological
study, linked to the macro project entitled
“INTEGRAHANS: an integrated approach to the
clinical, epidemiological (spatio-temporal),
operational and psychosocial aspects of leprosy in
highly endemic Piauí municipalities”, with people
with leprosy reported in the Brazilian Health
Information System, between 2001 and 2014,
living in a Northeast city classified as hyper
endemic. After the exclusion of duplicated data, 4
incomplete notifications, addresses not found and
deaths, 347 people were addressed and 290 met the
inclusion criteria: above 15 years old, answering
all the instruments of study. The exclusion criteria
was having some cognitive deficit.
The data gathering occurred between July
2015 and July 2016, the approach was made at the
participants home, where we invited them to
participate and booked the instrument application
in social devices, public or private places (schools,
churches, social associations), near their houses to
provide privacy.
The data were collected by a form with
questions about sociodemographic conditions,
elaborated by the researches, and Alcohol Use
Disorder Identification Test (AUDIT) on the
consumption of alcoholic beverages. It contains 10
questions and the score ranges from 0 to 40, the
results are classified as: 0 to 7 points, that indicates
low risk or abstinence, between 8 and 15 points,
risk or simple use, between 16 and 19 points that
indicates harmful use, which recommends brief
intervention and monitoring, and above 20 points,
demonstrates possible dependence, where
diagnosis, assessment and treatment is indicated
(WHO, 2001). However, for the purpose of this
study, a recategorization was performed in which
below seven points are classified as low risk and
those that obtained a result above eight are
considered risk consumption, thus constituting the
outcome variable (BRITES; ABREU, 2014).
The explanatory variables used in the study
were: gender, age range, marital status, schooling,
individual income, having leprosy was a factor in
changing the consumption of alcoholic beverages
and the questions regarding the consumption that
make up the AUDIT. The individual income
considered the value of the minimum wage
converted from "real" (R$ 880, value in force in
2016) to dollar, equivalent to US$ 244.44.
A double-digit technique was used in the
Epi Info TM software, version 7.1.3 of the Center
for Disease Control and Prevention - CDC) and it
was later exported to the Statistical Package for the
Social Science (SPSS), version 20.0 and a chi-
square test for statistical treatment was performed
A double-digit technique was used in the Epi Info
TM software, version 7.1.3 of the Center for
Disease Control and Prevention - CDC) and it was
later exported to the Statistical Package for the
Social Science (SPSS), version 20.0 and the non-
parametric chi-square test was applied, with
significance level of 0,05, in order to verify the
association among the consumption of alcoholic
beverages and explanatory variables. The study
was approved by the Research 5 Ethics Committee
of the Federal University of Piauí (UFPI) (Parecer
1.115.816).
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Association between alcoholic... DOURADO, G. O. L. et al
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Table 1. Sociodemographic characterization associated with the consumption of alcoholic beverages. Floriano
(PI). 2017. (n = 290)
Variable Low power consumption
risk (n=260) n (%)
Consumption of risk
(n=30) n (%) p-value
Sex
Female 120 (43.6) 24 (80.0) 0.012
Male 140 (56.4) 6 (20.0)
Age range
>Age group 4 (1.6) 0 (0.0)
0.023
15 to 39 years 68 (26.1) 14 (46.6)
40 to 59 years 84 (32.3) 12 (40.0)
60 years and over 104 (40.0) 4 (13.4)
Marital status
Not married 78 (30.1) 11 (36.7)
0.456 Married 122 (46.9) 15 (50.0)
Divorced/ Widowed 60 (23.0) 4 (13.3)
Schooling*
Illiterate 48 (18.7) 4 (13.3)
0.712 Until high school 198 (76.7) 24 (80.0)
Higher education 12 (4.6) 2 (6.7)
Individual income
No income 24 (10.8) 3 (12.0)
0.778
Up to US$ 244,44. 140 (62.8) 14 (56.0)
One to US$ 733,32 55 (24.6) 8 (32.0)
Above US$ 733,32 4 (1.8) 0 (0.0)
Having leprosy was a factor in
changing the consumption of
alcoholic beverages
Never drank 154 (59.0%) 0 (0.0%)
0.000
There was no change 67 (26.0%) 16 (53.4%)
Yes, with increase 0 (0%) 2 (6.6%)
Yes, with reduction 18 (6.9%) 9 (30%)
Yes, I stopped drinking 21 (8.1%) 3 (10%)
*2 people did not respond
RESULTS
According to table 1, the participants were
classified as low risk and risk consumers. The low-
risk consumers (n=260) were males (56.4%), those
aged 60 or over (40.0%), married (46.9%),
educated up to high school (76.7%), individual
income 140 (62.8%) up to US$ 244.44. The
participants were questioned if the leprosy
diagnosis was a changing factor on the
consumption of alcoholic beverages, and we
observed that it took to reducing the consumption
(6.9%) and even quitting (8.1%).
Among those classified as risk consumers
(n=30), there was more prevalence of the female
gender (80.0%), between 15-39 years old (46.6%),
married (50.0%), with high school education
(80%), and individual income (56.0%) up to
$244.44 With the diagnosis of leprosy, they
reduced consumption (30.0%), stopped drinking
(10.0%) and increased the intake (6.6%). Table 1
showed statistical significance between sex with
p=<0.01 and age group p=0.02. The change in the
consumption after diagnosis was positive for the
exact fisher test with 0.000.
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Table 2. Characterization of people with leprosy who have consumed alcoholic beverages in the last year.
Floriano (PI). 2017. (n = 290)
Variable Low power consumption
risk (n=260)
n (%)
Consumption of risk
(n=30) n
(%)
How often do you have a drink containing
alcohol?
Never 200 (76.9) 0 (0.0)
Monthly or less 33 (12.7) 3 (10.0)
2 to 4 times a month 25 (9.7) 15 (50.0)
2 to 3 times a week 2 (0.7) 7 (23.4)
4 or more times a week 0 (0.0) 5 (16.6)
How many drinks containing alcohol do you
have
on a typical day when you are drinking?
None 200 (76.8) 0 (0.0)
1 or 2 33 (12.7) 2 (6.7)
3 or 4 16 (6.3) 5 (16.7)
5 or 6 7 (2.8) 9 (30.0)
7,8 or 9 2 (0.7) 7 (23.3)
10 or more 2 (0.7) 7 (23.3)
How often do you have six or more drinks on
one
occasion?
Never 228 (87.7) 2 (6.7)
Less than monthly 19 (7.3) 5 (16.6)
Monthly 10 (3.9) 6 (20.0)
Weekly 3 (1.1) 12 (40.0)
Daily or almost daily 0 (0.0) 5 (16.7)
How often during the last year have you found
that you were not able to stop drinking once
you
had started?
Never 258 (99.2) 23 (76.7)
Less than monthly 1 (0.4) 4 (13.3)
Monthly 1 (0.4) 2 (6.6)
Weekly 0 (0.0) 1 (3.4)
How often during the last year have you failed
to
do what was normally expected from you
because of drinking?
Never 260 (100.0) 25 (83.3)
Less than monthly 0 (0.0) 3 (10.0)
Monthly 0 (0.0) 2 (6.7)
How often during the last year have you
needed
a first drink in the morning to get yourself
going
after a heavy drinking session?
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Never 251 (96.5) 26 (86.6)
Monthly 9 (3.5) 2 (6.6)
Weekly 0 (0.0) 1 (3.4)
Daily or almost daily 0 (0.0) 1 (3.4)
How often during the last year have you had a
feeling of guilt or remorse after drinking?
Never 258 (99.2) 16 (53.4)
Less than monthly 2 (0.8) 6 (20.0)
Monthly 0 (0.0) 7 (23.3)
Daily or almost daily 0 (0.0) 1 (3.3)
How often during the last year have you been
unable to remember what happened the night
before because you had been drinking?
Never 259 (99.6) 19 (63.4)
Less than monthly 1 (0.4) 8 (26.6)
Monthly 0 (0.0) 2 (6.6)
Weekly 0 (0.0) 1 (3.4)
Have you or someone else been injured as a
result of your drinking?
No 255 (98.0) 25 (83.3)
Yes, but not in the last year 5 (2.0) 4 (13.3)
Yes, during the last year 0 (0.0) 1 (3.4)
Has a relative or friend or a doctor or another
health worker been concerned about your
drinking
or suggested you cut down?
No 253 (97.3) 16 (53.3)
Yes, but not in the last year 7 (2.7) 1 (3.4)
Yes, during the last year 0 (0.0) 13 (43.3)
Table 2 shows the characterization of
people with leprosy who consumed alcoholic
beverages. Among those classified as low risk, it is
highlighted the ones that not consume in the last
year or never drank (76.9%), reported that they had
consumed 1 to 2 doses per day (12.7%), that never
consumed more than 6 doses on one occasion
(87.7%), reported that they never had a drink and
could not stop (99.2%). The total number of
participants reported that, on any occasion, they
did not perform a task due to alcoholic beverage
(100.0%). Drinking in the morning is a situation
denied (96.5%), no feeling of guilt after drinking
(99.2%) and have not been unable to remember
what happened the night before because of the
drink (99.6%). Most did not cause injury or harm
to themselves or another person because they
drank (98.0%) and responded that it was not
suggested by others that they stopped drinking
(97.3%).
Among those classified as risk consumers,
it is clear that they consume 2 to 4 times a month
(50.0%), ingest in a typical day 5 or 6 doses
(30.0%), frequency of 6 doses or more in a single
occasion for (40.0%). Regarding the frequency of
drinking and not being able to stop, they reported
that it never happened (76,7%). The activities
performance did not have the interference of the
alcohol ingestion, as reported by (83.3%), they
reported that they did not drin
k in the morning (53.4%). Regarding
feeling guilty after drinking, they reported not
having this feeling (53.4%). As to being unable to
remember what happened the night before because
of drinking (63.4%) reported it has not occurred, as
to cause injury or harm to themselves or to another
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person after drinking, (83.3%) reported not having
caused any type of injury.
Regarding the fact that someone suggested
that they stop drinking, they said that it occurred in
the last year (43.3%).
DISCUSSION
The study results showed that most
participants abstained from alcoholic beverages in
the last year, therefore, they were classified as low
risk for alcohol dependence. The characterization
of low risk consumers was men, elderly, high
school, married and with income up to 1 minimum
wage. This reality is similar to the study conducted
in Fernandópolis (São Paulo) with people with
leprosy, which found low income, low schooling,
age between 40 and 69 years old, married
(BALDAN; SANTOS, 2012).
The consumption among men is similar to
a Brazilian survey, in which 62% of men used to
consume alcoholic beverages (LENAD, 2014). In
the world population in general, men are the main
consumers of alcohol and present the highest rates
of morbidity and mortality, however, it is
estimated that the consumption among women in
some years is equal to that of men (OPAS, 2015).
The prevalence of alcohol consumption
among the elderly classified as low risk calls
attention. This point is subject for other studies,
research on alcohol consumption regarding the
elderly is scarce and the results diverge. A study
carried out in Portugal found the prevalence of
alcohol consumption of 63% Martins et al (2016)
and research in Brazil found a prevalence of 8.9%
(SOARES et al., 2016). When working with this
population, consideration should be given to biases
related to memory and omission of information
due to fear of judgment and exposure. The elderly
constitute a risk group because of comorbidities
associated with the concomitant use of alcohol and
drugs, which increases the risk of toxicity
(MARTINS et al., 2016). One of the concerns
about alcohol consumption regarding the elderly is
the possibility of being related to a lack of
knowledge of the health consequences and
complications of leprosy.
The results of this study reveal that there is
a close proximity of the quantitative between the
genders regarding the low risk consumption, but in
the risk consumption there is a considerable
difference between the genders. The study showed
statistical significance on the consumption of
alcoholic beverages risk and the variables sex and
age group. On average, the consumption of
alcoholic beverages in the Americas is higher than
in the rest of the world and has increased in both
genders. The female consumption is worrying,
since women health is more affected than men.
American women have a higher prevalence of
alcohol-related disorders in the world OPAS
(2015) and, when analyzing the alcohol-
attributable deaths in Sergipe between 1998 and
2010, there was a higher level of mortality, which
was more pronounced among women (OHLAND;
GONÇALVES, 2015). Such context requires
differentiated attention to the female audience and
specific actions to try to minimize the damages
resulting from the association of leprosy and
alcoholic beverages.
Among the consumers at risk, the most
prevalent age group was between 15 and 39 years
old. This phenomenon is observed in national
studies, with research carried out in which
participants had chronic diseases and found in both
low-risk and higher-risk consumption, the
prevalence between 18 and 44 years old (MOURA;
MALTA, 2011). A study carried out in a
municipality in northeastern Brazil showed that
younger people aged from 14 to 29 years old
showed a greater chance of abuse and addiction
(FERREIRA et al., 2013). The consumption
among young people represents
a risk factor for mortality, since they
present a pattern of more dangerous consumption
and health problems in economically productive
people between 15 and 49 years old (OPAS, 2015).
Having attended up to high school in this
study prevailed in both drinking patterns. Leprosy
often affects people with low levels of schooling,
which is an indicator of poor living conditions
(SOUZA et al., 2018). The poorest population is
the most affected by the consequences of alcohol
use, due to lack of access to health care and greater
social exclusion (OPAS, 2015). In people affected
by leprosy in Campos dos Goytacazes (Rio de
Janeiro), low income, low schooling levels, and
aspects related to the limitation of participation in
the labor market to jobs that provide lower income
prevailed. Such context propels a social
vulnerability, which is associated with greater
possibilities of leprosy contagion (LOPES;
RANGEL, 2014).
The highest prevalence among married
women in both consumption patterns was found,
but the civil status variable did not present
statistical association. It is a similar result from a
study that found no association between income,
marital status, race and schooling (FERREIRA ET
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AL., 2013). However, a study conducted in
Bebedouro (São Paulo) showed a different result,
that people with incomes of up to one minimum
wage, in a stable relationship, were positively
associated with a harmful use (PEREIRA;
VARGAS; SILVA, 2016).
The risk consumption in this study was
more prevalent among women, young people
between 15 and 39 years old, married, with high
school and income up to 1 minimum wage. The
results differ from those found in the Brazilian
northeast, which showed abusive consumption by
34.9% of men and an association between abusive
consumption and dependence in males
(FERREIRA et al., 2013).
Regarding the consumption of alcoholic
drinks after the leprosy diagnosis, there were
changes. There was a reduction in the
consumption, abstention and cases in which there
was an increase. In agreement with a study of
people affected by leprosy, in which 20% of the
participants consumed alcoholic beverages and
14% suspended the consumption with the
diagnosis of the disease (BALDAN; SANTOS,
2012).
Not consuming alcoholic beverages is seen
as a self-care action adopted by patients with
leprosy (DUARTE et al., 2014). After the
diagnosis it is necessary to change the lifestyle and
adopt healthy habits and the consumption of
alcoholic beverages causes behaviors that
undermine the self-care and interfere in the
regularity and adherence to the treatment. Cases of
increased alcohol intake can be understood as a
way to alleviate the fear and sufferings of the daily
life (LUNA et al., 2010).
Amongst the consumers classified as risk,
the frequency of consumption was 2 to 4 times a
month, from 5 to 6 doses per week. An analogous
finding was found in a study involving 515 people
with leprosy in Campinas (São Paulo), which
showed that they consume 2 or more times a week,
3 or more doses on a typical day, 6 or more doses
at least once a month (BARROS et al., 2008).
The use of alcoholic beverages interferes
with the treatment of chronic diseases, which have
a worse prognosis in alcoholic patients when
compared to non-alcoholics. The use is considered
a clinical condition that causes aggravation of the
case (SILVA; LAFAIETE; DONATO, 2011). The
combination of alcohol consumption and leprosy is
a concern, since the consumption can interfere with
the therapeutic regimen and self-care, which can
influence the prevention of disabilities, leading to
complications (FERREIRA; IGNOTTI; GAMBA,
2011). In addition to being associated with the
non-adherence and abandonment of the treatment,
which represents a great obstacle to the cure of the
disease, since the daily use of alcohol associated
with the treatment of leprosy reduces the effect of
medication, making it difficult to cure (ROLIM et
al., 2016).
It is highlighted that the abusive
consumption of alcohol entails detrimental bio
psychosocial, political and economic effects that
affect the individual, health and society as:
reduction of conditions and quality of life, loss of
work productivity,accidents at work, greater
demand for health care and expenses, emergence
of antisocial practices (OPAS, 2015; WHO, 2014).
As a study limitation, we highlight the
non-usage of a multimethod approach, since it
could increase the amount of results. However, we
aimed to develop the results descriptive aspects,
aiming a more critical analysis. Another limitation
refers to the quality of SINAN database in relation
to its completeness and inconsistency, situation
that made deeply difficult the cases location. In
order to reverse this situation, we crossed with
other available databases (CADSUS, SIM)
CONCLUSIONS
Among the patients with leprosy classified
as low-risk consumers, men were the majority,
followed by the elderly; a reality that concerns,
since, even with moderate consumption, serious
health damage can occur. And among the
participants classified as risk consumers, there was
a higher prevalence among young female people.
In both consumption patterns, married people, with
low schooling and income of up to 1 minimum
wage prevailed.
The diagnosis of leprosy contributed to the
change in the alcohol consumption by the
participants in both consumption patterns.
Although the results show a low level of
risk in the consumption of alcohol, it is necessary
to develop interventions that aim to reduce this
level of consumption in this specific population
and, consequently, the risks to which they are
susceptible. Therefore, it should be highlighted the
need to carry out other studies in order to be able
to draw up a state profile.
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RESUMO: Este artigo tem como objetivo investigar a associação entre o consumo de bebidas
alcoólicas e condições sociodemográficas de pessoas com hanseníase. Trata-se de um estudo transversal, que
incluiu 347 com hanseníase notificadas no Sistema Brasileiro de Informação em Saúde, entre 2001 e 2014, em
um município do Nordeste do Brasil, classificado como hiperendêmico., foram incluídas na pesquisa 290
pessoas, com idade acima de 15 anos que responderam a todos os instrumentos do estudo. O critério de
exclusão foi ter algum déficit cognitivo. Os dados foram coletados por meio de um formulário com questões
sobre condições sociodemográficas, elaboradas pelos pesquisadores, e o “Alcohol Use Disorder Identification
Test (AUDIT)”. Os participantes foram classificados como consumidores de baixo risco e de risco. Os
consumidores de baixo risco (n = 260) tinham 60 anos ou mais, homens, casados, até o ensino médio, com
renda individual de até US $ 244,44. Entre os consumidores de risco (n = 30), houve uma prevalência de
mulheres de 15 a 39 anos, casadas, até o ensino médio, com renda individual de até US $ 244,44. O sexo e a
faixa etária foram estatisticamente significantes com o consumo de álcool (p-valor = 0,012). . O conhecimento
do consumo de risco e a relação com condições sociodemográficas devem ser considerados na implementação
de ações preventivas e políticas públicas, uma vez que o consumo de bebidas alcoólicas merece atenção, pois
dificulta o tratamento e o autocuidado.
PALAVRAS-CHAVES: Bebidas Alcóolicas. Hanseníase. Saúde Pública.
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