Adult binge drinking: rate, frequency and intensity in Buffalo City Metropolitan Municipality, South Africa

Abstract

Background: Binge drinking (BD) is a significant risk factor for several acute and chronic illnesses, including injuries. This study examines the rate, frequency and intensity of BD in Buffalo City Metropolitan Municipality (BCMM), South Africa.Methods: This was a cross-sectional survey of 998 adults attending the three largest outpatient clinics in BCMM. Rate, frequency and intensity of BD were assessed using the WHO STEPwise questionnaire. Descriptive and inferential statistics were carried out to determine the rate and determinants of binge drinking.Results: The overall rate of BD was 15.0%. Frequency and intensity of BD were 5.4 episodes per month and 13.4 drinks on one occasion, respectively. The study data showed that BD was commoner in males than females (24.0% vs. 10.8%). Smokers engagemore in BD than non-smokers (44.0% vs. 9.9%). In the analysis of socio-demographic variables, BD was commonest among students, age group 18–25 years, those never married and those on incomes between 2001 and 5000 Rand per month. In themultivariate logistic regression, after adjusting for confounders, only age less than 25 years (p 0.001) and male gender (p 0.001) were significant predictors of binge drinking. Also, male gender (p = 0.002) was significantly associated with frequency of BD. There was no significant gender variation in the intensity of BD. Only age and smoking were significantly associated with the intensity of BD.Conclusion: The rate of binge drinking was high among the study participants, and those who binge drink tend to do so frequently and at a high intensity. Women who binge drink also do so at a high intensity. There is a need for sensitisation campaigns and health advocacy talks on the dangers associated with binge drinking among young adults in this setting.

Full text

S Afr Fam Pract
ISSN 2078-6190 EISSN 2078-6204
© 2018 The Author(s)
RESEARCH
Adult binge drinking 2018; 60(2):46–52
https://doi.org/10.1080/20786190.2017.1382970
Open Access article distributed under the terms of the
Creative Commons License [CC BY-NC 3.0]
http://creativecommons.org/licenses/by-nc/3.0
South African Family Practice is co-published by Medpharm Publications, NISC (Pty) Ltd and Informa UK Limited
[trading as the Taylor & Francis Group]
Adult binge drinking: rate, frequency and intensity in Bualo City Metropolitan
Municipality, South Africa
Eyitayo Omolara Owolabi
a
*, Daniel Ter Goon
a
, Oladele Vincent Adeniyi
b
 and Eunice Seekoe
a
a
Department of Nursing Science, University of Fort Hare, East London, South Africa
b
Department of Family Medicine, Walter Sisulu University/Cecilia Makiwane Hospital, East London, South Africa
*Corresponding author, email: owolabiomolara101@gmail.com
Background: Binge drinking (BD) is a signicant risk factor for several acute and chronic illnesses, including injuries. This study
examines the rate, frequency and intensity of BD in Bualo City Metropolitan Municipality (BCMM), South Africa.
Methods: This was a cross-sectional survey of 998 adults attending the three largest outpatient clinics in BCMM. Rate, frequency
and intensity of BD were assessed using the WHO STEPwise questionnaire. Descriptive and inferential statistics were carried out
to determine the rate and determinants of binge drinking.
Results: The overall rate of BD was 15.0%. Frequency and intensity of BD were 5.4 episodes per month and 13.4 drinks on one
occasion, respectively. The study data showed that BD was commoner in males than females (24.0% vs. 10.8%). Smokers engage
more in BD than non-smokers (44.0% vs. 9.9%). In the analysis of socio-demographic variables, BD was commonest among
students, age group 18–25years, those never married and those on incomes between 2001 and 5000 Rand per month. In the
multivariate logistic regression, after adjusting for confounders, only age less than 25years (p < 0.001) and male gender (p <
0.001) were signicant predictors of binge drinking. Also, male gender (p = 0.002) was signicantly associated with frequency of
BD. There was no signicant gender variation in the intensity of BD. Only age and smoking were signicantly associated with the
intensity of BD.
Conclusion: The rate of binge drinking was high among the study participants, and those who binge drink tend to do so frequently
and at a high intensity. Women who binge drink also do so at a high intensity. There is a need for sensitisation campaigns and
health advocacy talks on the dangers associated with binge drinking among young adults in this setting.
Keywords: Binge drinking, Bualo City, frequency, intensity, rate, South Africa
Introduction
Alcohol is a mind-altering substance that has been in use for
centuries and in various cultures and it is associated with varieties
of health, social and economic burden.1 Globally, alcohol use is
the third leading modiable risk factor for morbidity and
mortality and the rst leading risk factor in middle-income
countries.2 Alcohol use is responsible for 3.3 million deaths (5.9%)
worldwide and a cause of over 200 diseases and injuries.3
Alcohol is a leading risk factor for morbidity and mortality in
South Africa.4 South Africa is considered a hard-drinking country
with an annual per-capita consumption rate of 5 billion litres,
one of the highest recorded globally.3,5,6 Excessive alcohol
consumption constitutes a signicant public health threat for
South Africans.5,7 Alcohol use in South Africa is often characterised
by abstinence from alcohol juxtaposed with heavy episodic
drinking, basically binge drinking, with a signicant rise among
females and a relatively stable rate among males.7 Alcohol use in
South Africa varies by gender, race and province.8
Binge drinking, dened as the consumption of four or more
alcoholic drinks among women or ve or more among men on a
single occasion, is a form of hazardous drinking.7,9 Binge drinking
often results in acute impairment with numerous health
consequences and constitutes a risk factor for several chronic
and acute traumas and illnesses such as motor vehicle accidents,
violence, suicide, hypertension, acute myocardial infarction, and
sexually transmitted diseases among others.3,10 Binge drinking
increases the risks of breast cancer and unintended pregnancies
in women in the reproductive age group, sudden infant death
and foetal alcohol spectrum disorders during pregnancy.9
Apart from the prevalence of binge drinking, the frequency and
intensity of binge drinking are two other important measures for
determining the adverse health outcomes of hazardous alcohol
use.11 The frequency of binge drinking is dened as the number of
binge-drinking episodes over a certain time period while intensity
is dened as the average number of drinks consumed per episode
of binge drinking.12 These two measures, frequency and intensity,
have been reported to contribute signicantly to poor health-
related quality of life as well as alcohol-related morbidity and
mortality.11,13 Several studies have reported the prevalence of
alcohol use in South Africa.5,7,8,14 However, binge drinking has
rarely been investigated in the Eastern Cape Province, an
economically disadvantaged province with an anecdotal report
of high alcohol-drinking habits. Most importantly, no study has
been conducted in South Africa on the frequency and intensity of
binge drinking among individuals who binge drink. Such
information is vital in determining the severity and pattern of
binge drinking, and assessing the population at risk of adverse
health outcomes of alcohol use, as well as crafting eective public
health policies targeted towards the reduction of harmful alcohol

Adult binge drinking: rate, frequency and intensity in Bualo City Metropolitan Municipality, South Africa 47
use. This study aimed at determining the rate, frequency and
intensity of binge drinking among adults in BCMM, South Africa.
Study methods
Study settings and participants
This cross-sectional study forms part of the Bualo City
Metropolitan Municipality (BCMM) Non-Communicable Disease
Surveillance Study. The methods for the larger study have been
published elsewhere.15 Briey, participants were recruited from
the three largest outpatient clinics: Cecilia Makiwane hospital,
and Nontyatyambo and Empilweni-Gompo Community Health
Centres. These health facilities are located in the rural and semi-
urban communities of BCMM and provide healthcare services for
a total of 755 200 residents in BCMM.16 Bualo City Metropolitan
Municipality is situated on the east coast of Eastern Cape
Province and consists of the towns of East London, King William’s
Town, Bisho and the large townships of Mdantsane and
Zwelitsha. The majority (85.1%) of the residents of BCMM are
black Africans, with 6.0% coloured population, 0.8% Asian/
Indians and 7.7% whites.16
Sample and sampling technique
The appropriate sample size was estimated using the following
formula:
Where Z1−α is the condence level, P is the expected proportion
of individuals with cardio-metabolic risk factors, and D is the
margin of error. P was set at 0.40 and D at 0.05. The calculation
was performed at 95% condence level. The required sample
size (1 107 participants; 369 per study site) was included in the
study. All ambulatory individuals (both patients and relatives)
who fullled the inclusion criteria and were available during the
period of study were conveniently recruited. The study was
conducted in April and May 2016. Participants were included if
they were 18years and above. However, debilitated, pregnant,
breastfeeding or individuals with psychiatric disorders were
excluded from the study. Due to incomplete data, 199
participants were excluded, thus a total of 998 participants were
included in the data analysis.
Data collection
Study instrument
The previously validated WHO STEPwise questionnaire17 was
used to obtain information from the study participants. It
comprised three major items: demographic and behavioural
data, and measurements. The instrument was adapted locally
and a pilot study that included 20 participants at one of the
sites was conducted to validate its suitability in the local setting
as well as to test the eectiveness of the research process.
However, the result of the pilot study was not included in the
analysis.
Study procedure
Data were obtained by personal interview on demographic and
behavioural characteristics using the WHO STEPwise
questionnaire. Demographic variables included items on sex,
age, marital status, level of education, employment status and
average monthly income. Participants’ income was categorised
into R2000 or less per month, R2001–5000 and above R5000.
Their level of education was determined by self-reporting of the
highest grade level attained in school and was categorised as
having no formal education, primary (grade 1–7), secondary
N
=(Z
1−𝛼
)
2
×(P(1−p))∕D
2
(grade 8–12) or tertiary (post-secondary). Participants were
dened as unemployed if they reported that they were not
employed in either the formal or informal sector.
Binge drinking was dened as self-reported consumption of four
or more standard alcoholic drinks on one occasion by women or
ve or more standard alcoholic drinks on one occasion by men in
the past 30days. Frequency of binge drinking was dened as the
average number of episodes of binge drinking while intensity of
binge drinking was dened as the average number of drinks
consumed during occasions of binge drinking in the past 30days.
Data analysis
Descriptive and inferential statistics were used for the data analysis.
Frequencies (n) and proportions (%) were reported for categorical
variables. The associations between the demographic variables
and binge drinking were assessed through bivariate analysis.
Multivariate analysis was used to ascertain the determinants of
binge drinking. Mean frequency and intensity were compared
across the socio-demographic variables using analysis of variance
(ANOVA). Analysis was carried out at a 95% condence level. A p-
value of < 0.05 was considered statistically signicant. The
Statistical Package for Social Science (SPSS®) version 21.0 was used
for the data analysis (IBM Corp, Armonk, NY, USA).
Ethical considerations
Ethical approval was obtained from the University of Fort Hare
Research Ethics Committee (Reference number, GOO061SOLO01).
Afterwards, permission to conduct the study was obtained from
the Eastern Cape Department of Health, the management of the
Sub-District Department of Health in Bualo City Metropolitan
Municipality and nally the management of the respective
health facilities. Participants received detailed information on
the purpose and process of the study. Each participant
subsequently gave written, informed consent for his/her
voluntary participation in the study including referral to clinicians
for interventions in the event of abnormal ndings. The
participants’ right to privacy, condentiality and anonymity were
taken into consideration.
Results
Table 1 presents the demographic characteristics of the
participants. A total of 998 participants were included in the
analysis. The mean age of participants was 42.6 (SD±16.5)years,
with an age range of 18 to 75 years. The majority of the
participants were black (98.1%), female (67.8%), single (63.9%)
and had at least a grade 8 level of education (69.7%). About half
of the participants had no means of income (44.6%) and were
unemployed (47.7%), while only a few (7.5%) participants earned
above R5000 monthly.
Of the 998 participants, the prevalence of binge drinking was
15% (n = 150). However, 47% of those who reported current
alcohol consumption (n = 319) binge drink.
As shown in Table 2, gender, age, marital status, employment
status, income categories, body mass index (BMI) categories and
smoking were statistically associated with binge drinking. Binge
drinking was highest among males (24%), participants aged 18 to
25years (24.6%), those never married (19.2%), students (23.2%),
those earning an income of R2001 to R5000 per month (21.8%),
those who were underweight (21.9) and current smokers (44%).

48 South African Family Practice 2018; 60(2):46–52
In the multivariate regression, only age less than 25years, male
gender and current smoking were signicant predictors of binge
drinking. Participants aged less than 25years were three times
more likely to binge drink compared to those above 25years.
Males were twice as likely to binge drink compared to females
while smokers were about seven times more likely to binge drink
than non-smokers (Table 3).
The mean frequency of binge drinking was 5.4 episodes and it
ranged from 1.0 to 32.0 episodes. Sex was the only signicant
factor associated with the frequency of binge drinking (p-
value=0.002). Male participants had a higher frequency of binge
drinking (6.4 episodes) (Table 4).
The mean intensity of binge drinking among the study
participants was 13.4 drinks (4.0–56.0 drinks) with no signicant
gender variation. Age and smoking were signicantly associated
with the intensity of binge drinking. The highest mean intensity
of binge drinking was found among participants aged 36 to
45years (16.0 drinks) and current smokers (13.9 drinks) (Table 5).
Discussion
Binge drinking is an essential public health issue that often
results in acute impairment with several health consequences.3
Of the 998 participants, 15% binge drink, while 47% of current
alcohol users binge drink. The rate of binge drinking among
adults in this setting in Eastern Cape Province is higher than the
reported national prevalence of 9.7%.18 This points at the
documented increase in hazardous alcohol use in South Africa.5
This rate is slightly lower than the reported prevalence among
US adults, which ranged from 17.1% to 23% between 2010 and
2015.9,19,20 Harmful alcohol users are not only at risk, but also put
others at risk. Considering its signicant adverse health and
social impacts, harmful alcohol use requires health intervention
measures among the general population.
Binge drinking was found to be higher among males, younger
participants (aged 18–25years), never-married participants and
students. This is not surprising, as several studies have
documented similar ndings.9,19,21 Males have been reported as
the most frequent perpetrators of harmful alcohol use.5,22,23
Alcohol use is perceived to be more socially acceptable among
males than females and this might be the underlying factor for
the higher rate recorded among the male participants. However,
evidence indicates a convergence in the prevalence of alcohol
use among the two genders, as the gap has been documented
to be closing in recent years.7,24 The increase in hazardous
drinking among women in this setting could be attributed to
women’s rights and social status.25 This trend portends grave
danger in the region for increasing unintended pregnancies,
sexually transmitted infections, especially HIV, and the risks of
sudden infant deaths and foetal alcohol spectrum disorders
during pregnancy. Thus, alcohol reduction interventions should
not only target males; rather, both sexes should be targeted as
there is a possibility of escalation of this burden in the near
future.
Also, those in the younger age group binge drink more than the
older participants. This corroborates the ndings of Reddy et al.21
in a National Youth Survey in South Africa, which reported a high
(25.1%) prevalence of binge drinking. This might also explain the
high prevalence found among students and single participants
as they constitute the majority of the younger age group.
Hazardous and binge drinking have been identied as habits
commonly found among youths. These often decline with age,
as people become mature, undertake more responsibilities or
even develop health problems.26 Other reasons could be peer
pressure, boredom, ignorance of the harmful eects of alcohol
use, the relatively low price of alcohol, as well as ease of access to
alcohol, evidenced by growing numbers of unlicensed liquor
outlets in South Africa.5 Young adults should be specically
targeted for screening and interventions by primary health care
physicians in the study setting. This is supported by evidence
Table 1: Demographic characteristics of the participants by gender
Variables Male
(n = 321) n (%)
Female
(n = 677) n (%)
Total
(n = 998) n (%)
Age group (years):
18–25 40 (12.5) 143 (21.1) 183 (18.3)
26–35 74 (23.1) 149 (22.0) 223 (22.3)
36–45 67 (20.9) 116 (17.1) 183 (18.3)
46–55 57 (17.8) 110 (16.2) 167 (16.7)
56–65 41 (12.8) 99 (14.6) 140 (14.0)
≥ 66 42 (14.1) 60 (8.9) 102 (10.2)
Level of education:
No formal
schooling
62 (19.3) 84 (12.4) 146 (14.6)
Grade 1–7 57 (17.8) 99 (14.6) 156 (15.6)
Grade 8–12 171 (53.3) 409 (60.4) 580 (58.1)
Tertiary 31 (9.7) 85 (12.6) 116 (11.6)
Monthly income (Rand):
No income 134 (41.7) 300 (44.3) 445 (44.6)
R150–2000 89 (27.7) 248 (36.6) 326 (32.7)
R2001–5000 74 (23.1) 100 (14.8) 174 (17.4)
R5001and above 24 (7.5) 29 (4.3 53 (5.3)
Marital status:
Single 193 (60.3) 444 (65.6) 637 (63.9)
Married 115 (35.9) 185 (27.3) 300 (30.1)
Separated 1 (0.3) 5 (0.7) 6 (0.6)
Divorced 9 (2.8) 13 (1.9) 22 (2.2)
Widowed 2 (0.6) 30 (4.4) 32 (3.2)
Racial group:
Black 313 (97.5) 666 (98.4) 979 (98.1)
Coloured 8 (2.8) 9 (1.3) 17 (1.7)
White 0 (0.0) 2 (0.3) 2 (0.2)
Type of employment:
Government
employee
30 (9.3) 33 (4.9) 63 (6.3)
Non-government
employment
98 (30.5) 133 (19.7) 231 (23.2)
Self-employment 30 (9.3) 32 (4.7) 62 (6.2)
Students 19 (5.9) 80 (11.8) 99 (9.9)
Unemployed 115 (24.2) 361 (53.4) 476 (47.7)
Retired 29 (9.0) 37 (5.5) 66 (6.6)

Adult binge drinking: rate, frequency and intensity in Bualo City Metropolitan Municipality, South Africa 49
Binge drinking was also found to be higher among those
participants earning between R2000 and R5000. This nding is
similar to those of Keyes and Hasin,28 Cerdá et al.,29 Matheson et
al.,30 Mulia and Karriker-Jae31 and Public Health England.32 The
high prevalence of binge drinking found among low-income
earners has been associated with poverty-inicted economic
deprivation and stress experienced by low-income earners. As
such, alcohol use is seen as an ‘easy way’ out with a tendency to
drink at a hazardous rate.31,33,34 Also, nutritional deciency has
been documented as one of the adverse eects of binge
drinking,35 thus supporting the observed higher rate found
among underweight patients.
Binge drinking was found to be higher among smokers. Smoking
and harmful alcohol use often goes hand-in-hand.36 Thus, the
higher rate of binge drinking found among cigarette smokers is
not surprising.37,38 The relationship between smoking and alcohol
has long been documented.37–39 Alcohol use and smoking have
been reported to be complementary behaviours.39 Several factors
have been identied to be closely associated with this. Such
factors range from physiological to psychological factors.
Repeated use of nicotine, the major component of cigarettes, has
been implicated in stimulating alcohol consumption.40 Also,
nicotine has been shown to reduce the intoxicating eects of
alcohol, which could prompt individuals seeking the intoxicating
eect to drink more.22,41 Since both behaviours are complementary
and the major focus of primary health physicians is often on
smoking, there is an urgent need to integrate screening and
behavioural counselling interventions for both lifestyle habits at
the primary health care facilities in the region. Likewise, prevention
programmes should take cognisance of both behaviours, and
there should be a reconsideration of the long-separated public
health policies relating to tobacco and alcohol use.
The mean frequency of binge drinking among the study
participants was 5.4 episodes (1.0–32.0 episodes) with a
signicant gender dierence. However, the mean intensity of
binge drinking was 13.4 drinks (4.0–56.0 drinks) with no
signicant gender dierence. To the best knowledge of the
authors, no study in South Africa has been conducted on the
frequency and intensity of binge drinking among binge drinkers.
and recommendation of the United States Preventive Services
Task Force27 on screening of patients 18years or older for alcohol
misuse during consultation by primary care physicians, thus
creating opportunity for behavioural counselling interventions.
Table 2: Association between socio-demographic characteristics and
binge drinking
OR = odds ratio; CI = condence interval.
Variables Binge drink Do not binge
drink
p-value
Gender:
Male 77 (24.0) 244 (76.0) < 0.001
Female 73 (10.8) 604 (89.2)
Age (years):
18–25 45 (24.6) 138 (75.4)
26–35 45 (20.2) 178 (79.8)
36–45 24 (13.1) 159 (86.9) < 0.001
46–55 25 (15.0) 142 (85.0)
56–65 8 (5.7) 132 (94.3)
≥ 66 3 (15.0) 99 (85.0)
Level of education:
No formal
schooling
27 (18.5) 119 (81.5)
Grade 1 to 7 14 (9.0) 142 (91.0)
Grade 8 to 12 89 (15.3) 491 (84.7) 0.096
Tertiary 20 (17.2) 96 (82.8)
Marital status:
Never married 122 (19.2) 515 (80.8) < 0.001
Married 28 (7.8) 332 (92.2)
Employment status:
Government
employee
9 (14.3) 54 (85.7)
Non-govern-
ment employee
47 (20.3) 184 (79.7)
Self-employed 9 (14.5) 53 (85.5)
Student 23 (23.2) 76 (76.8) 0.001
Unemployed 60 (12.6) 416 (87.4)
Retired 2 (3.0) 64 (97.0)
Income categories (Rand):
No income 73 (16.4) 372 (83.6)
150–2000 32 (9.8) 294 (90.2)
2001–5000 38 (21.8) 136 (78.2) 0.003
Above 5000 7 (13.2) 46 (86.8)
Body mass index categories:
Underweight 9 (25.0) 27 (75.0)
Normal 55 (20.3) 216 (79.7)
Overweight 44 (18.3) 196 (81.7) <0.001
Obese 42 (9.3) 409 (90.7)
Current smoker:
Yes 66 (44.0) 84 (56.0) < 0.001
No 84 (9.9) 764 (90.1)
Table 3: Multivariate logistic regression showing predictors of binge
drinking
Variables βWald Adjusted odds
ratio (95% CI)
p-value
Age (years):
≤ 25 1.2 12.4 3.4 (1.7–6.8) < 0.001
25 and above
(reference)
Gender:
Male 0.8 7.5 2.3 (1.3–4.1) 0.006
Female (reference)
Smoking:
Yes 1.9 37.8 6.5 (3.5–11.9) < 0.001
No (reference)
Income (Rand):
Less than 3000 0.4 2.2 1.5 (0.9–2.7) 0.136
3000 and above
(reference)

50 South African Family Practice 2018; 60(2):46–52
signicant gender variation was found for intensity of binge
drinking. This is disturbing, as females who binge drink do so at
almost the same rate as their male counterparts. This further
corroborates the documented increasing hazardous drinking
rate among South African women.7 Women are more vulnerable
to many adverse consequences of alcohol use than men. Also,
women have a greater likelihood of developing organ damage
and trauma related to alcohol than men.42 With the current
ongoing increase in hazardous drinking among women, there is
a need for prompt interventions to reduce this adverse behaviour
among South African women. Participants aged 36 to 45years
and those who currently smoke had a higher intensity of binge
drinking. This nding among current smokers is expected.
Nicotine is believed to reduce the intoxicating eects of alcohol,
which will likely prompt individuals seeking this eect to drink
more.22,41 Finally, middle-aged individuals are likely to have more
disposable income, which improves their purchasing power and
enables them to increase their intensity of binge drinking.
As such, the nding concerning the frequency and intensity of
binge drinking in our sample could only be compared with
studies elsewhere. The frequency and intensity of binge drinking
in this present study is higher than the reported frequency and
intensity among US adults, with 4.1 episodes and 7.7 drinks,
respectively.9 This nding substantiates the documented
hazardous pattern of drinking reported among South Africans.7
Considering the detrimental eect of high frequency and
intensity of binge drinking on health-related quality of life, there
is a need to intensify eorts to reduce this unhealthy lifestyle
behaviour among adults in Bualo City Metropole. Health
education of patients attending healthcare facilities on these
harmful behaviours should also be prioritised in the district.
Additionally, male participants had a higher frequency of binge
drinking. Harmful alcohol use has been reported to be higher
among this group23 and, as such, the higher frequency of binge
drinking found among them is not surprising. However, no
Table 4: Distribution of mean frequency of binge drinking by socio-
demographic variables using ANOVA
Variables nMean SD p-value
Age (years):
18–25 45 4.8 4.5
26–35 45 5.6 4.9
36–45 24 6.8 2.5
46–55 25 4.6 4.0 0.393
56–65 8 6.2 2.9
Above 65 3 4.7 0.6
Sex:
Male 77 6.4 5.2 0.002
Female 73 4.3 2.4
Level of education:
No formal schooling 27 4.6 1.2
Grade 1–7 14 5.5 3.6
Grade 8–12 89 5.9 4.9 0.226
Tertiary 20 4.0 3.0
Marital status:
Never married 122 5.4 4.3 0.893
Ever married 27 5.5 4.0
Smoker:
Yes 66 5.9 4.7 0.154
No 84 4.9 3.7
Income categories (Rand):
No income 73 5.3 5.3
150–2000 32 4.9 2.7
2001–5000 38 5.5 3.0 0.658
Above 5000 7 7.1 2.6
Employment status:
Government 9 6.1 2.5
Non-government 47 5.7 2.7
Self-employed 9 7.8 9.7 0.427
Student 23 4.9 4.3
Unemployed 60 4.8 4.0
Retired 3 6.5 2.1
Table 5: Distribution of mean intensity of binge drinking across socio-
demographic variables using ANOVA
Variable nMean SD p-value
Age (years):
18–25 45 11.9 7.7
26–35 45 15.7 12.5
36–45 24 16.0 9.2 0.042
46–55 25 10.0 6.0
56–65 8 15.8 8.2
Above 65 3 4.7 0.6
Gender:
Male 77 13.8 8.8 0.653
Female 73 13.1 10.5
Level of education:
No formal schooling 27 11.5 10.0
Grade 1–7 14 11.6 5.4
Grade 8–12 89 14.2 10.3 0.539
Tertiary 20 13.6 8.2
Marital status:
Never Married 122 14.2 10.0 0.893
Ever married 27 9.9 7.1
Smoker:
Yes 66 13.9 10.8 0.037
No 84 13.0 8.6
Income categories (Rand):
No income 73 12.6 10.2
150–2000 32 12.7 10.0
2001–5000 38 15.1 8.6 0.493
Above 5000 7 16.1 9.0
Employment status:
Government 9 13.4 8.1
Non-government 47 13.5 7.6
Self-employed 9 18.1 15.0 0.741
Student 23 14.0 8.5
Unemployed 60 12.5 10.8
Retired 3 13.0 9.9

Adult binge drinking: rate, frequency and intensity in Bualo City Metropolitan Municipality, South Africa 51
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Strength and limitations
Although a standardised procedure and questionnaire was
utilised in this study, the limitations of this study cannot be
ignored. The study was conducted in the health facilities, and
utilised a cross-sectional design and self-reporting of lifestyle
behaviours. The convenience sampling used in this study might
have introduced some bias, thus the rate reported cannot be
generalised to the entire BCMM population. Also, it is possible
that sampling patients from 18years of age might have led to
under-reporting of the prevalence of binge drinking in the
setting as binge drinking has been reported to be higher among
adolescents and young adults. However, given the scarcity of
information about the frequency and intensity of binge drinking
in the Eastern Cape Province of South Africa, the study provides
a snapshot of the magnitude of this particular lifestyle behaviour,
which is a public health concern in South Africa. Anecdotal
evidence has linked high binge drinking with morbidity and
mortality in South Africa, including the Eastern Cape. The
relatively large sample size of the study gave credence to the
ndings of this study. In addition, this study provided useful
epidemiological data on binge drinking, the ndings of which
could assist district health managers in crafting eective
interventions at the primary health care level across the district
to help individuals reduce their level of alcohol consumption to
the barest minimum for better healthy living.
Conclusion
There is an alarmingly high prevalence of binge drinking among
the study participants, and those who binge drink tend to do so
frequently and at a high intensity. Also, increasing harmful
alcohol use was found among the women. There is a need for
multilevel interventions to target high-risk drinkers and to create
awareness in the general population on the problems associated
with hazardous drinking. Finally, primary health care practitioners
and district health managers should prioritise awareness
creation, screening and implementation of prevention strategies
for harmful alcohol use, particularly among young adults.
Acknowledgements – The authors are grateful to the National
Research Foundation and the Health and Welfare Sector
Education and Training Authority, South Africa for funding the
study. They also acknowledge all the patients who took the time
to participate in this study.
Conicts of interest – The authors declare that they have no
conicts of interest.
ORCID
Oladele Vincent Adeniyi http://orcid.org/0000-0003-0216-
6701
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