Alcohol consumption among tertiary students in the Hohoe municipality, Ghana: analysis of prevalence, effects, and associated factors from a cross-sectional study

Alcohol consumption is an integral part of many cultural, religious, and social practices worldwide [1, 2]. However, in recent years, the volume and risky pattern of consumption pose a significant public health threat to the consumer, family, friends, and the larger society [3‐5]. Harmful alcohol consumption results in health, social, and economic burden on both the individual and others in both immediate and distal environments [4].

Alcohol is a commonly used substance among the youth in tertiary institutions [5, 6]. In many instances, alcohol serves as a gateway to the usage of other psychoactive substances [6]. Tertiary education is a transitional period characterized by autonomy or independence from family control, and self-decision making, academic pressures, forming social groups, and sharing living quarters with new students with diverse cultural values [5, 7‐9], and peer influence [9‐13]. Other factors shown by researchers to predispose students to alcohol consumption include; ease of availability and accessibility of alcohol [14], academic pressures [12, 15], family member use of alcohol [8], and psychological distress [3, 16]. These features of tertiary institutions’ environment elsewhere are synonymous with those in the Ghanaian setting [17].

Globally, alcohol consumption is the leading causal factor for the overall morbidity and mortality burden [18, 19]. Harmful alcohol consumption serves as a risk factor in over 200 diseases and injuries [4]. These diseases and injuries contribute to about 3million deaths annually, representing 5.3% of all mortality globally and 132.6 million (5.1%) disability-adjusted life years (DALYs) [2, 4]. About 13.5% of all mortality cases in young people aged 20–39 years were attributed to excessive alcohol consumption [2]. However, the association between alcohol consumption and its negative health implications remains complex and inconclusive given the protective effects of moderate alcohol consumption on the human body [19].

Alcohol consumption during the early years is associated with negative consequences such as alterations in attention, verbal learning, and memory, along with altered development of major parts of the brain [20]. These negative consequences subsequently lead to behavioural, emotional, social, and academic problems in later life [21]. Researchers have shown that harmful alcohol consumption leads to the development of cardiovascular diseases [18], cancer [22], liver diseases [23], hepatitis [24], risky sexual behaviours and sexually transmitted diseases [25, 26], mental and behavioural disorders, injuries, violence [2], and poor academic performance [27‐29].

Most countries in sub-Saharan Africa are experiencing rapid economic, social, and cultural transitions which have created an avenue for increased and socially disruptive use of alcohol [30]. Ferreira-Borges et al. [31] asserted that alcohol consumption and disease burden in Africa are expected to increase, but that policymakers have paid little or no attention to the issue of increasing alcohol consumption. Studies conducted in various parts of Africa reported a significant prevalence of alcohol consumption among tertiary students. For instance, reported lifetime and current prevalence of alcohol consumption ranged from 16.9 to 34.5% in Ethiopia [8, 9, 32], 31.1 to 78.4% in Nigeria [33, 34], 31.9% in Botswana [5], 50.7–63.2% in Kenya [35, 36], and 2.7% in Sudan [37].

Limited studies (example [17, 38]) have been conducted on alcohol consumption among tertiary students in Ghana. This makes it difficult to implement effective interventions due to the dearth of literature on the magnitude of alcohol consumption and its contributory factors. In Ghana, recent evidence showed that there has been an increase in the promotion, competition, and popularity of alcohol beverages in both the media and non-media sources [38]. These alcoholic beverages are considerably cheaper than soft drinks. As a result, young people (majority of which are students) tend to consume alcoholic beverages due to its accessibility and low cost [38]. Anecdotally, there has been an increased proliferation of drinking spots, night clubs, and alcoholic vending sites in the Hohoe Municpality. This has also resulted in easy accessibility to alcoholic beverages by students in the Hohoe Municipality. Hence, the present study sought to determine the prevalence of alcohol consumption and its associated factors among tertiary students in the Hohoe Municipality of Ghana. The findings are likely to inform the development of school-based programmes and interventions aimed at reducing alcohol consumption and promoting healthy lifestyles among students.

This study sought to determine the prevalence of alcohol consumption among tertiary students in the Hohoe Municipality of Ghana. We also assessed the factors associated with alcohol consumption and the perceived effects of alcohol among the consumers. We found that the overall lifetime and current prevalence of alcohol consumption among the students were 39.5% and 19.4% respectively. These findings are similar to that of Gebremariam et al. [32] who reported the lifetime and current alcohol consumption prevalence of 36.3% and 16.9% respectively among university students in Ethiopia. However, our prevalence rates were lower than some studies from Kenya [35], Nigeria [6, 33], and Ghana [17, 38]. For instance, the study conducted in Ghana reported an ever alcohol consumption prevalence of 56.3%, whiles current consumers were 25.8% [17]. Also, Hassan [36] found in Kenya that lifetime alcohol consumption was prevalent among 63.2% of tertiary students. The observed differences in prevalence could be because of the inclusion of two health tertiary institutions in the current study. These students from health institutions might be knowledgeable about the health implications of alcohol consumption hence the less consumption rate.

Our findings showed that the odds of alcohol consumption among the students increased with increasing age. Students aged 26 years and above were more likely to consume alcohol. This finding is consistent with results from a cross-sectional study conducted in China [42] and  Nigeria [33]. The finding also confirms the association between older age and alcohol consumption found in a study that used data from 24 different countries [43]. The plausible explanation of the finding could be that older students were more likely to access alcohol because they have passed the legal age of alcohol consumption [33]. Also, older age is associated with societal pressure, stress, and increased quest to achieve success and this could have increased their likelihood of resorting to consuming alcohol as a way of coping [33].

Consistent with previous literature from Ethiopia [7, 9] and Ghana [38], this study found that being a Muslim was associated with lower odds of alcohol consumption. This finding is not surprising as alcohol consumption is prohibited in the Islamic religion. It is against the religious doctrines as a Muslim to consume alcohol.

Also, the study found that peer influence was associated with higher odds of alcohol consumption. This finding corroborates studies from South Africa [13], Ethiopia [8, 9, 12, 15, 44] where peer influence was a significant predictor of alcohol consumption among tertiary students. Studies conducted in Ghana also reported similar findings [10, 11]. The social learning principle which emphasizes that individuals can learn bad behaviours from watching their peers [14] could explain the findings in the study. Also, as peers are important sources of social support and therefore, their pressure can be an enforcer for good and bad behaviour [14].

We found academic adjustment problems to be a significant predictor of alcohol consumption among the students. This finding is in line with previous studies which reported significant associations between students’ academic adjustment problems and alcohol consumption [12, 15, 45]. That is, the rate of alcohol consumption was higher among students with academic problems or those dissatisfied with their academic performance. Plausible factors that could explain the observed association include; difficulties in balancing academics with social life, low level of commitment towards the field of study, and course and assignment overload which could have predispose the students to consume alcohol.

Our study found a relatively high prevalence of alcohol consumption among tertiary students in the Hohoe Municipality. Almost half of lifetime alcohol consumers were current drinkers. Among the lifetime alcohol consumers, self-reported effects included stomach pains or upset, accident, unprotected sex, loss of valuable items, excessive vomiting, diarrhea, risk of liver infection, debt, and petty theft. Factors perpetuating alcohol consumption among the students were peer pressure, increasing age (26 years and above), and academic adjustment problems. Being a Muslim was protective against alcohol consumption. Regular alcohol assessment should be carried out in tertiary schools to help identify students with potential alcohol problems in order for appropriated and tailored psychosocial interventions. Students with poor academic performance and psychological distress should be counseled to help them cope with their challenges without resorting to alcohol consumption. Health education on alcohol consumption, the risk factors and its effects should be intensified especially in both health and non-health training institutions highlighting the short- and long-term consequences of alcohol and the role of peers in shaping their behaviour.