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Alcohol Consumption and Risky Drinking Patterns in Malaysia: Findings from

NHMS 2011

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DOI: 10.1093/alcalc/agu042 · Source: PubMed

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Alcohol and Alcoholism Vol. 49, No. 5, pp. 593–599, 2014 doi: 10.1093/alcalc/agu042
Advance Access Publication 11 July 2014

Alcohol Consumption and Risky Drinking Patterns in Malaysia: Findings from NHMS 2011
Mohd Hatta B. Abdul Mutalip1, *, Rozanim Bt. Kamarudin2, Mala Manickam1, Hamizatul Akmal Bt. Abd Hamid1
and Riyanti Bt. Saari1
1
Institute for Public Health, Ministry of Health Malaysia, JalanBangsar, 50590 Kuala Lumpur, Malaysia and 2Disease Control Divisions, Ministry of Health
Malaysia, Level 3, Block E10, Complex E, Pusat Pentadbiran Kerajaan Persekutuan, 62590 Wilayah Persekutuan Putrajaya, Malaysia
*Corresponding author: Tel.: +60322979400; Fax: +60322832050; E-mail: [email protected]

(Received 22 December 2013; first review notified 26 February 2014; in revised form 1 March 2014; accepted 18 June 2014)

Abstract — Aims: To identify the characteristics of current drinker and risky alcohol-drinking pattern by profiles in Malaysia.
Methods: We analyzed data from the National Health and Morbidity Survey 2011. It was a cross-sectional population-based with two
stages stratified random sampling design. A validated Alcohol Use Disorder Identification Test Malay questionnaire was used to assess
the alcohol consumption and its alcohol related harms. Analysis of complex survey data using Stata Version 12 was done for descriptive
analysis on alcohol use and risky drinking by socio-demography profiles. Logistic regression analysis was used to measure the associ-
ation of risky drinking status with the socio-demography characteristics. Results: The prevalence of current alcohol use was 11.6%
[95% confidence interval (CI): 10.5, 12.7], among them 23.6% (95% CI: 21.0, 26.4) practiced risky drinking. The onset for alcohol
drinking was 21 years old (standard deviation 7.44) and majority preferred Beer. Males significantly consumed more alcohol and prac-
ticed risky drinking. Current alcohol use was more prevalent among urbanites, Chinese, those with high household income, and high
education. Conversely, risky drinking was more prevalent among rural drinkers, Bumiputera Sabah and Sarawak, low education and
low household income. The estimated odds of risky drinking increased by a factor of 3.5 among Males while a factor of 2.7 among
Bumiputera Sabah and Sarawak. Education status and household income was not a significant predictor to risky drinking. Conclusion:
There was an inverse drinking pattern between current drinker and risky drinking by the socio-demography profiles. Initiating early
screening and focused intervention might avert further alcohol related harms and dependence among the risky drinkers.

INTRODUCTION drinking such as irregular excessive drinking to heavy episodic

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drinking are widespread across the population and not merely
In 2011, the World Health Organization estimated that there exhibited by abusive or dependence drinkers (Woerle et al.,
were ~2 billion people worldwide consuming alcohol bev- 2007; Neumark, 2012). Initiating early population-based ap-
erages and 76.3 million had an alcohol use disorder (WHO, proach may avert the severity of hazardous drinking in commu-
2011). Alcohol problems exist on a continuum of severity nity that might reduce the cost of hospitalization and palliative
ranging from social drinker to alcohol dependence. The detri- care caused by alcoholism (Room et al., 2005).
mental effects of alcohol use to health may not associated only For a better feasible intervention, it is important to identify
with the total volume of consumption or drinking frequency— the high-risk population by examining the pattern of alcohol
in fact irregular heavy drinking has been proven to cause harm consumption by socio-demographic factors that could impart
to the drinker (Rehm et al., 2003; Room et al., 2005). information on lifestyles and health outcomes due to their
Consuming higher volume of alcohol may increase the risk drinking (Oers et al., 1999). Few studies had reported socio-
of non-communicable diseases such as cancer, coronary heart demography factors such as age, gender and socio-economic
disease and intentional injury (Room et al., 2005). Alcohol also status were associated to drinking problems (Oers et al., 1999;
causes harm to developing fetus, psychiatric morbidity; includ- Thomkins et al., 2007; Wu et al., 2008a; Assanangkornchai
ing depression, anxiety and suicides (WHO, 2011; Petrakis et al., 2010) and their findings were useful in providing infor-
et al., 2002). Though the per capita consumption of alcohol mation for focused intervention at their respective communities.
varies widely around the world, the burden of disease and death Therefore, this study was carried out to obtain insight infor-
remains significant in most countries (Hagmann, 2001). mation pertaining to the patterns of alcohol consumption and
In Malaysia, alcohol-drinking estimates of 5-year change in risky drinking in relation to socio-demography characteristics
recorded adult aged 15 years and above per capita consump- among the population in Malaysia. We would also like to
tion have been classified as stable (WHO, 2011) and Malaysia examine the preference for types of alcohol beverages and
was classified under low consumption with high percentages adverse effects that associated with drinking use among the drin-
of past year abstainers. Strikingly, recent study reported one in kers. This information is essential to estimate the magnitude and
two of current drinkers in Malaysia engaged with harmful trends of alcohol-related harms, strengthening the advocacy, for-
drinking pattern like binge drinking habit that is alarming mulating policy and assess the impact of existing intervention.
(Mutalip et al., 2013). Perhaps the most worrisome is
the factors of access, price and availability of alcohol in the
market that potentially affect risky drinking pattern as the METHODOLOGY
cheapest bottle of high alcoholic content like Samsu (local
alcoholic beverage) costs as little as RM 1.50, equivalent to Data source and sample
US 0.36 per bottle and easily available at local convenient Data was obtained from the National Health and Morbidity
stores (GAPA, 2001). Survey (NHMS) 2011, a cross-sectional population-based
Presently in Malaysia, primary health care and hospital-based study conducted between the period of April 2011 to July
setting focus on intervention and treatment among drinkers 2011. The study employed two stages stratified random sam-
diagnosed with alcohol abuse and dependence. In fact, harmful pling design with a proportionate allocation across the stratum.

© The Author 2014. Medical Council on Alcohol and Oxford University Press. All rights reserved
594 Mutalip et al.

Details of the methodology were provided in the report cider, champagne, peri, tuak, tuak kelapa, lihing or todi, with
(IPH, 2011). alcohol content between 10 and 25%, and category 4 = Brandy
All eligible households aged 13 years and above who con- includes rum, whiskey, vodka, gin, samsu, samcheng, montoku
sented to participate were included in the NHMS study. For or langkau with alcohol content >30%. Harmful effects due to
the purpose of this study, we included all respondents who alcohol use were examined include feeling of remorse, blackout
reported consumed alcohol for the past 12 months prior to and self-inflicted injury or causing injury to others.
data collection. The NHMS 2011 study protocol was approved
by the Medical Review and Ethics Committee (MREC), Data analysis
Ministry of Health Malaysia.
Analysis of complex sample design was incorporated in this
study including weights and stratification using Stata 12 soft-
Instruments ware (Stata Corporation).
A structured and validated Malay version of Alcohol Use A descriptive analysis for continuous variables was carried
Disorder Identification Test (AUDIT-M) questionnaire was out to observe the estimated mean of drinking onset among all
used in this study and was adopted from AUDIT questionnaire respondents by sex. Bivariate categorical analysis was done to
designed by the WHO that has been published elsewhere calculate estimated prevalence of alcohol consumption and
(Saunders et al., 1993; Allen et al., 1997; Babor et al., 2001). risky drinking by the socio-demography characteristics.
The AUDIT-M has been translated into three languages in- A multiple logistic regression analysis of survey data were
cluding Bahasa Malaysia, Mandarin and Tamil. The Bahasa utilized to assess the association between categorical depend-
Malaysia translation has been back translated and cross- ent variable of risky drinking with the independent variables
culturally validated (Pearson’s correlation, r = 0.94, Cronbach of potential socio-demographic characteristics, i.e. strata, sex,
α = 0.84), while the Mandarin version was adapted from the ethnicity, education level and household income.
validated Chinese study (Wu et al., 2008b). Respondents were Preliminary bivariate association analyses were done includ-
provided with a codebook that illustrated one standard drink of ing Rao-Scott F-Tests to assess the association of risky drinking
alcoholic beverage that contains 10 g of pure alcohol (KKM, with the individual selected socio-demography characteristic
2010). Score was given to respondent who completed their variables. All significant independent variables that associated
AUDIT-M. For the purpose of this study, two classifications with risky drinking at P-value <0.25 were selected for main

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were used namely low risk (score = 1–7) or risky (AUDIT-M effects in multivariate logistic regression. Adjusted Wald test
score = 8–40). was utilized to evaluate the contribution of each selected inde-
pendent variables in multivariate logistic model. A diagnostic
testing for the goodness of fit was done to ensure the fit of the
Measures and definition of variables logistic regression model for all selected parameters with the
All independent variables in categorical included socio- risky drinking status. Interactions were assessed to ensure any
demography and alcohol use variables. Socio-demography interactions might scientifically relevant among the independent
variables include residency either urban or rural, sex, ethnicity variables that may affect the model in term of multi-collinearity.
comprised Malay, Chinese, Indian, Bumiputera Sabah and A final model that was created includes all those predictors,
Sarawak (Borneo natives), and 16 other ethnicities grouped in which were significantly associated with risky drinking at the
‘Others’. Education attainment includes those who never attended level of P-value <0.05.
school was grouped ‘No formal education’, followed by primary
education, secondary education and tertiary education. Household
income status includes low income with household income less RESULTS
than RM 2600, middle income with household income ranging
from RM 2600 to RM 5599 and high income with household Response rate
income greater than RM 5600 per month. In total, 21,011 respondents were eligible to participate in this
study and there were 99.3% (n = 20,869) had responded.
Alcohol use data variables Among them, there were 86.7% (n = 18,073) reported did not
consume alcohol and 8.4% (n = 1,759) respondents consumed
Prior to data collection, all respondents who consumed alcohol
alcohol for the past 12 months prior to data collection. Among
beverages for the past 12 months were defined as current
the past year drinkers, there were only 96.2% (n = 1692) had
drinker. The ex-drinker was among those who had stopped
completed their AUDIT-M questionnaire and was given a score
drinking alcohol beverages for the past 12 months. Ever-drinker
while 0.7% (n = 181) were excluded and not given score for
was among those who had history of alcohol consumption at
their drinking status due to incompleteness. There were 4.9%
least once in their lifetime, and lifetime abstainer was defined
(n = 1,037) ex-drinker were also excluded for the purpose of
among those who never consumed alcohol beverages in their
this study.
lifetime.
Frequency of drinking was measured by how much drink
they drank for the past 12 months with a possible categorical Socio-demography characteristics of respondent
answer (1) = once in a month, (2) = 2–4 times a month, Majority of respondents (71.3%) resided in urban areas and
(3) = 2–3 times a week or (4) = 4 or more times a week. 51.5% were males. The population consisted of the following
The types of alcohol beverages were grouped according to ethnicities: 50.5% Malays, 24.9% Chinese, 7.0% Indian,
the percentage of alcohol content. Category 1 = Shandy with 11.1% Bumiputera Sabah and Sarawak, and 6.4% other ethni-
alcohol content <2%, category 2 = Beer includes Lager, Ale, or cities. By education level, majority of respondents had com-
Stout, with alcohol content <9%. Category 3 = Wine, includes pleted secondary education (45.4%), followed by primary
 Alcohol consumption and risky drinking patterns in Malaysia 595
Table 1. Baseline socio-demographic characteristics of the current drinker in Malaysia

Current drinker Risky drinker

SCD characteristics n N Prevalence (%) n N Prevalence (%)

Malaysia 1759 2,394,204 11.6 (10.5, 12.7) 395 540,888 23.6 (21.0, 26.4)
Location
Urban 1144 1,887,084 12.6 (11.3, 14.0) 236 391,518 21.8 (18.9, 24.9)
Rural 615 507,119 8.9 (7.3, 10.9) 159 149,369 30.4 (24.9, 36.5)
Sex
Male 1314 1,815,499 17.2 (15.6, 18.9) 364 493,367 28.3 (25.3, 31.5)
Female 445 578,705 5.7 (4.9, 6.6) 31 47,521 8.7 (5.3, 13.9)
Ethnicity
Malay 71 89,354 0.9 (0.6, 1.2) 24 26,774 31.5 (20.6, 44.8)
Chinese 966 1,416,402 27.5 (25.2, 30.0) 137 220,247 16.4 (13.5, 19.8)
Indian 255 272,440 18.8 (15.7, 22.3) 65 76,956 29.8 (22.1, 38.8)
Bumiputera Sarawak and Sabah 360 466,266 20.3 (16.8, 24.3) 136 170,879 37.4 (31.1, 44.3)
Others 107 149,743 11.3 (7.7, 16.1) 33 46,031 30.9 (21.0, 42.9)
Education attainment
No formal education 107 130,797 7.7 (5.6, 10.5) 20 25,672 20.9 (12.6, 32.6)
Primary education 388 460,830 9.4 (8.1, 10.9) 94 109,753 25.2 (19.9, 31.3)
Secondary education 855 1,160,078 12.0 (10.7, 13.4) 228 328,261 29.4 (25.2, 33.9)
Tertiary education 401 635,858 15.0 (12.8, 17.4) 53 77,201 12.7 (9.2, 17.2)
Household income
Low income 606 740,044 8.4 (7.3, 9.7) 165 203,505 28.4 (23.6, 33.7)
Medium income 710 974,245 12.0 (10.5, 13.7) 159 217,407 23.7 (19.8, 28.2)
High income 443 679,913 18.1 (15.4, 21.2) 71 119,974 18.2 (14.1, 23.2)
Age
13–17 83 121,053 4.2 (3.3, 5.6) 17 303,305 26.8 (15.9, 41.5)
18–29 504 866,650 14.0 (12.2, 16.0) 142 220,300 26.4 (21.4, 32.0)
30–39 418 568,060 14.5 (12.8, 16.5) 94 126,364 23.1 (18.4, 28.7)
40–49 354 435,155 13.2 (11.3, 15.4) 80 98,166 23.3 (18.3, 29.2)

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50–59 250 244,664 10.5 (8.8, 12.4) 39 40,180 17.9 (12.6, 24.7)
≥60 150 158,621 7.7 (6.2, 9.5) 23 25,572 16.9 (10.7, 25.5)

education (26.5%), tertiary education (18.5%), and those who attainment. Similar patterns were exhibited by the household
had no formal education (9.7%). Majority of respondents income status.
came from low-income family (42.5%), middle income Those aged between 18 and 39 years old showed the
(39.3%) and high income (18.2%). highest prevalence of alcohol consumption than the other age
groups and the pattern declined by the advanced age. Elderly
was more common with low risk drinking but young adults
were prevalent to risky drinking.
Prevalence of alcohol use and risky drinking status
The prevalence of lifetime abstainer was 81.7% (95% CI: Onset age for alcohol drinking
80.3, 83.1) and ever-consumed alcohol was 17.8% (95% CI:
16.4, 19.2). Meanwhile, the prevalence of current drinker was The onset age for alcohol drinking was 21 years old (SD 7.4).
11.6% (95% CI: 10.5, 12.7) and ex-drinker was 6.1% (95% Male was significantly more likely to drink earlier at age of
CI: 5.5, 6.7). Among the current drinker, 23.6% (95% CI: 20.3 [95% CI: 19.9, 20.7] than female (21.9, 95% CI: 21.3,
21.0, 26.4) had practiced risky drinking. 22.6).
As demonstrated in Table 1, the prevalent of current drinker
was significantly higher among the urbanites than in rural. Alcoholic beverages commonly consumed
Despite low alcohol consumption in rural, they were more Overall beer (59.7%, 95% CI: 56.8, 62.6) was the most pre-
likely to practice risky drinking. As for sex, males consumed ferred drink in Malaysia, followed by Wine (16.9%, 95% CI:
more alcohol than females and concurrently practiced risky 14.6, 19.3), Shandy (13.3%, 95% CI: 11.3, 15.5) and Brandy
drinking. (10.1%, 95% CI: 8.3, 12.2). Males and females showed
By ethnicity, Chinese were more prevalent with alcohol use similar favoritism to beer compared with other alcoholic
followed by Bumiputera Sabah and Sarawak, Indian and other beverages.
ethnicity while Malays were the least. Conversely Chinese Majority of those who practiced risky drinking preferred
were the least who practiced risky drinking, therefore, risky Beer (64.3, 95% CI: 58.1, 70.0) followed by Brandy 15.6%,
drinking was more predominant among the Bumiputera Sabah 95% CI: 11.3, 21.2), Wine (13.0%, 95% CI: 9.5, 17.6) while
and Sarawak, Malays and Other ethnicity. Shandy was the least preferred (7.1%, 95% CI: 3.9, 12.6).
By education attainment, those with tertiary education were
more prevalent to alcohol use. The drinking pattern declined
from those with higher to lower education attainment. In con- Amount consumed and drinking frequency
trast, those with at least secondary education were more preva- More than half of current drinkers drank at least once a month
lent to risky drinking followed by the lower education or less (62%, 95% CI: 58.6%, 65.4%) and the prevalence of
596 Mutalip et al.

than other neighboring countries like Singapore (74.8%) and

Thailand (61.9%) (DEDC, 2007; Assanangkornchai et al.,
2010) and these drinking pattern might differ due to socio-
cultural factors exhibited by the drinkers from each of the
countries (Bloomfield et al., 2003). As the Malays were the
major respondents in this study, they had diluted the preva-
lence of alcohol use due to alcohol-drinking restrictions by
their religion.
However, when comparing lifetime abstainers in Malaysia
with other countries populous by the Muslims, Malaysia had the
lowest lifetime abstainers (81.7%) compared with Bangladesh
(93.6%) and Indonesia (84.3%) (WHO, 2011). Higher abstin-
ence in Bangladesh was due to their country’s policy on strict
prohibition of production, sale and consumption of alcoholic
beverages that prevent accessibility and alcohol use in their
population (GAPA, 2001).
Fig. 1. Drinking frequency by male and female. In this study, the urbanites drank more alcohol than rural resi-
dents and the pattern remain unchanged for the past 5 years
(IPH, 2008). Higher alcohol use in urban is associated with
drinking at least 4 or more times a week was low (5.5%, 95% living status and social activity as reported in few studies (Wu
CI: 4.2%, 7.2%). In overall, males consumed alcohol more et al., 2008a; Peltzer and Ramlagan, 2009; Assanangkornchai
frequently than females as per illustrated in Figure 1. et al., 2010).The widespread of alcohol marketing, affordability
and accessibility to drinking outlets have influenced more urba-
Adverse effects nites to drink (Room, 1990; WHO, 2001; Wu et al., 2008a).
In contrast, alcohol use in rural was lower than urban but
Most of the current drinkers were ever advised on their drink-
rural drinkers exhibited higher prevalence of risky drinking.
ing while ever experienced injury or self-inflicted injury due
Excessive drinking in rural was related to the availability of

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to alcohol drinking was the least. Males were getting more
homemade alcohol production that induced risky drinking
alcohol-related problems than females as per illustrated in
(Room, 1990; ADCA, 2011). It was denoted that excessive
Table 2.
drinking in rural has become a community acceptance that
was associated with their poor awareness on adverse alcohol
Multivariate analysis to predict socio-demography as use (ADCA, 2011).
associated potential predictors to risky drinking Differences in drinking by ethnicity background have been
From the Table 3, potential predictors like sex and ethnicity associated with religious beliefs and cultural practices espe-
(excluding the Malays) had a significant relationship with the cially among the drinkers in Asia (Bich et al., 2009). This
risky drinking after adjusting for the relationships of all other study found high consumption of alcohol among the Chinese
potential predictors at P < 0.05. that also contributed to a higher prevalence of alcohol use as
Males significantly had higher odds of 3.5 times to risky noted among the urbanites. As for Indians, similar pattern
drinking than females after adjusting the effect of strata, ethni- was observed from previous study where alcohol use and risky
city, education level and household income. Ethnicity was sig- drinking among them was low (IPH, 1999, 2008). However,
nificantly associated with risky drinking where Bumiputera this does not imply that the Indian drinkers at lower risk
Sabah and Sarawak had the highest odds of 2.7 followed by because it was noted they were inclined for cheap alcohol bev-
other ethnicity with the odds of 2.1 higher than Chinese rela- erages with high alcohol content (GAPA, 2001) and majority
tively. Indian had odds of 1.7 higher than Chinese relatively of alcohol dependence cases at hospital were predominant by
after adjusting for all the other covariates, however the Malays the Indians (IPH, 1999).
showed no significant association with risky alcohol use. The high-risk group for alcohol consumption was clearly
Strata, education level and household income did not show observed among the Bumiputra Sabah and Sarawak where
any significant association with risky alcohol use. alcohol drinking is socially acceptable in their community that
attributable to their cultural background (IPH, 1999). Alcohol
is easily available especially during festive seasons because
DISCUSSION they tend to produce homemade alcohol beverages with high
alcohol content (IPH, 1999; GAPA, 2001). Alcohol use
For the past 5 years, there was no significant change to the among the Malays is uncommon and they were the least to
prevalence of current alcohol use despite slight increased from consume alcohol due to religion restrictions. Strikingly, the
11.1% in 2006 to 11.6% in 2011 (IPH, 2008). This study is Malays drank hazardously and the pattern has remained un-
not comparable to a study in NHMS 1996 because the alcohol changed from previous study (IPH, 2008). It is also proven
use module only included nonMuslim respondents aged 18 that irregular drinking pattern among the Malays induced
years old and above (IPH, 1999). heavy drinking and this behavior of drinking was similarly
In comparison to other Asian country, the prevalence for reported among those irregular underage drinkers in Thailand
current alcohol use status in Malaysia was still lower than (Assanangkornchai et al., 2010).
Thailand (28.6%) (Assanangkornchai et al., 2010). As ex- This study found gender differences on alcohol consump-
pected, the prevalence of abstinence in Malaysia was higher tion where males were predominant than females, which is
 Alcohol consumption and risky drinking patterns in Malaysia 597
Table 2. Associated adverse effects due to alcohol consumption by sex

Drinking problems National Male Female P-value

Feeling of remorse/guilt after drinking 13.10% (11.0, 15.5) 15.50% (12.8, 18.2) 5.20% (1.8, 8.7) P < 0.001a
Blackout 15.70% (13.1, 18.8) 18% (14.9, 21.6) 6.60% (3.5, 12.2) P < 0.001a
Injury to self or others 3.70% (2.7, 5.0) 4.70% (3.2, 6.2) 0.50% (−2.3, 1.2) P < 0.001a
Advice on drinking 27.30% (24.4, 30.3) 32% (28.5, 35.6) 12.2 (7.9, 16.5) P < 0.001a
a
Significance at P < 0.05.

Table 3. Estimates of crude and adjusted odd’s ratios for the risky drinking outcome (n = 1,684, n = 2,284,554)

Simple logistic regression Multiple logistic regression

Variable Category b Crude OR (95% CI) P b Adjusted OR (95% CI) P

Strata Urban – 1 – – 1 –
Rural 0.452 1.571 (1.125, 2.193) P = 0.008a −0.136 0.873 (0.576, 1.322) P = 0.521
Sex Male 1.422 4.144 (2.422, 7.092) P = < 0.000a 1.266 3.546 (2.111, 5.954) P = 0.000a
Female – 1 – – 1 –
Ethnicity Malay 0.851 2.341 (1.252, 4.373) P = 0.008a 0.590 1.805 (0.909, 3.583) P = 0.091
Chinese – 1 – – 1 –
Indian 0.770 2.160 (1.353, 3.447) P = 0.001a 0.544 1.722 (1.081, 2.745) P = 0.022a
Bumiputera Sabah and Sarawak 1.114 3.048 (2.111, 4.399) P = 0.000a 1.008 2.741 (1.768, 4.250) P = 0.000a
Others 0.823 2.277 (1.302, 3.982) P = 0.004a 0.758 2.135 (1.143, 3.988) P = 0.017a
Education level No formal education – 1 – – 1 –
Primary education 0.248 1.282 (0.584, 2.814) P = 0.535 0.408 1.504 (0.640, 3.535) P = 0.348
Secondary education 0.459 1.582 (0.773, 3.239) P = 0.209 0.712 2.038 (0.920, 4.514) P = 0.079
Tertiary education −0.590 0.554 (0.255, 1.204) P = 0.136 −0.080 0.923 (0.385, 2.212) P = 0.857
Unclassified 0.203 1.020 (0.294, 3.537) P = 0.974 0.192 1.212 (0.384, 3.822) P = 0.742

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Household income Low income 0.574 1.775 (1.198, 2.631) P = 0.004a 0.0679 1.070 (0.656, 1.747) P = 0.785
Medium income 0.333 1.396 (0.946, 2.058) P = 0.092 −0.062 0.940 (0.615, 1.437) P = 0.774
High income – 1 – – 1 –

Adjusted Wald Test for all parameters: F(12, 434) = 7.08 P < 0.001.
Reference categories for categorical predictors are: strata (urban); sex (female); ethnicity (Chinese); education level (no formal education; household income
(≥RM 5600)
a
Significance at P < 0.05.

consistent with other studies (WHO, 2001; Almeida-Filho disorder in later life (Kraus et al., 2000; Hingson et al., 2006;
et al., 2004; Lim et al., 2007; Saarni et al., 2008; Bich et al., Gomez et al., 2011). Several countries reported early onset for
2009; Assanangkornchai et al., 2010). Males also more prone alcohol drinking as early as 16 years old and below (Kraus
to risky drinking practice and simultaneously took alcohol et al., 2000; Pitkanen and Lyyra, 2005). Conversely, this study
more frequent and experienced more alcohol related problems reported a drinking onset later as early as 21 years old and as
(Almeida-Filho et al., 2004; Hao et al., 2004; expected, males more likely to drink earlier than females.
Assanangkornchai et al., 2010). Study revealed place of drink- Similarly with other studies, current alcohol drinking was
ing signify the differences of alcohol drinking among males more prevalent among those aged 30 to 39 years old and the
and females (Assanangkornchai et al., 2010). Males drink fre- pattern increased from aged 18 to 29 years old and declined as
quently at bars or friend’s house (Assanangkornchai et al., advanced age (McKee et al., 2000; Hao et al., 2004; Lim
2010) that linked to their socializing and networking activity et al., 2007). However, risky drinking pattern was prevalent
(Wu et al., 2008a). Males also found to drink more at their among those aged 29 years old and below that is noted with ir-
workplace (Assanangkornchai et al., 2010) when they were regular drinking habit leading to excessive consumption of
occupationally stress (Almeida-Filho et al., 2004). Females alcohol (Assanangkornchai et al., 2010).
tend to abstain themselves from alcohol due to cultural restric- This study revealed an antipodes-drinking pattern by the
tions (WHO, 2001; Assanangkornchai et al., 2010) and typic- socioeconomic status such as household income status and
ally they might drank occasionally at home or at parties education attainments. Current drinking pattern peaked among
(Assanangkornchai et al., 2010). Despite lower prevalence of those with high income and high education attainments while
alcohol consumption, females tended to drink more frequent in contrary, risky drinking pattern was prevalent among those
when compared with other types of risky drinking (Lim et al., with low household income and low education attainments.
2007) and younger females prone to drink more and get drunk Previous study in Malaysia reported similar findings where
as cultural changes by time in Thailand (Assanangkornchai alcohol consumption has positive relationship with the in-
et al., 2010). crease of income (IPH, 1999). Other study revealed that educa-
There is evidence suggesting that the age of onset played a tion attainment was significantly correlated with risky
significant predictor to lifetime alcohol related problems drinking habit whereby those with lower education attain-
(Kraus et al., 2000) and early drinking may cause alcohol ments reported at risk for heavy drinking compared with those
598 Mutalip et al.

with high education attainments (Thomkins et al., 2007; Bich CONCLUSION

et al., 2009). Low self-esteem, insecure feeling and lack of
economic and social stability were factors that induced risky Alcohol consumption was higher in urban but the risky drink-
drinking among those with low education attainment ing pattern widespread in rural. Males, Bumiputera Sabah and
(Thomkins et al., 2007). Sarawak were prevalent for alcohol consumption and at risk
In this study, majority drinkers preferred Beer than any for risky drinking. Risky drinking was also more predominant
other beverages as Beer is easily available at the markets com- among lower socio-economic groups despite lower consump-
pared with other alcoholic beverages (GAPA, 2001). In tion. Early screening and focused intervention is necessary to
Malaysia, beer and stout are sold together with soft drinks at prevent prolong drinking and severe alcohol dependence that
supermarkets without requirement for license, and it is the could burden the cost of treatment and medical care.
most commonly served at most coffee shops (GAPA, 2001)
compared with other alcoholic beverages like Wine that are Acknowledgements — The authors are grateful to the Director General of Health in
limited and served at selected licensed premises and bars. Malaysia for allowing us to publish the findings of this study.
Those with risky drinking pattern also had preference for beer Conflict of interest statement. None declared.
and high alcohol content like brandy. Risky drinker with
alcohol dependence problem usually has preference for high
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