Harmful life style practices and associated factors among fishermen in Cuddalore district, Tamil Nadu: a cross sectional study

INTRODUCTION

Tobacco and alcohol consumption are considered as significant public health challenges. The consumption of these two substances in India remains relatively high.¹ Tobacco use continues to be the leading global cause of preventable death. Tobacco kills nearly 6 million people and causes hundreds of billions of dollars of economic damage worldwide each year.² Global adult tobacco survey (GATS) India revealed that more than one-third (35%) of adults in India use tobacco in some form or the other.³ The harmful use of alcohol is one of the leading risk factors for population health worldwide and has a direct impact on many health-related targets.⁴ The Lancet found that alcohol was the third main risk factor for death and reasonable for 5.5% of disability-adjusted life years lost globally, i.e., 136 million years of life lost due to dying early or living with an alcohol-related disability.⁵

Fishing is not simply a job but it is a way of life with its own traditions and values.⁶ Many studies suggested, tobacco and alcohol consumption are higher in fishermen community. Fishermen community possesses unique characteristics of a folk society, since major portion of the life of fishermen is spent at sea with bizarre sleep and eating pattern difficult physical conditions, dislocation, isolation and prolonged working hours which could be the predisposing factors for smoking and alcohol consumption among fishermen community.⁷

In fishing occupation, fishers were exposed to health risk, both onshore and offshore. Many of these risks and associated health concerns extend to fishing families and wider communities also. Sociodemographic factors have known to play a crucial role in the initiation and continuation of drinking during early life among Fishermen.⁸

Fishing occupation holds inherent freedom and autonomy to decide, according to their experience in fishing, climate, need for money etc. As informal workers, they have autonomy to make decisions about their work, and responsible for providing their own tools and for all states of production which increase the chances of use of tobacco and alcohol at work place.⁹

The profession itself confers risk of accidents to workers, risk of injury, and others which may be potentiated by alcohol and tobacco consumption. Alcohol adversely affects multiple organ system of the body manifested as various health problems. A community-based study on coastal area of south Kerala showed that all organ systems were affected among the fisher men who consume alcohol as reported by the participants.¹⁰

The health risk involved in their work activities that were known to compromise the quality of life. The high morbidity and mortality associated with fishing activity, which could cause significant drain their income. The resultant poverty reduces health seeking behaviour of the community and causing more disease burden in the community.

Hence the identification of harmful practices and associated factors were required to prevent the morbidity and mortality among fishermen. Since limited studies were done among fishermen community, this study was planned to find out harmful life style practices and associated variables among fishermen community in Cuddalore district.

METHODS

Study design and area

A descriptive cross-sectional study was conducted among fishermen in Parangipettai, Cuddalore district in Annamalai University, Chidambaram. Tamil Nadu. for a period of 6 months (October 2021 to March 2022).

Sample size

This study is a part of dissertation work. The required sample size for the dissertation work was 266. However, 275 subjects were selected following Area cluster sampling method.

Inclusion criteria

Fishermen >18 years who venture into the sea for fishing were included.

Exclusion criteria

Fishermen >18 years, who didn’t give consent for the study were excluded.

Study procedure

The purpose of the study, was explained to the society leaders and individuals in the local language and their cooperation was sought. Written informed consent of the individual was obtained before initiating the data collection. The information pertaining to basic socio-demographic variables, detailed occupational history, health status of fishermen, tobacco consumption and alcohol intake were collected using pre-tested semi-structured proforma. This study was approved by institutional ethical committee of RMMCH, Annamalai University, Chidambaram. Tamil Nadu.

Statistical analysis

Data was entered in Microsoft excel and statistical analysis was done using statistical package for social sciences (SPSS) version 17. Chi-square test and stepwise logistic regression with backward LR tests were done to find the association between harmful lifestyle practices and selected variables among the fishermen.

RESULTS

In this study of 275 fishermen, 46.4% belonged to 31-45 years age group, 90.2% were Hindus, 25.1% were illiterate, 23.3% attained up to secondary level of education, 70.2% were married, 64.7% were lower middle class, majority 77.1% were lived in pucca house (Table 1).

*Others– separated/divorcee/widower; #others– ITI/diploma courses.

In this current study, among 275 fishermen, 111 (40.36%) fishermen consumed either tobacco or alcohol, 68 were cigarette smokers, 42 were tobacco chewers, 54 were alcohol consumers, 14 were both smoker and tobacco chewers, 30 were both smoker and alcohol consumer, 16 were both tobacco chewer and alcohol consumers, 7 were involved in smoking, tobacco chewing and alcohol consumption (Figure 1).

In the present study it was observed that, proportion of harmful life style practices were higher among fishermen aged more than 45 years (73.4%), those were separated or divorced or widower (60%), low per capita income per month (57.1%), illiterate (72.5%). All these socio demographic variables were statistically significant (p<0.001) with harmful life style practices among fishermen (Table 2).

In this study it was found that, proportion of harmful life style practices were higher among fishermen experienced more than 10 years (59.2%), who work less than a week per month (66.7%), used non-motorized boat (56.8%), own the boat (64.0%), those were not able to contact the family while at the sea (53.5%), those sleep less than 6 hours /day (67.5%). All these occupational related variables were significantly associated with harmful life style practices among fishermen (Table 3).

In this current study it was observed that, proportion of harmful life style practices were higher among those were diabetic (90.2%), hypertensive (74.6%), musculo skeletal disorder (44.2%) visual impairment (74.1%), hearing impairment (60.9%), obese (70.2%). All these health-related variables were significantly associated with harmful life style practices among fishermen (Table 4).

Further on stepwise logistic regression with backward LR, only variables such as diabetes, hypertension, sleep duration, boat ownership and income were found to be statistically significant with tobacco and alcohol consumption among fishermen.

Harmful life style practices were 9.5 times higher among hypertensive (p<0.001) (95% CI, (4.768- 8.938)), 5.5 times higher among diabetic (95% CI, (1.672-18.291), 3.6 times were higher among the boat owners (95% CI, 1.256-10.358)), 5.4 times higher among those sleep less than 6 hours per day (95% CI, 1.440-20.285)) and 2.6 times (95% CI, 1.228-5.813) higher among lower income group (Table 5).

Others – separated/ divorcee/ widower.

****Others- peeling/processing worker /net mending.

DISCUSSION

In this study it was found that 40.36% fishermen consumed either alcohol or cigarette or smokeless tobacco or both, 24.72% participants were cigarette smokers, 15.27% were tobacco chewers, 19.6% were alcohol consumers. Similarly, a study done in South India among fishermen community showed that, prevalence of consumption of tobacco, alcohol were 25.1% and 21.9% respectively.¹¹

In the present study, significant association found between diabetes, hypertension, boat ownership, sleep duration, income and harmful life style practices among fishermen.

In this current study, it was found that harmful life style practices were 9.5 times higher among hypertensive and 5.5 times higher among diabetic. Many cross-sectional studies among fishermen community showed the significant association between diabetic, hypertension and cigarette smoking, tobacco chewing, alcohol consumption.^7,12-14

In the present study proportion of harmful life style practices were 5.4 times higher among those had inadequate sleep (<6 hour). This study findings were similar to the findings were shown in A systematic review of the literature on night work and alcohol consumption by Richter et al.¹⁵ A study on correlation between shift-work-related sleep problems and heavy drinking in Japanese male factory workers showed that tobacco consumption was higher among those workers on shift basis.¹⁶

In this study, harmful life style practices were 2.6 times higher among lower income group. This study findings were similar to the study of use of tobacco and alcoholic beverages in a low-income coastal community in south India.¹⁷ Similarly a study on tobacco and alcohol use and dependence among workers in a fish processing factory in coastal Karnataka showed that alcohol and tobacco consumption were high among low income group.¹ This study findings were similar to the study of socioeconomic status and smokeless tobacco consumption in fishermen community of a coastal area of Karachi.¹⁸ In contrast to this study, a study on alcohol, harmful use and dependence: assessment using the WHO alcohol use disorder identification test tool in a south Indian fishermen community showed that there is no significant association between socio economic class and cigarette smoking, tobacco chewing, alcohol consumption among fishermen.

In our study it was noted that higher proportion of tobacco and alcohol consumption among boat owners. It’s probably due to the high affordability for tobacco and alcohol among boat owners.

Limitations

The information on alcohol and tobacco intake was self-reported one. Hence, there is a possibility of social desirability bias. The data on health status of fishermen were self-reported and there are chances of reporting bias.

CONCLUSION

Harmful lifestyle practices among fishermen found to be high, among the fishermen with poor health profile, less sleep and low income.

ACKNOWLEDGEMENTS

Authors would like to thank all study participants, all the faculty and staff of department of community medicine, RMMCH, Annamalai University.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

REFERENCES

1. 1. Kulkarni MM, Jacob GP, Praharaj SK, Vaddar T, Rajamohan M, Chaudhary AS. Tobacco and alcohol use and dependence among workers in a fish processing factory in coastal Karnataka. Int J Community Med Public Health. 2021;8(3):1337.
2. 2. World Health Organization. Compendium of WHO and other UN guidance on health and environment [Internet]. 2022 update. Geneva: World Health Organization. Available at: https://apps.who.int/iris/handle/10665/352844. Accessed on 20 September 2022.
3. 3. Global Adult Tobacco Survey India 2009-2010 Report. 2010. Available at: https://ntcp.nhp.gov.in/assets/document/surveys-reports-publications/Global-Adult-Tobacco-Survey-India-2009-2010-Report.pdf. Accessed on 20 September 2022.
4. 4. World Health Organization, UNAIDS. Integration of mental health and HIV interventions: key considerations. Geneva: World Health Organization. Available at: https://apps.who.int/iris/handle/10665/353571. Accessed on 20 September 2022.
5. 5. Maria Louis HS, Somasundaram AK, Swamynathan M, Vaikuntavasan DB. A Study on Prevalence of Alcohol Dependence in Coimbatore District. J Evol Med Dent Sci. 2020;9(32):2279-83.
6. 6. Parasuraman G, Mithrason AT, Jain T, Shilpa BP, Sivakumar K. A study on the morbidity profile among the fishermen community in Ennore Creek. Indian J Med Healthcare. 2015;4:10.
7. 7. Annadurai N, Balan N, Ranaganathan K. Non-communicable disease risk factor profile among Fishermen community in Kancheepuram. Int J Community Med Public Health. 2018;5(2):708-13.
8. 8. Halgar P, Anandi B, Indupalli A, Biradar S, Reddy S. Alcohol consumption and associated sociodemographic factors among medical students in an urban locality. Int J Med Sci Public Health. 2019;7(11):1.
9. 9. Müller J, Falcão I, Couto M, Viana W, Alves I, Viola D, et al. Health-Related Quality of Life among Artisanal Fisherwomen/Shellfish Gatherers: Lower than the General Population. Int J Environ Res Public Health. 2016;13(5):466.
10. 10. Catherine R, Bibiyana DB. Alcohol Consumption and Related Health Problems among fishermen A cross sectional study in southern coastal area of kerala. IOSR J Nurs Health Sci. 2020;9(6):1-5.
11. 11. Vaithiyanathan P, Thekkur P, C. K, Datta SS. Alcohol use, harmful use of alcohol and probable dependence among residents of a selected fishermen community in South India: A community based cross-sectional analytical study. Int J Community Med Public Health. 2018;5(2):520.
12. 12. Doddamani A, Ballala ABK, Madhyastha SP, Kamath A, Kulkarni MM. A cross-sectional study to identify the determinants of non-communicable diseases among fishermen in Southern India. BMC Public Health 2021;21(1):414.
13. 13. Muthukrishnan G, Pillai Uma SBK, V. AV. A cross sectional study of hypertension and their risk factors in fishermen of Chennai district. Int J Community Med Public Health. 2018;5(6):2464.
14. 14. Rane PP, Narayanan P, Binu V, Unnikrishnan B. Prevalence of Tobacco and Alcohol Consumption among Fishermen in Udupi Taluk, Karnataka, India: a Cross-Sectional Study. Asian Pac J Cancer Prev. 2016;17(4):1733-7.
15. 15. Richter K, Peter L, Rodenbeck A, Weess HG, Riedel-Heller SG, Hillemacher T. Shiftwork and Alcohol Consumption: A Systematic Review of the Literature. Eur Addict Res. 2021;27(1):9-15.
16. 16. Morikawa Y, Sakurai M, Nakamura K, Nagasawa SY, Ishizaki M, Kido T, et al. Correlation between Shift-work-related Sleep Problems and Heavy Drinking in Japanese Male Factory Workers. Alcohol. 2013;48(2):202-6.
17. 17. George A, Varghese C, Sankaranarayanan R, Nair MK. Use of tobacco and alcoholic beverages by children and teenagers in a low-income coastal community in south India. J Cancer Educ. 1994;9(2):111-3.
18. 18. Patoli S, Jabeen N, Masood RT, Butt AI. Socioeconomic Status and Smokeless Tobacco Consumption in Fishermen Community of a Coastal Area of Karachi. 2015;(20):6.