Setting
The study was conducted in Jimma University, located Southwest part of Ethiopia. Jimma University has currently four colleges (College of Natural and Computational Science, College of Medicine and Health Science, College of Social Science and Humanity and College of Law and Governance). A total of 31 departments and 6,155 regular undergraduate students were enrolled in the main campus. The study was conducted from April, 1-20, 2016.
Study design
Cross-sectional study design was used.
Sample size estimation
The sample size was determined by assuming alcohol use disorders prevalence rate of 50.2% (9), giving any particular out come to be with 5% margin of error and 95% confidence interval of certainty. Based on this assumption, the actual sample size for the study was computed using one-sample population proportion formula.
Where: n = Sample size, z = critical value 1.96, α/2= confidence level, P= 50.2, and
d= margin of error=0.05 (5%)
Considering non response rate of 10% the final sample size was 398. Since a multistage sampling procedure was used, the final sample was multiplied by two, giving 796.
Main campus was selected using lottery method then students were divided in to four strata of colleges (i.e. college of health science, college of natural and computational science, college of social science and humanity and college of law and governance). Out of the total of 31 departments of the campus in the four colleges, 18 departments were selected by using a lottery method. More than 50% of departments were included from each college. Then a total of 796 students were selected using simple random sampling method. Proportional allocation was used from each year of studies in each department.
Outcome variables
Alcohol use disorders: Standardized tool, alcohol use disorder identification test (AUDIT) was used to measure alcohol use disorders (AUDs) among Jimma university undergraduate students. The AUDIT has proven to be accurate in detecting alcohol use disorders in University students (12). The AUDIT consists of 10 questions about recent alcohol use, alcohol dependence symptoms, and alcohol-related problems (12). For cultural appropriateness, the “standard drink” referred on questions two and three of AUDIT was modified to be understandable by the study participants. The measurements of local alcohol beverages, “Tella”, “areke” and “Tej” were converted to milliliters based on previous studies (5).Then the measured amount of alcohol was converted to a standard drink after calculating the mass and volume of the alcohol. Beer, “draft” and wine (bottle/big/small) were converted to standard drink based on their alcohol content. For this study, the English version of AUDIT was translated into both Amharic and Afan Oromo languages. Back-translation into English was undertaken for both languages after experts’ consensus on the final versions.
Independent variables
Socio-demographic and economic characteristics: Age, sex, year of study, field of study, marital status, living condition (dormitory or outside of campus), living condition before campus, ethnicity, religion, monthly pocket money,
Mental health: History of mental illness, history of prior suicidal thoughts/ attempts.
Use of other substance: smocking cigarette, chewing khat.
Psychological distress: Kessler-6 was used to assess level of mental distress. A cut-off point 5 or more was used to screen mental distress (13).
Social support: Oslo 3 items social support scale (OSS-3) was used to measure the level of social support study participants could report to have. In order to score OSS-3, total scores are calculated by adding up the raw scores for each item. The sum of the raw scores has a range from 3-14. A score ranging between 3 and 8 is classified as poor social support, a score between 9 and 11 as intermediate (moderate) social support and a score between 12 and 14 as strong social support. It was validated in Ethiopia with sensitivity and specificity of 84.2% and 82.7% respectively (14).
Risky sexual behaviors: are behaviors that include engaging in sexual activity from an early age, inconsistent use of condoms during sexual intercourse, having sex with commercial sex workers and the tendency to have multiple sexual partners. An individual with at least one of these behaviors was considered to have risky sexual behavior (10, 15, 16).
Data collection procedure
Data collection was supervised by four BSc psychiatry professionals after two days of training on administration of the study instruments, consent form, and on maintaining confidentiality. Data collection was carried out after the questionnaires had been pretested on a sample (5% of the total sample) of students from Agriculture campus. Principal investigator was involved in overall controlling activities of data collections. The supervisor monitored data quality and checked all questionnaires for completeness.
Data analysis
Data were entered to Epi-Data version 3.1then exported to and analyzed using the Statistical Package for Social Science (SPSS, version 20). Both bivariate and multivariate logistic regressions were used to determine the association of socio demographic factors & other independent variables with AUD. Firstly, each independent variable were entered into bivariate analysis one by one. Then, variables associated with AUDs with p-value of less than 0.25 on bivariate analysis were entered to multiple logistic regression altogether to control confounders. Finally, variables with p-value of <0.05 on multivariable regression are considered as predictors of AUD.
Operational definitions
“Tej”: is a home processed, fermented alcoholic beverage, prepared from honey, sugar, water and leaves of Gesho (Rhamnus prepoides) (5).
“Areki”: is a colorless, traditional alcoholic beverage which is distilled from fermentation products (5).
“Tella”: like “Tej” and “Areki”, “Tella” is also one of Ethiopian traditional beverages it is brewed from various grains and different cereals which include; barely, corn, wheat and sorghum and also and maize, although in some regions, millet and Rhamnus prinioid (5).
A total AUDIT score of eight or morewas used to define alcohol use disorders (31).
Risky sexual behavior: Based on recommendation from other studies (18, 32, 36), participants who engaged into at least one of the four behaviors (i.e. inconsistent use of condom, presence of multiple sexual partners, sexual activity from an early age (before 18), and having sex with commercial sex workers), were considered as having risky sexual behavior.
Ethical consideration
Ethical clearance was obtained from the ethical review board of Jimma University. Students were informed that the information they give will kept anonymous at all stage of data process. Written informed consent was obtained from every study participant prior to data collection. For those participants who have concern regarding their alcohol consumption and mental health status and wish to get help, contact address (phone number) was left at the end of the questionnaires and it was also explained by supervisors.