A study on addiction pattern among construction workers in a metropolitan city of Southern India

Introduction

The construction sector is an important sector of economy and contributes significantly to GDP. In India, it is the largest economic activity after agriculture and since it is a labor-intensive industry consist 44% of all urban unorganized workers.^1-3 World Health Organization (WHO) has estimated the excess premature mortality attributable to tobacco use as 5 million per year which is expected to reach 10 million by 2025. Tobacco related deaths are increasing in India, and account for approximately a sixth of the world’s tobacco related deaths. In India tobacco consumption in various forms is the single most important avoidable factor in the growth of noncommunicable diseases. It has also been observed that the Tobacco demand in India has remained high.⁴ National Family Health Survey - 3 (NFHS-3) suggests an estimated 120 million Indians smoke, 57% of men and 11% of women aged 15-49 consume some form of tobacco, smoked or non-smoked. After China, India is the second most populous country and the second largest producer and consumer of tobacco in the world.⁴ Alcohol abuse or other risk-taking behaviour is quite common in any area of this sector.⁵ Workers in this industry need to do heavy physical work while living in shabby environment. The unhygienic situation, working pattern, absence of any recreational activity and company of friends force them to indulge in various abuse activities. Substance abuse is influenced by a variety of factors including individual attitudes & beliefs, social norms, easy affordability, acceptability, availability, lesser cost and advertising campaigns.⁶ The Substance Abuse and Mental Health Services Administration study shows that substance use can pose major risks to the health and productivity of workers.⁴ There are many misconceptions regarding the tobacco and alcohol, that it helps increase concentration, suppresses appetite, reduces anxiety and tension, causes skeletal muscle relaxation and induces feeling of pleasure.⁷ In the era of globalization construction is a fast-growing industry and very little research has been done on the occupational health and substance abuse of these workers. In this context to understand the health problems and addiction pattern among the construction workers and to enable appropriate interventions, this study was conducted.

Materials and Methods

This is a cross-sectional study carried out at two construction sites in Bengaluru south during 2015. Study was started after taking permission from Institutional ethical committee and concerned authorities at construction sites. All the migrant workers who were semiskilled and unskilled were enrolled for the study and included 315 subjects. The skilled, technical and support staffs were excluded.

Data was collected in a pre-tested and semi structured questionnaire. General information, history of habits, addiction pattern was included in the proforma. During medical examination, they were asked about their present health problems and physical examination was done and findings recorded. Those requiring medications were given free drugs and referrals were given.

The following operational definitions were used for the study. A person staying in the study area for 5 yrs or less was considered to be a “Migrant”. A person using any tobacco product on a daily basis for more than 1 year was labelled as “Tobacco user. Alcohol users were considered as those who had consumed alcohol at least once per month.⁸

Data Analysis

All the collected data was coded and entered in Excel data sheet and Statistical analysis was performed. Mean and standard deviations were derived for numerical data. Prevalence was reported in percentages. Chi square test was performed to find the statistical significance. Significance level was defined as p < 0.05.

Results

Data was collected from 315 workers. Most of them belonged to 15-45-year age group (87.3%). Majority were Illiterates (38.5%), belonged to class IV (40.3%) and were Hindus (85%) followed by Muslims. Majority of the workers (68%) were unskilled, rest semiskilled workers. Most of them stayed within premises of construction site. Dwelling arrangement was in the form of tin shed and dormitory with temporary public toilets.

The prevalence of tobacco smoking, chewing and alcohol were 26.98%, 47.62% and 32.28% respectively (Table 1). There was a statistically significant association (P < 0.05) between tobacco smoking, tobacco chewing and morbidity status (Table 2).

Discussion

The construction workers are exposed to multiple risks at working and living places. They are exposed to physical, chemical, biological, ergonomic hazards, environmental and psycho social risks. ^2,8 In most places the workers reside in make shift camps inside the project sites that expose them to health risks even after working hours. Due to poor environmental conditions at work sites chances of diseases from poor sanitation and unsafe drinking water are high.^2,8,9

The risk of accidents increases with extremes of temperature, age, male gender, personal habits like use of alcohol, personality traits of risk-taking behaviour and physical and mental state of the worker.¹⁰

Since 40% of the workers were illiterate, a lack of awareness about healthy choices and prevalence of addictions were expected to be high. Among the workers 26.98% were tobacco smokers, 47.62% were tobacco chewers. Earlier studies reported prevalence of 50.48%, 60.2% and national prevalence of 57%.^8,11,12 Most of them were using smokeless tobacco products. The current alcohol use was higher (32.3%) than previous studies (14.6%) ,18.8% and national estimate of 21%.^8,11,12 The absence of recreational facilities, the nature of work, hours of work, low pay, poor housing and separation from family, lack of job security and lack of access to occupational health services cause anxiety in these workers.^2,9

There was a statistically significant association between tobacco smoking, tobacco chewing and morbidity status in our study.

Conclusion

The prevalence of high-risk behaviours in the form of tobacco and alcohol addiction was reported to be high among unskilled and semiskilled construction workers. This study will contribute to further development of health promotion strategies. Measures are needed to improve the work environment of construction workers by ensuring availability of protective gears, good living conditions and sanitation facilities at the sites along with an accessible and accountable occupational health services.