Problematic Alcohol Use in Debre Berhan, Ethiopia: A Community-Based Cross-Sectional Study

Background Problematic alcohol use (PAU) negatively affects physical, psychological, and social well-being. This study aims to estimate the community-level prevalence of PAU and identify factors associated with PAU in Central Ethiopia. Methods A community-based cross-sectional study was conducted in Debre Berhan, Ethiopia, in January and February 2022. We recruited 1,400 adults aged 18 years and older using multistage sampling, and 1,380 completed the study interview. PAU was assessed with the alcohol use disorder identification test (positive AUDIT score). We conducted multivariable logistic regression to identify factors associated with PAU, with predictors selected using least absolute shrinkage and selection operator (LASSO) regression, in the overall sample and in sex-stratified analyses. Results The prevalence of PAU was 15.5% (95% CI: 13.7% –17.5%) overall, and 26.3% (95% CI: 23.2%–29.6%) and 3.4% (95% CI: 2.2%–5.1%) for men and women, respectively. For the overall sample, factors associated with PAU included being male (AOR = 7.83; 95% CI: 4.59–13.36), unemployment (AOR = 2.73; 95% CI: 1.29–5.78) or engaged in income-generating roles (AOR = 2.38; 95% CI: (1.23–4.58) compared to those in non-income generating roles like housewives and students, smoking (AOR = 5.24; 95% CI: 1.73–15.91), high blood pressure (AOR = 2.04; 95% CI: 1.30–3.21), only one or ≥2 stressful life events (AORs = 1.60 and 1.65; 95% CIs: 1.03–2.47 and 1.05–2.61, respectively), and family history of PAU (AOR = 4.04; 95% CI: 2.09–7.81). For men, smoking (AOR = 5.29; 95% CI: 1.66–16.81), high blood pressure (AOR = 2.33; 95% CI: 1.39–3.90), ≥2 stressful events (AOR = 1.71; 95% CI: 1.04–2.82), and family history of PAU (AOR = 4.10; 95% CI: 1.90–8.84) were associated with greater odds of PAU. For women, being 25-34 years compared to >35 years old (AOR = 8.88; 95% CI: 1.56–50.63), being divorced (compared to married) (AOR = 5.72 95% CI: 1.27– 25.72) were associated with greater odds of PAU, as were only one stressful life event (AOR = 4.05; 95% CI: 1.14–14.36), and family history of PAU (AOR = 10.98; 95% CI: 1.69–71.14). Conclusions PAU prevalence was high in this sample, significantly higher among men compared to women. Our study highlights the need to implement public health interventions that target risk factors for PAU in Ethiopia. Findings also highlight the need for selective PAU prevention interventions that target individuals with a family history of PAU or exposure to stressful life events.