RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE
ANNEXURE - II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DESSERTATION

Name of the candidate and
1:
address (in block letters)
MR.TONYMON THOMAS
Ist YEAR M. Sc NURSING
AKKAMAHADEVI COLLEGE OF
NURSING. BIDAR,
KARNATAKA.
AKKAMAHADEVI COLLEGE OF

2: Name of the Institution NURSING

BIDAR,
KARNATAKA.
3: Course of Study and Subject M. Sc. NURSING
COMMUNITY HEALTH NURSING
4: Date of Admission to the
Course 26-09-2010
5: TITLE OF THE STUDY:
“A STUDY TO ASSESS THE KNOWLEDGE AND
ATTITUDE TOWARDS THE EFFECT OF ALCOHOL AMONG
THE STUDENTS IN SELECTED PRE-UNIVERSITY COLLEGE IN
BIDAR, WITH A VIEW TO DEVELOP AN INFORMATION
LEAFLET ON PREVENTION OF ALCOHOLISM”.

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6. Brief resume of the intended work:

6.1 Need for the study:

“All the children and adolescents have the right to grow up in

an environment protected from the negative consequences of alcohol consumption,

and to the extent possible, from the promotion of alcoholic beverages”

-World Health Organization’s European Charter on Alcohol.

The National Institute of Mental Health and Neuro Science

(NIMHANS) in Bangalore reveals that 70% of HIV patients were alcoholics and they

were teenagers. All India Institute of Medical Sciences (AIIMS) in Delhi showed that

every 5th teenagers between 15-19 age group in Delhi takes alcohol regularly. 3,00,000

are addicted and another lakhs needs medical attention for alcohol related disorder1

Alcohol problems are associated with life style and socio-

economic conditions of people. These are becoming more – prevalent in adolescents –

both boys and girls mainly because of their risk taking behaviour and more over the

emotional control of family; the moral control of school and the social control of

community are declining. Information explosion and communication across cultural

boundaries through mass media have lot of influence on behaviour pattern of

adolescents all over the world. In India, the prevalence of drug abuse, which is

generally low in early adolescence, aged 12 & 13 rises – steeply in the late teenage

and is highest during the early 20’s.2

Alcohol consumption has been steadily increasing in

developing countries like India and decreasing in developed countries since the

1980s.The pattern of drinking to intoxication is more prevalent in developing

2
countries indicating higher levels of risk due to drinking. 62.5 million alcohol users

are estimated in India. Per capita consumption of alcohol increased by 106.75% over

the period from 1970 to 1996 3.

A study on alcoholism reveals that worldwide, alcohol

accounted for 3.5% of the global burden of disease, 1.5% of all deaths, 2.1% of all life

years lost and 6% of all years lost to disability. In other words, the relative impact of

alcohol on disability is considerably larger than its impact on mortality.4

A study conducted by Media vision India on alcoholism , in the

findings it has been estimated that 40-50% of all males drink alcohol as compared to

less than 1% of female adults. So alcoholism appears to be predominantly a male

disorder especially in India. Because of the influence of urbanization peer pressure,

westernization, media, curiosity and age, the college students are more prone to

alcohol abuse 1.

According to current concept, alcoholism is consider as a

disease and alcohol a “disease agent” which causes acute and chronic intoxication,

toxic psychosis, cirrhosis of liver, gastritis, pancreatitis, cardiomyopathy and

peripheral neuropathy. Also evidence in mounting that is related to cancer of mouth,

pharynx, larynx and oesophagus. Further alcohol is an important etiologic factor in

suicide, automobile and other accidents, and injuries and death due to violence. The

health problem for which alcohol is responsible are only part of social damage, which

includes family disorganisation crime and loss of productivity.5

The consequences of living with an alcoholic are also

significant. Families must deal with emotions such as anger towards the alcoholic and

guilt over what role they believe they may play in the addiction. Family breakdown,
3
financial problems, legal problems and psychological troubles all result from

alcoholism. Society as a whole also pays a price for the alcoholic's addiction.

Employers may see productivity affected. Police and law courts may deal with crimes

committed by alcoholics while they are drunk. The health-care system pays for

treatment of alcoholics, either for illnesses resulting from alcoholism or for treatment

of the disease itself.4

Young adolescents are at risk of alcohol related problems and

are noted as special population in need of services in the report by the institute of

medicine. Young adolescents as a group are heaviest drinkers in America and other

Western societies. In India too the trend is increasing in favour of alcohol use among

student population. Campus atmosphere and peer pressure is forcing and influencing

the adolescent students to indulge in alcoholism mainly due to lack of adequate

knowledge about the consequences of its use or falsely perceived knowledge and

attitude towards alcoholism as the students use alcohol for “company, festivity or

curiosity6.

Therefore the investigator felt that there is a compelling need to

assess the knowledge and attitude of adolescent students regarding ill effects of

alcohol, based on this a specific content of information guide sheet can be developed

and it would enhance the knowledge of adolescent students there by develop a very

positive attitude towards alcohol use and prevent them from alcoholism. As nurses are

recognized as authorities on health, they can educate individuals, groups and

communities about alcoholism, its adverse effects. Prevention and education are the

important aspects of nursing care in any setting.

6.2 Review of literature :

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 Review of literature refers to the process in which the

investigator examines the strength and weakness of the appropriate scholarly

publications. The review of literature for the present study will be presented under the

following headings.

1. Literature related to knowledge and attitude regarding effect of alcohol.

2. Literature related to prevalence of alcohol use in India and at global level

3. Literature related to the causes of alcohol use.

4. Literature related to effects of alcohol.

1. Literature related to knowledge and attitude regarding the effect of

alcohol:-

A descriptive study was conducted on alcoholism among college

students in Salem, India. The sample was selected by using purposive sampling

technique and data collection was done using structured questionnaire. The study

results were overall students had only moderate awareness on alcoholism (68%) of

total samples. So the result of the study reveals that students were moderately aware

with problems related to alcoholism1.

A study was conducted A total of 545 Spanish university

students from the University of Valladolid, were surveyed in about their alcohol use,

knowledge of the effects of alcohol, and attitudes towards social drinking and towards

alcoholism and alcoholics. The knowledge regarding alcohol (mean scores 7.7 +/- 0.1,

ranging 1-15) was associated with academic aspects: it was higher among medicine

and nursing students and increased according to the length of stay at university. The

5
attitudes both towards social drinking (mean scores 0.6 +/- 0.1, ranging -9 to 9) and

towards alcoholism and the alcoholics (mean scores 3.0 +/- 0.1, ranging -6 to 9), were

related to alcohol consumption: those students self-reported as "heavy" and

"moderate" drinkers, and those with alcohol intake over 40 g/day, had a more

favourable attitude. The results suggest a need for education on alcohol7.

A study was conducted about the utilization of the perceived

need for alcohol treatment services among college-age young adults (18-22 years)

according to their educational status: full-time college students, part-time college

students, non-college students (currently in school with the highest grade level below

college), and non-students (N=11,337). And secondary analyses were conducted on

data from the 2002 National survey on Drug Use and Health. And Result suggest that

the full-time college students (21%) were as likely to have an alcohol use disorder as

non students (19%), but were more likely than part-time college students (15%) and

non college students (12%). Only 4% of full-time college students with an alcohol use

disorder received any alcohol services in the past year. Of those with an alcohol use

disorder who did not receive treatment services, only 2% of full-time college students,

close to 1% of part-time college students, and approximately 3% of young adults who

were not in college reported a perceived need for alcohol treatment. Full-time college

students were less likely than non college students to receive treatment for alcohol use

disorders 8.

A longitudinal study was conducted to investigate the

relationship between temperament (novelty seeking, harm avoidance and reward

dependence), alcohol expectancies, membership in a deviant/substance-using peer

group and drinking behaviour of adolescents drawn from a general population. And

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147 adolescents about 15 years of age were interviewed and completed several self-

rating questionnaires. Gathered additional information by interviewing their parents.

One year after the initial assessment the adolescents only were interviewed and given

questionnaires again. And this study results that, Adolescents with alcohol problems at

the time of the second interview reported less harm avoidance, less reward

dependence, and were more likely to be a member of a deviant/substance-using peer

group a year before, compared to offspring without alcohol problems. Furthermore,

they held more positive alcohol expectancies than adolescents without alcohol

problems. Taking into account the quantity of alcohol consumed per occasion, all

results were confirmed, but temperament did not predict the extend of alcohol

consumed after one year9.

A study was conducted in Bangalore among pre-university

students on knowledge and effect related to alcoholism. The sample selected for the

study includes 50 Pre-University students and simple random sampling method was

used. The data was collected by using structured questionnaire. Each correct response

was given one score and zero for incorrect response. Results The overall mean

knowledge was found to be more (68.8%) about general information on alcohol than

the knowledge on the effects of alcohol (33.2%). The overall mean attitude was

77.7%. The highest attitude response identified in the aspect of keeping away from

alcoholics (92%).A significant association is found between knowledge and type of

family. There exists a significant association between attitude and type of family, and

also between attitude and academic marks. Interpretation and Conclusion Overall

findings showed that, respondents knowledge about effect of alcohol is inadequate

(33.2%), although the respondents overall attitude towards effect of alcohol is found

to be favourable (77.7%). So enhancement in knowledge aspect is required10.

7
 A study was held among Students from the 6th, 8th, 10th, and

12th grades in six school districts throughout Georgia and South Carolina completed a

questionnaire to determine their knowledge, attitudes, and behaviour regarding

alcohol use. 3017 samples were taken by using random sampling technique. Results

suggest that knowledge, attitudes, and behaviour are significantly correlated. Two

distinct attitudes were discovered: acceptable use of alcohol and unacceptable uses of

alcohol, and these interacted with knowledge and behaviour in different ways.

Students who reported school as their major source of information about alcohol were

more knowledgeable and had the most conservative attitudes toward unacceptable use

of alcohol (p < 0.001). White students scored higher on the knowledge test and had

more liberal attitudes than minority students (p < 0.001). Females were more

conservative than males (p < 0.001), and older students had more liberal attitudes (p <

0.001). Our results suggest that efforts to educate youth about alcohol should

incorporate acceptable uses as well as the negative aspects of drinking11.

A study was conducted among high school students from Holon

(a city in the center of Israel) were surveyed about their consumption, knowledge and

attitudes towards alcohol use and alcohol dependence.509 samples were taken in that

259 pupils attended a vocational high school and 253 attended an academic high

school. 40% of the pupils attending the academic school reported that they had drank

beer between 1 to 9 times during the last 2 months. In comparison with 72% of the

vocational pupils, 42% of the academic pupils and 47% of the vocational pupils drank

other alcoholic beverages (such as hard liquor, cognac, whisky or vodka) between 1 to

9 times during the last 2 months. Boys drank alcohol more frequently than girls did.

An earlier mean age of beer consumption was found among pupils in the vocational

schools—12.8 years; as opposed to pupils in the academic school—13.4 years

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.Among the three leading reasons for drinking in the two schools were helping foster

a sense of belonging, wish to feel like an adult and desire to forget daily anxieties and

conflicts12.

2. Literature related to prevalence of alcohol use in India and at global level:-

A cross-sectional study was conducted among high

school students to evaluate the prevalence, behavioural pattern and correlates of

regular alcohol drinking. The study involved completion of a modified version of

“Health behaviour of school age children” using questionnaire and data was collected

from 4,153 samples of 9-11 grade students from 26 randomly selected high school in

Istanbul. Overall, 61% of students are experimental drinkers, and 46% of students

were current drinkers. The result of the study shows that alcohol consumption is more

prevalent among adolescent high school students. Therefore there is a need of school-

based alcohol prevention programme which also deal with family and peer influence

on drinking13.

A study was conducted among undergraduate medical

students in two medical colleges of Calcutta. The study indicated that the prevalence

of total long abusers were 76.8% of the respondents student population. The long

abuse rate-gradually increased with advancement of each academic years i.e. from

24% in 1st year to 74.4% in the final year, it was maximum in the age group of 25-29

years. The prevalence among boys (58.4%) was significantly higher than girls.

Twenty five percentage of hostelites were found to be more long users than non-

hostelites. In the pattern of long abuse 12.6% of students used tobacco and 3.6%

alcohol. Most common combination was of alcohol and tobacco. Other drugs

constituted 12.7% of students14.

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 A study was conducted on prevalence and pattern of

alcohol and substance abuse among adolescents and interviewed a sample of 4691,

subjects aged 14 years and above on a schedule based on WHO questionnaire to

collect data. The study reveals information about the prevalence rate of 19.78%. In

terms of age of onset 64.83% respondents had their first drink between the ages of 15-

25 years. Most common type of alcohol consumed was country liquor by 69.07%15.

A study was conducted about, the prevalence of alcohol

dependence among excessive drinkers in New Mexico and results that of 4,761

respondents, 16.5% were excessive drinkers; 14.4% binge drank and 1.8% were

alcohol dependent. While the rates of alcohol dependent were higher among the

youngest age group, males, those with some college education, and those of

race/ethnicity other than White, non-Hispanic, only differences by age were

statistically significant. The prevalence of alcohol dependence was the highest among

those who reported alcohol-impaired driving in the past 30 days (15.9%) and was

lower among those who reported heavy drinking (13.4%) and binge drinking (8.1%)16.

3. Literature related to causes of alcohol use:-

A study Conducted by Ponnudurai, which was designed

to assess the various factors pertaining to alcohol and long abuse among college

students with the help of youth survey questionnaire developed by WHO. The results

showed that 22.67% of the males - indulged in alcohol abuse atleast once in a month.

The commonest explanation offered for this seemed to be enjoyment curiosity and

relief of psychological stress. Friends have been the main source of information6

A study was conducted about Alcohol abuse in a rural

community in India: Part II characteristics of alcohol users. About 50% of both male
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and female users were between 20 and 39 years of age; 8.1% of males and only 1.3%

of females used alcohol daily or several times in a week. Desi (country) liquor was

the beverage used by more than 85% of the users; 77.5% of males and 96.5% of

females consumed less than one quarter of a bottle of alcohol, and 65.3% of males

and 93.6% of females were taking alcohol at their houses only. The reasons given for

drinking by the majority of users were 'for pleasures', 'for celebration of an event' and

'status symbol'. The quantity/frequency index analysis showed that the percentage of

alcoholics was 4.2 and the remaining were social drinkers. Physical, economic and

social problems were reported by a significantly higher percentage of alcoholics than

social drinkers17.

A pilot study focused on the social construction of the

meanings associated with use of alcohol and alcoholism from an Indian perspective.

Using qualitative methods, the researcher collected ideas on the meanings of alcohol

use from eight alcohol-dependent clients of a South India alcoholism treatment center

who participated in focus groups and in-depth interviews. An important aspect of this

research was that the researcher considered the alcohol-dependent participants as the

“experts” who validated their point of view. Several themes emerged: Alcohol use is

a symbol of economic status, caste, a person’s karma, a period of turmoil and gender

privilege, it is important that social workers and other intervention agents understand

the meanings of alcohol use for each alcohol-dependent client so that they may plan

creative and individualized interventions.18

4. Literature related to effects of alcohol:-

A study was conducted about whether children of

alcoholics (COAs) are characteristics by more behavioral problems than non-children

11
of alcoholics (non-COA’s) and also to determine the influence of a paternal antisocial

personality disorder (ASPD) and this study, 1340 children and adolescents between

the ages of 11 and 18 years and their parents were included of this sample, 76

adolescents showed a positive family history of alcoholism and 47 adolescents a

positive history of paternal antisocial personality disorder (HSPD). Also a study

finding says the higher of behavioral problems relates primarily to a higher prevalence

in both cases of antisocial personality disorder among fathers. Further more, children

with family history of alcoholism and / or family history of anti – social personality

disorder represent high-risk groups and should be the focus of prevention and

intervention measures19.

A comparative study was conducted on Alcohol and

drug consumption among students in Pachuca, Hidalgo in Mexico. The study reveals

that out of the total sample, 47.9% had tried alcohol and 12.6% had drunk large

quantities-5 drinks or more per sitting-during the month previous to the survey. With

respect to drugs, 5.1% had tried illegal or medical drugs without prescription, in

particular inhalants, marihuana and tranquilizers. More boys consumed illegal drugs

and more girls medical drugs without prescription. Boys, who are also older, more

frequently consumed alcohol and drugs and were more often employed during the

previous year at part-time jobs. High alcohol level and drug consumers were

characterized by their frequent report of being bored in their free time, drinking with

friends and enrolling in antisocial behaviour20.

A study was conducted about Correlations among first-

degree relatives for responses on the Self-Rating of the Effects of Alcohol

Questionnaire in teenagers in USA and as part of the Collaborative Study on the

12
Genetics of Alcoholism Phase II (follow-up) Protocol, SRE scores were available on

251 females and 236 males ages 13-19 years. These analyses compare the

correlations among father-offspring, mother-offspring, sibling pairs and comparable

unrelated individuals and this study results that for the 487 subjects, correlations

among first-degree relatives ranged from 0.14 to 0.22 and were all-significant.

Correlations among comparable unrelated pairs ranged from 0.02 to 0.06 and were no

significant. When males and females were evaluated separately, the pattern of results,

with higher correlations among first-degree relatives than among unrelated

individuals, was similar, although, perhaps reflecting fewer subjects, correlations were

more variable21.

6.3 Problem Statement:

“A study to assess the knowledge and attitude towards the

effect of alcohol among the students in selected pre-university college in Bidar, with a

view to develop an information leaflet on prevention of alcoholism”.

13
6.4 Objectives of the study:

The objectives of the study are,

1. To assess the knowledge of students regarding the effect of alcohol in selected

pre-university college, Bidar.

2. To assess the attitude of students regarding the effect of alcohol in selected

pre-university college, Bidar.

3. To find the association between knowledge and attitude scores with selected

demographic variable

6.5 Operational definitions

1. Assess - to examine something in order to judge, evaluate it or estimate the

nature, quality, ability, extent, or significance of 22.

2. Knowledge – it refers to the awareness and understanding of effect of alcohol,

its consequences and preventive measures.

3. Attitude – it refers to the expressed feelings of adolescents regarding

alcoholism, which was measured by using attitude scale.

4. Pre-university students – it refers to the adolescents students in the age group

of 16- 18 years who were studying in 10+2 or two year pre- university

courses.
5. Alcohol – it refers to a colourless volatile flammable liquid that is the

intoxicating constituent of wine, beer, spirits, and other drinks, and is also

used as an industrial solvent and as fuel23.

6. Prevention- it refers to an action or actions taken to stop somebody from

doing something or to stop something from happening22.

7. Leaf let – It refers to folded printed sheet intended for free distribution to

improve knowledge24.

14
 In this study it refers to the self explanatory information consisting of

introduction, path of alcohol in the body, effect of alcohol, effect of alcoholism,

message to teenagers for prevention of alcoholism.

6.6 Assumptions:

The study assumes that;

1. Pre-university students will have some knowledge and favourable

attitude regarding the effect of alcohol.

2. Pre-university students knowledge and attitude can be measured by

structured knowledge and attitude questionnaire.

3. The association between knowledge and attitude with selected

variables can be measured and compared.

6.7 Delimitations:

 Study is limited to a selected pre-university college in Bidar.

 The study is limited to students who can understand English.

 Study is limited to students who are willing to participate to participate in the

study.

 The study is limited to two months.

15
 6.8 Hypothesis :

 H1: Pre-university students will have adequate knowledge and favourable

attitude about effect of alcohol.

 H2: There will be a significant difference between knowledge and attitude

scores regarding the effect of alcohol with selected variables.

7. Material and method:

7.1 Source of data:

Data will be collected from pre-university students of, Bidar using

demographic performa and self administered questionnaire.

7.1.1 Research design:

The research design is the overall framework for

conducting the study. The research design selected for the study is descriptive survey

design. The survey was carried out for providing the accurate portrayal of knowledge

and attitude regarding the effect of alcohol. In this study the design selected would be

appropriate and useful in understanding the knowledge and attitude of pre-university

college students regarding the\effect of alcohol.

7.1.2 Settings:

The study will be conducted in pre-university college at

Bidar. Strength of college, medium of instruction is English.

16
 7.1.3 Population

In the present study, the population will be the students

of ………… pre-university college, Bidar.

7.2 Method of data collection:

7.2.1 Sampling procedure

In this study simple random sampling technique will be adopted to select the

sample according to the purpose of study.

7.2.2 Sample size

The sample for the study will be consist of 60 students from ..................pre-

university college.

7.2.3 Inclusion Criteria

 Students studying 10+2 or pre university courses in…………pre-university

college, Bidar.

 Students who are present during data collection period.

 Students who are willing to particípate.

 Students who can understand English.

7.2.4 Exclusion criteria.

 Students who are not availabe during the period data collection.
 Students who are not willing to participate in the study.

17
7.2.5. Instruments intended to be used

Part 1: The tool consists of demographic Performa.

Part 2: Structured questionnaire to assess the knowledge and attitude of students.

7.2.6. Data collection method

The investigator will obtain formal permission from the

selected institution to conduct the study. The samples will be selected for the proposed

study by simple random sampling method. The investigator will give self introduction

and purpose of the study will be explained to the students, informed written consent

will be obtained from them. Structured questionnaire will be administered to the

students, based on that data will be collected.

7.2.7. Data analysis plan

The data will be analysed by using the descriptive method and

inferential statistics. The plan for data analysis is as follows,

1. Data will be organised in master sheet.

2. Percentage, mean and standard deviation to asses the existing knowledge and

attitude scores.
3. F-test and t-test to find the significant association with selected demographic

variables.

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 7.3 Does the study require any investigations or interventions to be conducted

on patients, or other animals? If so please describe briefly.

Yes, information leaflet on prevention of alcoholism will be given to the pre-

university students.

7.4. Has ethical clearance been obtained from your institution in case of

Yes, ethical clearance will be obtained.

8. List of references:

1. Selvaraj, P. "A study on alcoholism among students "Nursing Times Journal 31

(5): 2007, Pp 9-19.

2. Krishna Kumari Gulani, "Community Health Nursing", First edition,

Kumar Publication, 2006.

3. Available online on [5 Sept 2009] from web page URL/

www.indianalcoholpolicy.org/article.

4. Singhal, Nagalakshmi, "Psycho-social study”.1992, NIMHANS Journal.

5. Park.K.,Park’s ‘Text Book of preventive and Social-Medicine’ Nineteenth

edition, Jabalpur M/s Banarasidas Bhanot publication, 2007. Pp 635.

6. Ponnudurai et al., 1984 " alcohol & Drug abuse among college students ",

Indian Journal of Psychiatry 26 (2) : 128-132.

7. Del Rio C, Alvarez FJ, Queipo D. ‘Knowledge about and attitudes towards

drinking among university students in Spain’. Dept of Pharmacology and

19
 Therapeutic, University of Valladolid, Spain. 26/09/009 available from

URL/www.PubMed.com - indexed for MEDLINE

8. Pilowsky DJ, et al., (2002) "Alcohol use disorders and the use of treatment

service among college age young adults ", litzycox@yahoo.com

9. Barnow S. et al., (2004) "Effect of temperament, effect of alcohol expectancies

and peer group on amount of drinking and alcohol - related problems in

adolescence ", Z Kinder Jugendpsychiatr Psychoher ; 32 (2) : 85-95.

10. Kumar, Ravindra K V , “A study to assess the knowledge and attitude towards

the effect of alcohol among the students”. 2006, available from

http://hdl.handle.net/123456789/1510

11. Paul David Forney, Mary Ann Forney.and William K. Ripley. University of

Georgia, USA.” Alcohol and adolescents: Knowledge, attitudes, and

behaviour” Available online 10 May 2005.

http/www.ncbi.nlm.nih.gov/pubmed.

12. U Brooka, A Tepperb. “Consumption, knowledge and attitudes of high school

pupils towards alcohol and alcoholism: the Israeli experience”,2 September

2001. Available from http://www.pec-rnal.com/article/S0738-3991(01)00182-

3/abstractjou

13. Alikasifoglu M, Erginoz E, Ercano, Uysal O, Aslbayrak- Kaymak D, Itler O.

Alcohol drinking behaviours among Turkish high school students. Turk J

Pediatr(serial online) 2004 Jan-Mar [cited 2005 Mar 12; 46 (1) 44-53];

available from URL; http/www.ncbi.nlm.nih.gov/query-fcgi?

CMD=search&db=pubmed.

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14. Narendranath Bhattacharya, - "Prevalence of alcohol abuse in selected medical

college of Calcutta city" 1993; Indian Journal of Psychiatry 35 (2) : pp 12 - 13.

15. Meena, Pradeep khanna, Vohra AK, Rajesh Rajput, Prevelence and pattern of

alcohol and substance abuse, [Indian journal of Psychiatry 2002] 44(4): 348.

16. Woerle S, Roeber J, Landen M.G. " Prevalence of alcohol dependence among

excessive drinkers" National Institute of Justice, Washington, (2002) Journal of

alcohol, 38 (4) : 452-458.

17. Mohan D. " Alcohol abuse in a rural community in India Part II :

Characteristics of alcohol users, Drug alcohol Depend” , [Oct 1984] ; 14 (2) :

121-128

18. Nimmagadda J, "A pilot study of the Social construction of the meanings

attached to alcohol use ; perceptions from India ; Subst use Misuse [1999]; 34

(2) 251-67.

19. Barnow. S. Ulrich, "The influence of parental drinking behaviour and

antisocial personality disorder on adalescent behavioural problems [cited on

2007] ;42 (6) : 623 - 8. www.pubmed.com.

20. Flez, Baustista. A study on" Alcohol and drug consumption among students"

(1999) ; Salud Publica Mex ; 41 (4).

21. Smith T.L." Correlations among first - degree relatives for - responses on the

self-rating of the effects of Alcohol questionnaire in teenagers", 2005 :Journal

of student alcohol 66 (1) 62-65.

21
22. Encarta® World English Dictionary [North American Edition] © & (P)2009

Microsoft Corporation. All rights reserved. Developed for Microsoft by

Bloomsbury Publishing Plc.

23. The American Heritage® Dictionary of the English Language, Fourth Edition

copyright ©2000 by Houghton Mifflin Company. Updated in 2009. Published

by Houghton Mifflin Company.Available from http://www.merriam-

webster.com/dictionary/leaflet, cited on 26/06/2009

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