|Year : 2012 | Volume
| Issue : 2 | Page : 92-96
A Case Control Study on School Dropouts in Children of Alcohol-Dependent Males Versus that in Abstainers/Social Drinkers' Children
Violet N Pinto1, Rajan N Kulkarni2
1 Department of Community Medicine, Dr. D. Y. Patil Medical College, Nerul, Navi Mumbai, India
2 Department of Preventive and Social Medicine, Topiwala Nair Medical College, Bombay Central, Mumbai, Maharashtra, India
|Date of Web Publication||20-Dec-2012|
Violet N Pinto
Department of Community Medicine, 4th Floor, Dr. D. Y. Patil Medical College, Nerul, Navi Mumbai - 400 706, Maharashtra
Objective: To study and compare in the children of alcohol-dependent males versus those in a socio-demographically similar control group, the occurrence of school dropouts, and to examine the link between certain factors like parental education and socioeconomic status on school dropout. Materials and Methods: This was a community-based case control study. The participants were 107 family units in both study group (alcohol-dependent male, wife, at least one child less than 14 years of age) and control group (abstainer/social drinker, wife, at least one child less than 14 years of age). It was conducted in an urban slum community in Mumbai. Interview technique was used for data collection. The study was conducted for a period of 1 year. Statistical Analysis: Using software SPSS version 17.0, percentages, Chi-square test. Results and Conclusion: The number of school dropouts was significantly higher (45.31%, P < 0.001) in the children of alcohol-dependent males as compared to 22.47% in the abstainers/social drinkers' children. In the study group, there was higher number of school dropouts among boys (52.73%, P < 0.05) as compared to girls (35.37%). There was a statistically significant association between parental illiteracy and school dropout in children in both the groups. In the control group, significantly higher number of school dropouts of socioeconomic class IV and V had dropped out as compared to those of socioeconomic class III and II.
Keywords: Case control study, children of alcohol dependent males, school dropout
|How to cite this article:|
Pinto VN, Kulkarni RN. A Case Control Study on School Dropouts in Children of Alcohol-Dependent Males Versus that in Abstainers/Social Drinkers' Children. J Fam Med Primary Care 2012;1:92-6
|How to cite this URL:|
Pinto VN, Kulkarni RN. A Case Control Study on School Dropouts in Children of Alcohol-Dependent Males Versus that in Abstainers/Social Drinkers' Children. J Fam Med Primary Care [serial online] 2012 [cited 2014 Dec 18];1:92-6. Available from: http://www.jfmpc.com/text.asp?2012/1/2/92/104944
| Introduction|| |
Alcohol use and disorders are a major public health problem. Alcohol abuse in poor and deprived communities is particularly deleterious as the scarce financial resources of the family needed for food, health care, and education are diverted to alcohol. ,,, Alcoholism is a family disease - one that affects every member of the family in a devastating way. Because the entire family revolves around the alcoholics' behavior, the children are often second best, and the children's problems are often invisible. , One in four children is exposed to family alcohol abuse or dependence.  An extensive amount of research has been conducted on the psychosocial correlates, , cognitive, behavioral, and emotional aspects, , psychological functioning,  nutritional neglect and physical abuse,  social competence,  dysfunctional family environment,  and alcohol abuse  in children of alcoholics, although relatively few studies have addressed these children's school adjustment.  The upheaval that typifies the alcoholic household interferes with the children's concentration in and out of school. Poverty conditions combined with parental alcoholism contribute to dropping out of school in the children. Various studies ,, show that children of alcoholics constitute an at risk population for poor performance, skipping school days, and school dropout. Education is universally recognized as an important investment in human capital. It contributes to socioeconomic development by endowing individuals with the means to improve their health, skills, knowledge, and capacity for productive work.  Especially for the children of alcoholics it forms vital tool of escape from an abusive and unhealthy environment and provides hope for a better future. Keeping this in mind, the current study was conducted in an urban slum community.
| Materials and Methods|| |
The study was conducted in an urban slum community at P/N ward of B. M. C., Mumbai, the field practice area adopted by a teaching institute and hospital of Greater Mumbai.
Study group selection criteria
Family unit consisting of alcohol dependent male (diagnosed by DSM criteria IV),  wife, and at least one child less than 14 years of age, with no other substance abuse, excluding tobacco, with no other coexisting psychiatric illness [Table 1].
|Table 1: Educational status of males, wives, and socioeconomic classifi cation of both groups|
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Control group selection criteria
Family unit consisting of abstainer*/social drinking male, wife, and at least one child less than 14 years of age, with no other substance abuse, excluding tobacco, with no other coexisting psychiatric illness.
(*Abstainer - never drinks;  social drinker - drinks on infrequent occasions, ranging from less than once a month up to 1-2 times per week. No more than two drinks at a time.)
Socioeconomic classification was done as per the modified method of social classification (urban) by Kuppuswamy.  The alcohol-dependent males were diagnosed at the mental health outpatient department at the slum community's urban health center. Their wives and children were visited at their houses in the community and interviewed. One hundred and seven family units were identified during the study period. The control group was selected from the neighborhood of the study group. House with first number in the same plot as the study group was considered. If the criteria of control group family unit were not fulfilled, the next serial order house was considered and so on till the same number of control group family units was obtained as the number of study units in that plot. Data collection was done by personal interview technique using a semi-structured questionnaire. Initially 10-15 minutes were spent on rapport building, the nature of the study was explained and consent taken. The entire study period was of 1 year. After collection, the data were analyzed using software SPSS; percentages and Chi-square test of significance were applied [Table 1].
| Results|| |
Males (alcohol dependent, abstainers/social drinkers) were in the age range of 20-59 years and their wives ages ranged from 18 to 54 years. A majority of the families were nuclear type 87 (81.31%) and 94 (87.85%), while 20 (18.69%) and 13 (12.15%) were joint families in the study and control groups, respectively, a common feature of urbanization.
[Table 2] shows the age-wise distribution of children.
School dropout was found to be significantly higher (45.31%, P0 < 0.001) in the children of alcohol-dependent males as compared to (22.47%) in the abstainers/social drinkers' children [Table 3]. There were seven and five repeaters among the schooling children in the study and control groups, respectively. Maximum number of dropouts was seen between 5 th and 8 th standards in both the groups. 58% in the study group had dropped out between 5 th and 7 th standards, while in the control group 67% had dropped out after 7 th standard. In the study group, there was higher number of school dropouts in boys (52.73%, P < 0.05) as compared to girls (35.37%) [Table 4].
In [Table 5] and [Table 6], a statistically significant association between parental illiteracy and the number of school dropouts was seen in children of both groups.
|Table 3: Distribution of the children based on school dropout/continued schooling|
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|Table 4: Sex-wise distribution of children based on school dropout/continued schooling|
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|Table 5: Distribution according to educational status of the males and school dropouts in their children|
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|Table 6: Distribution according to educational status of wives and school dropouts in their children|
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In the study group, there was no significant relationship between socioeconomic class (SEC) and the number of school dropouts [Table 7]. In the control group, there was significantly higher number of school dropouts in SEC IV and V as compared to those of SEC III and II.
|Table 7: Distribution according to socioeconomic class (SEC) and dropout|
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| Discussion|| |
In this study, the two groups were matched on key sociodemographic variables and the alcoholism of the males (fathers) of the study group children was a major differentiating factor between the two. A significantly larger number of children 45.31% in the study group had dropped out of school as compared to 22.47% in the control group [Table 3]. Similar findings were reported in the studies conducted by Casas-Gil et al.  and in the TISS  study. In the 100 children studied by Sundari et al.,  64% were school dropouts and 40% had alcoholic fathers. A significantly higher percentage of school dropouts were present in children with illiterate parents in both groups [Table 5] and [Table 6]. Khokkar et al.  also found in their study a statistically significant association between literacy status of parents and the desire to educate their children. This may be due to the general apathy of illiterate parents toward education or their inability to appreciate the educational needs of the child particularly in terms of time needed for homework and curricular activities.
In the control group, there was significantly larger percentage of dropouts in children belonging to SEC IV and V (25.54%) as compared to 9.3% in SEC III [Table 7]. Financial constraint is an important factor [Table 8], coupled with low parental motivation, for higher dropout of children of low SEC. In the study by Mohsin,  56% students and 70% teachers gave educational expenditures as one of the causes of school dropout. Khokkar et al.  found that financial constraints accounted for 22.22% of dropouts. In the study by Maithly et al.,  financial reason for dropout was given by 40% males and 30% female students. In the study group children, no significant relationship between SEC and dropout was seen as various other reasons besides financial problems contributed to school dropout in these children.
|Table 8: Reasons for school dropout in the children (multiple responses)|
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The reasons for dropout differed in both groups as well as between boys and girls of both groups [Table 8]. 19.54% boys in the study group had left to earn. This could be because the maximum family income in the study group is spent on the father's alcoholism, leading to severe financial problems. Similar findings were seen in the study of Sundari et al.  In the TISS study,  most of the children from alcoholics' homes had dropped out of school to take on financial responsibilities. Hyphantis et al.  in their study found that the alcoholics' families were of low socioeconomic status with increased economic needs so that the adolescents had to work simultaneously with their school education and finally at its expense. Sixteen girls in the study group as compared to eight in the control group mentioned "help in household chores and to look after siblings" as reasons for dropout. In the study group, due to financial crisis, there were many working mothers, so the girls were kept back to help at home. Some even accompanied their mothers as domestic help.
In their study, Khokkar et al.  reported that 53.33% girls were pulled out school to look after their siblings. In the Maithly et al.  study, 7% girls had dropped out to do household work. Pratinidhi et al.  in their study reported that 27.9% girls had dropped out of school as they were required at home for work. Other reasons for dropout were lack of interest in studies and adolescence (girls). Lack of interest in studies as the reason for school dropout was also reported by 26.16% subjects in the Khokkar et al.  study, by 31% boys and 13% girls in the Maithly et al.  study, and by 16 students in the Govindraju et al.  study. In the study group, 10 dropouts were due to truancy, absenteeism, and failures. Pathak et al.  in their study found that children in families with alcohol addiction had a three times higher prevalence of behavioral and emotional problems as compared to those from families without addiction. This could be because children of alcoholics, besides facing financial problems and the above-mentioned reasons, are also exposed to a chaotic environment at home, a poor role model in an alcoholic father, and parental fights, all of which contribute to an environment unfavorable for their scholastic as well as overall development.
Limitation of study
Exploring the role of other factors (besides father's alcohol dependence and the socio-demographic factors considered here) on school dropouts in the children was beyond the scope of this study.
| Conclusion and Recommendations|| |
Children in families where there is an alcohol-dependent father are at increased risk for behavioral, emotional, and scholastic problems due to dysfunctional environment and financial crisis in the family; our study endorses these findings. Alongside sustained and committed efforts to curb alcohol use, screening for these vulnerable children with appropriate referrals should be incorporated within alcohol treatment  programs. A special "outreach activity" to these children in schools can be made through Alcohol and Drug Education programs to address their problems without secluding them from the rest of their peers. Availability of counseling facilities  in schools, and workshops for school teachers to create awareness in them about the plight of these children, ways to identify them, and methods of dealing with them should be conducted. Medical social workers at hospitals and health centres form an important link to network with social welfare organizations and charitable trusts to arrange funds for the education of these children. Children of alcoholics form an important "at risk" group and preventive strategies in the form of early assessment and multidisciplinary coordinated interventions are the need of the hour.
| Acknowledgment|| |
We acknowledge Dr. Joshi Sumedha M., mentor and guide, for her encouragement, guidance, and invaluable advice.
| References|| |
|1.||World Health Organization. Global Status Report on Alcohol and Health 2011. Switzerland: WHO [Internet]; 2011. p. 35. Available from: http: www.who.int/substance_abuse/publications/global_alcohol_report/msbgsruprofiles.pdf. [Last cited on 2012 Apr 15]. |
|2.||Prasad R. Alcohol use on the rise in India. Lancet 2009;373:17-8. |
|3.||Mohan D, Chopra A, Ray R, Sethi H. Alcohol consumption in India: A cross sectional study. In: Room R, Demers A, Bourgault C, editors. Survey of Drinking Patterns and Problems in Seven Developing Countries. Geneva: World Health Organisation; 2004. p. 103-14. |
|4.||Desai NG, Isaac M. Mental health in South- East Asia: Reaching out to the community. regional health forum. Vol. 5. New Delhi: WHO/SEARO; 2001. p. 10. ISSN 1020 4237, RHF. |
|5.||Parsons T. Alcoholism and its effects on the family. [Internet] Allpsych Journal; 14/12/2003. Available from: http://www.allpsych.com/journal/alcoholism.html. [Last cited on 2012 Feb 14]. |
|6.||Robinson EB, Rhoden JL. In: Working with Children of Alcoholics: A Practitioner's Guide. 2 nd ed. New Delhi: Sage Publications; 1998. p. 1, 34, 98. |
|7.||Liberman DZ. Children of alcoholics: An update. Curr Opin Pediatr 2000;12:336-40. |
|8.||Stanley S, Vanitha C. Psychosocial correlates in adolescent children of alcoholics- Implications for intervention. Int J Psychosoc Rehabil 2008;12;67-80. |
|9.||Andreas JB, O'Farrell TJ, Longitudinal association between fathers' heavy drinking patterns and children's psychosocial adjustment. J Abnorm Child Psychol 2007;35:1-16. |
|10.||Raman V, Prasad S, Appaya MP. Children of men with alcohol dependence: Psychopathology, neurodevelopment and family environment. Indian J Psychiatry 2010;52:360-6. |
|11.||Chandy JM, Harris L, Blum R, Resnick R. Children of alcohol misusers and school performance outcomes. Child Youth Serv Rev 1993;15:507-19. |
|12.||Furtardo EF, Laucht M, Schmidt MH. Psychiatric problems in children of alcoholic fathers. J Child Adolesc Psychiatr Psychotherapy 2002;30:241-50. |
|13.||Rao KN, Begum S, Venkataramana V, Gangadharappa N. Nutritional neglect and physical abuse in children of alcohol dependent parents. Indian J Pediatr 2001;68:843-5. |
|14.||Hussong AM, Zucker RA, Wong MM, Fitzgerald HE, Pultler L. Social competence in children of alcoholic parents over time. Dev Psychol 2005;41:747-59. |
|15.||Dube SR, Anda RF, Felitti VJ, Croft JB, Edwards VJ, Giles WH. Growing up with parental alcohol abuse: Exposure to childhood abuse, neglect, and household dysfunction. Child Abuse Negl 2001;25:1627-40. |
|16.||Chopra A, Dhawan A, Sethi H, Mohan D. Association between parental and offsprings' alcohol use-population data from India. J Indian Assoc Child Adoles Ment Health 2008;4:38-43. |
|17.||Torvik FA, Rognmo K, Ask H, Roysamb E, Tambs K. Parental alcohol use and adolescent school adjustment in the general population: Results from the HUNT study. BMC Public Health 2011;11:706. |
|18.||Casas -Gil MJ, Navarro- Guzman JI. School characteristics among children of alcoholic parents. Psychol Rep 2002;90:341-8. |
|19.||Mohsin AQ, Aslam M, Bashir F. Causes of school dropout at the secondary level in the Barani areas of the Punjab. (A case study of Rawalpindi District). J Appl Sci 2004;4:155-8. |
|20.||American Psychiatric Association. Diagnostic and statistical manual of mental health disorders. 4 th ed. Washington DC: American Psychiatric Association; 1994. |
|21.||Kauffman-Kantor KG, Strauss MA. The "drunken bum" theory of wife beating. In: Strauss MA, Gelles RJ, editors. Physical violence in American Families: Risk factors and Adaptations to Violence in 8,145 Families. New Brunswick, NJ: Transaction Publications; 1990. p. 203-24. |
|22.||Kulkarni AP, Baride JP. Textbook of community medicine. 2 nd ed. In: Part 1, Chap-2, Sociology. Mumbai, India: Vora Medical Publications; 2002. p. 33. |
|23.||Sundari L, Natarajan V, Ananthakrishna. Sociological aspects of child labour. Indian J Pediatr 1984;51:665-8. |
|24.||Reaching out to children of alcoholics- a training package, department of extramural studies. Mumbai: T.I.S.S.; 1999. p. 33. |
|25.||Khokkar A, Garg S, Bharti N. Determinants of reasons of school drop-outs amongst dwellers of an urban slum of Delhi. Indian J Community Med 2005;30:92-3. |
|26.||Maithly B, Saxena V. Adolescent's educational status and reasons for dropout from the school. Indian J Community Med 2008;33:127-8. |
|27.||Hyphantis T, Koutras V, Liakos A, Marselos M. Alcohol and drug use, family situation and school performance in adolescent children of alcoholics. Int J Soc Psychiatry 1991;37:35-42. |
|28.||Pratinidhi AK, Kurulkar PV, Garad SG. Epidemiological aspects of school dropouts in children between 7-15 years in rural Maharashtra. Ind J Pediatr 1992;59:423-7. |
|29.||Govindaraju R, Venkatesan S. A study on school drop-outs in rural settings. J Psychol 2010;1:47-53. |
|30.||Pathak R, Sharma RC, Parvan UC, Gupta BP, Ojha RK, Goel NK. Behavioural and emotional problems in school going adolescents. AMJ 2011;4:15-21. |
|31.||Andreas JB, O'Farrell TJ, Fals-Stewart W. Does individual treatment for alcoholic fathers benefit their children? A longitudinal assessment. J Consult Clin Psychol 2006;74:191-8. |
|32.||Lambie DM, Sias SM. Children of alcoholics: Implications for professional counselling. Professional school counselling, special issue: Professional School Counselling in Urban Settings 2005;8:266-73. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]