There is lack of information on the correlates of sedentary behaviour among persons with alcohol use disorders. The study aimed to examine socio-demographic and health correlates among adolescents and adults with hazardous, harmful or probable dependent alcohol use (= problem drinking).
Data from the cross-sectional South African National Health and Nutrition Examination Survey (SANHANES-1) 2011–12 were analysed. From a total sample of 15 085 persons aged 15 years and older, 2849 adolescents and adults (mean age = 37.1 years, standard deviation [s.d.] = 15.1) were identified as problem drinkers, based on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). Multivariable logistic and linear regression were used to determine the associations between socio-demographic characteristics, health variables and high sedentary behaviour (≥8 h/day) and total minutes of sedentary behaviour a day.
The prevalence of high sedentary behaviour (≥ 8 h/day) was 11.9% overall (11.9% among men and 12.1% among women), and the mean (s.d.) duration of sedentary behaviour was 263 (169) min/day. In bivariate analysis, older age, population group, functional disability, cognitive impairment, having hypertension, having had a stroke and posttraumatic symptoms were correlated with high sedentary behaviour. In adjusted logistic regression analysis, older age and being Indian or Asian were positively, and having been diagnosed with angina was negatively, associated with high sedentary behaviour. In linear regression analysis, older age, not employed and having had a stroke were positively, and being of mixed race and having angina were negatively, associated with total minutes (up to 960 min/day) of sedentary behaviour in a day.
The study provides socio-demographic and health correlates of sedentary behaviour among problem drinkers. This information can guide possible future interventions in reducing sedentary behaviour among problem drinkers.
Globally, harmful alcohol use ranks 8th among the 79 largest contributors to global disability-adjusted life-years (DALYs).
Considering the limitations of various biological and psychological treatment approaches for alcohol use disorders, Vancampfort et al.
‘Sedentary behavior refers to any waking behavior characterized by an energy expenditure ≤ 1.5 metabolic equivalent (MET) while in a sitting or reclining posture’.
Considering the importance of sedentary behaviour interventions, that may differ in terms of correlates from physical activity interventions,
The first South African National Health and Nutrition Examination Survey (SANHANES-1) is a cross-sectional and multistage population-based household health survey conducted in 2012.
The survey response rate of participants was 92.6%.
Sedentary behaviour was measured with two questions on the time sitting or reclining in the past 7 days during a usual weekday and usual weekend day.
Problem drinking was assessed with the three-item Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), with scores of 3 or more in women and 4 or more in men indicating hazardous, harmful or dependent alcohol use (or problem drinking)
Socio-demographic information included sex, age, population group, employment and residential status.
Self-rated health was assessed with the item: ‘In general, how would you rate your health today?’
Functional disability was assessed with the item: ‘Overall in the last 30 days, how much difficulty did you have with work or household activities?’ Response options ranged from 1 = none, 2 = mild, 3 = moderate, 4 = severe to 5 = extreme.
Cognitive impairment was assessed with two items:
How much difficulty did you have with concentrating or remembering things?
How much difficulty did you have in learning a new task (e.g. learning how to get to a new place, learning a new game, learning a new recipe)?
Response options range from 1 = none to 5 = extreme. The two items were summed and cognitive impairment was defined as moderate to severe (scores 6–10).
Current tobacco use was assessed with two questions on daily or less than daily tobacco smoking and use of other tobacco products.
Fruit consumption: ‘How many fruits do you usually eat per day?’ Vegetable consumption: ‘How many portions of vegetables, excluding potatoes, do you usually eat per day?’ Response options were 1 = 4 or more per day, 2 = 1–3 per day, 3 = not every day, but 4 or more a week, 4 = not every day, but less than 4 per week, and 5 = none.
Handwashing hygiene behaviour was assessed with the question: ‘How often do you wash your hands before eating?’ Response options ranged from 1 = always to 4 = never.
Bodily pains were measured with the question: ‘How much bodily aches or pains did you have?’ Response options ranged from 1 = none to 5 = extreme or cannot do.
Physical ill-health conditions were assessed with the question: ‘Has a doctor or nurse or health worker at a clinic or hospital told you that you have had any of the following conditions? High blood pressure, stroke, heart disease, a heart attack or angina (chest pains), high blood cholesterol, high blood sugar or sugar diabetes, and tuberculosis’.
Visual difficulties were assessed with two questions asking about the difficulty of near and distant vision. Response options ranged from 1 = none to 5 = extreme or cannot do.
Hearing difficulties were assessed with two items about the difficulty in ‘hearing someone talking on the other side of the room in a normal voice’ and ‘hearing what is said in a conversation with one other person in a quiet room’. Response options ranged from 1 = none to 5 = extreme or cannot do.
Sleep problems were measured with the item: ‘How much of a problem did you have with sleeping, such as falling asleep, waking up frequently during the night, or waking up too early in the morning?’ Response options ranged from 1 = none to 5 = extreme/cannot do. Sleeping problems were classified in response to this question as ‘moderate’, ‘severe’ or ‘extreme/cannot do’.
Psychological distress in the past month was assessed with the 10-item Kessler 10 scale,
Posttraumatic stress disorder (PTSD) was assessed with the 17-item Davidson Trauma Scale (DTS) that assesses all primary DSM-IV symptoms of PTSD related to intrusion, avoidance and hyperarousal symptoms. Participants were considered to have PTSD ‘if they score at least one -re-experiencing, three avoidance/numbing and two hyper-arousal phenomena at a frequency of at least twice in the previous week’.
Data were analysed with STATA software version 13.0 (Stata Corporation, College Station, TX, USA). Descriptive statistics were calculated for the proportions of the study variables. Pearson chi-square statistics was used to test for differences in proportions. We used multivariable logistic and linear regression to determine the associations between socio-demographic characteristics, health variables and high sedentary behaviour (≥ 8 h/day) and total minutes of sedentary behaviour a day. No collinearity was detected. Missing data were excluded from the analysis. All results were adjusted for the multistage sampling design.
The study protocol was approved by the research ethics committee (REC) of the HSRC (REC 6/16/11/11).
From a total sample of 15 085 persons aged 15 years and older, 2849 adolescents and adults (mean age = 37.1 years, standard deviation [s.d.] = 15.1) had been identified as hazardous, harmful or dependent drinkers (or problem drinkers). In the sample of problem drinkers, the prevalence of high sedentary behaviour (≥ 8 h/day) was 11.9% (11.9% among men and 12.1% among women), and the mean (s.d.) duration of sedentary behaviour was 263 (169) min/day.
Compared with individuals without hazardous, harmful or dependent drinking, the prevalence of high sedentary behaviour (13.7%) and the mean duration of sedentary behaviour (267 min/day) did not significantly differ from persons with hazardous, harmful or dependent drinking (11.9%) (
Sample characteristics and prevalence of high sedentary behaviour among problem drinkers (
Variable | Sample |
Sedentary behaviour (≥ 8 h/day) |
|||
---|---|---|---|---|---|
No |
Yes |
Chi-square |
|||
% | % | % | |||
- | - | - | - | - | |
15–24 | 721 | 23.1 | 24.1 | 16.8 | 0.037 |
25–44 | 1266 | 51.1 | 49.9 | 59.2 | - |
45–64 | 722 | 21.7 | 22.0 | 17.8 | - |
65+ | 135 | 4.0 | 4.0 | 6.2 | - |
- | - | - | - | - | |
Female | 1015 | 70.4 | 70.8 | 70.4 | 0.918 |
Male | 1834 | 29.6 | 29.2 | 29.6 | - |
- | - | - | - | - | |
Black African | 1746 | 71.3 | 70.4 | 76.6 | 0.011 |
White people | 186 | 13.6 | 14.1 | 9.3 | - |
Mixed race people | 813 | 13.6 | 14.2 | 10.1 | - |
Indian or Asian | 92 | 1.5 | 1.2 | 4.0 | - |
- | - | - | - | - | |
Employed | 1227 | 47.6 | 48.4 | 40.7 | 0.104 |
Not employed | 1565 | 52.4 | 51.6 | 59.3 | - |
- | - | - | - | - | |
Rural | 855 | 28.4 | 29.8 | 26.3 | 0.374 |
Urban | 1994 | 71.6 | 70.2 | 73.7 | - |
- | - | - | - | - | |
Self-rated health status (poor) | 684 | 22.9 | 22.8 | 26.8 | 0.315 |
Functional disability | 284 | 9.2 | 8.4 | 15.3 | 0.009 |
Cognitive impairment | 157 | 5.2 | 4.7 | 8.1 | 0.049 |
- | - | - | - | - | |
Current tobacco use | 1382 | 47.1 | 48.0 | 45.4 | 0.581 |
Fruits (less once/day) | 1344 | 45.1 | 45.0 | 49.1 | 0.329 |
Vegetables (less once/day) | 1266 | 43.8 | 43.3 | 47.2 | 0.374 |
Hand washing before meals (not always) | 552 | 20.8 | 20.2 | 19.2 | 0.776 |
- | - | - | - | - | |
Bodily pain | 369 | 12.7 | 12.1 | 15.9 | 0.140 |
Ever had tuberculosis | 246 | 8.5 | 8.2 | 9.6 | 0.532 |
Hypertension | 468 | 14.7 | 14.1 | 18.4 | < 0.001 |
High cholesterol | 101 | 3.8 | 3.3 | 3.9 | 0.674 |
Diabetes | 106 | 3.0 | 2.9 | 2.3 | 0.536 |
Stroke | 55 | 1.8 | 1.3 | 4.9 | < 0.001 |
Angina | 104 | 4.1 | 4.1 | 4.9 | 0.633 |
Heart disease | 58 | 1.7 | 1.6 | 2.8 | 0.187 |
Visual problems | 145 | 4.9 | 4.5 | 7.4 | 0.145 |
Hearing problems | 50 | 1.3 | 1.1 | 1.3 | 0.765 |
- | - | - | - | - | |
Sleep problem | 288 | 10.9 | 10.3 | 13.7 | 0.199 |
Psychological distress (20+) | 508 | 17.2 | 16.4 | 22.5 | 0.069 |
PTSD any of three symptom criteria | 267 | 11.2 | 11.4 | 13.2 | 0.008 |
PTSD, posttraumatic stress disorder; s.d., standard deviation.
In bivariate analyses, older age, population group, functional disability, cognitive impairment, having hypertension, having had a stroke and PTSD symptoms were correlated with high sedentary behaviour (see
In adjusted logistic regression analysis, older age and being Indian or Asian were positively, and having been diagnosed with angina was negatively, associated with high sedentary behaviour, while in linear regression analysis older age, not employed and having had a stroke were positively, and being of mixed race and having angina were negatively, associated with total minutes of sedentary behaviour in a day (see
Associations of socio-demographic and health variables with sedentary behaviour levels among problem drinkers.
Variable | Logistic regression: Sedentary ≥ 8 h/day |
Linear regression: Minutes per day sedentary |
|||
---|---|---|---|---|---|
AOR | 95% CI | 95% CI | |||
- | - | - | - | ||
15–24 | 1 | Reference | - | Reference | |
25–44 | 2.44 | 1.44–4.13 |
14.65 | 1.89–26.70 |
|
45–64 | 1.42 | 0.72–2.81 | 16.70 | 1.52–30.60 |
|
65+ | 2.43 | 1.01–6.15 |
46.92 | 18.55–75.34 |
|
- | - | - | - | ||
Female | 1 | Reference | - | Reference | |
Male | 1.10 | 0.75–1.64 | 7.19 | −1.58–15.96 | |
- | - | - | - | ||
Black African | 1 | Reference | - | Reference | |
White people | 0.84 | 0.36–1.94 | −9.71 | −33.06–13.66 | |
Mixed race people | 0.70 | 0.43–1.15 | −26.08 | −43.73–-9.07 |
|
Indian or Asian | 3.40 | 1.72–6.72 |
−17.07 | −48.16–14.21 | |
- | - | - | - | ||
Employed | 1 | Reference | - | Reference | |
Not employed | 1.38 | 0.69–2.74 | 28.77 | 14.86–42.68 |
|
- | - | - | - | ||
Rural | 1 | Reference | - | Reference | |
Urban | 1.26 | 0.75–2.13 | 9.38 | −16.88–35.63 | |
- | - | - | - | ||
Self-rated health status (poor) | 1.03 | 0.60–1.78 | 1.17 | −12.71–15.06 | |
Functional disability | 1.80 | 0.94–3.42 | 6.69 | −13.71–27.13 | |
Cognitive impairment | 1.02 | 0.42–2.48 | 1.55 | −6.18–9.29 | |
- | - | - | - | ||
Current tobacco use | 0.74 | 0.49–1.11 | −3.22 | −14.57–8.14 | |
Fruits (less once/day) | 1.07 | 0.69–1.65 | 7.93 | −6.68–22.53 | |
Vegetables (less once/day) | 1.05 | 0.71–1.57 | −4.92 | −19.93–10.09 | |
Hand washing before meals (not always) | 0.96 | 0.56–1.67 | 10.00 | −6.62–26.63 | |
- | - | - | - | ||
Bodily pain | 1.37 | 0.69–2.74 | 1.46 | −14.81–17.75 | |
Ever had tuberculosis | 1.08 | 0.58–2.00 | 3.86 | −12.88–20.55 | |
Hypertension | 1.59 | 0.91–2.78 | 14.25 | −0.42–23.25 | |
High cholesterol | 0.67 | 0.21–2.16 | 3.31 | −28.83–34.75 | |
Diabetes | 0.54 | 0.20–1.45 | −13.78 | −34.84–7.28 | |
Stroke | 2.94 | 0.81–10.71 | 44.17 | 10.39–77.59 |
|
Angina | 0.28 | 0.08–0.93 |
−27.04 | −50.75–-3.33 |
|
Heart disease | 1.12 | 0.32–3.92 | −2.55 | −36.21–31.11 | |
Visual problems | 1.29 | 0.58–2.84 | −8.81 | −35.22–17.95 | |
Hearing problems | 0.99 | 0.25–3.85 | 30.88 | −26.53–88.30 | |
- | - | - | - | ||
Sleep problem | 0.94 | 0.44–2.02 | −11.98 | −29.71–4.63 | |
Psychological distress (20+) | 1.22 | 0.67–2.22 | 5.00 | −14.52–24.52 | |
PTSD any of three symptom criteria | 0.97 | 0.55–1.69 | 2.29 | −19.66–24.25 |
AOR, adjusted odds ratio; CI, confidence interval; PTSD, posttraumatic stress disorder.
This is the first study in Africa to investigate correlates of sedentary behaviour among problem drinkers. The investigation found that among problem drinkers (
This study found among problem drinkers that sedentary behaviour increased with age and that there were population group differences: Indian or Asian persons had a higher prevalence of high sedentary behaviour than other population groups, and back Africans had a higher total time of sedentary behaviour than the other, especially mixed race people, population groups. In the general adult population, older age was associated with higher sedentary behaviour.
In our study, not being employed was a strong predictor of increasing minutes per day sedentary behaviour among problem drinkers. A similar correlation was found in a previous study in six middle-income countries, including South Africa.
In bivariate analyses, functional disability and cognitive impairment were associated with high sedentary behaviour among problem drinkers. In agreement with a previous study,
Our findings seem to show that helping problem drinkers to get employment may be a relevant strategy to decrease sedentary behaviour.
The study variables, such as sedentary behaviour, alcohol use and physical illness conditions, were self-reported, and the cross-sectional nature of the study limits our ability to establish causality. Longitudinal studies on sedentary behaviour among problem drinkers are warranted.
This investigation found among problem drinkers that older age, being Indian or Asian, not employed and having had a stroke were positively, and being of mixed race and having been diagnosed with angina were negatively, associated with high sedentary behaviour and/or with total minutes of sedentary behaviour in a day. Findings provide information on possible future interventions that can help to reduce sedentary behaviour among problem drinkers.
The authors have declared that no competing interests exist.
K.P., N.P.-M. and S.P. designed the study. K.P. analysed the data and wrote the draft article. All authors read and approved the final manuscript.
This research analysis received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors.
Data are available at