The use of alcohol by workers of the garbage collection service

Abstracts

El estudio tuvo como objetivo describir el consumo de alcohol en 100 trabajadores que trabajan recolectando basura en los alrededores de la región sur del municipio de São Paulo. Se utilizó como metodología el estudio transversal. La recolección de datos fue realizada a través del cuestionario QRCAP, el cual sea basa en el cuestionario AUDIT. Los resultados muestran que 94% de los sujetos ingieren algún tipo de bebida alcohólica, de los cuales 15% fueron considerados como dependientes. La influencia de los amigos fue señalada como el mayor motivo para iniciar con el vicio (46%). Sesenta y siete por ciento de los sujetos había sentido algún síntoma como consecuencia del consumo de bebida alcohólica, 80% mencionaron tener miedo adquirir enfermedad mental debido al vicio. Condiciones externas e internas fueron citadas como resultado del uso del alcohol. No obstante, se evidenció que la falta de orientación e información sobre el alcohol contribuye con su prevalencia.

alcoholismo; servicio de limpieza; salud laboral; enfermería

O presente estudo teve como objetivo descrever o consumo de álcool em 100 trabalhadores do serviço de coleta de lixo na periferia da região sul do município de São Paulo. Foi utilizado como referencial metodológico o estudo transversal. A coleta de dados foi realizada através do questionário QRCAP, baseado no questionário AUDIT. Os resultados mostraram que 94% dos sujeitos ingerem algum tipo de bebida alcoólica, sendo que 15% foram considerados dependentes. A influência de amigos foi apontada como maior motivo para a iniciação do vício (46%). Sessenta e sete por cento dos sujeitos já sentiram algum sintoma conseqüente da ingesta de bebida alcoólica e 80% disseram ter medo de adoecerem mentalmente em virtude do vício. Situações externas e internas foram por eles citadas como precursoras do uso de álcool. Contudo, foi evidenciado que a falta de orientação e de informação acerca do álcool contribuem para a prevalência dessa doença.

alcoolismo; serviço de limpeza; saúde do trabalhador; enfermagem

ORIGINAL ARTICLE

The use of alcohol by workers of the garbage collection service

Alessandra dos Santos Mabuchi^I; Daniel Francis de Oliveira^I; Marlúcia Pereira de Lima^I; Miriã Barbosa da Conceição^I; Hugo Fernandes^II

^INursing undergraduate student, e-mail: [e-mail]

^IIM.Sc.in Nursing, e-mail: [e-mail]. Professor Faculdade Ítalo Brasileira

ABSTRACT

The present study aimed to describe the alcohol consumption of a hundred workers of the garbage collection service in the peripheral South region of São Paulo, SP, Brazil. The Transversal Study was adopted as the theoretical-methodological referential. Data were collected through the questionnaire QRCAP, based on the questionnaire AUDIT. The results showed that 94% of the interviewees ingest some kind of alcoholic beverage, while 15% were considered dependents. Peer pressure was pointed as the main reason to initiate the habit (46%). A total of 67% of the interviewees had already felt some symptom as the result of the ingestion of alcohol and 80% reported to be afraid of getting mentally ill due to the vice. External and internal situations were reported as the precursors of alcohol consumption. However, it was evidenced that the lack of orientation and information contributes for the prevalence of this illness.

Descriptors: alcoholism; housekeeping; occupational health; nursing

INTRODUCTION

Alcohol is the eldest legal and social psychoactive drug. Its consumption form as individual, family or cultural conduct is influenced by beliefs, habits and meanings attributed to its euphorizing, aphrodisiac, relaxing, sleep inducing and anxiolytic effects⁽¹⁾.

The consumption of alcoholic beverages is a problem of huge interest in Public Health, as it affects not only consumers' health, but also causes economic, social and psychological problems, with enormous repercussions on families and society^(2-5).

According to the Ministry of Health, in the State of São Paulo, at least 1 million people suffer from this problem. Alcoholism is the third motive of absenteeism from work and the eight cause of the concession of disease aid by the Ministry of Social Security^(6-7). The work situations that represent greater risks for alcohol consumption are socially unprivileged activities, with the constant creation of tensions. This is the case of urban cleaning workers⁽²⁾.

These professionals are generically called garbage collectors or sweepers. The social view on this group of workers and their self-image are problematic from the perspective of our society. The contempt of this profession originates in the collectors themselves, in their adverse economic and work conditions, which dynamically Interact with the social image of the profession itself. The garbage collectors find themselves obliged, on a daily basis, to deal with such a universally abject reality, without receiving dignified and socially balanced wages, even in comparison with those from other categories in the third sector, which they are part of. Thus, there are no conditions in which any social negotiation of professional prestige could overcome both the sources of the collectors' mental discomfort related to their professional life and identity⁽⁸⁾.

As a way of fleeing from the mental suffering and emotional overload, connected with or deriving from the work conditions, some urban cleaning professionals find an exit in alcohol, which induces to severe situations of alcohol dependence⁽⁹⁾.

Studies carried out at general hospitals in different Brazilian regions reported that between 9 and 32% of patients' deaths are related to the abuse and consumption of alcoholic beverages. In Brazil, it should also be considered that alcoholism is not diagnosed correctly during appointments and hospitalizations, thus impairing more precise interpretations of this kind of disease. In fact, we can talk about the professionals, lack of training as something to be considered and reconsidered in political and Public Health proposals. Thus, studies about alcoholism contribute to the development and improvement of professionals who fight against chemical addiction, to provide new elements to analyze the subject, taking into account the objective and subjective aspects of illness caused by alcohol in the workplace⁽⁷⁾.

This study aimed to describe alcohol consumption in garbage collection workers, appointing the factors responsible for the start of the addiction and the impact of this reality on these workers' social and professional life, thus providing support for more specific care delivery.

METHODOLOGY

This cross-sectional and descriptive study was carried out to describe to the use of alcoholic beverages, the motives and the consequences of this habit among 100 workers from the garbage collection service in São Paulo City.

Data were collected at a company responsible for public cleaning in three neighborhoods from the periphery in the South of São Paulo City. Subjects were included through "snowball" sampling. This type of sampling was chosen because the study gets into a sphere surrounded with stigmas, whose target population is difficult to access. In this type of sampling, the subjects invited to participate in the study indicate other possible participants, substantially increasing the possibility of locating characteristics of interest in the research.

It is know that the type of sampling used here creates some important limitations, as important biases in the external validity of this kind of studies, besides the impossibility of generalizing results, due to the sample size⁽¹⁰⁾. Nevertheless, the authors consider that the originality of the findings go beyond the study limitations, due to the lack of nursing research with approaches that simultaneously look at alcohol use and socially unprivileged activities.

Before starting the research, the involved subjects received rapid explanations about the study objectives, the data collection method and the importance of their collaboration. The authors also requested authorization to carry out the study on the premises of the company, under the supervision of the social worker active there.

In compliance with ethical standards for research involving human beings, according to resolution 196/96 by the National Health Council, the subjects were asked to participate voluntarily through the Free and Informed Consent Term.

In order to identify and stratify alcoholism, a questionnaire called QRCAP was developed. This questionnaire was elaborated by Mabuchi, one of the authors of this study, and based on The Alcohol Use Disorder Identification Test (AUDIT), which the World Health Organization elaborated in 1992, as a self-reporting instrument to identify various alcohol usage patterns, which is easily applied and corrected and has been cross-culturally validated⁽¹¹⁾. Besides scoring the frequency, quantity, dependence, damage and consequences of this consumption, the QRCAP (Questionnaire: Relation of Alcohol Consumption to the Profession) aims to assess the relation between ethylic consumption and the work of these professionals, identifying the motives for starting the addiction, the use of alcohol or not while at work, the symptoms related to alcohol intake and the subjects' fears related to the addiction.

The answers given to the questionnaire were analyzed and the obtained information was submitted to thematic content analysis. The results described here are presented as tables and then discussed with a view to a better understanding.

RESULTS

The results showed that 91% of the subjects were men and 9% women. In this group, 6 women, characterizing 66.7% of the female sample, used some kind of alcoholic beverage, but were not considered dependent. Fifty-two percent of the subjects had not finished basic education and only 9% finished secondary education. The subjects' ages ranges from 20 to 59 years.

It was observed that the subjects' alcohol consumption frequency was very high, as illustrated in Table 1. Ninety-four percent of the subjects consume some kind of ethylic substance, even if occasionally. In the research group of 91 men, 96.7% consume alcoholic beverage, most of whom started this use during adolescence. Only six subjects (6%) answered that they had never consumed alcoholic beverages, all of them with unfinished basic education.

As to consumption frequency, 34% of the subjects, male, consumed alcohol four or more times per week, 15% of whom alleged the consumption of more than 3 glasses per day, which evidences alcohol dependence. Moreover, 18% of the investigated workers said that they drank or had already drunk while at work.

Table 2 resumes the subjects' concern with being affected by some alcohol-related disease and the symptoms they experience when using alcohol. Thirty-three percent said they had never felt any collateral effect, while 67% said they felt, or had already felt some symptoms. Twenty-eight percent of the subjects affirmed that they had already experienced convulsions or hallucinations when consuming large quantities of alcohol, which were frequent symptoms in the group of interviewees that was considered dependent. The subjects considered liver cirrhosis as the most frightening disease deriving from alcohol. Some subjects marked the column "others" (3%), describing in this space that the consequences related to alcohol that most caused panic were the fear of being murdered when getting involved in fights while being drunk and loss of family structure.

It was observed that 54% of the subjects did not know anyone who had acquired some mental or behavioral disorder due to alcohol. However, the questionnaire contained an open space where the subjects could make observations and, in these observations, 80% of the subjects mentioned they were afraid of suffering some mental or behavioral disorder deriving from alcohol consumption, such as mental delay due to head traumas caused by falls while drunk, panic syndrome, aggressiveness and loss of control on different occasions.

Table 3 indicates the motives that facilitated alcohol intake, attempting to assess what the subjects associate the fact with that some of them turn alcoholic beverages into an addiction. The stressors related to the public cleaning service were appointed as precursors of the workers' initiation in alcohol, characterizing 30% of all answers. However, most of the subjects (46%), associated the start of alcohol consumption with the influence of friends. They also mentioned other motives like "drinking to relax a little", "misery", "separation", "leisure" and "unemployment", corresponding 18% of opinions under the item named "others". The 6% of the sample who affirmed that they had never consumed alcohol alleged that this situation was due to their belonging to some religion.

When the subjects were asked whether merchants from the region where they collect the garbage offered them alcoholic beverages as a kind of pleasure, 61% answered "yes" and 39% "no". Among the group that said no, 6% of the subjects alleged that, even if they were not offered any drink, they asked for it and, in most cases, their requests were attended.

DISCUSSION

This study revealed that a large part of the examined garbage collection workers consume some kind of ethylic substance, a fact that was also observed in studies by the São Paulo Municipal Government, which found a severe picture in this worker category with respect to the Alcohol Dependence Syndrome⁽⁹⁾.

Like in other studies, it was evidenced that the use of ethylic substances is more frequent in the productive age^(2,7). Moreover, alcohol consumption was higher among male workers (96.7%), in line with other studies carried out in Brazil and in other countries^(2,7,11).

The stressors (smell expelled by the garbage, lack of acknowledgement or incentive, excessive hour load, social discrimination) deriving from the public cleaning service were appointed in this study as precursors of alcohol intake (30%) and coincide with the motives for starting alcohol consumption mentioned by the group of subjects considered as dependent. These data are in accordance with other studies that consider socially unprivileged activities, tensions, monotonous work, lack of opportunity and development as potential higher risks for alcohol consumption^(2,7).

Alcohol is considered as the most easily accessible drug. It is inserted in our culture, present in leisure, inside people's homes, in secular as well as religious ritual life. Alcohol is offered by friends, family and is seen as a source of "social insertion"⁽¹²⁾. In this context, the results of this study showed that 46% of the subjects alleged that they started consuming alcohol due to influence from friends. Society directly collaborated to maintain the addiction, where 61% of bar or bakery owners in the region where the workers collect the garbage used to offer alcoholic beverages as a form of friendship, pleasure or gratitude.

Chronic alcoholism gradually establishes in individuals across, on the average, 15 years PF continuous use, on a daily or almost daily basis, consuming more than 40 grams of absolute alcohol per day, according to the World Health Organization⁽¹³⁾. One can of beer (350 ml) contains 17 grams of alcohol and one dose of sugar cane liquor (50 ml) 25 grams of alcohol⁽¹⁴⁾. The results of this study showed that 38.4% of the subjects started to consume alcoholic beverages more than 10 years ago, when many were still adolescents. Moreover, 15% of the subjects, male, alleged they consumed more than three doses of ethylic substances per day, which means alcohol dependence according to the above mentioned references.

Alcoholism constitutes one of the four most common causes among men between 20 and 40 years old: suicide, accidents, homicide and liver cirrhosis. Moreover, it interferes in some aspects of the individual's life, whether health, civil status, carrier, interpersonal relations or other necessary social adaptations⁽⁷⁾. In this study, these relations also coincided and constituted a great source of concern among the subjects. Many of them appointed fights, job loss, family discussions, divorce and violence against their wife and children as common problems secondary to addiction.

Public cleaning workers are subject to situations that can provoke mental suffering and emotional overload, given some characteristics related to their work⁽⁹⁾. These were appointed by the subjects in this study as precursors of ethylic initiation, causing fear of acquiring some mental or behavioral disorder deriving from alcoholism. Besides symptoms like tachycardia or mood alterations, 80% of the subjects mentioned the fear of acquiring mental problems secondary to alcohol. Forty-six percent of the subjects affirmed that they knew someone who acquired one of these disorders as a consequence of alcoholism.

Psychiatric disorders secondary to alcoholism include amnesia, dementia, hallucination, delirium syndromes; anxiety, sexual, sleep and non-specific disorders and, finally, delirium tremens, which can be fatal⁽¹⁵⁾. Twenty-eight percent of the examined workers experiences or has experience convulsion or (visual and auditory) hallucination crises, which are symptoms present in severe cases of alcoholism, which are frequently terrifying and, depending on their severity, the quantity of alcohol consumed and ingestion time, entail death risks and increased mortality levels. Moreover, homicide or suicide responses can result from these hallucinations, which also put the integrity of non-alcoholic people at risk⁽¹⁶⁾. Thus, this context deserves special attention, not only by health professionals, but also in public policies that act on this reality, through care programs that include prevention, follow-up and rehabilitation of the people involved.

CONCLUSION

Based on the results obtained in this study, it was observed that 94% of the examined public cleaning workers consume some kind of alcoholic beverage, 15% of whom are already considered alcoholics (drink more than three doses per day). This is a delicate situation, as it is known that, according to a survey by the Interdisciplinary Group on Alcohol and Drugs Studies (GREA), from the Psychiatric Institute at the Hospital das Clínicas, Brazil spends 7.3% of its Gross Domestic Product (GDP) per year to treat alcohol-related products, ranging from treatment of addicts to related diseases and productivity loss due to alcoholic drinks⁽¹⁷⁾.

Most examined workers are concerned about the fact of acquiring biopsychosocial problems secondary to alcohol. However, as alcohol exerts exciting effects, it promotes a temporary lack of inhibition and, mainly, as it is an easily accessible drug, based on cultural premises, it ends up being offered by local merchants as a social pleasure and starts to be used as a means of refuge or pastime, in a circle of friends.

As a large part of the investigated workers started their alcohol consumption during adolescence and as most of these people did not even finish basic education, actions should be taken to improve children's and adolescents' education, delaying or decreasing addictions like alcoholic drinks, and providing better access to professionalizing courses, which make it easier to obtain less exhaustive work, which is also loaded with "prejudices" by a large part of the population.

As soon as efforts are made to attend to the needs and changes the evolution of the disease requires, such as the lack of information about the harm caused by alcohol use, unemployment, lack of opportunity and incentives, lack of psychological activities to improve these workers' self-esteem, misery and lack of respect by the population, which ends up exposing garbage collection workers, even if unconsciously, to shameful and inferiorizing situations, it is believed that alcoholism incidence levels will go down.

Knowledge about the drugs phenomenon, including ethylic substances, is fundamental for nursing practice, as these professionals are responsible for promoting care, not only in curative treatment, related to the effects of alcohol, but mainly in prevention actions aimed at creating social awareness about the harm caused by this addiction. Therefore, we believe that the academic curriculum should address themes about the use and abuse of licit and illicit substances in a broader sense, as suggested in a research among nursing students in the South of Brazil⁽¹⁸⁾.

The result of this study indicated that the investigated garbage collection workers in the periphery of São Paulo City commonly consume alcoholic beverages. However, it cannot be affirmed that the type of work they perform justifies the use of alcohol. This is a complex issue, in which other cause and effect relations should be analyzed, which induce these workers to this causality. Therefore, we suggest that this study be replicated with a larger sample, so as to compare data, with a view to qualitative contributions to the development of actions aimed at improving this reality.

Recebido em: 16.8.2006

Aprovado em: 8.3.2007

• 1. Oblitas YM, Deza CT, Diaz ES, Cachay EC. Factores de riesgo del consumo de bebidas alcohólicas en escolares de educación secundaria. Rev Latino-am Enfermagem março 2005; 23(1):54-67.
• 2. Campa TJM, Robazzi MLCC. Consumo de alcohol en trabajadores de uma industria em Monterrey, México. Rev Latino-am Enfermagem 2005 setembro-outubro; 13 (número especial):819-26.
• 3. Mendes IAC. Nursing integration in Latin America and challenges to prepare leaderships for drugs research development. Rev Latino-am Enfermagem 2005 setembro-outubro; 13(especial): 767-8.
• 4. Mendes IAC, Luis MAV. Interinstitutional partnerships: the investment in the construction of multicenter projects on legal and illegal drugs. Rev Latino-am Enfermagem 2005 novembro-dezembro, 13(especial 2):1164-8.
• 5. Wright MGM, Caufield C, Gray G, Olson J. International research capacity-building programs for nurses to study the drug phenomenon in Latin America: challenges and perspectives. Rev Latino-am Enfermagem. 2005 novembro-dezembro; 13(especial 2): 1095-101.
• 6. Ministério da Saúde (BR). [site na Internet] Brasília; [acessado em 04 de julho de 2006]. Álcool: da diversão ao vício. Disponível em: http://www.saude.gov.br
• 7. Ramos TJA. Alcoolismo: trabalho e violência. Um estudo a partir do programa de atendimento ao trabalhador alcoolista da UFRJ. [Tese] - Rio de Janeiro (RJ): Escola Nacional de Saúde - Fundação Oswaldo Cruz; 2002.
• 8. Velloso MP, Santos EM, Anjos LA. Processo de trabalho e acidentes de trabalho em coletores de lixo domiciliar na cidade do Rio de Janeiro, Brasil. Cad Saúde Pública 1997 outubro-dezembro; 13(4):693-700.
• 9. André LM. Heróis da lama: sobrecarga emocional e estratégias defensivas no trabalho de limpeza pública. [Tese]. São Paulo (SP): Faculdade de Saúde Pública/USP; 1994.
• 10. Biernacki P, Waldorf D. Snowball sampling-problems and techniques of chain referral sampling. Sociol Methods Res 1981; 10: 141-63.
• 11. Ronzani TM, Ribeiro MS, Amaral MB, Formigoni, MLOS. Implantação de rotinas de rastreamento do uso de risco de álcool e de uma intervenção breve na atenção primária à saúde: dificuldades a serem superadas. Cad Saúde Pública 2005 maio-junho; 21(3):852-61.
• 12. Zago JA. Consumo de Álcool na adolescência [site na Internet] Brasil; [acessado em 06 de julho de 2006]. Adolescência, crise de identidade e álcool. Disponível em: http://www.adroga.casadia.org/alcoolismo/alcool_e_adolescencia.htm
• 13. Vaissman M. Alcoolismo como problema de saúde no trabalho: avaliação de um programa de tratamento para funcionários de uma universidade. [Tese] - Rio de Janeiro (RJ): CCS/IP/UFRJ; 1998.
• 14. Laranjeira R, Pinsky I. O alcoolismo: conhecer e enfrentar. São Paulo: Contexto; 1997.
• ¹⁵
  Alcoolismo. [site na Internet] Brasil; [acessado em 6 de julho de 2006]. Transtornos relacionados por semelhança ou classificação; Disponível em: http://www.psicosite.com.br/tra/drg/alcoolismo.htm
• 16. Smeltzer SC, Bare BG. Tratado de enfermagem médico-cirúrgica. 9 ed. Rio de Janeiro: Guanabara Koogan; 2002.
• 17. Ortigoza SAG, Bresighello MLM. Projeto Conhecer. [site na Internet] Brasil; [acessado em 07 de julho de 2006]. Introdução à problemática do álcool. Disponível em: http://www.rc.unesp.br
• 18. Carraro TE, Rassool GH, Luis MAV. A formação do enfermeiro e o fenômeno das drogas no sul do Brasil: atitudes e crenças dos estudantes de enfermagem sobre o cuidado. Rev Latino-am Enfermagem 2005 setembro-outubro; 13 (número especial): 863-71.

Publication Dates

• Publication in this collection
  12 July 2007
• Date of issue
  June 2007

History

• Accepted
  08 Mar 2007
• Received
  16 Aug 2006