European Journal of Cardiovascular Medicine

Substance use has become an escalating public health issue in India, with increased prevalence noted among informal sector workers ¹. Construction workers are particularly vulnerable due to harsh working environments, long hours, low wages, and job insecurity ². Global data show that labor-intensive occupations, including construction, face a substantial burden of substance use disorders (SUDs) ³.

Factors contributing to substance use in this population include physical and mental stress, peer pressure, lack of recreational outlets, and social acceptance of substances like tobacco and alcohol ⁴. These behaviors lead to reduced productivity, increased health risks, and occupational injuries ⁵. Despite these risks, region-specific data in India, particularly in North India, remain limited ⁶.

Aim:
To assess the prevalence and patterns of substance use among construction workers in North India.

Objectives:

1. To determine the prevalence of substance, use across different job roles and experience levels.
2. To explore implications on workplace safety, productivity, and overall well-being.

2.1) Study-Design
A cross-sectional descriptive study using a quantitative approach.

2.2) Setting
Construction sites in Bareilly, North India, including urban and semi-urban areas.

2.3) Population
Male and female construction workers aged 18–60 years.

2.4) Sampling-Technique
Stratified random sampling by job role (e.g., laborers, masons, carpenters). A sample of 500 workers was selected to ensure diversity across gender, job type, and experience level.

2.5) Data-Collection-Tools
A structured checklist with two sets of questionnaires:

• Set 1: 12 closed-ended questions on substance use (alcohol, tobacco, cannabis, stimulants, sedatives).
• Set 2: Frequency, setting, peer influence, and risky behaviors in the past 12 months.

3.1 Demographics

• Total participants: 500 (250 males, 250 females)
• Age range: 18–60 years

3.2 Prevalence by Gender

3.3 Substance Use by Age Group

3.4 Substance Use by Job Role

3.5 Substance Use by Work Experience

A total of 500 construction workers participated in the study, comprising 250 males and 250 females. The participants’ ages ranged from 18 to 60 years, with a relatively even distribution across age groups and job roles. Substance use was more prevalent among male participants than females across all categories. Alcohol was the most commonly reported substance, with 51.06% of males (n = 127) and 38.00% of females (n = 95) reporting usage. Nicotine use followed a similar trend, reported by 47.46% of males (n = 118) and 22.00% of females (n = 55). Anabolic steroid use was observed exclusively among males (4.80%, n = 12), while none of the female participants reported usage. The use of cannabinoids, inhalants, and opioids was also significantly higher in males (18.80%, 21.60%, and 20.00% respectively) compared to females (6.00%, 10.00%, and 4.00%, respectively).

Substance use was most prevalent in the 18–29 age group, followed by the 30–44 group, and least common among those aged 45–60. Alcohol use was highest among participants aged 18–29 (48.3%) and declined with age. Nicotine use followed a similar trend, most common among younger workers (38.9% in 18–29) and lowest in the oldest age group (25.0%). Cannabinoid and inhalant use also peaked in the youngest group and declined with age. Opioid use was slightly higher in the 30–44 group (14.5%) compared to the other age groups. This pattern suggests that younger workers are at greater risk for substance use across most categories.

Substance use varied notably across different construction job roles. Laborers reported the highest prevalence of alcohol (50.0%) and nicotine (42.0%) use, as well as elevated levels of cannabinoid (14.5%) and inhalant use (20.0%). Masons also showed high prevalence across most substances, second only to laborers. Carpenters, electricians, and painters showed lower but still significant levels of use, particularly alcohol and nicotine.Painters/others showed the highest opioid use at 14.0%, despite lower rates of other substances. These findings indicate that manual labor-intensive roles are associated with a higher risk of substance use.

Work experience also influenced patterns of substance use. Workers with less than 5 years of experience reported the highest levels of substance use across all categories. Alcohol: 52.2%, Nicotine: 40.0%, Cannabinoids: 15.0%, Inhalants: 20.0%. Usage decreased progressively with more years of experience. Workers with over 10 years of experience showed the lowest rates, particularly for cannabinoids (8.1%) and alcohol (36.3%). This trend suggests that early-career workers—often younger—are more vulnerable to substance use, possibly due to peer influence, lack of awareness, or inadequate coping mechanisms for occupational stress.

This study explored the prevalence and patterns of substance use among construction workers in North India, revealing a significant burden of alcohol, nicotine, and illicit substance use. The findings are consistent with national and international evidence, while also highlighting unique trends within the construction industry.

Construction workers are exposed to a unique combination of occupational and environmental stressors that contribute to the high prevalence of substance use. These include physical, chemical, ergonomic, and psychosocial hazards both at the workplace and in their living environments. Many workers live in temporary shelters or camps at construction sites, where unsanitary conditions, unsafe drinking water, and lack of recreational facilities increase their health vulnerabilities, not only during work hours but beyond them as well.

Our study found that 44.4% of construction workers consume alcohol, and 34.6% use nicotine products. These findings align with and, in some cases, exceed earlier studies. For instance:

• A prior study reported 98% tobacco smokers and 47.62% tobacco chewers, while national smokeless tobacco use is estimated at 57%.
• In contrast, our study found lower smokeless tobacco use (24.6%), which may be due to regional differences or increased awareness in certain groups.
• Alcohol use (44.4%) in our study was significantly higher than previously reported rates of 6%, 18.8%, and even the national average of 21%. This trend suggests a rising pattern of alcohol consumption among construction workers, potentially linked to worsening job insecurity and social isolation. ^8,13,14

About 40% of workers were illiterate in earlier reports, and a similar pattern was seen in our population. Illiteracy and lack of health education are strongly associated with poor health choices, limited awareness, and increased prevalence of addictions. Substance use in this population often serves as a coping mechanism for physical fatigue, stress, and mental health strain due to long work hours, poor pay, and separation from family. Moreover, factors such as male gender, risk-taking personality traits, and exposure to extreme temperatures were previously identified as significant predictors of workplace accidents and substance use. Our findings echo this, with male workers showing significantly higher usage of alcohol, nicotine, and opioids compared to females. ^13,16,17

The construction sector often lacks occupational health services, leaving workers without access to counseling, de-addiction support, or mental health care. The absence of recreational facilities, long hours, and lack of job security contribute to psychological distress, which in turn feeds into higher rates of substance dependence. These findings resonate with earlier studies that reported anxiety and poor mental health as key drivers of substance use among construction laborers. ^8,14

There is evidence of a statistically significant association between substance use and morbidity, as seen in previous studies. Tobacco use, in particular, was linked to respiratory, cardiovascular, and oral health problems. This underscores the need for routine health surveillance, behavioral counseling, and health promotion programs tailored for this workforce.

Substance use among construction workers in North India is a pressing issue, driven by occupational stress, lack of awareness, and poor socio-environmental conditions. There is a strong need for health education, mental health support, and workplace-based de-addiction programs.

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