2708_Alcohol-use-Among-Adolescents-in-Europe.pdf

2708_Alcohol-use-Among-Adolescents-in-Europe.pdf - Alcohol...

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Unformatted text preview: Alcohol use Among Adolescents in Europe Environmental Research and Preventive Actions Majone Steketee Harrie Jonkman Hans Berten Nicole Vettenburg Editors Alcohol use Among Adolescents in Europe Environmental Research and Preventive Actions Editors Majone Steketee Harrie Jonkman Hans Berten Nicole Vettenburg Utrecht, April 2013 1 Summary Foreword7 Executive Summary Partners bibliographical statements 9 13 Part I: Setting the stage 1 Theory and model of the study 1.1 Introduction 1.2 Theoretical framework  1.3 The model of this study 1.4 References 17 17 19 25 29 2 Methodology and design 2.1 Introduction 2.2 Sampling 2.3 Measurements 2.4 Multilevel analysis 2.5 Regional expert meetings on national policies and effective prevention programs  2.6 Summary and conclusions 2.7 References 35 35 35 40 45 46 49 49 Part II: Alcohol use among adolescents in Europe 3 Descriptive Analysis of Substance Use in Europe  3.1 Introduction 3.2 Sample Statistics 3.3 Substance use variables 3.4 Descriptive Statistics 3.5 Summary Alcohol use patterns of youngsters from 25 European countries: A comparison of cluster analysis and defining by theoretical premeditated conditions 4.1 Introduction 4.2 Methods 4.3 Results 4.4 Alternative Solutions 4.5 Discussion 4.6 References 53 53 53 57 58 65 4 67 67 68 70 73 74 76 Part III: Social contexts, other factors and their influence on alcohol consumption 5 The family 5.1 Introduction 5.2 Theoretical framework 5.3 Method 5.4 Results 5.5 Discussion 5.6 Conclusion and policy recommendations 5.7 References 2 79 79 79 82 85 87 88 88 6 The School 6.1 Introduction 6.2 Description of independent variables and outcomes 6.3 School-related risk factors: overall results  6.4 The relationship between school factors and alcohol and drug use: differences between European countries 6.5 A multilevel analysis of differences in associations between school risk factors and heavy episodic drinking  6.6 Summary and conclusions 6.7 References 93 93 95 100 7 Leisure time and Peers  7.1 Introduction 7.2 Theory about alcohol and the influence of peers 7.3 Characteristics of leisure time in European countries 7.4 Friends and the use of alcohol and drugs 7.5 Differences in leisure time and peers between the European countries 7.6 Conclusion 7.7 References 117 117 117 119 122 125 127 128 8 The neighbourhood  8.1 Introduction 8.2 The Method 8.3 Results 8.4 Differences in neighbourhood-related factors between European countries 8.5 Alcohol use of youngsters in a multilevel perspective 8.6 Conclusion and discussion 8.7 References 129 129 131 131 133 135 137 138 9 Delinquency, Victimization and alcohol involvement 9.1 Introduction 9.2 Materials and methods 9.3 Methods 9.4 Results 9.5 Conclusions and recommendations 9.6 References 139 139 140 142 142 151 153 10 Self-control 10.1 Introduction 10.2 Methodology 10.3 Results 10.4 Conclusions 10.5 References 155 155 155 156 164 166 11 A combined model 11.1 Theoretical framework 11.2 Data and methods 11.3 Results  11.4 Summary and conclusions 11.5 References 167 167 169 171 178 180 103 109 111 114 3 Part IV: Risky or intense alcohol use from a multilevel perspective: Individuals within schools within countries 12 The family  12.1 Introduction 12.2 Theoretical framework 12.3 Method 12.4 Results 12.5 Discussion 12.6 References  185 185 185 187 189 194 196 13 The School 13.1 Introduction 13.2 Explaining cross-national variations in truancy by association with alcohol use 13.3 Tracked education systems and substance use 13.4 Discussion and conclusion 13.5 References 199 199 199 202 209 212 14 Peers and deviant group behaviour 14.1 Introduction 14.2 Multilevel analysis 14.3 Results 14.4 Conclusion 14.5 References 215 215 217 219 225 226 15 Neighbourhood disorganization 15.1 Introduction  15.2 Method 15.3 Results 15.4 Conclusion and discussion 15.5 References 229 229 231 232 234 235 16 Delinquency and alcohol use  16.1 Introduction 16.2 Materials and methods 16.3 Results  16.4 Conclusions and recommendations 16.5 References 237 237 238 240 244 245 17 Self-control  17.1 Introduction 17.2 Methodology 17.3 Results 17.4 Conclusions 17.5 References 247 247 248 249 252 253 18 Country level predictors of alcohol use: The impact of alcohol policy, drinking culture characteristics and socioeconomic conditions of alcohol use 18.1 Introduction 18.2 Methods 18.3 Results 18.4 Conclusions 18.5 References 4 255 255 256 259 262 263 19 Testing the cross national influences of the risk and the protective factors and national characteristics on the drinking pattern of juveniles. 19.1 Introduction 19.2 Analysis 19.3 Conclusion for the multi-level analysis of the full model 19.4 Bayesians analysis of the full model 19.5 Conclusions 19.6 References 265 265 266 271 271 275 276 Part V: Practice: policies and programs 20 Paper on policies toward alcohol among juveniles in Europe 20.1 Introduction 20.2 Policies  20.3 Alcohol regulation by law  20.4 Conclusions 20.5 References  Practices and interventions for prevention of alcohol use among young people in Europe: Synthesis report and identification of effective programmes 21.1 Introduction 21.2 Practices and interventions for prevention of alcohol use: an overview 21.3 Method 21.4 Results and discussion 21.5 Website of good practices 21.6 Conclusions and recommendations 21.7 References 279 279 279 281 291 292 21 Policies, programmes and interventions: Results of focus groups with practitioners, policymakers and researchers  22.1 Introduction 22.2 Levels to work on prevention 22.3 Handling alcohol cultures 22.4 Involving parents and adolescents in prevention 22.5 Alcohol use and schools 293 293 294 295 296 301 302 302 22 305 305 305 309 312 314 Part VI: The Bigger Picture 23 Afterthoughts 23.1 Introduction 23.2 What do we know? 23.3 Lessons learned from prevention workers and practitioners  23.4 What we need to know 23.5 Policy recommendations 23.6 References 321 321 322 327 329 331 335 Part VII: Appendices Appendix A 339 Appendix B 349 5 6 VVerwey Jonker Instituut Foreword Since 2006 the European Commission launched a Communication that outlines a strategy to support member states in reducing alcohol-related harms. This strategy not only explicitly focuses on protecting young people, it also aims to develop and maintain a common evidence base at the EU level. The European Commission actively contributes to develop this evidence base, by funding research that can help attain the goals as set out by Europe’s Alcohol Strategy. The report Alcohol use Among Adolescents in Europe: Environmental Research and Preventive Actions is one outcome of these investments and the result of three years of dedicated collaborative work of a cross-national and interdisciplinary research team. Alcohol policy is a challenging topic for the European Union, and the health message on alcohol has never been greater than today. This health voice is of particular importance given also the rise in problematic alcohol consumption among young people (i.e. underage drinking and heavy episodic drinking) over the past years. Young people are particularly at risk of short term effects of drunkenness, including accidents and violence. While several studies exist that monitor alcohol and substance use from a European perspective (e.g. ESPAD, HBSC), the pathways that lead to problematic and underage drinking are not always well understood. This research complements these studies by focusing on the risk and protective factors of alcohol use. Through objective analysis the researchers have tried to provide a comprehensive overview of risk factors in different domains and on different levels, while at the same time investigating the variation in these relationships between the different European countries. I believe that this report provides valuable insights and is an excellent resource for policymakers, practitioners, and researchers who work on the topic of prevention of adolescent alcohol use. Philippe Roux Head of Unit Health Determinants unit European Commission 7 8 VVerwey Jonker Instituut Executive Summary In the contemporary context of globalization, nations can no longer make their alcohol policies in an international vacuum. Several organizations have come to the foreground in handling alcohol policy from a cross-national perspective, of which the most important one is the World Health Organization. Since 2001 also the EU itself has engaged itself in this sphere of public health, and since 2006 the European Commission has distributed a communication that sets out an alcohol strategy to support member states in reducing alcohol related harm. Not only does the EU alcohol strategy explicitly aims to protect young people from alcohol misuse and its harmful consequences, it also sets as one of its five priority themes the development and maintenance of a common evidence base at the EU level. It is in this regard that the current seventh framework programme ‘Alcohol use Among Adolescence Prevention Program’ (AAA-Prevent) should be framed, that is, as a means to attain these goals for its member states based on the ‘knowledge triangle’ of research, education, and innovation. The starting point of this study was the observation that the consumption of alcohol among young people has risen over the past years, and that especially problematic drinking (i.e. underage drinking and heavy episodic drinking) is an issue of growing importance. As drinking patterns only start to develop from adolescence onwards, and strongly determine later drinking habits, tackling these problems necessary asks for a focus on prevention. However, given the unequal allocation of funds in the advantage of treatment and harm reduction programs in most European countries, the impression arises that programs that focus on prevention are much less valued among politicians and policy makers. In this study, we investigate some of the potentials of alcohol prevention by focusing on both person-related and structure-related antecedents of alcohol use as well as on guidelines and examples of good practices in prevention programs. Alcohol in Europe To investigate the projects’ objectives we made use of the International Self-Report Delinquency study or ISRD-2 (2006), a cross-national dataset of European countries that surveyed also adolescents’ alcohol and substance use patterns (aged 12 to 16 years old). The analyses revealed that alcohol use is quite common among European adolescents, although clear differences were observed between the various countries. Overall, 60.4% of the adolescents have been drinking beer, wine and breezers at least once in their lifetime and 34.2% have been drinking spirits. The last month prevalence rates are were nearly half, respectively 28.1% and 13.5%. The prevalence rates for heavy episodic drinking are 28.1% for beer, wine and breezers and 13.5% for spirits. These results are congruent with previous cross-national studies, such as the ESPAD study. When comparing the different countries, the following conclusions can be made. The highest lifetime prevalence rates of alcohol use for beer, wine, and breezers were found among Eastern European countries, led by Estonia (85.7%), followed by Hungary (84.7%), Czech Republic (84.2%), and Lithuania (81.7%). The lowest prevalence rates for lifetime use was found in Iceland (21.6%), and Bosnia & Herzegovina (30.9%).The country ranking for last month prevalence of beer, wine & breezers differs only minimally with Hungary leading (45.9%), followed by Estonia (44.6%), and Denmark (39.8%). The rates for use during the last four weeks were lowest for Bosnia & Herzegovina (7.5%), followed by Iceland (9.3%). The country rankings were quite similar for spirits. 9 The analyses indicated high prevalence rates in heavy episodic drinking of beer, wine and breezers in mainly Northern, Western and Anglo-Saxon countries. The highest prevalence rates are observed in Ireland (26.1%), Finland (25.5%), Denmark (22.2%), the Netherlands (19.2%), and Germany (16.7%). Low prevalence rates are observed in Armenia (2.9%), France (3.9%), Iceland (4.4%), Bosnia & Herzegovina (4.9%) and in other countries that border the Mediterranean Sea. The binge drinking prevalence rates for spirits are quite similar. The only exception now is that some countries that border the Baltic Sea (Estonia, 19.9%; Lithuania, 11.4%; and Poland, 11.9%) now complement Ireland (16.7%), and Denmark (15.2%) as the top ranking countries with the highest prevalence rates of heavy episodic drinking. The lowest rates of heavy episodic drinking (spirits) were found in Armenia (1.5%), Bosnia & Herzegovina (1.6%), and Iceland (1.6%). Risk factors of problematic drinking A first principal aim of the project is to focus on the multifaceted etiology of alcohol use. In health research, scientists have traditionally focused on what may be called social-cognitive theories, to explain differences in alcohol and substance use. As the umbrella denominator of these theories suggests, these theories pay attention to the question of how cognitive structures (i.e. self-control, self-esteem, attitudes, et cetera) determine adolescents’ alcohol and substance use. This tendency to focus on the most proximal risk factors is also illustrated in alcohol prevention practices, where it is observed that most attention is focused at strengthening the individual (i.e. individual prevention), for instance, by working on the development and consolidation of the necessarily skills to manage emotiveness and interpersonal relationships, to resist social pressures, and to prevent and/or delay the use of tobacco, alcohol, and other psychoactive substances. One of the main criticisms on this strand of research is however that little attention is paid to the social and contextual environment in which these behaviours occur. This project tries to fill this gap by focusing on the more distal risk factors that relate to the structural and cultural environment in which teenagers spent most of their time together (i.e., peers, school, neighbourhood). The analyses conducted in this report showed that investing in these structural environment directly impacts alcohol use, and that the risk and protective factors in different domains are strongly correlated. First of all, and in line with studies in the psycho-individual sphere, our analyses confirmed that teenagers with low self-control have a much higher prevalence of drinking alcohol. More important from a prevention perspective is however the observation that low self-control is more prevalent in the more vulnerable social groups (i.e. students in disorganized schools and neighbourhoods, and among students living with disrupted families or families characterized by low bonding and weak parental supervision). Given that self-control is a trait that is developed from early childhood onwards, and once formed remains relatively stable over the life course, it is important that parents supervise their children, recognize their deviant behaviour and punish them adequately for it. One of the most salient findings is that a more peer-oriented lifestyle has the strongest association with alcohol use, and this is true for all analyses and country clusters. This finding makes sense, of course, because for many teenagers adolescence is a phase of experimentation and the most important reference group in this regard are peers. Given that drinking is a largely social phenomenon, and given that adolescents often drink as a way of integrating themselves into groups and gaining status (Crosnoe, Muller, & Frank, 2004), it should not come as a surprise that a more peer-oriented lifestyle is strongly associated with alcohol use. Apart of the peer domain, the analyses also revealed strong associations with bonding aspects in other domains. For instance, we observed that an intact family structure is a protective factor for alcohol use, and that having a good relation with your parents and parental control decreases the consumption of alcohol. We also found that drinking with the family acted as a protective mechanism for problematic alcohol behaviour, while negative life events (e.g. divorce, death of a parent, et cetera) are considered an important risk factor. Also the neighbourhood where the students’ family lives was investigated. Adolescents who experience social cohesion in their neighbourhood or feel connected to their neighbourhood are less likely to drink alcohol. On the other hand, when youngsters describe their neighborhood as disorganized they show higher levels of alcohol use. For the school domain it holds that students who spent a lot of time doing homework, enjoy school, and to a lesser 10 degree students who perceive their school climate to be positive, have lower prevalence rates on all alcohol outcomes. It is essentially the disaffection from school, as expressed in truancy, which contributes most to alcohol use. In countries where repetition is prevalent as an educational practice (i.e., mainly Western and Southern European countries), it showed significant and sometimes quite strong associations with alcohol use (especially heavy episodic drinking). Finally, the analyses showed that an educational practice such as tracking (or streaming) leads to gradients in adolescents’ alcohol use, to the disadvantage of the more vulnerable social groups. Good practices This second aim of the project is to draw together a number of good practices that can strengthen the local, national or European policies on alcohol use among adolescents. Given the very few evidencebased prevention programs that exist in Europe, we organized a series of seminars with experts in the field of alcohol prevention in order to get a better view on what works in prevention. From these discussions, several recommendations can be distilled, of which we here briefly summarize the three most important ones. First, prevention programmes that focus on empowering young people with psychosocial skills (e.g. self-efficacy, coping strategies, assertiveness, handling peer pressure, et cetera) is a powerful tool and currently one of the most popular prevention programmes in Europe. Important in any person-related prevention programme is however to involve the students themselves in this educational process by working interactively and by putting their particular social world to the foreground. By making students actors in prevention instead of passive recipients, and by focusing on positive messages (e.g. it can be cool and healthy to be a non-alcohol drinker) instead of negatives ones (e.g. drinking can kill you) investments in prevention programmes would have stronger and longer-lasting effects. Ideally, this empowerment program is be complemented with the provision of accurate and up-to-date information on both alcohol and drugs themselves, as well as on the use of substances by adolescents’ peers. This because adolescents tend to overestimate systematically the alcohol and substance use of their age mates. Adjusting these misperceptions through accurate information campaigns has the additional benefit of diminishing possible negative peer influences. Second, given the strong relationship with structural factors such as liking school, school climate, family bonding, neighbourhood disorganization, et cetera, our analyses suggest that sometimes changes are needed in the structural conditions these adolescents’ lives (i.e. structural prevention) and several recommendation in this regard were put forward in this report. While structural prevention has been widely adopted in the domain of regulation (e.g. drink-driving policy, controlling the availability and taxation of alcoholic beverages, et cetera), this is not the case for the different structural and cultural environments students gr...
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