The Pediatric Intensive and Critical Care Unit, Department of Pediatrics, University Hospital Ostrava, Czech Republic

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1 Cet Eur J Nurs Midw 216;7(1): doi: /CEJNM ORIGINAL PAPER ALCOHOL CONSUMPTION IN ADOLESCENTS Iloa Plevová 1, Michaela Hlávková 2 1 Departmet of Nursig ad Midwifery, Faculty of Medicie, Uiversity of Ostrava, Czech Republic 2 The Pediatric Itesive ad Critical Care Uit, Departmet of Pediatrics, Uiversity Hospital Ostrava, Czech Republic Received April 9, 215; Accepted Jauary 13, 216. Copyright: This is a ope access article distributed uder the terms of the Creative Commos Attributio Iteratioal Licese (CC BY). Abstract Aim: To determie the level of alcohol cosumptio i a selected group of adolescets. Desig: A descriptive cross-sectioal study. Methods: The data were obtaied usig a part of the stadardized ESPAD questioaire for assessig cosumptio of alcoholic beverages. The sample comprised 422 studets from seve secodary schools of differet types i the city of Ostrava. For statistical aalysis, the chi-squared test ad Fisher s exact test (for 5) were used. The data were processed usig Stata v. 1. Results: More tha half of respodets first tried alcohol before the age of 15. The most frequet alcoholrelated problems were uprotected sex, decreased school performace ad problems with parets or frieds. Icomplete families were foud to be a importat factor i adolescets preferrig ad more frequetly drikig beer. Coclusio: The study cofirmed results reported by the Europe-wide survey ESPAD, amely that adolescets start to drik alcohol as early as before they tur fiftee. Keywords: alcohol, adolescet, geder, cosumptio, family backgroud. Itroductio Alcohol cosumptio i adolescece is a serious societal issue. Most teeagers first ecouter alcohol whilst still at primary school. Accordig to data from the Europea School Survey Project o Alcohol ad Other Drugs (ESPAD), alcohol cosumptio has remaied early uchaged sice the mid-199s (Úřad vlády C R, 212). Over the past 1 years, developed coutries have witessed a earlier oset of adolescece ad overall populatio growth. The so-called secular acceleratio meas ot oly a more rapid pace of metal ad physical maturatio but also a loger time for completig the developmet of oe s full potetial. Thus, the period of childhood becomes shorter ad the oset of full adulthood is delayed (Lagmeier, Krejčířová, 26). Despite these factors, alcohol is more dagerous for the adolescet populatio tha for adults as adolescets have a smaller body size, lower weight ad smaller volume of blood. If a adolescet cosumes the same amout of alcohol as a adult perso, the alcohol cocetratio i their blood is higher. Correspodig author: Iloa Plevová, Departmet of Nursig ad Midwifery, Faculty of Medicie, Uiversity of Ostrava, Syllabova 19, Ostrava, Czech Republic; iloa.plevova@osu.cz Moreover, alcohol is much more slowly elimiated from the body i adolescets. They develop hypoglycemia more rapidly, potetially leadig to ucosciousess. Adolescets become addicted to alcohol more easily tha adults (Machová, Kubátová 29). The addictio occurs withi years i adults but oly takes moths to develop i adolescets ad its course may be rather dramatic, with itoxicatio resultig i death ot beig ucommo. Adolescet alcohol cosumers who become addicts clearly display slower psychosocial developmet, particularly i the areas of emotioal maturatio, social skills, educatio ad self-cotrol, leadig to problems i various areas of their lives (Nešpor, 211). If alcohol poisoig occurs ad a child or adolescet is admitted to a health care facility, circumstaces of the acute itoxicatio must be aalyzed. It has to be viewed i a wider cotext of their psychosocial history. As log as acute itoxicatio is merely their first cotact with addictive substaces, it should be sufficiet if both short- ad log-terms risk of alcohol abuse are adequately explaied to the patiet ad their family. I such cases, severe itoxicatio requirig hospital admissio is sufficiet warig for childre ad their families, leadig to adaptatios made to child-raisig patters, amely better moitorig of their leisure time ad devotig more 216 Cetral Europea Joural of Nursig ad Midwifery 377

2 Plevová I, Hlávková M. Cet Eur J Nurs Midw 216;7(1): time to the childre s extracurricular activities (Kabíček, C erá, 25). As stated by Hladík (29), health care is maily helpful i dealig with a itoxicated child s acute coditio but also aids i secodary or tertiary prevetio. Primary prevetio may be greatly iflueced by represetatives of ay society, icludig ours. Aim The survey aimed at assessig cosumptio of alcoholic beverages i a selected group of secodary school studets. The sub-goals were to ascertai whe their first experieces occurred, the frequecy of alcoholic beverage cosumptio, adolescets problems related to alcohol cosumptio ad the ifluece of the family o drikig. Methods Desig The survey was desiged as a descriptive crosssectioal study. Sample The sample comprised studets from seve secodary schools. To calculate alcohol cosumptio data, studets aged years were icluded i the study. From a total of 422 (1%) respodets, 275 (65%) were males ad 147 (35%) were females, with the followig age distributio: 49 (12%) 19-yearolds, 52 (12%) 18-year-olds, 167 (4%) 17-year-olds ad 154 (36%) 16-year-olds. Data collectio Data were collected betwee March ad Jue 212. School heads or deputy heads were approached with questioaires. Teachers were asked to distribute the questioaires to studets who coseted to participate. Out of a total of 5 distributed questioaires, 48 were completed (a respose rate of 96%); of those, 58 cotaied icomplete data ad were excluded. The data were obtaied usig a part of a stadardized questioaire of a modified Czech versio of the Europea School Survey Project o Alcohol ad Other Drugs or ESPAD (Evropská školí studie o alkoholu a jiých drogách, 29), a istrumet to asses cosumptio of alcoholic beverages i youg persos. The modified questioaire cotaied 2 alcohol-related items. The ESPAD project is a collaborative effort of idepedet research teams i more tha 4 Europea coutries ad the largest cross-atioal research project o adolescet substace use i the world. The overall aim with the project is to repeatedly collect comparable data o substace use amog 15- to 16-year-old studets i as may Europea coutries as possible (ESPAD, 212). The Czech Republic joied the project i 23 (Šťastá, 21). Data aalysis Descriptive data aalysis was carried out usig the absolute () ad relative frequecies, arithmetic mea (M), stadard deviatio (SD), miimum ad maximum, ad media. For statistical aalysis, the chi-squared test ad Fisher s exact test (for 5) were used; a 95% cofidece iterval (CI) was calculated for proportios. The statistical tests were performed at a sigificace level of 5%. The data were processed usig Stata v. 1. Results First experiece with alcohol The first time studets drak a alcoholic beverage, they were less tha 15 years old. A vast majority of them (83%) tried alcohol before the age of 15, amely beer (82.9%), alcopops (56.4%), wie (62.1%) ad spirits (56.9%). After the age of 15, the percetages were as follows: beer 11.4% of respodets, alcopops 21.3%, wie 17.5% ad spirits 29.6% (Table 1). Table 1 Ages at which adolescets first drak a alcoholic beverage Beer Alcopops Wie Spirits % 95% CI % 95% CI % 95% CI % 95% CI Never years or less years or later CI cofidece iterval 216 Cetral Europea Joural of Nursig ad Midwifery 378

3 Plevová I, Hlávková M. Cet Eur J Nurs Midw 216;7(1): Frequecy of alcohol cosumptio durig the last 3 days Whe asked about alcohol cosumptio durig the last 3 days, oly 23% of studets stated that they had had o driks. The others reported the followig frequecies: 1 day / 3 days 14.5%, 2 days / 3 days 16.4%, 3 days / 3 days = 2.1%, 1 day / week 9.7%, 2 days / week 1.9%, 3 4 days / week 4.7 %, every or early every day / 3 days 1 %. Alcohol cosumptio by geder There were o statistically sigificat differeces i the frequecy of alcohol cosumptio betwee male ad female studets (p =.151) (Table 2). Similarly, o differeces were foud i alcohol cosumptio durig the last 12 moths (p =.539). The oly sigificat differece was oted i alcohol cosumptio over the last 3 days (p =.377), with male studets drikig more frequetly tha their female couterparts. Table 2 Frequecy of alcohol cosumptio by geder Frequecy Geder Never 1 2x Durig the last 12 moths Males (9.9) (12.73) Females (7.48) (19.5) Males Durig the last 3 days Females (26.18) 4 (27.21) (3.18) 62 (42.18) 3 5x 42 (15.27) 26 (17.69) 6 (21.82) 27 (18.37) 6 9x 39 (14.18) 24 (16.33) 31 (11.27) 12 (8.16) 1 19x 66 (24.) 31 (21.9) 24 (8.73) 4 (2.72) 2 39x 25 (9.9) 19 (12.93) 5 (1.82) (.) 4x or more 43 (15.64) 8 (5.44) (.) 2 (1.36) p-value Adolescets problems related to alcohol cosumptio The alcohol cosumptio-related problems most frequetly idetified by studets were uprotected sex, decreased school performace, fights ad problems with parets or frieds (Table 3). Also metioed were accidets, ijuries or trouble with police. Oly few studets (M = 1.5) were victimized by robbery or theft or hospitalized or admitted to a emergecy room. Table 3 Adolescets problems resultig from alcohol cosumptio (over the last 12 moths) Problems Media M SD Mi Max Physical fight Accidet or ijury Problems with parets Problems with frieds Bad result at school Victimized by robbery or theft Trouble with police Hospitalized or admitted to a emergecy room Sexual itercourse without a codom Sexual activities that were regretted the ext day M mea, SD stadard deviatio, Mi miimum, Max maximum Ifluece of the family o the frequecy of alcohol cosumptio The study also ascertaied how may respodets lived i complete ad icomplete families (complete family refers to a family cosistig of both parets livig i the same household, irrespective of whether they are biological or ot; icomplete family refers to a family comprisig oly oe paret irrespective of the cause). A total of 312 studets (74%) stated that they lived i complete families (198 males ad 114 females), as opposed to 11 studets (26%) livig i icomplete families (77 males ad 33 females). Table 4 shows o how may occasios studets bought alcoholic beverages for their ow cosumptio, with regard to their family status. 216 Cetral Europea Joural of Nursig ad Midwifery 379

4 Plevová I, Hlávková M. Cet Eur J Nurs Midw 216;7(1): Statistically sigificat differeces betwee studets from complete ad icomplete families were observed for beer (p =.415), alcopops (p =.36) ad spirits (p =.361), with alcoholic beverages beig more frequetly bought by studets from icomplete families. Table 4 Frequecy of purchasig alcoholic beverages by adolescets (over the last 3 days) Frequecy Beverages Family Never 1-2x 3-4x 6-9x 1-19x 2x or more Beer Icomplete (5.91) (27.27) (1.91) (8.18) (1.82) (.91) (62.18) (22.12) (7.69) (3.85) (2.24) (1.92) Alcopops Icomplete (69.9) (2.91) (8.18) (1.82) (.) (.) (79.81) (12.18) (6.9) (.32) (.64) (.96) Wie Icomplete (8.91) (16.36) (1.82) (.91) (.) (.) (85.26) (1.9) (1.28) (.96) (.96) (.64) Icomplete Spirits (58.18) 214 (68.59) (24.55) 68 (21.79) (1.) 11 (3.53) (5.45) 7 (2.24) (1.82) 7 (2.24) (.) 5 (1.6) p-value Alcoholic beverages preferred by adolescets Statistically sigificat differeces betwee male ad female studets were oted for beer (p <.1), alcopops (p =.1) ad wie (p =.2). While beer was cosumed by males (56%) much more frequetly tha females (32%), alcopops (27%) ad wie (24%) were more ofte cosumed by females studets. Statistically isigificat differeces were foud betwee males ad females who ever drak alcohol (p =.843) ad those who did ot drik spirits (p =.656) (Table 5). Table 5 Alcoholic beverages cosumed by adolescets durig the last days Beverages Geder % p-value I ever drik alcohol Males Females Beer Males Females <.1 Alcopops Males Females Wie Males Females Spirits Males Females Discussio The survey results cofirmed the seriousess of the problems related to alcohol cosumptio i adolescets. For each alcoholic beverage, more tha half of the respodets idicated that they had tried it before the age of 15. Particularly alarmig is the fact that early all (94%) had druk alcohol. The fidigs cocerig the first experieces with alcohol are cosistet with the ESPAD report. Nearly six out of te 15- to 16-year-old studets had tried alcohol at least oce whe aged 13 years or youger; at the same age, as may as 12% of them had got druk. Similar tedecies were reported i all coutries participatig i the project (ESPAD 212). Accordig to a 26 report published by the Natioal 216 Cetral Europea Joural of Nursig ad Midwifery 38

5 Plevová I, Hlávková M. Cet Eur J Nurs Midw 216;7(1): Istitute o Alcohol Abuse ad Alcoholism, as may as 75% of 17- to 18-year-olds, more tha two-thirds of 15- to 16-year-olds ad two-fifths of 13- to 14- year-olds have experieces with alcohol. The average age of first use of alcohol decreased cosiderably, from 17.5 years i 1965 to 14 years i 23 (NIAAA, 26). Similar results were reported by Ferreira ad Torgal (21) ad by Swedse et al. (212), with early 3% of secodary school studets havig their first experiece with alcoholic beverages before the age of 13. Less tha half of respodets cosumed 5 or more alcoholic driks oce or twice every weeked. Approximately 6% of 1,5 participatig adolescets met the criteria for the diagosis of alcohol abuse ad depedece. The first use of alcohol before reachig the age of 15 was also metioed i a Germa report of the study Studie zur Gesudheit vo Kider ud Jugedliche i Deutschlad or KiGGS, comprisig 17,641 childre ad adolescets youger tha 18 years. At the age of 11 years, 1% of girls ad 2% of boys had experieces with alcohol; at the age of 12, the rates were 25% ad 33%, respectively. As may as 85% of 15-year-olds ad virtually all 17-year-olds had experieces with drikig alcohol. Compared to the preset survey, with 82.9% of respodets tryig alcohol before the age of 15, the Germa report showed a somewhat lower rate (7%) (Bergma et al., 213). The Czech report Národí zpráva o zdraví a životím stylu dětí a školáků, that was based o the WHO s iteratioal survey Health Behaviour i School-aged Childre or HBSC, mapped childre s lifestyle determiats i 21. Data from the survey have cofirmed that childre ecouter alcohol at a youg age; they try it by the time they reach the age of 13 (Kalma et al., 21). I the preset survey, more tha 5% of studets stated that over the last 3 days, they had druk a alcoholic drik, o average, less tha oce a week. Oe i seve studets drak alcohol several times (2 4 x) weekly ad 1.36% of adolescets drak every or early every day. Although the iteratioal ESPAD (211) project does ot provide direct compariso, it determies the proportio of adolescets drikig alcohol over the last 3 days. Alcohol cosumptio is highest i the Czech Republic. Accordig to Kalma et al. (21), three out of four 15-year-olds, irrespective of geder, drik alcohol every moth. Alcohol cosumptio rates ted to icrease quite sigificatly with age. As for the amout of alcohol cosumed o a sigle occasio, five or more glasses may be cosidered a excessive volume. I the preset survey, early a third of studets drak five or more glasses of alcohol. Nearly a teth of studets reported drikig te or more glasses of alcohol o a sigle occasio (1 glass =.2 L of beer/wie or.25 L of spirits), correspodig to, for istace, 1 beers or half a liter of spirits. Similar results were preseted i the Polish part of ESPAD 211, with oe i five studets i the age category drikig five or more glasses of alcohol o a sigle occasio of the last 3 days; i the category, the proportio rose to a third (Sierosławski, 211). A study by Clark cofirmed that with advacig adolescece, bige drikig ad drikig to itoxicatio becomes relatively commo. The earlier 27 ESPAD also provided a compariso of regios withi the Czech Republic. Accordig to the report, the most frequet regular drikers were studets from Prague ad the Cetral Bohemia Regio, with more tha a third of them drikig alcohol five times a moth; the least frequet drikers were studets from the Moravia-Silesia Regio (16%) ad Carlsbad Regio (19.3%) (Csémy, Chomyová, Sadílek, 29). There were o marked differeces i alcohol cosumptio betwee male ad female studets. However, there was a sigificat differece i alcohol cosumptio durig the last 3 days, with males drikig more frequetly tha females. The same fidigs were produced by the ESPAD (211) ad a study by Ferreira ad Torgal (21). Sierosławski (211) foud differeces i alcohol cosumptio betwee males ad females, with rates beig approximately 4% higher i males i both age categories (15 16 years; years). Accordig to Feliz, tee girls were more likely to see beefits i drug ad alcohol use tha boys. The most frequetly idetified beefit was the possibility to forget their troubles such as depressio, family problems or exam-related stress. Thus, girls were more susceptible to abuse drugs ad alcohol. I the preset survey, the most frequetly stated problems resultig from alcohol use durig the last 12 moths were uprotected sex, decreased school performace, fights ad problems with parets or frieds. I the ESPAD (211), the most commoly idetified problems were bad results at school ad serious problems with fieds or parets. I the Polish ESPAD, the most typical problems due to alcohol were problems with parets, performig poorly at school, problems with frieds, physical fights ad accidets or ijuries i the age group, ad performig poorly at school, problems with parets, physical fights, problems with frieds ad sexual itercourse without a codom i studets aged years (Sierosławski, 211). Clark (24) oted that alcohol use-related disorders were virtually abset i childre youger tha 14 years. I the age category, more tha a fifth of respodets had at least 216 Cetral Europea Joural of Nursig ad Midwifery 381

6 Plevová I, Hlávková M. Cet Eur J Nurs Midw 216;7(1): oe symptom of alcohol abuse or depedece as listed i the Diagostic ad Statistical Maual of Metal Disorders, 4th Editio. Aother serious cosequece of alcohol cosumptio is suicide, metioed by Esposito-Smythers ad Spirito (24). There is a higher proportio of alcohol ad other substace users amog adolescets who committed or at least attempted suicide. As for purchasig alcoholic beverages, studets from complete families bought less alcohol for their ow use tha their couterparts from icomplete families. I a HBSC study, Krch ad Csémy (26) focused o the relatioship betwee the family structure ad developmet of certai health-threateig habits. Childre raised i complete families had relatively fewer such habits. Ulike the other childre, childre from complete families stated that they had meals together with some members of their family, usually did ot miss their mai meals, had more physical activity, got ivolved i sports with their parets more frequetly, smoked less ad drak less alcohol. The study results suggest that losig a paret is a risk factor i the developmet of the child s lifestyle. I the ivestigated cotext, family was a comprehesive factor, with a importat role played by the family atmosphere ad parets educatio. Surprisigly, icomplete families showed more joit activities ad better cotrol over some risky habits tha families with oe step-paret. The preset study foud differeces i preferred alcoholic beverages betwee male ad female studets. While males preferred beer, girls cosumed alcopops ad wie more frequetly; the fidigs are cosistet with those reported by the ESPAD (211) ad Sierosławski (211). Accordig to Kalma et al. (21), beer is cosiderably more preferred to wie by subjects of both geders ad all age categories. With icreasig age, cosumptio rates for spirits ad mixed driks approach those for wie. Amog 15-year-olds, two i five boys ad 1 i five girls drik beer. Prefereces for particular kids of alcohol is related to the so-called drikig culture that may be determied by historical, cultural ad socioecoomic factors. Accordig to Ferreira ad Torgal (21), alcoholic beverages most frequetly cosumed by studets of both geders are spirits. Coclusio Although the legal drikig age, or the miimum age at which a perso ca purchase alcoholic beverages, i the Czech Republic is 18 years, more tha half of teeagers first try alcohol before the age of 15. The preset survey showed o sigificat differece i the frequecy of alcohol cosumptio betwee male ad female studets. Icomplete families were foud to be a importat factor i adolescets preferrig ad more frequetly drikig beer. Czech society has traditioally had a very tolerat attitude towards ot oly regular drikig but also excessive drikig. As a result, these tolerat orms i adults form the attitudes of childre ad youg people towards alcohol. Very soo, they cosider drikig as a ormal ad essetial compoet of social cotacts. Ethical aspects ad coflict of iterest I the survey, recommeded ethical priciples were adhered to. All respodets were iformed about the objectives, how the results would be published ad their aoymity protected. The subjects voluteered to participate ad gave writte coset to the use of their data. The authors claim that they are uaware of ay coflict of iterests. Ackowledgemets Supported by the Moravia-Silesia Regio (project o. 2679/214/RRC). Author cotributio Coceptio ad desig (MH, IP), data collectio (MH), data aalysis ad iterpretatio (MH), draftig the mauscript (IP), critical revisio of the mauscript (IP, MH), fializatio of the mauscript (IP). Refereces Bergma KE, Bergma RL, Richter R, Schlack R. Alkohol ud Jugedliche. Die Drogebeauftragte der Budesregierug. 213 [cited 213 Oct 29]. Available from: Clark DB. The atural history of adolescet alcohol use disorders. Addictio. 24;99(2):5 22. Csémy L, Chomyová P, Sadílek P. Evropská školí studie o alkoholu a jiých drogách (ESPAD): výsledky průzkumu v České republice v roce vyd. Praha: Úřad vlády C eské republiky; 29. (i Czech) ESPAD The Europea School Survey Project o Alcohol ad Other Drugs. 212 [cited 215 Ja 6]. Available from: Esposito-Smythers C, Spirito A. Adolescet substace use ad suicidal behavior: a review with implicatios for treatmet research. Alcoholism: Cliical ad Experimetal Research. 24;28(5 Suppl):77S 88S. Evropská školí studie o alkoholu a jiých drogách (ESPAD) 211: meziárodí zpráva. Drogy-ifo.cz. [cited 212 Dec 3]. Available from: _o_alkoholu_a_jiych_drogach_espad_211_meziarodi_zp rava (i Czech) Feliz J. Natioal study: ew data show tee girls more likely to see beefits i drug ad alcohol use. 21 [cited Cetral Europea Joural of Nursig ad Midwifery 382

7 Plevová I, Hlávková M. Cet Eur J Nurs Midw 216;7(1): ]. Available from: Ferreira MM, Torgal MC. Tobacco ad Alcohol Cosumptio amog Adolescets. Revista Latio-Americaa de Efermagem. 21;18(2): Hladík M. Alkohol problém u dětí a mladistvých. Pediatrie pro praxi. 29;1(1):48 5. (i Czech) Kabíček P, C erá O. Itoxikace alkoholem u dětí a dospívajících. Lékařské listy. 25;1 2: (i Czech) Kalma M, Sigmud E, Sigmudová D, Hamřík Z, Beeš L, Beešová D, Csémy L. Národí zpráva o zdraví a životím stylu dětí a školáků. Olomouc: Uiverzita Palackého v Olomouci; 211. (i Czech) Krch D, Csémy L. Rodiá struktura a životí styl českých dětí. Praktický lékař. 26;86(12): (i Czech) Lagmeier J, Krejčířová D. Vývojová psychologie. 2. vyd. Praha: Grada Publishig; 26. (i Czech) Machová J, Kubátová D. Výchova ke zdraví. 1. vyd. Praha: Grada Publishig; 29. (i Czech) Nešpor K. Návykové chováí a závislost: současé pozatky a perspektivy léčby. 4. vyd. Praha: Portál; 211. (i Czech) Sierosławski J. Używaie alkoholu i arkotyków przez młodzież szkolą. Warszawa: 211 [cited 212 Dec 3]. Available from: (i Polish) Swedse J, Burstei M, Case B, Coway KP, Dierker L, He J, Merikagas KR. Use ad abuse of alcohol ad illicit drugs i US adolescets: results of the Natioal Comorbidity Survey Adolescet Supplemet. Archives of geeral psychiatry. 212;69(4): Šťastá L. Nástroje pro evaluaci prevetivích a léčebých programů. Dotazík používaý v rámci studie ESPAD. 21 [cited 215 Nov 11] Available from: k-pouzivay-v-ramci-studie-espad (i Czech) Tisková koferece 2. úora 212 ESPAD. Vláda ČR. Praha: Úřad vlády C R, 212 [cited 212 Dec 3]. Available from: politika/media/tiskova-koferece-2--uora espad- 9313/ (i Czech) Uderage Drikig: Why Do Adolescets Drik, What Are the Risks, ad How Ca Uderage Drikig Be Preveted? I: Natioal Istitute o Alcohol Abuse ad Alcoholism. 26 [cited 213 Ja 29]. Available from: Cetral Europea Joural of Nursig ad Midwifery 383