Peers and social network on alcohol drinking through early adolescence in Taiwan

Zero alcohol products and adolescents: A tool for harm reduction or a trojan horse?

INTRODUCTION

Zero alcohol products (ZAPs) could reduce alcohol-related harms by acting as a substitute for alcoholic beverages. However, concerns have been raised regarding the potential for these products to expose young people to additional alcohol-related stimuli, further normalising alcohol use and acting as a gateway to underage alcohol consumption. Scarce research has examined whether these concerns are warranted.

METHOD

This project comprised two parts involving Australian adolescents aged 15-17 years. Part 1 was a series of 5 online focus groups (n = 44) that provided initial insights into perceptions of and experiences with ZAPs. Part 2 was a national online survey (n = 679) that assessed the generalisability of the focus group findings and identified factors associated with ZAP-related attitudinal and behavioural outcomes.

RESULTS

ZAPs were found to be salient and attractive to Australian adolescents. Over a third of surveyed adolescents (37%) had tried ZAPs. The focus group participants and survey respondents generally perceived ZAPs in a positive light, seeing them as a useful alternative to alcohol for both adolescents and adults who want to circumvent social expectations to use alcohol. Some of the study participants acknowledged the potential for ZAPs to serve as a gateway to alcohol use and recommended reducing their visibility and accessibility.

CONCLUSION

ZAPs are likely exposing minors to additional alcohol-related stimuli potentially increasing their risk of underage alcohol consumption. Regulatory responses to ZAPS need to protect young people from the potential adverse consequences of ZAPs exposure while enabling the products to be used by adults as an alcohol substitute.

The impact of the peer effect on adolescent drinking behavior: instrumental-variable evidence from China

Background

Governments around the world have taken measures to limit adolescent drinking, however, rates are still alarmingly high. However, most of these measures ignore the peer effect of drinking among adolescents. Previous studies have not sufficiently considered the reciprocal relationship between adolescent alcohol consumption and peer alcohol consumption, which may lead to an overestimation of the peer effect and mask underlying issues. Good instrumental variables are powerful but rare tools to address these issues.

Objective

This paper aims to correctly estimate the peer effect of drinking on adolescent drinking behavior in China.

Methods

Owing to the detailed information of household background in the dataset of our survey, we were able to use the drinking behaviors of peers' fathers and their beliefs about the health risks of alcohol as instrumental variables, which are more powerful than school-average instrumental variables. We collected data from the 2017 Health and Nutrition Panel survey, which surveyed 10,772 primary school students from 59 urban migrant and 60 rural public schools.

Results

The instrumental variable method estimation revealed that peer drinking significantly influences adolescent drinking behavior, with adolescents who have peers who drink alcohol being 10.5% points (2 stage least square, i.e., 2SLS, full sample estimation) more likely to engage in drinking compared to those without such peers. Furthermore, the effect differs significantly between migrant and rural adolescents.

Conclusion

The study found that parental care plays a significant role in the degree of peer effect, with the absence of parental care being a key factor in the presence of the peer effect.

Does religiosity impact binge drinking among early adolescents? A cross-sectional study in a city in Southeastern Brazil

This study evaluated the association between religiosity and binge drinking in early adolescence. A cross-sectional study was conducted with adolescents aged 10-13 from Belo Horizonte, Brazil. Stratified random sampling was performed considering the administrative district and school year. Adolescents filled an AUDIT-C form, containing questions about religiosity and binge drinking by parents and their best friends. Adolescents' caregivers answered a form regarding socioeconomic issues. Descriptive analysis, univariate, and multivariate logistic regression were performed. A total of 650 adolescents participated in the study. The frequency of binge drinking was 13.7%. In the adjusted model, religiosity was not associated with binge drinking. The covariates associated were the age of 12-13 years (OR: 1.94; CI95%: 1.06-3.56; p=0.030), maternal binge drinking (OR: 3.12; CI95%: 1.76-5.52; p<0.001) best friend binge drinking (OR: 6.01; CI95%: 3.40-10.62; p<0.001) and nonnuclear family (OR: 1.80; CI95%: 1.01-3.23; p=0.045). The findings revealed that, for binge drinking, the main factors that influenced this decision were the best friend and maternal binge drinking and family structure, although the adolescents claimed to be religious.

Dark Side or Bright Side: The Impact of Alcohol Drinking on the Trust of Chinese Rural Residents

Existing studies have explored the causal effect of social capital on harmful drinking, while the effect of drinking habits on trust is scant. In China, drinking rituals and drinking culture are considered important ways of promoting social interaction and trust, especially in rural areas where traditional culture is stronger. Based on a field survey in rural China in 2019, this paper explores the relationship between drinking habits and trust. First, we found a negative relationship between drinking habits and trust, indicating that those people who drink alcohol are more likely to have a lower trust. Second, we found significant heterogeneity in the effect of alcohol consumption on social trust across various groups. Specifically, the negative effects of alcohol consumption on trust were stronger for the females than for males; drinking alcohol did not reduce the level of trust among the Chinese Communist Party (CCP) in rural China; compared with the Han nationality, we found that the effect of drinking on trust was not significant for the ethnic minority. Third, we observed that the negative effects of alcohol consumption on trust had thresholds across age and income. Among people under 51, the risk of trust from drinking was greater than for those over 51; the negative effect of drinking on residents’ trust was more obvious in low-income families, but not significant in the group with an annual household income of more than CNY 40,000. Our empirical study provides a deeper understanding of drinking culture in rural China from a dialectical perspective.

Social Norms Regarding Alcohol Use, Perceptions of Alcohol Advertisement and Intent to Drink Alcohol among Youth in Uganda

The objective of this paper is to address the scarcity of research on alcohol marketing exposure and underage drinking in sub-Saharan Africa. This study examines perceptions of alcohol advertisements and perceived peer, adult, and parental attitudes regarding alcohol use and intentions to drink among vulnerable youth. The Kampala Youth Survey is a cross-sectional study conducted in 2014 with service-seeking youth (ages 12-18 years) living in the slums of Kampala (n=1,134) who were participating in Uganda Youth Development Link drop-in centers. Survey measures assessed perceptions of alcohol ads, social norms regarding alcohol use, and intentions to drink alcohol. Chi-square tests and structural equation modeling analyses were computed. Among participants, 32% reported intentions to drink alcohol. In fully adjusted multivariable models, current drinking status (AdjOR=5.13; 95%CI:3.93, 6.72) and perceived attractive alcohol ads (AdjOR=3.71; 95%CI:2.88, 4.78) were most strongly associated with the intention to drink. Analyses examining social norms as a moderator between perceptions of alcohol ads and intention to drink found that peer networks that disapproved of drinking were protective against intent to drink. Perceived alcohol advertisement effectiveness and peer networks supportive of alcohol use are associated with intentions to drink among both boys and girls in Kampala and are not buffered by parental disapproval of drinking. Reducing exposure to alcohol marketing and developing prevention programs that strengthen peer networks disapproving of underage alcohol use and reduce exposure to alcohol marketing may be promising strategies among these vulnerable youth.

Associations of parental and peer cross-substance use with 12-17-year-old adolescents' problematic alcohol use: A parent-child dyadic gender analysis

BACKGROUND

Adolescent alcohol use was found to be influenced by parental and peer alcohol use. Drinking behaviors also differed by gender. However, previous studies mainly focused on adolescents' substance use in relation to the same substance use among their salient others. Hence, this study investigated the cross-substance relationships of alcohol and tobacco use of parents and peers with adolescents' problematic alcohol use, separately by gender.

METHODS

Data were derived from 4445 adolescents aged 12-17 years from the 2014 National Survey of Substance Use, a nationally representative survey in Taiwan. Problematic alcohol use was assessed using the Alcohol Use Disorders Identification Test (AUDIT). Multivariate multinomial logistic regression was used, stratified by gender.

RESULTS

For males, maternal (adjusted odds ratio [aOR] = 1.73) and peer (aOR = 2.57) alcohol use was related to social drinking (AUDIT < 2); paternal (aOR = 3.58), maternal (aOR = 2.18), peer alcohol use (aOR = 5.37), and their own tobacco use (aOR = 4.72) were related to problem drinking (AUDIT ≥ 2). For females, maternal (aOR = 2.26) and peer (aOR = 2.84) alcohol use was related to social drinking; maternal (aOR = 2.35) and peer tobacco use (aOR = 3.48), and paternal (aOR = 4.56) and peer alcohol use (aOR = 3.36) were linked to problem drinking.

CONCLUSIONS

Both male and female adolescents' alcohol use was associated with their peer alcohol use, and gender differences were found in relation to their parental and peer substance use. Specifically, the parental role-modeling of smoking was only significant in mother-daughter dyads. These findings could inform multifaceted adolescent alcohol prevention programs, tailoring for males and females and also targeting their parental and peer substance use.

Understanding alcohol-specific antecedents among Chinese vocational school adolescents

BACKGROUND

Alcohol use among Chinese vocational school students is widespread and associated with many negative consequences. However, alcohol-specific antecedents for this population are understudied.

OBJECTIVES

The current study explored: (a) which alcohol-specific antecedents are the most salient predictors for alcohol use intentions, (b) whether any mediational relationships exist among these alcohol-specific antecedents, and (c) whether gender-based differences exist among these relationships.

METHODS

This study analyzed data from 1,230 vocational school adolescents in three Chinese cities. Survey data were analyzed using dominance analysis and structural equation modeling.

RESULTS

Personal norms were the most salient antecedents for alcohol use intentions, followed by injunctive norms from friends and parents, descriptive norms from friends and classmates, and positive belief about drinking. We observed a statistically significant mediational chain from descriptive norms to injunctive norms, and in turn to personal norms and positive beliefs, and finally to alcohol use intentions. Gender moderated some of the paths.

CONCLUSIONS

Alcohol use norms and beliefs among Chinese vocational school students have distinct predictive relationships with alcohol use intentions. Alcohol use prevention programs designed for this population need to address normative beliefs (descriptive, injunctive, and personal norms) and the perceived benefit of alcohol use.

Peer social network processes and adolescent health behaviors: A systematic review

Research has highlighted the importance of peers for determining health behaviors in adolescents, yet these behaviors have typically been investigated in isolation. We need to understand common network processes operating across health behaviors collectively, in order to discern how social network processes impact health behaviors. Thus, this systematic review of studies investigated adolescent peer social networks and health behaviors. A search of six databases (CINAHL, Education Resources Information Centre, Embase, International Bibliography of the Social Sciences, Medline and PsycINFO) identified 55 eligible studies. The mean age of the participants was 15.1 years (range 13-18; 51.1% female). Study samples ranged from 143 to 20,745 participants. Studies investigated drinking (31%), smoking (22%), both drinking and smoking (13%) substance use (18%), physical activity (9%) and diet or weight management (7%). Study design was largely longitudinal (n = 41, 73%) and cross-sectional (n = 14, 25%). All studies were set in school and all but one study focused on school-based friendship networks. The Newcastle-Ottawa Scale was used to assess risk of bias: studies were assessed as good (51%), fair (16%) or poor (33%). The synthesis of results revolved around two network behavior patterns: 1) health behavior similarity within a social network, driven by homophilic social selection and/or social influence, and 2) popularity: health behavior engagement in relation to changes in social status; or network popularity predicting health behaviors. Adolescents in denser networks had statistically significant lower levels of harmful behavior (n = 2/2, 100%). Findings suggest that social network processes are important factors in adolescent health behaviors.

Leisure activity participation in relation to alcohol purchasing and consumption in adolescence

BACKGROUND

Building upon the socioecological perspective, this study examines prospective associations linking leisure activity participation with alcohol purchasing and consumption in early adolescence.

METHODS

A total of 1763 seventh graders (age 12-13 years) were recruited from middle schools in urban Taiwan via multi-stage sampling and followed-up 1.5 years later during ninth grade. Information about leisure activities, covariates (i.e., gender, puberty development, family structure, parental educational attainment, monthly allowance, peer drinking, and childhood alcohol experience), and two outcome variables (i.e., alcohol purchasing and drinking behaviors) was gathered via web-based self-administered questionnaires. Data concerning alcohol outlets and recreational resource for each community district were retrieved from official statistics and commercial sources. Two-level hierarchical generalized linear models were used to evaluate association estimates.

FINDINGS

Five percent of ninth graders ever purchased alcohol and nearly one in seven drank alcohol on three or more occasions (i.e., occasional drinking) in the past year. Sports, unstructured, and organized leisure activities were not linked with illegal alcohol purchasing when community contexts were statistically adjusted; a higher community on-premised alcohol outlet density increased alcohol purchasing by 94% (95% CI = 1.24-3.06). In contrast, unstructured leisure activity participation at 7th grade predicted occasional drinking (adjusted Odds Ratio [aOR] = 5.52; 95% CI = 3.13-9.74). Sports participation was associated with reduced risk of occasional drinking in the communities with high unregulated alcohol outlets (aOR for interaction = 0.58; P < .001).

CONCLUSION

Our research provides insights to differential roles of leisure activity participation in shaping adolescents' commercial alcohol access and occasional drinking. Macro-social contexts should be considered in the efforts to reduce underage drinking problems through leisure activities.

Understanding adolescent binge drinking in Spain: how school information campaigns moderate the role of perceived parental and peer consumption

Despite its potentially harmful effects, adolescent binge drinking is becoming increasingly common worldwide. To enable the design of more effective school information campaigns, the underlying factors of heavy alcohol use must be carefully analysed. This study investigated how individual, social and contextual factors relate to adolescent binge drinking. It also explored whether adolescents' exposure to information campaigns at school moderates the relationships between perceived parental and peer alcohol consumption and adolescent binge drinking. We used data from a Spanish nationwide representative sample of 47 803 students aged 14-18 years, of whom 25 576 had engaged in binge drinking behaviours. Data were collected every 2 years between 2006 and 2012. For the multilevel estimation in 2012, the sample comprised 10 577 students. Whilst perceived problems associated with binge drinking and perceived difficulty in accessing alcohol were associated with low levels of binge drinking, adolescents' perceptions of parental and peer consumption were associated, to a greater degree, with high levels of binge drinking. School information campaigns moderated the relationship between parental consumption and adolescent binge drinking but not the relationship between peer consumption and adolescent binge drinking. We conclude by highlighting implications for policymakers and offering possible directions for future research.

Media alcohol advertising with drinking behaviors among young adolescents in Taiwan

OBJECTIVES

To investigate potential effects of alcohol ads in six major marketing channels on drinking behaviors among young adolescents in Taiwan.

METHODS

The data were derived from the Alcohol-Related Experiences among Children study. The baseline sample was comprised of 1926 seventh-eighth graders from 11 public middle schools in Taipei in 2010; follow-up was conducted one year later (follow-up rate=97%). Information concerning individual sociodemographics, family characteristics, exposure to media portrayals of drinking and alcohol ads on major marketing channels, and drinking experience was collected through web-based self-administered questionnaires. Complex survey analyses were used to evaluate the association estimates, with stratification by prior drinking experiences in childhood.

RESULTS

Television, in-store displays, and websites are the three most common marketing channels for young adolescents to report past-month alcohol advertising exposure. With statistical adjustment for potential confounders and six market channels, exposure to alcohol ads on television was associated with subsequent increased drinking initiation (adjusted odds ratio [aOR]=2.62; 95% CI=1.14-6.02). For those who have initiated alcohol use in childhood, the exposure to ads on the web (aOR=1.50; 95% CI=1.04-2.15) and radio (aOR=2.58; 95% CI=1.60-4.15) may elevate subsequent risk of occasional drinking. Exposure to media drinking portrayals was not related to subsequent drinking behaviors in this sample.

CONCLUSIONS

Our results demonstrated that the effects of alcohol advertising on drinking behaviors in early adolescence may differ by marketing channels. Preventive strategies targeting underage drinking should consider restraining marketing channels (e.g., websites and radio) from certain advertising content and placement.

Residential environments, alcohol advertising, and initiation and continuation of alcohol consumption among adolescents in urban Taiwan: A prospective multilevel study

Background

Research indicates that place characteristics and the media environment are important contextual determinants of underage drinking behaviors in Western countries, but it is unknown whether these exposures influence adolescent alcohol consumption outside Western contexts, including in Asia׳s emerging global alcohol markets. Guided by the social ecological framework, we prospectively investigated the influences of place characteristics and alcohol advertising on initiation and continuation of alcohol consumption among adolescents in Taipei, Taiwan.

Methods

Data on individual-level characteristics, including alcohol use behaviors and perceived exposure to alcohol advertising, were obtained from two waves of a longitudinal school-based study through a stratified probability sampling method in 2010 (Grade 7/Grade 8, aged 13-14 years old) and 2011-2012 (Grade 9, aged 15 years old) from 1795 adolescents residing in 22 of 41 districts in Taipei. Data on district-level characteristics were drawn from administrative sources and Google Street View virtual audit to describe districts where adolescents lived at baseline. Hierarchical generalized linear models tested hypotheses about the associations of place characteristics and perceived alcohol advertising with underage drinking, with stratification by baseline lifetime alcohol consumption.

Results

Among alcohol-naïve adolescents, lower district-level economic disadvantage, a higher proportion of betel nut kiosks (a relatively unregulated alcohol source) compared to off-premises alcohol outlets, and exposure to television-based alcohol advertising predicted increased likelihood of alcohol initiation at one-year follow-up. Among alcohol-experienced adolescents, greater spatial access to off-premises alcohol outlets, and lower access to metro rapid transportation (MRT) and to temples were found to predict a subsequent increased likelihood of continued alcohol use. Parental drinking moderated the relationship between district-level violent crime and initiation of alcohol consumption.

Conclusions

These findings suggest that local social economic status, alcohol access, and institutional resource and individual media exposure affect underage drinking behaviors in Taiwan. We discuss potential public health implications for place-based interventions. Future research on place, media, and adolescent alcohol consumption in Asian contexts is warranted.

From genetic studies to precision medicine in alcohol dependence

Genetic factors contribute to more than 50% of the variation in the vulnerability to alcohol dependence (AD). Although significant advances have been made in medications for AD, these medications do not work for all people. Precise tailoring of medicinal strategies for individual alcoholic patients is needed to achieve optimal outcomes. This review updates the most promising information on genetic variants in AD, which may be useful for improving diagnostic, therapeutic, and monitoring strategies. We describe genetic candidates of various neurotransmitter and enzyme systems. In addition to biological and allelic associations with AD, genetic effects on AD-related phenotypes and treatment responses have also been described. Gene-gene and gene-environment interactions have been considered. Potential applications of genomewide and epigenetic approaches for identifying genetic biomarkers of AD have been discussed. Overall, the application of genetic findings in precision medicine for AD will likely involve an integrated approach that distinguishes effect sizes of specific genetic predictors with regard to sex, pharmacotherapy, ethnicity, and AD-related aspects and considers gene-gene and gene-environment interactions. Our work may pave the way toward more precise treatment for AD that could ultimately improve clinical management and interventions.