Relationship of binge drinking and other health-compromising behaviors among urban adolescents in China

The Association between the School Environment and Adolescent Alcohol Drinking Behavior in Six Cities in China

Drinking alcohol during adolescence has short-term and long-term effects on physical and mental health. At this stage, teenagers are greatly influenced by their schoolmates and friends. We conducted a multicenter cross-sectional study to investigate the association between school environment factors and adolescents’ drinking behavior in China. Using multistage stratified cluster sampling, the study investigated 27,762 middle school students from six cities in China. The logistic regression model was used to explore the association between the school environment and adolescent alcohol drinking behaviors after adjusting for confounders, including gender, age, city, location, and smoking status. Compared with students with none of their close friends drinking, students with more than half of their close friends drinking were more likely to drink in a year (OR = 20.148, 95% CI: 17.722−22.905, p < 0.001) and in a month (OR = 13.433, 95% CI: 11.779−15.319, p < 0.001). In addition, classmates’ drinking behaviors, friends’ persuasion, and attending parties were risk factors for adolescents’ drinking behavior, while the propaganda and regulations of banning drinking in school were protective factors. The school environment, especially friends drinking, is associated with students’ drinking behavior. It is necessary to mobilize the strength of schools and peers to strengthen the prevention and control of adolescent drinking.

The Association Between Family Environment and Adolescent Alcohol Drinking Behavior: A Cross-Sectional Study of Six Chinese Cities

Objective

Adolescents' alcohol consumption has lifetime adverse physical and mental health effects. Family environment factors have a significant influence in shaping adolescents' beliefs and habits. We conducted the multicenter cross-sectional study aiming to investigate the association between family environment factors and adolescent drinking behavior in China.

Methods

The study investigated 27,762 middle school students from Beijing, Shanghai, Guangzhou, Jinan, Chengdu, and Harbin. A logistic regression model was used to explore the association between family environmental factors and adolescent drinking behavior. Participants were asked to self-report previous experiences of drinking and getting drunk to access their drinking status. Factors of family environment related to alcohol consumption included: parents' educational level, family economic status, family composition, the number of times parents drank alcohol in the past 30 days, and parents' attitudes toward their drinking behavior. The logistic regression model was used to adjust the demographic confounders, including gender, age, city, location, and smoking status, and to explore the association between family environmental factors and adolescent alcohol drinking behaviors.

Results

Compared with students whose parents prohibited drinking, students who were approved drinking were more likely to drink in this year (OR = 16.544, 95%CI:15.265–17.929, P < 0.001; Full adjustment: OR = 13.111, 95% CI: 12.031–14.288, P < 0.001), drink in this month (OR = 7.791, 95% CI: 7.077–8.565, P < 0.001; Full adjustment: OR = 6.010, 95% CI: 5.439–6.641, P < 0.001). In addition, Low family economic status, not living with the mother, parents' ambivalent attitudes toward their children's drinking and parental drinking were risk factors for drinking among middle school students.

Conclusion

The family environment, especially parents' attitudes, is associated with students' drinking and drunken behavior. Mobilizing the power of parents may play a positive role in the effective prevention and control of adolescent drinking.

Prevalence and characteristics of alcohol consumption and risk of type 2 diabetes mellitus in rural China

Background

The study aimed to characterize the prevalence of alcohol consumption and further investigate the relationship between alcohol consumption and type 2 diabetes mellitus (T2DM).

Methods

We studied 39,259 participants aged 18 to 79 years of the Henan Rural Cohort study. The associations between alcohol consumption and T2DM were examined using the logistic regression models and restricted cubic spline.

Results

For men, alcohol abstinence was associated with an increased risk of T2DM (1.491(1.265, 1.758)), whereas current drinkers were not associated with T2DM (1.03(0.91, 1.15)). Further analysis of alcohol drinkers revealed that only high-risk drinkers of WHO drinking risk levels increased the risk of T2DM (1.289(1.061,1.566)) compared to never drinkers. The risk of T2DM increased as the age of starting to consume alcohol decreased and as the number of years of consuming alcohol and the alcohol intake increased only in men. We further found that the risk of T2DM decreased as the number of years of abstinence increases and no association between alcohol abstinence and T2DM was found after more than 10 years of abstinence among men.

Conclusions

Our results suggested that reducing the amount of alcohol consumed and adhering to abstinence from alcohol consumption are beneficial in reducing the risk of T2DM.

Trial registration

The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). Date of registration: 2015-07-06. http://www.chictr.org.cn/showproj.aspx?proj=11375

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11681-0.

Prevalence of Internet Addiction and Its Relationship With Combinations of Physical Activity and Screen-Based Sedentary Behavior Among Adolescents in China

BACKGROUND

Given the widespread prevalence and serious nature of Internet addiction (IA), this study aimed to estimate the prevalence of IA and assess the relationships between IA and combinations of physical activity (PA) and screen-based sedentary behavior (SB) among adolescents in China.

METHODS

This cross-sectional study surveyed 31,954 adolescents in grades 7 to 12 in Beijing. IA, PA, screen-based SB, and other information were obtained from a self-administrated questionnaire. The chi-square test and mixed-effects logistic regression model were applied to estimate the relationship between IA and combinations of PA and screen-based SB.

RESULTS

6.2% of the surveyed adolescents reported IA and the prevalence of low PA/high screen-based SB, high PA/high screen-based SB, low PA/low screen-based SB, and high PA/low screen-based SB were 53.7%, 19.5%, 18.8%, and 8.0%, respectively. Mixed-effects logistic regression analysis showed that adolescents with low PA/high screen-based SB were 1.99 (95% confidence interval, 1.62-2.44, P < .001) times more likely to prefer IA than those with high PA/low screen-based SB.

CONCLUSIONS

The prevalence of IA among Chinese adolescents is still high. Intervention programs like maintaining sufficient PA and reducing screen-based SB might contribute to reducing their IA.

The Moderating Role of Deviant Peer Affiliation in the Relation between Cyber-Victimization, Tobacco and Alcohol Use, and Age Differences

Cyber-victimization, tobacco and alcohol use are all prominent public health problems among adolescents throughout the world. Against this background, this study examined the association between cyber-victimization and tobacco and alcohol use, as well as the moderating role of deviant peer affiliation and the potential age differences among elementary, middle, and high school students. A survey conducted among 1488 school students (aged 9-19 years, consisting of 702 elementary school students, 318 middle school students, and 468 high school students) found that cyber-victimization was positively correlated with tobacco and alcohol use among students of all stages. However, the moderating mechanism was different. Among elementary school students, deviant peer affiliation played a positive moderating role. For individuals with high deviant peer affiliation, this association was stronger. Among middle school students, the moderating role of deviant peer affiliation was insignificant. Among high school students, deviant peer affiliation played a negative moderating role; this association was significant for individuals with low deviant peer affiliation. The results of this study clarify the relationship between cyber-victimization and tobacco and alcohol use by examining the moderating role of deviant peer affiliation and age differences, providing intervention guidance for reducing the negative influences of cyber-victimization on children and adolescents with respect their use of tobacco and alcohol.

Data Mining Algorithm for Physical Health Monitoring of Young Students Based on Big Data

With the continuous improvement of living standards, the level of physical development of adolescents has improved significantly. The physical functions and healthy development of adolescents are relatively slow and even appear to decline. This paper proposes a novel data mining algorithm based on big data for monitoring of adolescent student's physical health to overcome this problem and enhance young people's physical fitness and mental health. Since big data technology has positive practical significance in promoting young people's healthy development and promoting individual health rights, this article will implement commonly used data mining algorithms and Hadoop/Spark big data processing. The algorithm on different platforms verified that the big data platform has good computing performance for the data mining algorithm by comparing the running time. The current work will prove to be a complete physical health data management system and effectively save, process, and analyze adolescents' physical test data.

A latent class analysis of psychological symptoms and health risk behaviors among Chinese adolescents

Multiple health risk behaviors (HRBs) tend to co-occur which increase risks of mental disorder. In this study, we identified the association between latent class of HRBs and psychological symptoms in Chinese adolescents. We assessed 22 628 Chinese adolescents from November 2015 to January 2016. The average age of the students were (15.36 ± 1.79), among which there were 10 990 male students and 11 638 female students. A latent class analysis was applied to identity HRBs patterns. The multivariable logistic regression models were utilized to examine the association between HRBs patterns and psychological symptoms. Four latent classes were identified, characterized as low-risk class, moderate-risk class 1 (smoking/ alcohol use (AU)/screen time (ST)), moderate-risk class 2 (unhealthy losing weight (ULW)/ problematic mobile phone use (PMPU)), and high-risk class (ULW/smoking/AU/ST/ PMPU), which were 71.2 %, 3.2 %, 22.3 %, and 3.3 % of involved participants, respectively. Compared to the low-risk class, moderate-risk class 1, moderate-risk class 2, and high-risk class showed that adjusted OR (95 %CI) value of 1.97 (1.68-2.32), 3.98 (3.72-4.26) and 6.38 (CI: 5.47-7.44) were significantly associated with psychological symptoms (P < 0.001 for each). Our findings indicated that identifying different latent class of HRBs would be helpful for the design of tailored interventions, and prevention of different patterns of HRBs should be considered in the implementation of effective intervention programs related to psychological symptoms.

The Association between Gender Role Attitudes and Alcohol Use among Early Adolescents in Shanghai, China

Adolescent alcohol use was a major social and public health concern given its negative impacts. Previous studies indicated gender role attitudes (GRA) were associated with alcohol use; however, few studies focused on early adolescents (10 to 14 years) and similar researches were not found in China. Objective: This study sought to explore the association between GRA and alcohol use among early adolescents. Methods: A cross-sectional study was conducted among students in grades six to eight across three public secondary schools in Shanghai, China. Data were collected by Computer-Assisted Self-Interview (CASI) questionnaire on mobile tablets. Alcohol use was measured by self-report, and six items with 5-point Likert-type options assessed the attitude toward traditional gender roles. The logistic regression model was adopted to examine the associations between GAR and alcohol use. Results: Totally 1,631 adolescents aged 10 to 14 years with 50.33% of boys included in this study. The mean score of GRA in drinkers was significantly higher than nondrinkers among boys (3.03 vs. 2.78, p < 0.001) but not girls (2.15 vs. 2.18, p = 0.499). After controlling the covariates of age, depression, peers' substance use, social cohesion, etc., we found that more traditional GRA was associated with a higher risk of alcohol use among boys (OR = 1.39, 95%CI: 1.11-1.75), whereas the association was not significant among girls (OR = 0.96, 95%CI: 0.74-1.24). Conclusions: Traditional GRA may increase the risk of alcohol use among early adolescent boys, suggesting that altering traditional GRA among this population group may help to prevent alcohol use.

Combined Associations of Smoking and Bullying Victimization With Binge Drinking Among Adolescents in Beijing, China

Background: Binge drinking and smoking among adolescents are serious public concerns. However, very few studies have explored the reinforcement of bullying victimization by such behavior. Our study aimed at examining the individual and combined associations of smoking and bullying victimization with binge drinking among adolescents in Beijing, China. Methods: A total of 33,694 students aged 13-17 years old in Beijing, China were anonymously investigated via the cross-sectional Chinese Youth Risk Behavior Surveillance Survey from April to May 2014. A three-stage stratified sampling was used to select participants. Factors such as sociodemographic variables and indicators of smoking, bullying victimization, and binge drinking were analyzed with multiple logistic regressions, and joint and additive interaction effects were tested. Results: Overall, ever-drinking prevalence was 59.1% (boys: 64.4%; girls: 53.7%). Past 30-day binge drinking was 11.5% (boys: 15.6%; girls: 7.4%) and frequent binge drinking was 2.3% (boys: 3.3%; girls: 1.0%). Past 30-day smoking was 10.7% (boys: 16.4%; girls: 5.0%) and past 30-day bullying victimization was 48.7% (boys: 57.3%; girls: 40.1%). The combined effects of smoking and bullying victimization on occasional binge drinking (OR = 6.49, 95% CI = 5.60-7.52) and frequent binge drinking (OR = 10.32, 95% CI = 7.52-14.14) were significant, and the additive interaction effect was significant for current smoking and bullying victimization on frequent binge drinking (OR = 10.22, 95% CI = 9.43-11.07). The additive interaction effect for current smoking and bullying victimization on frequent binge drinking was significant among boys. Conclusion: Bullying victimization reinforced the association of smoking with frequent binge drinking, especially with findings specific to boys. Programs to prevent smoking or bullying or both may reduce binge drinking among adolescents in China.

Gender differences in self-harm and drinking behaviors among high school students in Beijing, China

BACKGROUND

Self-harm and drinking are both serious problems in adolescents and many studies presented evidence of their association. However, gender differences in this association are seldom deeply discussed. Our study aimed to evaluate the prevalence of self-harm and explore its association with drinking behaviors by gender and investigate the extent to which the gender differences exist in the association between self-harm and drinking.

METHODS

A total of 32,362 students in grades 7 to 12 in Beijing, China were anonymously surveyed and included in our study using two-stage, stratified probability proportion sampling. Self-harm, drinking behaviors and other basic information were obtained from an anonymous questionnaire. Demographic variables, self-harm and drinking behaviors were analyzed using the Chi-square test and the Gamma test between genders and the gender differences in this association were analyzed by Log-binomial regression.

RESULTS

The total prevalence of self-harm was 13.7% with no significant gender difference (χ² =0.352, P = 0.553). The prevalence of self-harm in girls decreased with age (G = -0.163, P < 0.001). Self-harm was associated with drinking behaviors in both boys and girls. The Log-binomial regression demonstrated that girls in the 16-19 years old group were at lower risk of self-harm than girls in the 12-15 years old group while this association was weaker in boys (1.493 vs 1.128). The higher OR for self-harm was found among girls with early drinking experiences compared with boys (2.565 vs 1.863). Girls who had previously drunk (i.e. drunk at least once) (2.211 vs 1.636), were currently drinking (3.400 vs 2.122) and performed binge drinking (6.357 vs 3.924) were at greater risk of self-harm than boys.

CONCLUSION

Among high school students, self-harm has a significant positive association with drinking and girls with drinking behaviors are at higher risk of suffering self-harm. Identifying adolescents' drinking behaviors is of vital importance to self-harm prevention and special attention should be focused on younger girls.

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.

Parenting as an inhibitor of gender disparities in alcohol use: the case of early adolescents in China

BACKGROUND

Gender differences in alcohol use are more substantial among early adolescents in China than in the United States, presumably because of more permissive drinking norms for boys than girls in Chinese culture. This study tested a theory that gender differences in early experimentation with alcohol can be reduced through general parenting practices. Whereas traditional research has identified mediators of gender differences in alcohol use, the current research isolated moderators of gender differences and developed their implications for prevention programs.

METHODS

The study analyzed the data from the China Global School-Based Student Health Survey (n = 8805 middle school students in four cities). Youth completed anonymous surveys in classroom settings. The study examined interaction effects between gender and parenting variables using multiple regression with robust standard errors.

RESULTS

Early adolescent boys exhibited higher levels of drinking than girls for all drinking outcomes. The gender differences in drinking were negatively associated with the level of perceived parental monitoring, parental involvement in adolescent school performance, and parental empathy in a nonlinear way.

CONCLUSIONS

Results suggested that early adolescents' perceptions of general parenting practice nonlinearly moderated gender disparities in alcohol use.

Fruit and vegetable intake in relation to depressive and anxiety symptoms among adolescents in 25 low- and middle-income countries

BACKGROUND

Fruit and vegetable intake (FVI) has been inversely associated with the risk of depression. However, there is a gap in evidence from low- and middle-income countries (LMICs) and among adolescents. Further, little is known about FVI in relation to the risk of anxiety. Therefore, we examined these associations among adolescents in 25 LMICs.

METHODS

Data from the Global School-based Student Health Survey were analyzed in 65267 adolescents aged 12-15 years (mostly nationally representative). Depressive and anxiety symptoms during the past 12 months were self-reported. Frequencies of FVI during the past 30 days were collected. Multivariable logistic regression and meta-analyses of country-wise estimates were undertaken.

RESULTS

The prevalence of depressive and anxiety symptoms were 30.3% and 9.8%, respectively. A meta-analysis indicated that FVI of <5 times/d (vs. higher) was associated with an increased risk of depressive symptoms (OR = 1.10; 95% CI = 1.02-1.18). The pooled estimate for anxiety symptoms was insignificant. When examined separately, fruit intake was significantly associated with both lower risks of depressive and anxiety symptoms; vegetable intake was significantly associated with a lower risk of depressive symptoms, but not with anxiety.

LIMITATIONS

Only adolescents attending school were included; the cross-sectional design cannot reveal causality; outcomes were not measured against the gold-standard diagnostic criteria.

CONCLUSIONS

Our study provides multi-national evidence of the protective effect of FVI against depressive and anxiety symptoms among adolescents in LMICs, enabling key stakeholders to address mental health issues among adolescents globally.

Gender differences in suicidal ideation and health-risk behaviors among high school students in Beijing, China

Background

Suicide is still the leading cause of death in the 15 to 34-year age group, especially for girls aging 15 to 19-year old. In China particularly, the suicide rate of female is 60% higher than male. The gender difference on suicidal ideation and its patterns with academic, family, social and health-risk factors is unknown among adolescents in Beijing, China.

Methods

A total of 33 635 students in grades 7-12 in Beijing participated in the 2014 Chinese Youth Risk Behavior Surveillance. Data were stratified by gender and associations with suicidal ideation were analyzed using χ² test and multivariate regression analyses. The interaction effects on suicidal ideation between gender and the related behaviors were also analyzed.

Results

The prevalence of suicidal ideation was significantly higher for girls (13.3%) than boys (10.7%). The multivariate regression analyses indicated that high academic pressure, running away from home, feeling lonely or sad/hopeless, being bullied, fighting, and binge drinking were significantly associated with suicidal ideation in boys and girls. Factors more strongly associated with suicidal ideation in girls than boys were being in junior vs senior high school (girl vs boys: 1.24 vs NA), high academic pressure (2.42 vs 1.55), ever smoking (1.52 vs NA), binge drinking (1.30 vs 1.17), fighting once (1.63 vs 1.06) and being sad/hopeless (2.39 vs 2.04) and their interaction with gender were all statistically significant (P < 0.05). A lower likelihood of suicidal ideation was found among boys, but not girls, who had PE class two or more days per week.

Conclusions

Girls showed more vulnerability to suicidal ideation than boys particularly among girls in junior school, reporting high academic pressure, smoking, binge drinking and fighting. The combinations of risk factors and differential patterns for boys and girls point to high-risk groups and potential targets for gender-specific suicide prevention.

Age Patterns in Risk Taking Across the World

Epidemiological data indicate that risk behaviors are among the leading causes of adolescent morbidity and mortality worldwide. Consistent with this, laboratory-based studies of age differences in risk behavior allude to a peak in adolescence, suggesting that adolescents demonstrate a heightened propensity, or inherent inclination, to take risks. Unlike epidemiological reports, studies of risk taking propensity have been limited to Western samples, leaving questions about the extent to which heightened risk taking propensity is an inherent or culturally constructed aspect of adolescence. In the present study, age patterns in risk-taking propensity (using two laboratory tasks: the Stoplight and the BART) and real-world risk taking (using self-reports of health and antisocial risk taking) were examined in a sample of 5227 individuals (50.7% female) ages 10-30 (M = 17.05 years, SD = 5.91) from 11 Western and non-Western countries (China, Colombia, Cyprus, India, Italy, Jordan, Kenya, the Philippines, Sweden, Thailand, and the US). Two hypotheses were tested: (1) risk taking follows an inverted-U pattern across age groups, peaking earlier on measures of risk taking propensity than on measures of real-world risk taking, and (2) age patterns in risk taking propensity are more consistent across countries than age patterns in real-world risk taking. Overall, risk taking followed the hypothesized inverted-U pattern across age groups, with health risk taking evincing the latest peak. Age patterns in risk taking propensity were more consistent across countries than age patterns in real-world risk taking. Results suggest that although the association between age and risk taking is sensitive to measurement and culture, around the world, risk taking is generally highest among late adolescents.

Binge drinking and associated factors among school students: a cross-sectional study in Zhejiang Province, China

OBJECTIVE

To investigate the prevalence and correlating factors of binge drinking among middle and high school students in Zhejiang Province, China.

METHODS

We performed a cross-sectional study using data from a school-based survey. A total of 23 543 (response rate=97.5%) eligible adolescents from 442 different schools (including middle schools, academic high schools and vocational high schools) were asked to fill in an anonymous self-administered behaviour questionnaire between April and May 2017. Multivariable logistic regression models were used to examine the associations of sociodemographic and behavioural factors with binge drinking.

RESULTS

The mean (SD) age of participants was 15.6 (1.7) years and 51.3% were boys. The proportions of students from middle schools, academic high schools and vocational high schools were 51.9%, 27.5% and 20.6%, respectively. In total, 22.8% (95% CI 21.6 to 23.9) of students reported drinking alcohol in the past 30 days and 9.2% (95% CI 8.5 to 10.0) of students reported binge drinking (defined as drinking four or more alcoholic drinks in 1-2 hours period among girls and five or more alcoholic drinks among boys) during the past month. The prevalence of binge drinking was highest among vocational high school students (17.9% vs 6.3% and 7.7% among middle school and academic high school students, respectively). Older age, studying at high school, poor academic performance, higher levels of physical activity, excessive screen-time, loneliness, insomnia, previous suicide attempt, cigarette smoking, fighting, being bullied and sexual experience were found to be positively associated with adolescent binge drinking.

CONCLUSIONS

Binge drinking is common among middle and high school students in Zhejiang, China. Efforts to prevent binge drinking may need to address a cluster of sociodemographic and behavioural factors. Our findings provide information to enable healthcare providers to identify students at high-risk of binge drinking and to inform planning of intervention measures for at-risk students.

Cultural Orientation and Its Associations with Alcohol Use by University Students in China

Cultural orientation is defined as an individual’s cultural preferences when encountering imported culture while still living in the native culture. Data was analyzed from 1305 Chinese university students attending universities in Beijing, Kunming, and Wuhan. Cultural orientation was assessed with the Chinese Cultural Orientation Questionnaire, which assesses both Western and Traditional Chinese cultural orientations. The analysis used hierarchical logistic regression with nondrinkers as the reference group and controlling for demographic factors (age, gender, and urban/rural background). Western cultural orientation was found to significantly increase the odds of recent drinking. The results indicated that higher Western cultural orientation was, after gender, the second most important factor associated with Chinese college student drinking frequency. Traditional Chinese cultural orientation was not associated with drinking frequency. This study highlights an unexpected outcome of globalization on students who have not left their home cultures.

Lifestyle and Addictive Behaviors Among Chinese Adolescents in Hong Kong, Macau, Taipei, Wuhan, and Zhuhai-a First Cross-subculture Assessment

PURPOSE

This study aimed at assessing the differences in prevalence rates of common health behavior among adolescents in the five Chinese cities and the influential factors at the contextual and individual levels.

METHOD

We compared the standardized rates of three lifestyle behaviors (sedentary, dietary, and physical activity) and three addictive behaviors (cigarette smoking, alcohol consumption, and participation in gambling) among a sample of 13,950 adolescents. The sample was randomly selected from five cities, including Hong Kong, Macau, Taipei, Zhuhai, and Wuhan. Population size, GDP per capita, and literacy at the city level as well as parental monitoring and school performance at the student's level were assessed. Multi-level mixed effect models were used to examine the interaction of individual level factors with study sites.

RESULTS

The six health behaviors differed significantly across sites with the highest rates of alcohol consumption in Hong Kong (39.5 %), of cigarette smoking in Macau (9.8 %), and of gambling in Taipei (37.1 %) and Hong Kong (35.9 %). The city-level measures were associated with only a few behavioral measures. Relative to Hong Kong, parental monitoring had stronger association with the three addictive behaviors in the other sites.

CONCLUSION

Findings suggest that although the study sites share similar Chinese culture, students in the five cities differed from each other with regard to levels of health behaviors. Relative to the broad socioeconomic development, differences in parental monitoring played a significant role in explaining the observed difference.

Influence of Parental Monitoring, Sensation Seeking, Expected Social Benefits, and Refusal Efficacy on Tobacco and Alcohol Use in Chinese Adolescents

The relationships between parental monitoring (PM), sensation seeking (SS), expected social benefits (ESB), refusal efficacy (RE), and tobacco and alcohol use (TAU) have been well documented among adolescents. However, the mechanisms by which these 4 determinants affect TAU remain unclear. Based on the Theory of Triadic Influence, this study aimed to explore how PM, SS, ESB, and RE simultaneously influenced TAU in Chinese adolescents. From September 2013 to June 2014, we used multistage cluster sampling to select 6269 students from 179 classes of 7 vocational high schools in 3 cities of China. Each student completed a battery of 5 measures: PM, SS, ESB, RE, and TAU. Then, we used structural equation modeling techniques and mediation analyses to investigate the relationships among these 5 measures, with TAU as the final dependent variable. Results demonstrated that the relationship between PM and TAU was fully mediated by ESB and RE (b = -0.18, P < 0.001), that SS influenced TAU directly (b = 0.10, P < 0.001) and indirectly through ESB and RE (b = 0.15, P < 0.001), and that ESB influenced TAU directly (b = 0.09, P < 0.001) and indirectly through RE (b = 0.28, P < 0.001).These findings indicate that the link between PM and SS to TAU among Chinese adolescents can be explained by ESB and RE. These 4 precursory determinants can play an important role in TAU prevention among adolescents in China.

Learning to drink: How Chinese adolescents make decisions about the consumption (or not) of alcohol

BACKGROUND

The aim of the study was to provide in-depth understanding of how Chinese adolescents learn to drink and how they make decisions about the consumption (or not) of alcohol. This study explored the ways in which social and cultural factors shape the drinking trajectories of Chinese underage young people.

METHODS

The study used a qualitative design to collect and analyse the data. We recruited adolescents aged between 14 and 17 from a range of secondary schools in Hong Kong. Focus group interviews were undertaken with 22 groups encompassing 111 participants. A thematic analysis based upon grounded theory was performed using NVivo 10.

RESULTS

The traditional Chinese drinking culture, characterised by the coming together of friends and relatives for celebrations, signifies the Chinese adolescents' first alcohol experiment. The adolescents' motivations for drinking essentially reflect the value placed upon alcohol within the Chinese culture - promoting conviviality, sociability and camaraderie. Whereas a sense of commonality encouraged alcohol use among them, there was little indication that drinkers and non-drinkers separately clustered around friendship networks. A high degree of self-regulation was exercised when drinking and this emerged as an acceptable social norm amongst young drinkers within social and cultural contexts. Most respondents saw underage drinking as an entirely normal and accepted part of social lives provided that it is kept under control.

CONCLUSIONS

This study sheds light on the Chinese adolescents' own understandings and interpretations of their drinking. Our findings suggest that interventions aimed to curtail underage drinking need to reflect social and cultural contexts within which alcohol comes into play and importantly, consider social environments that are conducive to underage drinking.

Secondhand effects of alcohol use among students in Vietnam

Background

In many countries worldwide, heavy drinking can cause harm not only to drinkers but also to those around them.

Objective

To examine the prevalence and predictors of secondhand effects of alcohol use among students in Vietnam.

Design

In this cross-sectional study, a multistage sampling strategy was used to select 6,011 students (from the first to final study year) of 12 universities/faculties in four provinces in Vietnam. During class, students filled in a questionnaire asking for demographic information, and about alcohol-related problems and details of secondhand effects of alcohol during the past year. Exploratory factor analysis of the secondhand effects indicated two factors: non-bodily harm and bodily harm. A logistic regression model was used to explore the association between predictors and non-bodily harm and bodily harm.

Results

The prevalence of secondhand effects of alcohol is high among students in Vietnam: 77.5% had non-bodily effects and 34.2% had bodily effects. More than 37% of the population reported three to four non-bodily effects and more than 12% reported two to three bodily harms due to the drinking of others. However, most respondents who reported secondhand effects experienced these less than once per month. Factors most strongly associated with the yearly non-bodily harm were the weekly drinking habits of the people the respondents live with, and living in a smaller city; the factor most strongly associated with the yearly bodily harm was the respondent's own alcohol-related problems. Moreover, weekly drinking habits of the people the respondents live with, and respondent's own alcohol-related problems are strongly associated with the frequent experience of non-bodily and bodily effects of alcohol.

Conclusions

In addition to dealing with alcohol-related harm of drinkers themselves, preventing secondhand effects should also be a major focus of prevention policy.

Binge drinking and eating problems in Russian adolescents

BACKGROUND

Binge drinking may be linked to problematic eating behavior, although as yet, little research has been conducted on this association. The objective of this study was to examine the relationship between binge drinking and eating problems in Russian adolescents.

METHODS

Data were drawn from the Social and Health Assessment, a cross-sectional school-based survey of 6th to 10th grade students (aged 12 to 17 years old) carried out in Arkhangelsk, Russia. Information was collected on various eating problems (worries about weight, feeling fat, excessive eating, fasting and excessive exercise, and purging behaviors) and binge drinking (5 or more drinks in a row). Logistic regression analysis was used to examine the relationship between binge drinking and eating problems.

RESULTS

Among the 2,488 adolescents included in the statistical analysis, nearly 50% of girls expressed worries about their weight, while 35.0 and 41.5% of adolescent boys and girls reported excessive eating, respectively. The prevalence of purging behaviors (vomiting/using laxatives) was, however, much lower among both sexes (females—2.6%; males—3.3%). In a regression model adjusted for demographic factors and depressive symptoms, among girls, binge drinking was associated with 5 of the 6 eating problems with odds ratios (ORs) ranging from 1.21 (upset about weight gain) to 1.68 (excessive eating). For boys, binge drinking was linked to feeling overweight (OR: 1.47, confidence interval [CI]: 1.20 to 1.81) and vomiting/used laxatives (OR: 4.13, CI: 1.58 to 10.80).

CONCLUSIONS

Many adolescents in Russia report problematic eating attitudes and behaviors, and eating problems are associated with binge drinking. More research is now needed in this setting to better understand adolescent eating problems and their association with alcohol misuse, so that contextually suitable interventions can be implemented to reduce these behaviors and mitigate their potentially detrimental effects.

Predictors of substance use among vulnerable adolescents in five cities: findings from the well-being of adolescents in vulnerable environments study

PURPOSE

Adolescent substance use has numerous consequences. Our goals in this article are to compare the prevalence and correlates of substance use among ethnically diverse adolescents.

METHODS

Data were from 2,332 adolescents aged 15-19 years recruited via respondent-driven sampling from disadvantaged settings in five cities. Multivariate logistic regression was used to identify correlates of current substance use.

RESULTS

About half of the respondents were male. Most adolescents (73.4%) were currently enrolled in school and identified a father (86.2%) and mother (98.6%) figure and strong peer support. Sixty-two percent reported lifetime use of at least one substance. Overall, the most common substances ever used were alcohol (44.6%), cigarettes (26.2%), and marijuana (17.9%). Mean age at first use of alcohol was 14.2 ± 3.1 years. Current alcohol use was highest in Johannesburg (47.4%) and lowest in Delhi (2.1%). The mean age at first use of cigarettes was 14.4 ± 2.8 years. Current cigarette smoking was highest in Johannesburg (32.5%) and lowest in Delhi (3.7%). Male gender predicted current alcohol use in all sites, older age (17-19 years) was also a predictor in Baltimore. Male gender (Johannesburg and Shanghai), older age (Baltimore and Shanghai), and being out of school (Baltimore, Johannesburg, and Shanghai) predicted current cigarette smoking. Absence of a caring father figure was predictive for current alcohol use in Baltimore and Shanghai. Stronger peer support predicted alcohol (Johannesburg and Shanghai) and cigarette use (Johannesburg).

CONCLUSIONS

Substance use is still a major issue among adolescents around the world, underscoring the need for continued research and interventions.

Sexual coercion and health-risk behaviors among urban Chinese high school students

Objective

To determine the association between health-risk behaviors and a history of sexual coercion among urban Chinese high school students.

Design

A cross-sectional study was performed among 109,754 high school students who participated in the 2005 Chinese Youth Risk Behavior Survey. Data were analyzed for 5,215 students who had experienced sexual intercourse (1,483 girls, 3,732 boys). Multivariate logistic regression was used to determine the relationship between sexual coercion and the related covariates, and data were stratified by gender.

Results

Of those students who had had sexual intercourse, 40.9% of the females and 29.6% of the males experienced sexual coercion (p<0.01). When analyses controlled for demographic characteristics, in the study sample, that is, students who had sexual intercourse, drug use (odds ratios [OR], 2.44), attempted suicide (OR, 2.30), physical abuse (OR, 1.74), binge drinking (OR, 1.62), verbal abuse (OR, 1.29), experience of being drunk (OR, 0.68), and smoking of cigarettes (OR, 0.52) were related to a history of sexual coercion. Patterns of health-risk behaviors also differed among female and male students who had experienced sexual coercion.

Conclusions

Sexual coercion is associated with health-risk behaviors. Initiatives to reduce the harm associated with sexual coercion among high school students are needed.

Alcohol consumption in 0.5 million people from 10 diverse regions of China: prevalence, patterns and socio-demographic and health-related correlates

Background Drinking alcohol has a long tradition in Chinese culture. However, data on the prevalence and patterns of alcohol consumption in China, and its main correlates, are limited.

Methods During 2004–08 the China Kadoorie Biobank recruited 512 891 men and women aged 30–79 years from 10 urban and rural areas of China. Detailed information on alcohol consumption was collected using a standardized questionnaire, and related to socio-demographic, physical and behavioural characteristics in men and women separately.

Results Overall, 76% of men and 36% of women reported drinking some alcohol during the past 12 months, with 33% of men and 2% of women drinking at least weekly; the prevalence of weekly drinking in men varied from 7% to 51% across the 10 study areas. Mean consumption was 286 g/week and was higher in those with less education. Most weekly drinkers habitually drank spirits, although this varied by area, and beer consumption was highest among younger drinkers; 37% of male weekly drinkers (12% of all men) reported weekly heavy drinking episodes, with the prevalence highest in younger men. Drinking alcohol was positively correlated with regular smoking, blood pressure and heart rate. Among male weekly drinkers, each 20 g/day alcohol consumed was associated with 2 mmHg higher systolic blood pressure. Potential indicators of problem drinking were reported by 24% of male weekly drinkers.

Conclusion The prevalence and patterns of drinking in China differ greatly by age, sex and geographical region. Alcohol consumption is associated with a number of unfavourable health behaviours and characteristics.

Alcohol consumption and psychological distress in adolescents: a multi-country study

PURPOSE

To examine the association between alcohol use and psychological distress among adolescents in a range of developing countries.

METHODS

Secondary data analysis of the Global School-Based Student Health Survey was conducted using nationally representative data from 12 developing countries: Botswana, Grenada, Indonesia, Kenya, Myanmar, the Philippines, Saint Lucia, Saint Vincent and the Grenadines, the Seychelles, Thailand, Trinidad and Tobago, and Uganda. The surveys were conducted between 2003 and 2008 and involved 32,001 adolescents primarily aged 13-15 years. We used multivariate logistic regression analysis to determine the association between alcohol use and psychological distress.

RESULTS

The prevalence of past 30-day alcohol use and lifetime drunkenness varied widely across countries, as did the occurrence of psychological distress (anxiety-induced sleeplessness and/or depression). The risk of psychological distress was significantly higher among adolescents when using alcohol in all countries except Myanmar. In nine of the 12 countries, past 30-day alcohol use was associated with psychological distress, while students who had been drunk at least once in their lifetime had an increased risk of experiencing psychological distress in 11 of the study countries.

CONCLUSIONS

The high prevalence of alcohol use among adolescents and the strength of the association with psychological distress present a major public health challenge in developing countries. The urgent need to reduce adolescent alcohol use necessitates the implementation of context- and culture-specific strategies that reduce the physical availability of alcohol.

Adolescent binge drinking and risky health behaviours: findings from northern Russia

BACKGROUND

Some evidence suggests that in recent years the prevalence of heavy drinking has increased among Russian adolescents. However, as yet, little is known about either heavy alcohol consumption or its relationship with other adolescent health risk behaviours in Russia. The aim of this study therefore was to investigate the association between binge drinking and health risk behaviours among adolescents in Russia.

METHODS

Data were drawn from the Social and Health Assessment (SAHA), a survey carried out in Arkhangelsk, Russia in 2003. Information was obtained from a representative sample of 2868 adolescents aged 13-17 regarding the prevalence and frequency of binge drinking (five or more drinks in a row in a couple of hours) and different forms of substance use, risky sexual behaviour and violent behaviour. Logistic regression analysis was used to examine the association between binge drinking and adolescent involvement in various health risk behaviours.

RESULTS

Adolescent binge drinking was associated with the occurrence of every type of health risk behaviour - with the sole exception of non-condom use during last sex. In addition, there was a strong association between the number of days on which binge drinking occurred and the prevalence of many health risk behaviours.

CONCLUSIONS

Binge drinking is associated with a variety of health risk behaviours among adolescents in Russia. Public health interventions such as reducing the affordability and accessibility of alcohol are now needed to reduce binge drinking and its harmful effects on adolescent well-being.

Increased cortical activity in binge drinkers during working memory task: a preliminary assessment through a functional magnetic resonance imaging study

BACKGROUND

Cerebral dysfunction is a common feature of both chronic alcohol abusers and binge drinkers. Here, we aimed to study whether, at equated behavioral performance levels, binge drinkers exhibited increased neural activity while performing simple cognitive tasks.

METHODS

Thirty-two participants (16 binge drinkers and 16 matched controls) were scanned using functional magnetic resonance imaging (fMRI) while performing an n-back working memory task. In the control zero-back (N0) condition, subjects were required to press a button with the right hand when the number "2" was displayed. In the two-back (N2) condition, subjects had to press a button when the displayed number was identical to the number shown two trials before.

RESULTS

fMRI analyses revealed higher bilateral activity in the pre-supplementary motor area in binge drinkers than matched controls, even though behavioral performances were similar. Moreover, binge drinkers showed specific positive correlations between the number of alcohol doses consumed per occasion and higher activity in the dorsomedial prefrontal cortex, as well as between the number of drinking occasions per week and higher activity in cerebellum, thalamus and insula while performing the N2 memory task.

CONCLUSIONS

Binge alcohol consumption leads to possible compensatory cerebral changes in binge drinkers that facilitate normal behavioral performance. These changes in cerebral responses may be considered as vulnerability factors for developing adult substance use disorders.

Alcohol-related harm among university students in Hanoi, Vietnam

Introduction and Aim

This study examines the prevalence of and risk factors for alcohol-related harm and types of harm among medical students from Hanoi Medical University (Vietnam). Risk factors include aspects of drinking patterns and relevant socio-demographic variables.

Study Design and Methods

A cross-sectional study involving 1st to 6th year students (N=1216; response rate 96.5%). Of these, 210 students from each academic year were randomly selected from a sampling frame covering all students from each academic year. Data were collected using a questionnaire distributed in class by researchers. Drinkers completed 23 questions on alcohol-related harm categorized into: 1) ‘negative influence on daily activities’; 2) ‘social conflict’; 3) ‘loss of control, acute consequences, and withdrawal’; 4) ‘mental health conditions’; and 5) ‘physical and medical health problems’. Logistic and Poisson regression models were used to identify the predictors of alcohol-related harm and the amount of harm, respectively.

Results

The prevalence of alcohol use associated with at least one or more of the five types of harm was higher in men (81.8%) than in women (60.4%). In female and male students, the most common harm category was ‘loss of control, acute consequences, and withdrawal’ (51.8 and 75.6%, respectively), followed by ‘negative influence on daily activities’ (29.4 and 55.8%, respectively). Age, living away from home, and average number of standard drinks per occasion among male drinkers, and age and frequency of drinking per week among female drinkers were associated with alcohol-related harm.

Conclusions

These data suggest that alcohol-related harm represents a serious public health problem among young educated individuals in Vietnam. The risk factors indicate that prevention should be aimed at aspects of drinking patterns and specific subpopulations defined by gender, age, and (for men only) type of living situation.

Development and psychometric properties of the health-risk behavior inventory for Chinese adolescents

BACKGROUND

There is a growing body of research investigating adolescent risk behaviors in China, however, a comprehensive measure that evaluates the full spectrum of relevant risk behaviors is lacking. In order to address this important gap, the current study sought to develop and validate a comprehensive tool: the Health-Risk Behavior Inventory for Chinese Adolescents (HBICA).

METHODS

Adolescents, ages 14-19  years (n = 6,633), were recruited from high schools across 10 cities in mainland China. In addition, a clinical sample, which included 326 adolescents meeting DSM-IV criteria for Conduct Disorder, was used to evaluate predictive validity of the HBICA. Psychometric properties including internal consistency (Cronbach's alpha), test-retest reliability, convergent validity, and predictive validity were analyzed.

RESULTS

Based upon item analysis and exploratory factor analysis, we retained 33 items, and 5 factors explained 51.75% of the total variance: Suicide and Self-Injurious Behaviors (SS), Aggression and Violence (AV), Rule Breaking (RB), Substance Use (SU), and Unprotected Sex (US). Cronbach's alphas were good, from 0.77 (RB) to 0.86 (US) for boys, and from 0.74 (SD) to 0.83(SS) for girls. The 8  weeks test-retest reliabilities were moderate, ranged from 0.66 (AV) to 0.76 (SD). External validities was strong, with Barratt Impulsiveness Scale-11 was 0.35 (p < 0.01), and with aggressive behavior and rule-breaking behavior subscales of the Youth Self Report were 0.54 (p < 0.01) and 0.68 (p < 0.01), respectively. Predictive validity analysis also provided enough discriminantity, which can distinguish high risky individual effectively (cohen' d = 0.79-2.96).

CONCLUSIONS

These results provide initial support for the reliability and validity of the Health-Risk Behavior Inventory for Chinese Adolescents (HBICA) as a comprehensive and developmentally appropriate assessment instrument for risk behaviors in Chinese adolescents.

The risk behaviors and mental health of detained adolescents: a controlled, prospective longitudinal study

Background

To assess the behavioral risk factors and mental health needs of adolescents in juvenile detention centers (JDC).

Method

A total of 238 boys aged 12–17 years was surveyed who had been admitted to a detention center and compared them with boys from the community (n = 238) matched for sex and age. We assessed behavioral risk factors and mental health problems by using the Youth Risk Behavior Survey questionnaire (YRBS) and the Youth Self-Report questionnaire (YSR).

Results

Young offenders had significantly higher YRBS scores than controls for drug use (odds ratio (OR) 5.16, 95% CI 2.27–7.84), sexual intercourse (OR, 2.51; 95% CI 1.55–2.90), irregular diet (4.78, 2.11–7.51), suicide attempts (1.96, 1.32–5.85), and physical fighting behavior (3.49, 1.60–7.07), but not for tobacco use, alcohol use, and high–risk cycling. Young offenders at the time of admission (6.61, 2.58–15.2), at 6 months (3.12, 1.81–10.1), and at 12 months (5.29, 1.98–13.3) reported statistically higher levels of total mental health problems than adolescents in a community sample.

Conclusions

Young offenders have a high rate of mental and behavioral disorders. In the detention period, aggressive behavior, self–destructive/identity, and externalizing of problems improved while withdrawn, anxious or depressed, and internalizing of problems worsened.

Prevalence of HIV risk behaviors between binge drinkers and non-binge drinkers aged 18- to 64-years in US, 2008

Using data from the 2008 Behavioral Risk Factor Surveillance System on 281,303 adults aged 18-64 years in the United States, we examined the relationship between HIV risk behaviors and binge drinking of alcoholic beverages and the frequency of binge drinking among a subgroup of 41,073 respondents who were acknowledged binge drinkers (bingers), based on reported drinking behavior in the year preceding survey. Our findings show that the weighted prevalence of HIV risk behaviors (including injection drug use, exchange of sex for money/drugs, and anal sex without a condom) among binge drinkers [corrected] [7.0%, 95% confidence interval (95% CI): 6.4-7.6%] is twice that among nonbingers (2.9%, 95% CI: 2.7-3.0%). The highest prevalence of HIV risk behaviors is among the bingers aged 18-20 years (14%, 95% CI: 11.2-18.2%). After adjusting for covariates, bingers are 1.77 (95% CI: 1.58-2.00) times more likely than nonbingers to report HIV risk behaviors. Risk increases in bingers with the number of episodes. Compared with bingers reporting 1-2 binge episodes in the month proceeding survey, the adjusted odds of reporting HIV risk behaviors among bingers are 1.27 (1.08-1.49), 1.68 (1.35-2.10), 1.67 (1.08-2.57), and 1.70 (1.34-2.16), respectively for bingers with 3-4, 5-6, 7-8, and ≥9 episodes in the same period. Our results suggest that HIV risk behaviors are strongly linked with binge drinking and its frequency. Effective measures to prevent binge drinking are essential to HIV prevention, especially among youth aged 18-20 years.

Early attentional modulation by alcohol-related cues in young binge drinkers: an event-related potentials study

OBJECTIVE

Episodic excessive alcohol consumption (i.e., binge drinking) is now considered to be a major concern in our society. Previous studies have shown that alcohol cues can capture attentional resources in chronic alcoholic populations and that the phenomenon is associated with the development and maintenance of alcoholism. Using event-related potentials (ERPs), we investigated the responses of binge drinkers to alcohol-related pictures.

METHODS

Two groups of college students (n=18 in each group) were recruited for the study. One group was composed of binge drinkers and the other of controls. Each student completed a simple visual oddball paradigm in which alcohol-related and non-alcohol-related pictures (positive, neutral or negative) were presented. ERPs were recorded to explore the electrophysiological activity associated with the processing of each cue during the different cognitive steps.

RESULTS

Although there were no behavioural differences between the two groups after detection of alcohol- and non-alcohol-related cues, the ERP data indicated that processing of alcohol-related stimuli was modulated by binge drinking: in the binge drinkers, the P100 amplitudes elicited by the alcohol-related pictures were significantly larger than those elicited by the non-alcohol pictures.

CONCLUSIONS

The present study provides evidence for an early processing enhancement, indexed by increased P100 amplitude, in binge drinkers when confronted with alcohol cues.

SIGNIFICANCE

These findings suggest that higher reactivity to alcohol cues is not a phenomenon limited to adult alcoholics, but that young binge drinkers exhibit signs of prioritizing processing related to alcohol. Prevention intervention for alcohol misuse in young people should consider approaches that address this automatic cue reactivity.

Drinking behaviour among men and women in China: the 2007 China Chronic Disease and Risk Factor Surveillance

AIM

To obtain information on drinking behaviour and to examine the associations between frequency of drinking, usual daily drinking quantity and binge drinking behaviour among Chinese residents aged 15-69 years.

DESIGN

A multi-stage clustering sampling method was used to select a nationally representative sample and data were collected as part of the China Chronic Disease and Risk Factor Surveillance by face-to-face interview.

SETTING

Respondents were selected randomly from 160 counties/districts scattered over 31 provinces/autonomous regions/municipalities between August and October, 2007.

PARTICIPANTS

Weighted analyses included 49,527 Chinese residents (aged 15-69 years).

MEASUREMENTS

Prevalence of current drinking and usual daily quantity, median number of annual binge drinking episodes, proportions of excessive drinking, frequent drinking and binge drinking among current drinkers were the main measurements.

RESULTS

The prevalence of male, female and total current drinking was 55.6%, 15.0% and 35.7%, respectively. On average, male drinkers consumed 47.8 g alcohol per drinking day, whereas females consumed 19.1 g. The median numbers of annual binge drinking episodes were 5.6 for male drinkers and 2.4 for females. Among the current drinkers, proportions of excessive drinking, frequent dinking and binge drinking were 62.7%, 26.3%, 57.3% for men and 51.0%, 7.8%, 26.6% for women, respectively. Logistic regressions showed that binge drinking was associated strongly with drinking frequency and drinking quantity increased with drinking frequency for both genders.

CONCLUSIONS

Excessive drinking, frequent drinking and binge drinking behaviour have reached epidemic proportions among current drinkers in China, and culturally appropriate public health strategies to reduce hazardous drinking behaviour are needed.

Parent-Child Engagement in Decision Making and the Development of Adolescent Affective Decision Capacity and Binge Drinking

The goal of this study was to investigate how parents' engagement of their child in everyday decision-making influenced their adolescent's development on two neuropsychological functions, namely, affective decision-making and working memory, and its effect on adolescent binge-drinking behavior.We conducted a longitudinal study of 192 Chinese adolescents. In 10(th) grade, the adolescents were tested for their affective decision-making ability using the Iowa Gambling Task (IGT) and working memory capacity using the Self-ordered Pointing Test (SOPT). Questionnaires were used to assess perceived parent-child engagement in decision-making, academic performance and drinking behavior. At one-year follow-up, the same neuropsychological tasks and questionnaires were repeated.Results indicate that working memory and academic performance were uninfluenced by parent-child engagement in decision-making. However, compared to adolescents whose parents made solitary decisions for them, adolescents engaged in everyday decision-making showed significant improvement on affective decision capacity and significantly less binge-drinking one year later.These findings suggest that parental engagement of children in everyday decision-making might foster the development of neurocognitive functioning relative to affective decision-making and reduce adolescent substance use behaviors.

Household displacement and health risk behaviors among HIV/AIDS-affected children in rural China

When parents die of or are infected with HIV, children might have to leave their own household and be displaced to other living arrangements and some may even be displaced multiple times. The objective of this study is to examine the association between household displacement and health risk behaviors among AIDS orphans (children who have lost one or both of their parents to HIV/AIDS) and vulnerable children (children living with HIV-infected parents) in rural China. The sample consisted of 1015 children (549 AIDS orphans, 466 vulnerable children) in family-based care. The children were assigned to three displacement groups according to the number of household displacement (i.e., none, once, at least twice) after their parents became ill or died of HIV/AIDS. Cigarette smoking, alcohol use, violence, public property destruction, suicidal ideation, and suicide attempt were used to assess the health risk behaviors of these children. Both bivariate and multivariate tests were used to assess the differences in health risk behaviors among displacement groups. The findings indicated that children who were displaced at least twice were more likely to report a higher frequency of public property destruction and suicide ideation than those who were never displaced or displaced once. Multivariate analysis revealed that public property destruction, suicide ideation and suicide attempt were significantly associated with the household displacement among these children, controlling for gender, age, child status (AIDS orphans vs. vulnerable children), and the duration of household displacement. Results in the current study suggest that a stable living environment was important for both AIDS orphans and vulnerable children in communities with a high prevalence of HIV/AIDS. The government, community, and other agencies need to make efforts to avoid frequent household displacement among these children after the HIV-related infection or death of their parents.

Social factors associated to binge drinking: a cross-sectional survey among Brazilian students in private high schools

BACKGROUND

Binge drinking (BD) seems to be related to health and social complications among adolescents. Considering that knowledge about BD in developing countries is limited and that in Brazil high socioeconomic status is a risk factor for alcohol abuse, this study sheds light about this phenomenon among adolescents from a different cultural background than prior North-American and European studies.

METHODS

Brazilian students (n = 2691) selected through a representative, stratified and clustered sampling method were asked to answer a self-report questionnaire. The questionnaire contained questions about patterns of alcohol consumption, religious beliefs, leisure activities, family structure and relationships. Data were analyzed with basic contingency tables with Chi-square tests followed by a decision tree analysis and weighted logistic regression.

RESULTS

Almost thirty-five percent of the students reported recent binge drinking. BD in the past month was positively associated with older age (aOR = 1.5[1.2-1.7]), male gender (aOR = 1.5[1.2-2.0]) going out with friends almost every night (aOR = 33.9[14.2-80.7]), not living with mother (aOR = 2.4[1.3-4.7]), believing in God with little conviction (aOR = 1.6[1.2-2.0]) and rarely talking to parents about anything (aOR = 1.7[1.3-2.2]) or always about drugs (aOR = 1.8[1.3-2.5]). Factors inversely associated with BD were: paying lower monthly tuition fees (aOR = 0.5[0.4-0.9]), living with people who do not get drunk (aOR = 0.6[0.4-0.7]) and frequent engagement in worships (aOR = 0.7[0.5-0.9]).

CONCLUSION

The habit of BD in adolescents enrolled in private high schools in Brazil is strongly linked to the frequency with which they go out with friends at night. Factors such as religiosity, expressed by trust in God and participation in worship, and being enrolled in a school with cheaper tuition fees were associated with avoidance of BD in this population.

Health compromising behaviors among Chinese adolescents: role of physical abuse, school experience, and social support

This study examined the influence of immediate social environment on health compromising behaviors (HCB) among 6564 high school students in China. Results showed that physical abuse by parents was a major risk factor that accounted for high rates of HCB. Perceived positive school experience and social support were protective factors associated with low rates of HCB. These two protective factors also buffered the adverse influence of abuse on the practice of individual HCB. In particular, parental abuse was associated with sexual experimentation, non-fatal self-harm, and suicide behaviors only at low levels of protective factors.

Test-retest reliability of selected items of Health Behaviour in School-aged Children (HBSC) survey questionnaire in Beijing, China

BACKGROUND

Children's health and health behaviour are essential for their development and it is important to obtain abundant and accurate information to understand young people's health and health behaviour. The Health Behaviour in School-aged Children (HBSC) study is among the first large-scale international surveys on adolescent health through self-report questionnaires. So far, more than 40 countries in Europe and North America have been involved in the HBSC study. The purpose of this study is to assess the test-retest reliability of selected items in the Chinese version of the HBSC survey questionnaire in a sample of adolescents in Beijing, China.

METHODS

A sample of 95 male and female students aged 11 or 15 years old participated in a test and retest with a three weeks interval. Student Identity numbers of respondents were utilized to permit matching of test-retest questionnaires. 23 items concerning physical activity, sedentary behaviour, sleep and substance use were evaluated by using the percentage of response shifts and the single measure Intraclass Correlation Coefficients (ICC) with 95% confidence interval (CI) for all respondents and stratified by gender and age. Items on substance use were only evaluated for school children aged 15 years old.

RESULTS

The percentage of no response shift between test and retest varied from 32% for the item on computer use at weekends to 92% for the three items on smoking. Of all the 23 items evaluated, 6 items (26%) showed a moderate reliability, 12 items (52%) displayed a substantial reliability and 4 items (17%) indicated almost perfect reliability. No gender and age group difference of the test-retest reliability was found except for a few items on sedentary behaviour.

CONCLUSIONS

The overall findings of this study suggest that most selected indicators in the HBSC survey questionnaire have satisfactory test-retest reliability for the students in Beijing. Further test-retest studies in a large and diverse sample, as well as validity studies, should be considered for the future Chinese HBSC study.

Prevalence and patterns of alcohol consumption and health-risk behaviors among high school students in Thailand

BACKGROUND

Underage drinking is a significant social and public health problem in Thailand. We report the prevalence and patterns of alcohol consumption and associated health-risk behaviors using data from a 2007-2008 national school survey.

METHOD

A cross-sectional survey using a self-administered questionnaire was conducted among 50,033 high school and vocational college students from 201 schools in 40 provinces between December 2007 and February 2008.

RESULTS

The prevalence rates of past-year drinking, past-30-day binge drinking, and drinking until intoxication were 25.5, 9.5, and 17.3% in boys and 14.5, 3.7, and 7.2% in girls, respectively. Higher school levels, lower grades, living with someone other than their own parents, and having family members with substance or alcohol problems were significantly associated with all kinds of drinking. Binge drinkers were significantly more likely to have drinking consequences, e.g., driving after drinking, nausea and vomiting, and having a hangover than were nonbinge drinkers. The rates of other behavior and emotional problems were 2.5 to 6.7 times as likely in drinkers as nondrinkers, including smoking (35.1% vs. 4.9%), prescription drug misuse (17.7% vs. 6.7%), illicit substance use (17.8% vs. 2.4%), carrying a weapon (6.5% vs. 1.8%), feeling depressed (23.2% vs. 10.9%), suicidal attempt (10.5% vs. 3.8%), and sexual intercourse (30.5% vs. 5.7%).

CONCLUSION

Alcohol consumption is a serious problem among adolescents in Thailand and is strongly associated with various health-risk behaviors. Effective age- and gender-specific interventions should be implemented to discourage underage drinking and associated adverse health and social consequences.

Affective decision-making predictive of Chinese adolescent drinking behaviors

The goal of the current investigation was to address whether affective decision making would serve as a unique neuropsychological marker to predict drinking behaviors among adolescents. We conducted a longitudinal study of 181 Chinese adolescents in Chengdu city, China. In their 10th grade (ages 15-16), these adolescents were tested for their affective decision-making ability using the Iowa Gambling Task (IGT) and working memory capacity using the Self-Ordered Pointing Test. Self-report questionnaires were used to assess academic performance and drinking behaviors. At 1-year follow-up, questionnaires were completed to assess drinking behaviors, and the UPPS Impulsive Behavior Scale was used to examine four dimensions of impulsivity: urgency, lack of premeditation, lack of perseverance, and sensation seeking. Results indicated that those adolescents who progressed to binge drinking or exhibited consistent binge drinking not only performed poorly on the IGT but also scored significantly higher in urgency compared to those who never or occasionally drank. Moreover, better IGT scores predicted fewer drinking problems and fewer drinks 1 year later after controlling for demographic variables, the previous drinking behaviors, working memory, and impulsivity. These findings suggest that deficits in affective decision making may be important independent determinants of compulsive drinking and potentially addictive behavior in adolescents.

Affective decision-making deficits, linked to a dysfunctional ventromedial prefrontal cortex, revealed in 10th grade Chinese adolescent binge drinkers

The primary aim of this study was to test the hypothesis that adolescent binge drinkers, but not lighter drinkers, would show signs of impairment on tasks of affective decision-making as measured by the Iowa Gambling Test (IGT), when compared to adolescents who never drank. We tested 207 10th grade adolescents in Chengdu City, China, using two versions of the IGT, the original and a variant, in which the reward/punishment contingencies were reversed. This enables one to distinguish among different possibilities of impaired decision-making, such as insensitivity to long-term consequences, or hypersensitivity to reward. Furthermore, we tested working memory capacity using the Self-ordered Pointing Test (SOPT). Paper and pencil questionnaires were used to assess drinking behaviors and school academic performance. Results indicated that relative to never-drinkers, adolescent binge drinkers, but not other (ever, past 30-day) drinkers, showed significantly lower net scores on the original version of the IGT especially in the latter trials. Furthermore, the profiles of behavioral performance from the original and variant versions of the IGT were consistent with a decision-making impairment attributed to hypersensitivity to reward. In addition, working memory and school academic performance revealed no differences between drinkers (at all levels) and never-drinkers. Logistic regression analysis showed that after controlling for demographic variables, working memory, and school academic performance, the IGT significantly predicted binge-drinking. These findings suggest that a "myopia" for future consequences linked to hypersensitivity to reward is a key characteristic of adolescents with binge-drinking behavior, and that underlying neural mechanisms for this "myopia" for future consequences may serve as a predisposing factor that renders some adolescents more susceptible to future addictive behaviors.