Lost in translation: a focus group study of parents' and adolescents' interpretations of underage drinking and parental supply

Prevalence of parental supply of alcohol to minors: a systematic review

Parental supply of alcohol to minors (i.e. those under the legal drinking age) is often perceived by parents as protective against harms from drinking, despite evidence linking it with adverse alcohol-related outcomes. This systematic review describes the prevalence of parental supply of alcohol, as reported in the international literature. The review was registered with PROSPERO (CRD42020218754). We searched seven online databases (Medline, Embase, PsycINFO, CINAHL, Scopus, Web of Science and Public Health Database) and grey literature from January 2011 to December 2022 and assessed the risk of bias with the JBI Critical Appraisal Checklist. Among 58 articles included in narrative synthesis from 29 unique datasets, there was substantial variation in the definition and measurement of parental supply of alcohol. Overall prevalence rates ranged from 7.0 to 60.0% for minor-report samples, and from 24.0 to 48.0% for parent-report samples. Data indicate that parental supply prevalence is generally proportionately higher for older minors or later-stage students, for girls, and has increased over time among minors who report drinking. Literature on the prevalence of parental supply of alcohol is robust in quantity but inconsistent in quality and reported prevalence. Greater consistency in defining and measuring parental supply is needed to better inform health promotion initiatives aimed at increasing parents' awareness.

Trends in and factors associated with parental provision of alcohol to minors in Western Australia, 2013-2019

INTRODUCTION

Some parents provide alcohol to their underage children, despite a range of negative outcomes being associated with this practice. The present study aimed to assess factors associated with and changes in parental provision behaviours from 2013 to 2019 in Western Australia.

METHODS

Annual cross-sectional online surveys were conducted (total n = 2635). Assessed variables included parents' demographic characteristics, alcohol use, awareness of the relevant Australian alcohol guideline, attitudes to parental provision of alcohol and provision behaviours. A binary logistic generalised linear model was used to identify factors associated with parental provision of alcohol.

RESULTS

Parental provision of alcohol prevalence decreased from 40% in 2013 to 27% in 2019. The following variables were significantly associated with parental provision: permissive attitudes to provision (β = 2.82); older parental age (β = 1.28); a lack of knowledge of the relevant guideline (β = 0.78); survey year (β = 0.083); and greater alcohol use (β = 1.12). Socioeconomic position was not associated with parental provision. Female parents were more likely to report that an adult in the household provided children with alcohol (β = 1.3) DISCUSSION AND CONCLUSIONS: The findings suggest that (i) although still commonplace, parental provision of alcohol to minors in Western Australia has declined over time; and (ii) the effectiveness of campaigns aiming to reduce this behaviour may be enhanced by targeting households with parents who are older and heavier drinkers and by including content that challenges permissive views on alcohol provision to minors.

Adverse childhood experiences and sipping alcohol in U.S. Children: Findings from the Adolescent Brain Cognitive Development study

The objective of this study was to explore the relationship between accumulating adverse childhood experiences (ACEs) and sipping alcohol in a large, nationwide sample of 9-to-10-year-old U.S. children. We analyzed data from the Adolescent Brain Cognitive Development (ABCD) Study (2016-2018). Of 10,853 children (49.1 % female), 23.4 % reported ever sipping alcohol. A greater ACE score was associated with a higher risk of sipping alcohol. Having 4 or more ACEs placed children at 1.27 times the risk (95 % CI 1.11-1.45) of sipping alcohol compared to children with no ACEs. Among the nine distinct ACEs examined, household violence (Risk Ratio [RR] = 1.13, 95 % CI 1.04-1.22) and household alcohol abuse (RR = 1.14, 95 % CI 1.05-1.22) were associated with sipping alcohol during childhood. Our findings indicate a need for increased clinical attention to alcohol sipping among ACE-exposed children.

How Adolescents and Parents See Their Moral Responsibilities With Regard to Adolescents Using Alcohol-A Deductive Secondary Analysis

BACKGROUND

This study described how adolescents and the parents saw their moral responsibilities with regard to adolescents using alcohol.

METHODS

This was a deductive secondary analysis, based on Hart's taxonomy of moral responsibility. The primary studies were based on 19 group interviews with 87 adolescents aged 14-16 and 17 interviews with 20 parents. Voluntary participants were recruited by purposive sampling from two public schools in Finland.

RESULTS

Role responsibilities comprised of adolescents taking care of themselves and parents providing authority figures and helping adolescents to make rational decisions about alcohol. Capacity responsibilities referred to adolescents' abilities to make independent decisions on using alcohol and their developing abilities to control their actions. Parents required abilities to get involved in and show an interest in their children's everyday lives. Causal responsibilities focused on ensuring that adolescents did not cause harm when they used alcohol, and parents had to acknowledge and react to the consequences. Liability responsibilities were about the law on alcohol use and responsibilities for any legal consequences. The role schools could play was important.

CONCLUSIONS

Adolescents and parents had wide-ranging responsibilities related to the adolescents' using alcohol and school nurses could play an important role in healthy decisions.

Trajectories of parental and peer supply of alcohol in adolescence and associations with later alcohol consumption and harms: A prospective cohort study

BACKGROUND

Supply of alcohol to adolescents is associated with increased alcohol consumption and harms including alcohol use disorder (AUD). We aimed to identify: (1) trajectories of alcohol supply to adolescents; (2) sociodemographic characteristics associated with supply trajectory; (3) patterns of alcohol consumption by supply trajectory; and (4) supply trajectory associations with adverse alcohol outcomes.

METHODS

We used Australian longitudinal survey data (N = 1813) to model latent trajectories of parent and peer alcohol supply over five annual follow-ups (Waves 2-6; M_age 13.9-17.8 years). Regression models assessed associations between supply trajectories and Wave 1 (M_age=12.9 years) sociodemographic factors and associations between supply trajectories and Wave 7 (M_age=18.8 years) alcohol outcomes.

RESULTS

We identified five alcohol supply classes: (1) minimal supply (n = 739, 40.8%); (2) early parent sips, late peer/parent whole drinks (n = 254, 14.0%); (3) late peer/parent whole drinks (n = 419, 23.1%); (4) early parent sips, mid peer/parent whole drinks (n = 293, 16.2%); (5) early peer/parent whole drinks (n = 108, 6.0%). Compared to minimal supply, the other classes were 2.7-12.9 times as likely to binge drink, 1.6-3.0 times as likely to experience alcohol-related harms, and 2.1-8.6 times as likely to report AUD symptoms at age 19.

CONCLUSION

Earlier supply of whole drinks, particularly from peers, was associated with increased risk of early adulthood adverse alcohol outcomes. While minimal supply represented the lowest risk, supplying sips only in early-mid adolescence and delaying supply of whole drinks until late adolescence is likely to be less risky than earlier supply of whole drinks.

Parent/caregiver attitudes, motivations and behaviours in relation to alcohol use among offspring aged 13-18 years: a qualitative study

BACKGROUND

Parental alcohol consumption and alcohol-related behaviour play a critical role in shaping adolescent alcohol use, but comparatively little is known about the perspectives of parents regarding adolescent alcohol use from qualitative studies in England. This study aimed to explore parental views and attitudes towards alcohol use during adolescence, among their offspring and among young people in general.

METHODS

Twenty-three parents (21 mothers, 2 fathers) of children aged 13-18 years were recruited via schools, workplaces and community settings, predominantly in the West of England (n = 19) between 2017 and 2018. Data were collected via in-depth one-to-one interviews and analysed thematically, using an inductive, constructionist approach.

RESULTS

Five major themes were identified in the data: (1) the parental alcohol environment, (2) balance and acceptance, (3) influences of the parental approach, (4) boundaries and parental monitoring, and (5) wider influences shaping young people's behaviour. Overall, parents were aware of the risks and consequences of alcohol use and the wide range of influences shaping drinking behaviour, and expressed broad disapproval of alcohol use among young people. However, adolescent alcohol use was viewed as inevitable, and set within a context of a tolerant drinking culture. Many parents therefore chose a balanced and reluctantly accepting approach. This approach was determined by weighing disapproval of drinking against consistency with wider culture and parental behaviour, support for autonomy of the child, and avoidance of social sanctions. Parents' responses were also determined by a desire to protect the parent-child relationship, maintain an open, communicative and trusting relationship, and ultimately limit risk and minimise harm. Various boundaries and strategies were employed to this end, including care around role modelling, gradual introductions to alcohol, boundaried provision, clear risk reduction messaging and parental monitoring.

CONCLUSIONS

Parents employ a range of mechanisms to reduce alcohol-related risk and to balance harms of alcohol use among their offspring against adolescent behavioural norms. A downward shift in community consumption and changing socio-cultural norms could alter the accepting context in which parents are required to navigate adolescent alcohol use.

Risk and protective factors for alcohol and tobacco related disorders: An umbrella review of observational studies

The credibility of evidence of various environmental risk factors for alcohol and tobacco use disorders (AUD/TUD) needs to be graded to identify groups to target with selective prevention. A systematic umbrella review was conducted (PubMed/PsycINFO), grading credibility of meta-analyses of prospective/retrospective observational cohort studies assessing risk/protective factors for AUD/TUD, applying established quantitative criteria. Sensitivity analyses were conducted. Quality of eligible meta-analyses was assessed with AMSTAR-2. Out of 8464 unique references, 80 full text articles were scrutinized, and 12 meta-analyses, corresponding to 21 individual estimates of 12 putative risk/protective factors (n = 241,300), were included. In main analyses no association had convincing nor highly suggestive evidence for AUD/TUD. Six associations had suggestive evidence for AUD, two for TUD. Among these, in sensitivity analyses without >1000 cases criterion, convincing evidence emerged for parental alcohol supply, and impulsivity traits in college students for AUD, and attention-deficit/hyperactivity disorder for TUD. Other associations were supported by weak evidence/were not nominally significant. Few risk factors identified at-risk groups where selective preventative strategies could be developed to prevent AUD/TUD.

Parental supply of sips and whole drinks of alcohol to adolescents and associations with binge drinking and alcohol-related harms: A prospective cohort study

BACKGROUND

Parents frequently supply alcohol to their children, often only sips. We investigated whether supply of sips and whole drinks, from parents and other sources, are differentially associated with subsequent drinking outcomes.

METHODS

A cohort of 1910 adolescents (mean age 12.9yrs) were surveyed annually over seven years from 2010-11. We examined prospective, adjusted associations between the quantity of supply from parental and non-parental sources in the preceding 12 months and five outcomes in the subsequent year, over several consecutive years: binge drinking; alcohol-related harms; symptoms of alcohol abuse, dependence and alcohol use disorder (AUD).

RESULTS

In early waves, most parental supply comprised sips, while supply of whole drinks increased in later waves. Among those not receiving alcohol from other sources, parental supply of sips was associated with increased odds of binge drinking (OR: 1.85; 99.5 % CI: 1.17-2.91) and alcohol-related harms (OR: 1.70; 99.5 % CI: 1.20-2.42), but not with reporting symptoms of alcohol abuse, dependence or AUD, compared with no supply. Relative to no supply, supply of sips from other sources was associated with increased odds of binge drinking (OR: 2.04; 99.5 % CI: 1.14-3.67) only. Compared with supply of sips, supply of whole drinks by parents or others had higher odds of binge drinking, alcohol-related harms, symptoms of dependence and of AUD. Secondary analysis demonstrated that supply of larger quantities was associated with an increased risk of all outcomes.

CONCLUSION

Parental provision of sips is associated with increased risks and the supply of greater quantities was associated with an increasing risk of adverse outcomes.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov (NCT02280551).

Relationship of Parental Support on Healthy Habits, School Motivations and Academic Performance in Adolescents

The objective of the study was to analyze how parental support relates to the physical activity practice, satisfaction with sports, level of physical activity, academic performance and alcohol consumption. Descriptive cross-sectional study, with 1100 adolescents (12-16 years old), where the factors related to parental support, gender and age acted as independent variables, and satisfaction with sport, level of physical activity (PA), academic performance and alcohol consumption acted as dependent variables. A multivariate statistical analysis was conducted. Adolescents with little parental support show (p < 0.001) more boredom, less fun, worse academic performance and higher alcohol consumption. Gender shows differences (p < 0.001) experiencing girls more boredom, less fun, less PA practice and higher academic performance than boys. Age establishes (p < 0.01) that older adolescents (15-16 years old) experience more boredom, less fun, less PA practice, lower academic performance and higher alcohol consumption than young boys and girls (12-14 years old). Parental support towards PA practice improves healthy habits, benefits academic performance and school satisfaction with physical and sports activity.

Does the social context of early alcohol use affect alcohol-related harms in adulthood? Findings from a national birth cohort

Internationally, laws on the provision of alcohol commonly exempt that provided by parents and/or consumed in private premises. Whether these exemptions mitigate alcohol-related harms, as has been posited, is unclear. We used data from 10,968 individuals (5216 women) from the 1970 British Birth Cohort Study. Exposures, self-reported at 16-years of age, were consumption of alcohol with specific people (including parents, siblings and friends) and acquisition from different places (including their own home). The outcomes, self-reported at 30-years of age, were high alcohol consumption (>14 units of alcohol in the last week), and screening positive for a possible alcohol problem using the cutting down, being annoyed by criticism, feeling guilty, and eye-openers (CAGE) questionnaire. At 30-years of age, 32.1% of study members consumed >14 units in the last week and 14.3% screened positive on the CAGE questionnaire. Neither consuming alcohol with parents nor the acquisition of alcohol from home was associated with later high consumption or alcohol problems. There was a suggestion, however, that drinking with other teenagers was related to an increased risk of both outcomes (consumption: 1.32 (1.16, 1.51); alcohol problems: 1.27 (1.01, 1.58), as was acquisition from an off-license (consumption: 1.23 (0.99, 1.51); alcohol problems: 1.49 (1.17, 1.90). This study strengthens the evidence that alcohol consumption with parents, or acquisition from home, does not protect against later alcohol-related harms.

Exploring the links between unhealthy eating behaviour and heavy alcohol use in the social, emotional and cultural lives of young adults (aged 18-25): A qualitative research study

Alcohol use peaks in early adulthood and can contribute both directly and indirectly to unhealthy weight gain. This is the first qualitative study to explore the links between unhealthy eating behaviour and heavy alcohol use in the social, emotional and cultural lives of young adults. We conducted 45 in-depth interviews with 18-25-year-olds in North-East England to inform development of a dual-focused intervention to reduce health risk due to excess weight gain and alcohol use. Data were analysed thematically, following the principles of constant comparison, resulting in three intersecting themes: (1) how food and alcohol consumption currently link together for this population group; (2) influences upon linked eating and drinking behaviours and (3) young adults' feelings and concerns about linked eating and drinking behaviours. Socio-cultural, physical and emotional links between food and alcohol consumption were an unquestioned norm among young adults. Eating patterns linked to alcohol use were not tied only to hunger, but also to sociability, traditions and identity. Young adults conceptualised and calculated risks to weight, appearance and social status, rather than to long-term health. This study is the first to evidence the deeply interconnected nature of food and alcohol consumption for many young adults. Findings have important implications for intervention development, UK public health policy and practice, and point to a need for similar research in other countries.

Socio-Ecological Influences on Adolescent (Aged 10-17) Alcohol Use and Unhealthy Eating Behaviours: A Systematic Review and Synthesis of Qualitative Studies

Excess body weight and risky alcohol consumption are two of the greatest contributors to global disease. Alcohol use contributes directly and indirectly to weight gain. Health behaviours cluster in adolescence and track to adulthood. This review identified and synthesised qualitative research to provide insight into common underlying factors influencing alcohol use and unhealthy eating behaviours amongst young people aged 10–17. Sixty two studies met inclusion criteria. Twenty eight studies focused on alcohol; 34 focused on eating behaviours. Informed by principles of thematic analysis and meta-ethnography, analysis yielded five themes: (1) use of alcohol and unhealthy food to overcome personal problems; (2) unhealthy eating and alcohol use as fun experiences; (3) food, but not alcohol, choices are based on taste; (4) control and restraint; and (5) demonstrating identity through alcohol and food choices. Young people faced pressure, reinforced by industry, to eat and drink in very specific ways, with clear social consequences if their attitudes or behaviour were deemed unacceptable. No qualitative studies were identified with an explicit and concurrent focus on adolescent eating behaviours and alcohol consumption. Further exploratory work is needed to examine the links between food and alcohol in young people’s emotional, social and cultural lives.

Underage drinking as a natural part of growing up: a UK study of parental beliefs

Purpose

Parental beliefs about underage drinking are known to influence the drinking behaviours of their children. The purpose of this paper is to explore parental beliefs about their own child drinking alcohol and young people in general, in order to ascertain whether there is a need to target such beliefs in the design of public health interventions.

Design/methodology/approach

Parents of 11–18 year olds attending one of nine schools in the Midlands of England, UK were invited to take part. Participants completed a newly designed 40-item questionnaire measuring parental beliefs about the impact and causes of underage drinking; talking to their child about alcohol; and how much and how often they thought their child consumed alcohol.

Findings

In total, 185 parents took part in the study, reporting on their eldest child aged 18 or under. The majority of parents agreed that underage drinking is detrimental to child health and wellbeing. However, over 60 per cent believed that alcohol consumption is a “natural part of growing up”, and stronger agreement with this belief was associated with higher parental reports of alcohol consumption in their children.

Social implications

The majority of parents recognised the risks and negative effects of alcohol; however, many also believe it is a natural part of growing up. Parents may hold conflicting beliefs about underage drinking, which could impact on the drinking beliefs and behaviours of their children.

Originality/value

Public health interventions may need to counter the common parental belief that underage drinking is a normal part of growing up and therefore to be expected. Clear messages about the impact parent beliefs and behaviour have on young people drinking, to ensure parents recognise that messages are aimed at themselves, and not just “other parents” are imperative.

Familial alcohol supply, adolescent drinking and early alcohol onset in 45 low and middle income countries

AIMS

This study estimated the extent of familial alcohol supply in 45 low and middle income countries (LMIC), and examined the country-level effects of familial alcohol supply on adolescents' alcohol use.

METHOD

We used data from 45 LMICs that participated in the Global School-Based Student Health Survey (GSHS) between 2003 and 2013 (n = 139,840). The weighted prevalence of familial alcohol supply in each country was estimated. Multilevel binary and ordinal logistic regression analyses were used to examine the country-level effect of familial alcohol supply on early onset of alcohol use (first alcohol before 12), past 30-day alcohol use, lifetime drunkenness and alcohol-related social problems.

RESULTS

There were large variations between LMICs in the prevalence of familial alcohol supply and pattern of adolescent alcohol use. The prevalence of familial supply ranged from 0.1% in Tajikistan to 23.8% in St Lucia. It was estimated that a one percentage change in prevalence of familial alcohol supply was associated with 10%, 12% and 12% change in the odds of lifetime drunkenness (OR = 1.10, 95% CI = [1.04, 1.16]), early onset of alcohol use (OR = 1.12, 95% CI = [1.07, 1.08]) and more frequent drinking in the past month (OR = 1.12, 95% CI = [1.04, 1.20]).

CONCLUSION

There were large variations in the prevalence of familial alcohol supply and adolescent alcohol use among LMICs. Adolescents in countries with higher prevalence of familial alcohol supply were more likely to start using alcohol at an earlier age, to have used alcohol in the past 30 days and experience intoxication.

Child-parent agreement on alcohol-related parenting: Opportunities for prevention of alcohol-related harm

ISSUE ADDRESSED

Excessive alcohol consumption places adolescents at increased risk of preventable, acute alcohol-related injury. Parental attitudes and behaviours influence adolescents' alcohol use. This study examined alignment in parent and child reports of alcohol-related parenting and whether misalignment related to the child ever having drunk alcohol.

METHODS

A cross-sectional online survey was conducted in five secondary schools in [information removed for blinding in Perth, Western Australia] in 2015. All students in Years 7, 10 and 12 and their parents were eligible, and data were matched for 124 child-parent dyads. Alignment of parent-child reports was assessed using kappa statistics. In dyads where the parent reported protective attitudes and behaviours, the association between misalignment and alcohol use was tested in logistic regressions.

RESULTS

Overall, child-parent reports were aligned on parents' expectations, knowledge and actions (65% and higher agreed). While alignment on parental expectations seemed to decrease with age, alignment on parental communication and rule-setting increased. Misalignment on reports of parents' expectations was associated with increased odds of the child reporting having ever had alcohol (OR = 5.5; 95% CI = 2.7-47.7), as was parental supply (OR = 20.2; 95% CI = 3.3-121.5), but misalignment on parental communication, rule-setting and knowledge were not.

CONCLUSIONS

Parent nonsupply of alcohol and disapproval of use were most important in terms of associations with ever drinking. SO WHAT?: These findings call for interventions that support parents to expect no alcohol use and enable parents to communicate their expectation in a manner that resonates with their child. Effective parenting will contribute to reducing alcohol-related harm in adolescents.

When are they old enough to drink? Outcomes of an Australian social marketing intervention targeting alcohol initiation

INTRODUCTION AND AIMS

This paper reports on the evaluation of an Australian whole-of-community social marketing intervention targeting social norms, which aimed to reduce inflated perceptions of the prevalence of underage drinking and increase the age at which alcohol initiation is considered acceptable.

DESIGN AND METHODS

A community-wide intervention was delivered in a single community over a period of 2 years, targeting adolescents, parents and community members. Pre-and post-intervention computer-assisted telephone interview surveys were conducted in the intervention and a matched comparison (control) community. A total of 417 respondents completed both surveys (215 in the intervention community and 202 in the control community).

RESULTS

The intervention community saw an increase of 6 months in the average age at which it is perceived to be acceptable for young people to have a sip/taste of alcohol and 5 months in the average age at which it is perceived to be acceptable to have weak/watered down alcohol. Furthermore, there was a reduction in the perception of the prevalence of alcohol consumption by young people to a level consistent with actual underage drinking rates. In comparison, the control community saw no change in any of these variables.

DISCUSSION AND CONCLUSIONS

This study provides preliminary evidence that a whole-of-community social marketing intervention can change perceptions of the prevalence, and acceptability, of underage drinking. Given the central role of social norms in decisions regarding alcohol consumption, these changes have the potential to reduce parental supply and thus underage drinking.

Drinking with parents: Different measures, different associations with underage heavy drinking?

Aims:

Is drinking with parents (DWP) likely to curb or to encourage adolescent heavy drinking? The scant number of studies addressing this issue have arrived at contradictory conclusions, which may reflect that different measures of DWP have been used. We pursued the assumption, taking potential confounding related to parental alcohol-specific rule-setting and parenting style into account.

Method:

Data stem from the Norwegian 2015 ESPAD survey of 15–16 year olds. Drinking with parents at the last drinking event and the frequency of DWP in the past year were assessed among those who had consumed alcohol (n = 1374). Severe drunkenness and binge drinking in the past month were the outcomes. Parental covariates were accounted for in Poisson regression models.

Results:

One in five (21%) had been drinking with their parents the last time they consumed alcohol, and this DWP measure was strongly and inversely related to both drunkenness and binge drinking. Adolescents who reported no DWP episodes in the past year (61%) and those who reported 1–2 such episodes (30%) barely differed with respect to the two outcomes. More frequent DWP (9%) was significantly associated with an increased risk of heavy episodic drinking, but the statistical impact on severe drunkenness was no longer significant when adjusting for parental covariates.

Conclusions:

Different measures of DWP were related differently to adolescent heavy drinking, indicating that studies based on DWP at the last drinking event are biased in favour of the view that adolescents may “learn” sensible drinking by consuming alcohol with their parents.

Exploring adolescent-parent interaction strategies for accessing alcohol at home

Purpose

The purpose of this paper is to determine the extent to which youth have ready access to alcohol and the extent to which immediate family influence affects consumption.

Design/methodology/approach

This qualitative descriptive exploratory study undertook semi-structured peer-group interviews with 20 participants from four New Zealand high schools. The interviews centred on exploring the “general” experiences of youth related to alcohol access – but with a focus on alcohol access “at home” and the parental role.

Findings

The study confirmed that the home unit was the main source of alcohol for most youth and parents were the most common source of provision. Parents provided financial access to alcohol by giving their child money to purchase it themselves through older family members or friends. It was also found that youth used negotiation strategies with their parents to influence their consumer purchases of alcohol.

Research limitations/implications

Youth frequently used strategies such as pressure tactics, exchange tactics, ingratiating tactics and consultation tactics to influence their family’s decision-making process and to pressure their parents into supplying them with alcohol.

Practical implications

It is important to recognise the role that family play as “gatekeepers” for readily allowing access and supplying youth with alcohol – and the reasons for doing so.

Social implications

Alcohol plays an important part in many societies. It is important to understand how young people consume and access alcohol – particularly when the family plays a major role in access and consumption.

Originality/value

Many studies have been conducted in relation to youth and alcohol consumption. Very few, as far as we can tell, explore the role of the family from the young consumers’ perspective and especially from a qualitative narrative perspective.

Socio-ecological influences on adolescent (aged 10-17) alcohol use and linked unhealthy eating behaviours: protocol for a systematic review and synthesis of qualitative studies

BACKGROUND

Excess body weight and risky alcohol consumption are two of the greatest contributors to global disease. Health behaviours cluster in adolescence and track to adulthood. Very little is known about similar and contrasting influences on young people's eating behaviours and alcohol use. Whilst there are bodies of literature which explore the influences on young people's eating behaviour and alcohol consumption respectively, no qualitative studies have been identified with an explicit and concurrent focus on adolescent eating behaviours and alcohol consumption. This review will identify and synthesise qualitative research evidence to provide insight into common underlying factors which influence alcohol use and unhealthy eating behaviours amongst young people aged 10-17. This will involve bringing together two separate bodies of literature to enable analysis and comparison across two associated fields of study.

METHODS

We will conduct searches in MEDLINE, Scopus, PsycINFO, Sociological Abstracts (via ProQuest social science premium collection), CINAHL, ERIC, IBSS (via ProQuest social science premium collection), ASSIA (via ProQuest social science premium collection), and Web of Science Core Collection. Studies reporting primary data of any qualitative design, for example, ethnographic studies, studies that used a phenomenological or grounded theory approach, or participatory action research will be included in the review. Database searches will be supplemented with searches of Google Scholar, hand searches of key journals, and backward and forward citation searches of reference lists of identified papers. Search records will be independently screened by two researchers, with full text copies of potentially relevant papers retrieved for in-depth review against the inclusion criteria. Reporting of identified studies will be assessed using the Critical Appraisal Skills Programme (CASP) Qualitative Research Checklist. GRADE-CERQual will also be used to assess confidence in the findings arising from our review. Qualitative synthesis will involve three core phases: line-by-line coding of findings; development of descriptive themes; and development of analytical themes. Findings from papers will be examined for overlaps, similarities and differences.

DISCUSSION

This synthesis will interpret individual studies by identification of second-order constructs (interpretations offered by the original researchers) and third-order constructs (development of new interpretations beyond those offered in individual studies) by way of the development of a 'model structure' of shared influences upon both unhealthy eating behaviours and alcohol use. It is anticipated that this 'model structure' will aid subsequent co-design and piloting of a future intervention to help reduce health risk and social inequalities due to excess weight gain and alcohol consumption.

SYSTEMATIC REVIEW REGISTRATION

CRD42017060624 .

'Hidden Habitus': A Qualitative Study of Socio-Ecological Influences on Drinking Practices and Social Identity in Mid-Adolescence

This study explored mid-adolescents' views and experiences of socio-ecological influences on their drinking practices in order to help inform the development of interventions to reduce alcohol-related risk. We conducted 31 in-depth interviews with young people aged 13-17 in North East England. Verbatim interview transcripts and field notes were coded systematically and analysed thematically, following the principles of constant comparison. We adopted Bourdieu's idea of social game-playing and elements of his conceptual toolkit (particularly habitus, capital and field) during analysis. Analysis yielded three intersecting themes: (1) 'drinking etiquette': conveying taste and disgust; (2) 'playing the drinking game': demonstrating cultural competency; (3) 'hidden habitus'-the role of alcohol marketing. Our work demonstrates that there is a nexus of influential factors which come together to help shape and reinforce mid-adolescents' behaviour, norms and values in relation to alcohol consumption. Drinking practices are not just formed by friendships and family traditions, these are also subject to wider cultural shaping including by the alcohol industry which can encourage brand identification, and gear specific products to add 'distinction'. However young people are not inactive players and they use aspects of capital and social games to help cement their identity and present themselves in particular ways which in turn are influenced by age, gender and social status. Guided by promising work in the tobacco field, interventions which focus on critical awareness of the framing of alcohol products by key stakeholders, such as policymakers, commercial industry and public health professionals, and by wider society may facilitate behaviour change among young people.