ISSN: 1679-9941 (Print), 2177-5281 (Online)
Official website of the journal Adolescencia e Saude (Adolescence and Health Journal)

Vol. 16 nº 1 - Jan/Mar - 2019

Risk factors associated with alcohol consumption among adolescents in a public school

Authors: Eliana Lessa Cordeiro1, Tania Maria da Silva2, Liniker Scolfild Rodrigues da Silva3, Edinayran Ediluergyla da Silva4, Thamires Fernanda Crystina de Mesquita5, Wangela Pimenta Maia5
1Master’s degree in Neuroscience from the Postgraduate Program in Neuropsychiatry and Behavioral Sciences (Posneuro) at the Federal University of Pernambuco (UFPE). Manager of the Undergraduate Nursing Course at the Salgado de Oliveira University (UNIVERSO). Recife, PE, Brazil
2Master’s degree in Education from the Federal University of Pernambuco (UFPE). Professor of the Undergraduate Nursing Course at the Salgado de Oliveira University (UNIVERSO). Recife, PE, Brazil
3Resident in the Multiprofessional Residency Program in Public Health at the University of Pernambuco (UPE). Professor, acting as a Tutor in the Undergraduate Course in Public Health, at the Faculty of Medical Sciences (FCM) at the University of Pernambuco (UPE). Recife, PE, Brazil
4Bachelor’s degree in Nursing from the Salgado de Oliveira University (UNIVERSO). Recife, PE, Brazil
5Bachelor’s degree in Nursing from Salgado de Oliveira University (UNIVERSO). Recife, PE, Brazil
Keywords: Adolescent; Alcoholism; Nursing; Education.
Abstract

OBJECTIVE: To verify the risk factors that may be associated with alcohol consumption among adolescents in a public school in the city of Recife, Pernambuco.
METHODS: For this study, inferential techniques were used through the quantitative evaluation method, through a structured model, idealized by the use of the Alcohol Use Disorder Test, that is, with scores in the answers of the options provided. The questionnaire responses were scored according to the highlighted levels of alcohol consumption.
RESULTS: The Alcohol Use Disorder Identification Test indicated that in 55.7% of cases the adolescents are at low risk, 25% are at risk, 17.3% are at high risk and 1.9% are likely dependent.
CONCLUSION: Adolescents have been consuming alcoholic beverages at an increasingly early age, in larger quantities and with easy access. It is necessary to intensify preventive campaigns and multidisciplinary incentives that would work in parallel with government programs, work in schools and the community, as well as raising awareness about the harm that can arise from the consumption of alcoholic beverages.

INTRODUCTION

There is no universal factor that explains the etiology of alcoholism. This is because everyone who consumes alcoholic beverages has the possibility of becoming dependent, and this possibility is greater or lesser depending on the interaction of vulnerability factors, which can be biological, psychological and social 1 .

The improper use of alcohol produces psychological, social and economic effects that cause incalculable losses to those who consume it, such as: reduced quality of life for the user and their family; biopsychosocial disabilities that cause the subject to lose opportunities in the productive, emotional and family process; as well as the emergence of antisocial actions 2 .

In this discussion, it is known that adolescents have easy access to alcoholic beverages, which makes them more susceptible to different risk situations and possible consequences, such as: early alcohol consumption, early pregnancy, Sexually Transmitted Infections (STIs), high blood pressure, accidents, poor school performance, tobacco and other drug use, conflict in social, professional and family relationships, among other problems 3 .

The World Health Organization (WHO) reveals that in both developing and developed countries, alcohol is the drug of choice for young people. It is the most widely consumed psychoactive substance in any age group and its consumption has been increasing among adolescents aged 12 to 15 years. In Brazil, this reality is no different, although there is a law (nº 9.294, of July 15, 1996), which establishes the prohibition of the sale of alcoholic beverages to minors under 18 years of age 4 .

According to the 5th National Survey of Students , conducted by the Brazilian Center for Information on Psychotropic Drugs 5 , 65.2% of students reported using alcohol at some point in their lives; 44.3% in the thirty days prior to the survey; 11.7% reported frequent use; and 6.7% reported constant consumption of alcoholic beverages, i.e., 20 or more times in the month preceding the survey 6 .

Adolescents are still negatively influenced by current media, such as television, radio, newspapers and, especially, the Internet, which facilitates access to numerous legal and illegal drugs, pornography and other harmful substances 7 .

Regarding family life, studies show that the quality of interaction between adolescents and their parents is considered a fundamental milestone for the young person’s approach to the consumption of alcohol and/or other drugs, since young people who report having a regular and/or poor relationship with their parents have a higher rate of alcohol consumption8 .

There is evidence that parents influence their adolescent children to consume alcoholic beverages, either by setting an example or by creating a happy marital environment. When observing their behavior, they perceive situations of joy and pleasure related to alcohol consumption and, consequently, they may repeat them, relating them to moments of relaxation, challenge and courage, not seeing them as harmful 9 .

In this sense, when dealing with issues related to excessive alcohol consumption among adolescents and young people, Nursing Care should include family members in individual interviews and support groups for guidance and support, since the family can be important in helping to change behavior and develop a healthier lifestyle 2 .

Within this discussion, the problem proposed for this study is: what risk factors can be associated with alcohol consumption among adolescents who study at a public school in the city of Recife, Pernambuco? This question becomes relevant, considering that abusive alcohol consumption among young people seems to be increasingly increasing and occurring at an earlier age.

Therefore, it is also up to the Nursing professional to highlight, through Health Education actions, the risk factors that may be associated with such consumption, in order to minimize possible problems.

OBJECTIVE

To verify the risk factors that may be associated with alcohol consumption among adolescents at a public school in the city of Recife, Pernambuco.

METHODS

Quantitative research is considered the most appropriate for ascertaining explicit and conscious opinions and attitudes of the interviewees, as it uses standardized instruments (questionnaires) and should be carried out when it is known exactly what should be asked to achieve the research objectives 10 .

In this sense, quantitative-descriptive studies can be carried out that aim at the exact description of certain quantitative characteristics of the population as a whole, organizations or other specific groups and, when researching qualitative aspects such as attitudes and opinions, scales that allow their quantification are used 11 .

In carrying out this research, advanced inferential statistical techniques were used, which can create models capable of predicting whether a person will have a certain opinion or act in a certain way, based on observable characteristics 12 .

The study population consisted of 52 students who were enrolled in the 3rd year of high school (in the afternoon period) at a public school located in the city of Recife-PE, in 2015. The institution was chosen based on the fact that it was a reference school and offered easy access as a research field.

The inclusion criteria adopted for this research were: being under 18 years of age and attending the 3rd year of high school. Students who were not present at the time of the researchers’ visit, and who did not present the terms of assent and informed consent signed by their parents or guardians were excluded from the study.

A questionnaire designed by AUDIT ( Alcohol Use Disorder Identification Test ) was applied, which is structured with scores that appear in the answer options, which were added up after the adolescents and young people answered the questions. The final scores promoted the classification of the same according to the levels of consumption highlighted below:

▪ Low-risk consumption = 0 to 7 points;

▪ Risky consumption = 8 to 15 points;

▪ Harmful use or high-risk consumption = 16 to 19 points;

▪ Probable dependence = 20 or more points (Maximum = 35 points).

Data were collected individually and statistical analysis was subsequently performed using tabulations using the Statistical Package for the Social Sciences (SPSS) software and Microsoft Excel® to present the variables.

This study complied with resolution no. 466/12 of the National Health Council, which is based on the main international documents that issue statements and guidelines on research involving human beings. It was approved by the Research Ethics Committee (CEP) of the Salgado de Oliveira University (UNIVERSO), receiving approval report no. 1,220,332, and under CAAE no. 48544615.2.0000.5289.

RESULTS

The results of the AUDIT test were presented in tables, according to the number of consumers of alcoholic beverages, age at first experience, influence at the beginning of consumption and frequency of consumption.

Table 1 shows that 61.5% of the students interviewed reported that they had never felt unwell after drinking alcohol, and 76.9% had never stopped performing tasks due to alcohol consumption. According to the data collected, the majority of the students interviewed stated that they had never felt ill, and that this consumption had never affected their daily activities.

Table 2 shows data related to risk factors associated with alcohol consumption among adolescents, where 53.8% of adolescents are male and 46.1% are female. Alcohol consumption was evidenced among adolescents aged between 14 years (30.7%) and 16 years (38.4%), showing that the consumption of this substance has been increasingly frequent in the daily lives of these adolescents.

It was also found that 28.8% of adolescents consume alcoholic beverages less than once a month, and can be considered social drinkers. However, this alcohol consumption can become abusive and turn into alcoholism 13 .

The AUDIT test applied to adolescents identified the frequency of alcohol consumption as well as factors related to this consumption. Recommended by the World Health Organization for this purpose, the AUDIT test is an easy-to-apply and cross-culturally validated instrument used in different services.

For each answer on the test there is a score; the sum of the scores of all the questions gives the final score for each adolescent. The AUDIT test considers that if seven or more points are added, there is a possibility that the adolescent is consuming alcoholic beverages in a dangerous manner.

Among the 52 participants in the AUDIT test, 55.7% of adolescents were low-risk consumers ( score = 0 to 7), 25% were high-risk consumers ( score = 8 to 15), 17.3% were high-risk consumers ( score = 16 to 19) and 1.9% were likely dependents ( score = 20 to 35).

DISCUSSION

It should be considered that adolescents are in a period of life in which biological, social and psychological changes are taking place and such changes make these young people more vulnerable, often including them in the risk group for the initiation of licit and illicit drug consumption 2-14 .

Problematic alcohol use by adolescents is associated with a series of impairments in the development of adolescence itself and in its later outcomes. The harm caused by alcohol use in adolescents is different from the harm seen in adults, whether due to existential specificities of this stage of life or neurochemical issues at this stage of brain maturation 15 .

Alcohol consumption in adolescence is also associated with a series of harms at school, knowing that memory is a fundamental function in the learning process, and that this is compromised by alcohol consumption 16 .

The decline in school performance, in turn, can reduce the self-esteem of young people, which represents a known risk factor for greater involvement in experimentation, consumption and abuse of psychoactive substances. Thus, the consequence of alcohol abuse for adolescents could lead them to increase consumption in a feedback chain, instead of motivating them to reduce or stop use 17. It is the responsibility of nursing to carry out health education actions, investigate signs and symptoms, alleviate current levels of anxiety and develop strategies to promote effective socialization in order to minimize future health damage 18 .

It was observed that a large proportion of young people consume alcohol after the age of 14, an age at which alcohol consumption is illegal in Brazil. This shows that adolescents have access to drugs in some way, even though the sale and distribution of alcoholic beverages to minors under 18 years of age are prohibited by Law No. 8,069 of 1990, the Statute of Children and Adolescents 19 .

Another important factor is the strong influence of friends in relation to the beginning of alcohol consumption. This pattern can be explained by the fact that adolescence is the phase in which the search for identity occurs and, in order to be part of the same group to which other adolescents belong, they carry out practices justified by the need to feel an integral part of the group 20 .

Nurses have a fundamental role in preventive actions for this population, as they are key agents in the process of social transformation. However, it is necessary to prepare professionals to work with this clientele, since assistance should focus on the need to diagnose alcohol abuse and the harm it causes to the adolescent’s life early 18 .

Health promotion activities tend to motivate individuals to act positively to achieve a higher level of health and well-being. Disease prevention activities are designed to motivate individuals to avoid a negative condition, rather than to take positive action with the aim of maintaining a level of health 18 .

The National Policy on Alcohol has assumptions in accordance with the PNAD (National Policies on Alcohol and Other Drugs) 4 , the main measures being: to encourage the conduct of research that performs a situational and epidemiological diagnosis on the consumption of alcoholic beverages in Brazil; to raise awareness among the population about the harm caused by alcohol through educational campaigns; to reduce the demand for alcohol in vulnerable populations, such as children and adolescents; to prevent traffic accidents related to alcoholism; and, finally, encourage the regulation, monitoring and inspection of alcoholic beverages.

Such strategies to prevent and reduce alcohol consumption by minors should involve public policies, campaigns, schools and interventions in Emergency Services 5 .

The educational process, in addition to generating and disseminating knowledge, enables an expansion of knowledge in the human dimension and an improvement in quality of life. In the school environment, one must also “learn to be” and “learn to live together”. With this, we understand that health promotion is an action with great potential to be implemented in schools, since these are privileged places for dialogues for the exchange of knowledge and expression of cultural diversity, remembering that health education helps in the construction of individuals and groups that constitute society 17 .

Given this context, it becomes necessary to analyze the role of the family due to the importance it acquires at this stage of life. The family can have different roles, either in inducing the use and abuse of alcohol in adolescence, or, on the contrary, as a protective institution for the health of adolescents, welcoming, supporting and guiding them.

CONCLUSION

This study showed that adolescents have been consuming alcoholic beverages at an increasingly early age, in larger quantities and with easy access. The first use usually occurs at home, in the presence of family and friends. Adolescents who drink are more likely to engage in health-risk behaviors, such as getting involved in fights, having accidents, being absent from school, and having risky sexual behavior. It is worth noting that advertising is an important incentive for consumption and that in Brazil there is a need for regulatory measures.

Adolescents should receive special monitoring because they represent a group that is more vulnerable to experimenting with alcohol, tobacco, and other drugs. Habits such as these, acquired at this stage of life, tend to be fixed in adulthood.

Given the magnitude and complexity of the problem, it is important to implement prevention programs aimed at adolescents and their families, and to monitor the sale of alcoholic beverages more effectively, considering that greater awareness is necessary to minimize the harm caused by alcohol abuse throughout life.

Bibliographic References

1. Aliane PP, Lourenco LM, Ronzani TM. Comparative study of social skills of alcohol-dependent and non-alcoholic individuals. Psicol Estud [internet]. 2006 ;11(1):83-88. [cited 2014 Oct 01] Available from: http://www.scielo.br/scielo.php?pid=S1413-73722006000100010&script;=sci_abstract

2. Almeida LM, Coutinho ESF. Prevalence of alcoholic beverage consumption in Brazil. Rev Saúde Pública [internet]. 1993; 27:23-9. [cited 2015 Apr 13]. Available from: http://www.scielo.br/scielo.php?pid=s0034-89102005000400011&script;=sci_arttext

3. National Council for Scientific and Technological Development (BR). Junior Scientific Registration Program – PIBIC/JR/FUNDECT/CNPq. Mato Grosso do Sul, April 11, 2011 [cited 2015 Mar 11]. Available at: http://www.pesquisaquantitativa.com.br/pesquisa-quantitativa.htm .

4. Barbor T. AUDIT – the alcohol use disorders identification test: guidelines for use in primary care. Geneva: World Health Organization; 2001 [cited 2015 Nov 26]. Available at: http://www.talkingalcohol.com/files/pdfs/WHO_audit.pdf

5. Edwarde EMD, Judith BRNC. Preventing Alcohol Misuse Among Adolescents. Ann Emerg Med. 2005;45(4):430 – 432. [cited 2015 Dec 10] Available from: https://www.annemergmed.com/article/S0196-0644(04)01745-7/fulltext?code=ymem-site

6. Ferreira MMSRS, Torgal MCLFPR. Tobacco and alcohol use in adolescence. Rev Latino-Am Enfermagem [internet]. 2010 ;18(2):255-261. [cited 2015 Nov 26] Available from: www.seer.ufu.br/index.php/revextensao/article/download/20832/12662

7. Facundo FRG, Castillo MM. Acquisition of alcohol use in a group of Mexican adolescents: the effect of relationships with friends. Rev Elet Mental Health Alcohol Drugs [internet]. 2005;1(2):[13 screens]. [cited 2015 Dec 01] Available at: http://www2.eerp.uso.br/smad/artigos.asp

8. Galduroz JCF, Noto AR, Fonseca AM, Carlini EA. V national survey on the use of psychotropic drugs among elementary and high school students in public schools in the 27 Brazilian capitals: 2004. São Paulo; Brazilian Center for Information on Psychotropic Drugs, UNIFESP; 2005.

9. Jorge CM, Neto Miranda MH. Verification of the knowledge of high school students at Colégio Positivo in Telêmaco Borba about the harm caused by drug use. Arq Apadec [internet]. 1998; 2(2):74-81. [cited 2015 Dec 10] Available from: periodicos.uem.br/ojs/index.php/ArqMudi/article/viewFile/…/10760

10. Lima M, Costa JA, Figueiredo WS, Schraiber LB. Invisibility of drug use and assistance from AIDS service professionals. Rev Saúde Pública [internet]. 2007; 41(supl 2):6-13. [cited 2015 Dec 02] Available from: http://www.scielo.br/scielo.php?pid=S0034-89102007000900004&script;=sci_abstract&tlng;=pt

11. Lopes GT, Lemos BKJ, Lima HB, et al. Conceptions of nursing students about drug users. Rev Bras Enferm [internet]. 2009; 62(4):518-523. [cited 2015 Dec 02] Available from: http://www.scielo.br/scielo.php?pid=S0034-71672009000400004&script;=sci_abstract&tlng;=pt

12. Meneses-Gaya C, Zuardi AW, Loureiro SR, Crippa JAS. Alcohol Use Disorders Identification Test (AUDIT): an updated systematic review of psychometric properties. Psychol Neurosci. [internet]. 2009; 2(1):83-97. [cited 2015 Mar 31] Available from:http://www.scielo.br/scielo.php?pid=S004720852012000300001&script;=sci_arttext

13. Pereira DS, Souza RS, Buaiz V, Siqueira MM. Use of psychoactive substances among medical students at the Federal University of Espírito Santo. J Bras Psiquiatr [internet]. 2008;57:188-95. [cited 2015 Dec 03] Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid;=S004720852008000300006&lng;=pt&nrm;=iso&tlng;=pt

14. Miranda FAN, Simpson CA, Azevedo DM, Costa SS. The negative impact of alcohol use and abuse disorders on family life. Rev Eletr Enferm [internet]. 2006;8(2). [cited 2007 Apr 21] Available from: http://www.fen.ufg.br/revista/revista8_2/v8n2a07.htm

15. Moreno EAC, Vieira DA, Couceiro TBS, Cavalcanti AMTS. Profile of schoolchildren aged 10 to 14 who use alcohol. Rev. enfermagem UFPE on line [internet]. 2011 Dec;5(spe):2599-608. [cited 2012 Feb 06] Available at: https://periodicos.ufpe.br/revistas/revistaenfermagem/article/viewFile/10248/10859

16. Mohanan P, Swain S, Sanah N, Sharma V, Ghosh D. A Study on the Prevalence of Alcohol Consumption, Tobacco Use and Sexual Behavior among Adolescents in Urban Areas of the Udupi District, Karnataka, India. Sultan Qaboos Univ Med J. [internet]. 2014;14(1):104-112. [cited 2015 Dec 03]Available at: https://www.ncbi.nlm.nih.gov/pubmed/24516739

17. Mckinnon SA, O’rourke KM, Thompson SE, Berumen JH. Alcohol use and abuse by adolescents: the impact of living in a border community. J Adolesc Health [internet]. 2004;34(1):88-93. [cited 2015 Dec 09] Available from: http://www.jahonline.org/article/S1054-139X(03)00251-9/abstract?cc=y%3D

18. Nossa L. Study shows drug use by students. O Estado de S. Paulo. São Paulo 2002 [cited 2014 Oct 16]. Available from: http://www.padrefelix.com.br/dr_alcool05.htm

19. Brazilian Observatory of Drug Information – (OBID). Alcohol. 2011 [cited 2015 Dec 11]. Available at: http://www.obid.senad.gov.br/portais/OBID/conteudo/index.php?id_conteudo=11288&rastro;=INFORMA%C3%87%C3%95ES+SOBRE+DROGAS%2FTipos+de+drogas/%C3%81lcool#historico

20. Pereira M. Alcohol consumption in adolescence and parental relationships. Iterações [internet]. 2010;1(5):179-88. [cited 2012 Feb 22] Available at: http://www.interacoes-ismt.com/index.php/revista/article/view/99