Preventing alcohol use among young urban adolescents.
Article Type: Letter to the editor
Subject: Alcohol and youth (Prevention)
Teenagers (Behavior)
Youth (Behavior)
Hispanic Americans (Behavior)
Children (Health aspects)
Authors: Quintana, Michelle
Soren, Karen
Kharbanda, Elyse Olshen
Pub Date: 12/01/2011
Publication: Name: Journal of Alcohol & Drug Education Publisher: American Alcohol & Drug Information Foundation Audience: Academic; Professional Format: Magazine/Journal Subject: Health; Psychology and mental health; Social sciences Copyright: COPYRIGHT 2011 American Alcohol & Drug Information Foundation ISSN: 0090-1482
Issue: Date: Dec, 2011 Source Volume: 55 Source Issue: 3
Product: Product Code: E121930 Youth; E123400 Hispanic Americans
Accession Number: 280092615
Full Text: Dear Editor,

The rates of alcohol consumption have increased among Latino adolescents (Johnston, Bachman, Schulenberg, 2008). This letter describes alcohol use and beliefs among a sample of urban, primarily Latino, adolescents and their parents. Data were obtained from a convenience sample of 50 parent/adolescent dyads presenting for primary care at two community-based pediatric health centers in New York City. The study assessed current drinking behaviors, beliefs regarding underage drinking, and preferences for programs to prevent early alcohol use in an urban Latino community.

BACKGROUND

Preventing underage drinking is a public health priority. Early alcohol use is particularly concerning, as it is associated with future problem drinking and escalation of other risk behaviors (Santelli, Robin, Brener, Lowry, 2001; Hingson, Heeren, Winter, 2006). While alcohol use is common among adolescents of all backgrounds, Latinos have the highest rates of early onset alcohol use and heavy drinking (Johnston et al., 2008).

Risks for early alcohol use are multifactorial, reflecting individual, family, and environmental influences (Zucker, Donovan, Masten, Mattson, Moss, 2008). The increased rates of drinking among urban Latino youth may be due to unique pressures in this community (Griffin, Botvin, Nichols, Scheier, 2004; Guilamo-Ramos, Jaccard, Johansson, Tunisi, 2004). Stress related to poverty, acculturation, and exposure to violence may all predispose to early experimentation. The recent Surgeon General's Report on underage drinking emphasizes the need for educational interventions to target families and be culturally appropriate. However,

few interventions to prevent underage drinking have specifically targeted Latino youth (O'Donnell, Myint, Duran, Stueve, 2010; Pantin, Prado, Lopez, 2009). Further research is needed to design culturally appropriate interventions that are likely to be accepted among Latino families. In the current study, we conducted semi-structured interviews with parent-adolescent dyads from an urban Latino community in order to assess current drinking behaviors, beliefs about underage drinking, and preferences for programs to prevent early alcohol use.

METHODS

A convenience sample of 50 parent/adolescent dyads presenting for primary care at two community-based pediatric health centers in New York City was recruited to participate. After providing informed written consent, parents participated in a semi-structured English or Spanish language individual interview with a trained, bilingual research assistant. Interviews were designed to last no more than 20 minutes. Adolescent and parent participants each received a $10 incentive. This study was approved by the Columbia University Institutional Review Board.

Parents' structured survey topics included: perceptions of their adolescent child's current drinking behaviors (3 questions) and beliefs about underage drinking (11 questions). The drinking behavior questions were measured by asking: "Do you believe that your child has ever had a drink of alcohol? Is alcohol easily available to the child at your home?" Questions on alcohol beliefs were assessed on a 5-point Likert scale that ranged from strongly agree to strongly disagree. Questions on underage drinking included: "Do you agree that teenagers 14 years or younger should not drink alcohol? It is safe for teenagers to drink in their own home? Do you think teenagers who drink alcohol are more likely to try other drugs?" Demographic data and measures of acculturation were also surveyed. Parent's open-ended questions included: "In your opinion, why do teenagers in this community choose to drink alcohol? How much do you worry about your child drinking alcohol? What are the best ways to help parents teach kids about alcohol?"

After obtaining assent, adolescents completed a brief English or Spanish language survey of current drinking behaviors (5 questions) and views on underage drinking (13 questions). Adolescent's current drinking behaviors questions included: "Have you ever had a drink of alcohol? Is alcohol easily available to you at your home? Is alcohol easily available at a friend's home?"

For fixed-response survey items, we conducted descriptive analyses. Responses regarding alcohol beliefs were dichotomized (strongly agree/agree versus neutral/disagree/strongly disagree). Concordance between parental and adolescent reports of drinking behaviors and beliefs regarding underage drinking was compared with the Kappa statistic. Univariate logistic regression was used to identify demographic variables and beliefs associated with an adolescent ever drinking alcohol.

Parent responses to open-ended questions were audio-recorded and professionally transcribed. Using content analysis, transcripts were independently coded by two investigators. Using an iterative process, dominant themes emerged, and a coding scheme was created. Through the use of the coding scheme, categories were created and put into a data display which was used to assist in organizing and visualizing the data. Categories in the data display included parental views on why adolescents in their community drink alcohol, the risks of adolescent alcohol use, and strategies parents endorsed to prevent adolescent alcohol use

DISCUSSION OF RESULTS

The mean ages of adolescents and parents were 14.6 and 44.6 years, respectively. Most participants self-identified as Hispanic and spoke Spanish. More than half of parents were born in the Dominican Republic, while approximately three-quarters of their adolescent children were born in the United States. The majority of parents either had a high school education or college degree. Less than half (36%) of adolescents surveyed reported ever drinking alcohol, and only 12% reported drinking alcohol in the past 30 days. There was moderate concordance between adolescents' reported drinking behaviors and parents' estimates of their child's alcohol use (Kappas range from .37-.52) with a tendency for parents to underestimate their child's drinking. The majority of parents and teens opposed adolescent alcohol use. However, nearly half of parents and adolescents believed that it was safe for teens to drink alcohol in their own homes. Furthermore, there was considerable discordance between adolescent and parental beliefs about whether teens should wait until age 21 to drink alcohol (Kappa = -.17). Additionally, there was only slight agreement between parent/adolescent dyads in their belief that most teens drink alcohol (Kappa =. 16), and that parents would be upset if they smelled alcohol on their teen's breath (Kappa =. 13).

Older teens, ages 15-17 years, (OR=4.5 (95% CI=1.2-16.7)) and those with US-born parents (OR=6.2 (95% CI=1.3-28.1)) were more likely to report ever drinking alcohol. Teens who believed alcohol would lead to other drug use were less likely to have tried alcohol (OR=.12 (95% CI=.03-.43)).

Three dominant themes emerged from the parent interviews. First, parents identified peer pressure and having a poor relationship with parents as the two primary reasons why adolescents in their community drink alcohol. Second, parents noted the relationship between early alcohol use and other risky behaviors and their consequences, including the use of other drugs, violence, car accidents, sexually transmitted diseases, and pregnancy. Third, parents endorsed four specific strategies to deal with underage drinking: communication, role modeling, improved parent-child relationship, and monitoring.

While parents felt that it was primarily their responsibility to teach their children about the risks of alcohol, they welcomed help from medical providers, schools and other community-based groups. Parents preferred comprehensive prevention programs that would teach communication skills and would address ways to reduce alcohol use, prevent violence, pregnancy, and other associated risk behaviors.

CONCLUSION

Many findings from this mixed-methodology study of urban adolescents and their parents are reassuring. First, teen-reported rates of recent alcohol use and heavy drinking in this community were low. Second, parents were already aware of effective strategies for reducing adolescent alcohol use, including monitoring, serving as a role model, and encouraging open communication (DeVore, Ginsburg, 2005; Riesch, Anderson, Krueger, 2006). In addition, we observed moderate agreement between adolescents and their parents in their estimation of adolescent drinking behaviors.

Despite these positive findings, parents expressed significant concerns about the consequences of underage drinking and requested further help to keep their children alcohol-free. Furthermore, although adolescent alcohol use in this sample was low, nationally, Latinos are a high risk population for early and problem drinking. One area that should be specifically addressed in programs to prevent early alcohol use in Latino communities is the belief that it is safe for youth to drink in their own homes.

Consistent with the observed clustering of risk behaviors (DuRant, Smith, Kreiter, Krowchuk, 1999), parents identified alcohol use as associated with violence perpetration, accidents, unintended pregnancy, and sexually transmitted infections. Similarly, teens who believed alcohol use would lead to other drug use were less likely to drink. Prevention efforts that address alcohol use in conjunction with other associated risk behaviors may be more effective than those focusing solely on alcohol use.

A few limitations to this research should be noted. Due to our small sample size and cross-sectional design, we were not able to fully assess the relationship between beliefs and initiation of alcohol use or to further characterize beliefs and behaviors by gender. In addition, our small sample size may have led us to underestimate the true level of agreement between parental and teen responses. Furthermore, subjects were urban, primarily Dominican, and thus our findings may not be generalizable to other communities. Nevertheless, we found a need for increased alcohol prevention efforts for urban youth. Programs designed to improve adolescents' refusal skills and promote positive parent-child communication are likely to reduce adolescent risk behaviors and improve health outcomes across multiple domains.

REFERENCES

DeVore, E. R., & Ginsburg, K. R. (2005). The protective effects of good parenting on adolescents. Current Opinion in Pediatrics, 17(4), 460-465.

DuRant, R. H., Smith, J. A., Kreiter, S. R., & Krowchuk, D. P. (1999). The relationship between early age of onset of initial substance use and engaging in multiple health risk behaviors among young adolescents. Archives of Pediatrics & Adolescent Medicine, 153(3), 286-291.

Griffin, K. W., Botvin, G. J., Nichols, T. R., & Scheier, L. M. (2004). Low perceived chances for success in life and binge drinking among inner-city minority youth. Journal of Adolescent Health, 34(6), 501-507.

Guilamo-Ramos, V., Jaccard, J., Johansson, M., & Tunisi, R. (2004). Binge drinking among Latino youth: role of acculturation-related variables. Psychology of Addictive Behaviors, 18(2), 135-142.

Hingson, R. W., Heeren, T., & Winter, M. R. (2006). Age at drinking onset and alcohol dependence: age at onset, duration, and severity. Archives of Pediatrics & Adolescent Medicine, 160(7), 739-746.

Johnston, L. D., Bachman, J. G., & Schulenberg, J. E. (2008). Monitoring the Future national results on adolescent drug use: Overview of key findings, 2008. Bethesda, MD: National Institute on Drug Abuse.

O'Donnell, L., Myint, U. A., Duran, R., & Stueve, A. (2010). Especially for daughters: parent education to address alcohol and sex-related risk taking among urban young adolescent girls. Health Promotion Practice, 11(3 Suppl), 70S-78S.

Pantin, H., Prado, G., Lopez, B., et al. (2009). A randomized controlled trial of Familias Unidas for Hispanic adolescents with behavior problems. Psychosomatic Medicine, 71(9), 987-995.

Riesch, S. K., Anderson, L. S., & Krueger, H. A. (2006). Parent-child communication processes: preventing children's health-risk behavior. Journal for Specialists in Pediatric Nursing, 11(1), 41-56.

Santelli, J. S., Robin, L., Brener, N. D., & Lowry, R. (2001). Timing of alcohol and other drug use and sexual risk behaviors among unmarried adolescents and young adults. Family Planning Perspectives, 33(5), 200-205.

Zucker, R. A., Donovan, J. E., Masten, A. S., Mattson, M. E., & Moss, H. B. (2008). Early developmental processes and the continuity of risk for underage drinking and problem drinking. Pediatrics, 121(Suppl 4), S252-272.

Corresponding Author:

Michelle Quintana, MPH

722 West 168th Street, 17th Floor Room 1701

New York, NY 10032

Author:

Karen Soren, AID

Columbia University Medical Center

622 West 168th Street, Vanderbilt Clinic 4th Floor Room 402

New York, NY 10032

Author:

Elyse Olshen Kharbanda, MD, MPH

Current address: HealthPartners Research Foundation

PO Box 1524, MS 21111R

Minneapolis, MN 55425

Phone: 952-967-5038

Fax: 952-967-2200
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