Michela Morleo

Predictors of risky alcohol consumption in schoolchildren and their implications for preventing alcohol-related harm

BackgroundWhile alcohol-related health and social problems amongst youths are increasing internationally, both consumption and associated harms are particularly high in British youth. Youth drinking patterns, including bingeing, frequent drinking and drinking in public spaces, are associated with increased risks of acute (e.g. violence) and long-term (e.g. alcohol-dependence) health problems. Here we examine economic, behavioural and demographic factors that predict these risky drinking behaviours among 15–16 year old schoolchildren who consume alcohol. A cross-sectional survey was conducted among schoolchildren in North West England (n = 10,271) using an anonymous questionnaire delivered in school settings. Analysis utilised logistic regression to identify independent predictors of risky drinking behaviour.ResultsOf all respondents, 87.9% drank alcohol. Of drinkers, 38.0% usually binged when drinking, 24.4% were frequent drinkers and 49.8% drank in public spaces. Binge, frequent and public drinking were strongly related to expendable income and to individuals buying their own alcohol. Obtaining alcohol from friends, older siblings and adults outside shops were also predictors of risky drinking amongst drinkers. However, being bought alcohol by parents was associated with both lower bingeing and drinking in public places. Membership of youth groups/teams was in general protective despite some association with bingeing.ConclusionAlthough previous studies have examined predictors of risky drinking, our analyses of access to alcohol and youth income have highlighted eradicating underage alcohol sales and increased understanding of childrens spending as key considerations in reducing risky alcohol use. Parental provision of alcohol to children in a family environment may also be important in establishing child-parent dialogues on alcohol and moderating youth consumption. However, this will require supporting parents to ensure they develop only moderate drinking behaviours in their children and only when appropriate.

Teenage drinking, alcohol availability and pricing: a cross-sectional study of risk and protective factors for alcohol-related harms in school children

BackgroundThere is a lack of empirical analyses examining how alcohol consumption patterns in children relate to harms. Such intelligence is required to inform parents, children and policy relating to the provision and use of alcohol during childhood. Here, we examine drinking habits and associated harms in 15-16 year olds and explore how this can inform public health advice on child drinking.MethodsAn opportunistic survey of 15-16 year olds (n = 9,833) in North West England was undertaken to determine alcohol consumption patterns, drink types consumed, drinking locations, methods of access and harms encountered. Cost per unit of alcohol was estimated based on a second survey of 29 retail outlets. Associations between demographics, drinking behaviours, alcohol pricing and negative outcomes (public drinking, forgetting things after drinking, violence when drunk and alcohol-related regretted sex) were examined.ResultsProportions of drinkers having experienced violence when drunk (28.8%), alcohol-related regretted sex (12.5%) and forgetting things (45.3%), or reporting drinking in public places (35.8%), increased with drinking frequency, binge frequency and units consumed per week. At similar levels of consumption, experiencing any negative alcohol-related outcome was lower in those whose parents provided alcohol. Drunken violence was disproportionately associated with being male and greater deprivation while regretted sex and forgetting things after drinking were associated with being female. Independent of drinking behaviours, consuming cheaper alcohol was related to experiencing violence when drunk, forgetting things after drinking and drinking in public places.ConclusionThere is no safe level of alcohol consumption for 15-16 year olds. However, while abstinence removes risk of harms from personal alcohol consumption, its promotion may also push children into accessing drink outside family environments and contribute to higher risks of harm. Strategies to reduce alcohol-related harms in children should ensure bingeing is avoided entirely, address the excessively low cost of many alcohol products, and tackle the ease with which it can be accessed, especially outside of supervised environments.

Under-reporting of foetal alcohol spectrum disorders: an analysis of hospital episode statistics

BackgroundInternationally, 0.97 per 1,000 live births are affected by foetal alcohol syndrome (FAS). However, prevalence intelligence has been limited in the UK, hindering the development of appropriate services. This analysis compares hospital admissions over time, between regions and with alcohol-related admissions for adult females to assess whether established patterns (such as the North experiencing elevated harms) can be identified.MethodsA retrospective analysis of hospital admissions data (April 2002 to March 2008) for foetal alcohol spectrum disorder (FASD)-related conditions: foetal alcohol syndrome (dysmorphic) (n = 457); foetus and newborn affected by maternal use of alcohol (n = 157); maternal care for (suspected) damage to foetus from alcohol (n = 285); and 322,161 women admitted due to alcohol-related conditions.ResultsWhilst the rate of admission for alcohol-related conditions in women aged 15-44 years increased significantly by 41% between 2002/03 and 2007/08 (p < 0.0001), significant increases were only seen in the numbers of FAS. Established regional rates of admission for alcohol-related conditions in women aged 15-44 years old were not associated with admission for FASD-related conditions.ConclusionsIt would be expected that the North West and North East regions, known to have higher levels of alcohol harm would have higher levels of FASD-related conditions. However, this was not reflected in the incidence of such conditions, suggesting under-reporting. With incomplete datasets, intelligence systems are severely limited, hampering efforts to develop targeted interventions. Improvements to intelligence systems, practitioner awareness and screening are essential in tackling this.

A cross-sectional survey of compliance with national guidance for alcohol consumption by children: measuring risk factors, protective factors and social norms for excessive and unsupervised drinking

BackgroundThe Chief Medical Officer for England has developed the first guidance in England and some of the first internationally on alcohol consumption by children. Using the most recent iteration of a large biennial survey of schoolchildren we measure the extent to which young peoples drinking fell within the guidelines just prior to their introduction and the characteristics of individuals whose drinking does not; how alcohol related harms relate to compliance; and risk factors associated with behaving outside of the guidance.MethodsA cross-sectional survey was conducted utilising a self-completed questionnaire with closed questions. A total of 11,879 schoolchildren, aged 15-16 years, from secondary schools in North West England participated in the study. Data were analysed using chi square and conditional logistic regression.ResultsAlcohol consumption is an established norm by age 15 years (81.3%). Acute alcohol related violence, regretted sex and forgetfulness were experienced by significantly fewer children drinking within the guidance (than outside of it). Over half of drinkers (54.7%) reported routinely drinking more heavily than guidance suggests (here ≥5 drinks/session ≥1 month), or typically drinking unsupervised at home or at a friends home when parents were absent (57.4%). Both behaviours were common across all deprivation strata. Children with greater expendable incomes were less likely to consume within guidance and reported higher measures for unsupervised, frequent and heavy drinking. Although drinking due to peer pressure was associated with some measures of unsupervised drinking, those reporting that they drank out of boredom were more likely to report risk-related drinking behaviours outside of the guidance.ConclusionsSuccessful implementation of guidance on alcohol consumption for children could result in substantial reductions in existing levels of alcohol related harms to young people. However, prolonged social marketing, educational and parental interventions will be required to challenge established social norms in heavy and unsupervised child drinking across all social strata. Policy measures to establish a minimum price for alcohol and provide children with entertaining alternatives to alcohol should also increase compliance with guidance.

Use of fake identification to purchase alcohol amongst 15-16 year olds: a cross-sectional survey examining alcohol access, consumption and harm.

BackgroundDespite legislation and enforcement activities to prevent underage access to alcohol, underage individuals continue to be able to access alcohol and to do so at levels which put them at significant risk of alcohol-related harm.MethodsAn opportunistic survey of 15-16 year olds (n = 9,833) across North West England was used to examine alcohol consumption, methods of access and related harms experienced (such as regretted sex). Associations between these were analysed using chi square and logistic regression techniques.ResultsOver a quarter (28.3%) of 15-16 year old participants who drank reported having bought their own alcohol. One seventh (14.9%) of these owned at least one form of fake identification for which by far the most common purchase method was online. Logistic regression analyses showed that those who owned fake identification were significantly more likely to be male (AOR = 2.0; 95% CI = 1.7-2.5; P < 0.001) and to receive a higher personal weekly income (comparing those who received > £30 with those who received ≤ £10: AOR = 3.7; 95% CI = 2.9-4.9; P < 0.001). After taking into account differences in demographic characteristics and personal weekly income, ownership of fake identification was significantly associated with binge drinking (AOR = 3.5, 95% CI = 2.8-4.3; P < 0.001), frequent drinking (AOR = 3.0, 95% CI = 2.5-3.7; P < 0.001) and public drinking (AOR = 3.3, 95% CI = 2.5-4.1; P < 0.001) compared with those who did not own fake identification. Further, those who reported owning fake identification were significantly more likely to report experiencing a variety of alcohol-related harms such as regretted sex after drinking (chi square, all P < 0.001).ConclusionsYoung people (aged 15-16 years) who have access to fake identification are at a particularly high risk of reporting hazardous alcohol consumption patterns and related harm. Owning fake identification should be considered a risk factor for involvement in risky drinking behaviours. Information on these hazards should be made available to schools and professionals in health, social and judicial services, along with advice on how to best to work with those involved.

Nightlife, verbal and physical violence among young European holidaymakers: what are the triggers?

OBJECTIVES There is an established relationship between nightlife, substance use and violence. This study investigated this relationship when people are on holiday, and explored the differences in experiences between physical and verbal violence. STUDY DESIGN A survey of young tourists at seven airport departure areas in Southern European resorts. METHODS Questionnaires from 6502 British and German tourists were analysed exploring demographics, violence (verbal and physical), substance use, and reasons for resort and venue selection. RESULTS Over two-thirds of respondents reported being drunk on their holiday, 12.4% had been involved in arguments and 2.9% had been involved in fights. Logistic regression highlighted more violence amongst visitors to Mallorca [arguments: adjusted odds ratio (AOR) 2.7; fights: AOR 2.0] compared with those visiting Portugal, males (arguments: AOR 1.3; fights: AOR 1.7), those who had used illicit drugs (arguments: AOR 1.5; fights: AOR 2.9), those who had been in fights at home in the last 12 months (arguments: AOR 2.2; fights AOR 2.9), and those who had frequently been drunk abroad (arguments: AOR 2.4; fights: AOR 2.5). Those aged 16-19 years, visiting Italy or Crete, who were drunk for fewer than half of the days of their stay, and who chose bars because they were frequented by drunk people were more likely to report having an argument. Fights were associated with cannabis use and were negatively associated with choosing bars with a friendly atmosphere. Economic status or frequency of visiting bars had no relationship with arguments or fights. CONCLUSIONS Understanding and addressing the variables involved in violence when holidaying abroad is critical in targeting appropriate health promotion and harm reduction measures.

Alcohol age of initiation and long-term impact: a cross sectional survey of adults in England

Abstract Background: Worldwide alcohol consumption is involved in 2.5 million deaths annually. Worryingly, the age of alcohol initiation may be decreasing; evidence suggests an inverse correlation between initiation and prevalence of alcohol use. European data are limited. Methods: Data are from a survey (n = 2638) on alcohol consumption of ≥18 y in England. Univariate and multivariate associations are reported between demography, last year alcohol consumption, historic drinking including having regularly drank alcohol <18 y (drank at least monthly), and experience of at least one serious alcohol-related problem (self-defined). Results: Lifetime alcohol consumption was reported by 93.2% of participants. Of these, 36.1% reported regular consumption <18 y; 18–30 y had a threefold greater odds of reporting alcohol consumption <18 y than 61–75 y. In total, 5.2% reported at least one serious alcohol-related problem; those who had regularly consumed alcohol <18 y had a twofold greater odds of reporting this than those who had not. Conclusion: Our sample supports a potential increase in the proportion of those reporting underage alcohol initiation. As those who regularly consumed alcohol <18 y were at risk of experiencing alcohol-related problems, incidence of harm could increase over time as early initiators start to experience harms, supporting the need for interventions to delay alcohol consumption in underage groups.

Screening for alcohol-related liver damage in the community: findings from the PrevAIL (Preventing Alcohol Harm in Liverpool) Study

Progression of alcohol-related liver fibrosis stops when drinking stops, but the diagnosis is usually missed because the process of fibrosis is symptom free and missed by the usual liver function tests. Non-invasive tests to detect fibrosis and cirrhosis are available, but not currently used in primary care. We aimed to: identify optimal ways of engaging communities with liver disease screening; to inform a future trial to augment brief interventions with a liver risk score; and to estimate the prevalence of liver disease. Participants, aged 36-55y, registered with general practice (GP) or working in Merseyside, UK, were contacted by post (GP) or through workplaces. Risky drinkers (previous week drinking >112g females/168g males) were invited for a liver screen. Blood samples were tested for fibrosis markers (hyaluronic acid and procollagen type III N-terminal peptide) and categorised using the Simple Traffic Light (STL) algorithm. Of 6439 GP registrants, 539 (8%) returned the alcohol consumption questionnaire; 152 were risky drinkers and were invited for liver screening, and 27 attended. Screening in the 13 participating workplaces (out of 37 approached) was attended by 2-6% of the eligible workforce (n=363). Of 142 risky drinkers, most (91%) accepted the liver screening test. In total, seven samples were graded ‘red’, yielding a prevalence of 4.6% (95%CI 2.02—9.14%) of probable liver disease and further 26.3% (20.0—33.7%; 41 samples) scored ‘amber’ (moderate risk). Detecting and supporting cases in the community could avert deaths and save costs, and this work informs development of a trial to determine whether feedback of liver disease risk scores is more effective than brief intervention alone. We conclude that workplaces are optimum sites, because screening takes place at a time and location that was convenient for participants; however alternative methods will be required to access those who do not work, whose risk may be higher.