[Policies to reduce harm caused by alcohol use: a public health perspective]

Adolescent Alcohol Use in Spain: Connections with Friends, School, and Other Delinquent Behaviors

This study examined the connections between adolescent alcohol use in Alicante, Spain and variables reflecting adolescents' academic problems, potentially delinquent behaviors, friends' alcohol consumption, and friendship quality. Information about alcohol use and a number of school and social variables was collected from adolescent students (N = 567) who completed the National Students School-Based Drug Survey in a classroom setting. Results suggested that gender was not significantly associated with alcohol use, although alcohol use increased with age and was more likely for adolescents enrolled in public schools compared to private. After controlling for age and type of school (public vs. private), academic problems explained 5.1% of the variance in adolescents' alcohol use, potentially delinquent behaviors explained 29.0%, friends' alcohol use 16.8%, and friendship quality 1.6%. When all unique predictors from these four models were included in a comprehensive model, they explained 32.3% of the variance in adolescents' alcohol use. In this final model, getting expelled, participating in a fight, going out at night, the hour at which one returns, and the number of friends who have consumed alcohol were uniquely and positively associated with adolescents' alcohol use. These results provide important information about multi-system influences on adolescent alcohol use in Alicante, Spain and suggest potential areas of focus for intervention research.

The relationships between the impact of alcoholic beverage control policies, selected contextual determinants, and alcohol drinking in Spain

Alcohol prevention policies alone neither cause nor explain changes in alcohol consumption, nor in related harm. Alcohol consumption in Spain throughout the period 1962-2008 was analyzed considering selected contextual factors and alcohol policies. Increased urbanization was found to be associated with higher consumption, especially of beer. Restrictive policies regulating purchase age, advertising, and licensing premises to sell alcohol were associated with decreased alcohol consumption, while lower blood alcohol concentration limits were followed by an increase. Study limitations are noted. Changes in the evolution of socioeconomic, sociodemographic, and cultural factors should be carefully analyzed to inform alcohol policy planning and evaluation.

[Risky alcohol consumption and associated factors in adolescents aged 15 to 16 years in Central Catalonia (Spain): differences between rural and urban areas]

OBJECTIVE

To determine the prevalence of risky alcohol consumption and associated risk factors among adolescents living in Central Catalonia (Spain) during the 2011-2012 academic year, depending on their area of residence.

METHOD

A cross-sectional study was carried out in a sample of 1268 10th grade students (4th grade of secondary education) in Central Catalonia.

RESULTS

Risky alcohol consumption was higher among adolescents in rural areas than in urban areas (59.6% versus 49.8%). Associated risk factors were drunkenness in siblings and friends, having positive expectations of alcohol consumption, and buying alcohol. Not living with both parents and poorer academic achievement were associated risk factors in rural areas, while higher socioeconomic status was a risk factor in urban areas.

CONCLUSIONS

Risky alcohol consumption was much higher among adolescents living in rural areas. The main associated factor was alcohol consumption among family and friends.

Heavy drinking and alcohol-related injuries in college students

OBJECTIVE

The main objective of this study is to evaluate the effect of heavy drinking on alcohol-related injuries.

MATERIAL AND METHODS

We carried out an open cohort study among university students in Spain (n=1,382). Heavy drinking and alcohol-related injuries were measured by administrating AUDIT questionnaires to every participant at the ages of 18, 20, 22 and 24. For data analysis we used a Multilevel Logistic Regression for repeated measures adjusting for consumption of alcohol and cannabis.

RESULTS

The response rate at the beginning of the study was 99.6% (1,369 students). The incidence rate of alcohol-related injuries was 3.2 per 100 students year. After adjusting for alcohol consumption and cannabis use, the multivariate model revealed that a high frequency of heavy drinking was a risk factor for alcohol-related injuries (Odds Ratio=3.89 [95%CI: 2.16 - 6.99]). The proportion of alcohol-related injuries in exposed subjects attributable to heavy drinking was 59.78% [95%CI: 32.75 - 75.94] while the population attributable fraction was 45.48% [95%CI: 24.91 - 57.77].

CONCLUSION

We can conclude that heavy drinking leads to an increase of alcohol-related injuries. This shows a new dimension on the consequences of this public concern already related with a variety of health and social problems. Furthermore, our results allow us to suggest that about half of alcohol-related injuries could be avoided by removing this consumption pattern.

Effects of socialization and family factors on adolescent excessive drinking in Spain

Adolescent drinking has an important health and social impact in many countries. In Spain, this behavior often takes place in groups and in open areas (known as "botellón"). The aim of this study is to describe the prevalence of excessive drinking among Spanish adolescents and its association with socialization and family factors. A national school survey was conducted in 2006 among 26,454 students aged 14-18 years who were selected by two-stage cluster sampling (schools and classrooms). The questionnaire was self-completed with paper and pencil. The outcomes were: habitual excessive drinking or HED (average consumption ≥30 g/day of alcohol among men, and ≥20 g/day among women), binge drinking (drinking 5 or more standard alcohol units in a 2-hour interval), and drunkenness. Logistic regression models were used to estimate the effect of socialization and family factors. Monthly prevalence of HED, binge drinking and drunkenness was 11.2%, 30.9% and 25.6%, respectively. The main factors positively associated with HED were: frequently going out for fun in the evenings, high proportion of friends who drink or get drunk, early onset of alcohol use, low perceived risk of drinking, truancy, illegal drug use, and amount of money spent for personal needs. Family factors were weakly associated with outcomes. Socialization in leisure environments with friends who drink excessively is an important predictor of adolescent excessive drinking in Spain. Thus, prevention must also focus on the community level, limiting alcohol access, building socialization environments without alcohol, and increasing adolescents' risk perception of drinking.

[Regulatory policies on alcohol in Spain. Experience-based public health? 2008 SESPAS Report]

The present article reviews the proposal for alcohol regulation made in Spain in 2006 by the Ministry of Health and Consumer Affairs and dropped a few months later as adverse positions took over the debate in the political arena and the media. The background to these regulations, as well as their components, the process, and the actors involved are analyzed, and the factors leading to this outcome are discussed. A comparison is made with the tobacco regulation initiative in 2005, which resulted in a regulatory law with a highly favorable impact on public health. The actors interested in promoting alcohol consumption and opposed to any regulation have a privileged institutional presence, generating powerful resistance. Although these regulatory proposals would have marginal impacts on their trade, wine growers and wineries have been the most visible forces against regulation and have had the greatest political and media impact. Equally, manipulated messages on the health benefits of alcohol use have fed arguments against regulation. The lack of political and media consensus in this case stands in contrast with the tobacco regulation process, in which a certain political consensus had previously been reached and the smoking prevention movement had permeated the media with preventive messages, framing the issue in terms favorable for regulation. To gain ground, the sectors interested in expanding public policies for the prevention of the harm caused by alcohol need greater cohesion and organization. Professional public health organizations can substantially contribute to this field.