ALCOHOL CONSUMPTION AMONG SCHOOL ADOLESCENTS IN PALMA DE MALLORCA

J. A. Tur*, M. S. Puig, A. Pons and E. Benito

Laboratory of Physical Activity Sciences, Universitat de les Illes Balears, E-07122 Palma de Mallorca, Spain

Received 1 August 2002; in revised form 3 December 2002; accepted 16 December 2002


    ABSTRACT
 TOP
 FOOTNOTES
 ABSTRACT
 INTRODUCTION
 SUBJECTS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Aims: To describe alcohol consumption of adolescent boys and girls in Palma de Mallorca, and its relationship with physical activity and socio-demographic factors. Methods: Four hundred and forty five adolescents (171 boys, 274 girls; 14–18 years old) selected from the school census (participation 96%), using two-stage probability sampling were studied. A semi-quantitative food frequency questionnaire was administered and alcohol intake was analysed. Physical activity was computed as a ratio of energy expended in basal metabolic rate. Socio-demographic data were collected, and categorized as gender, mother’s level of education, parental occupational status, and mother’s region of origin. Results: About 60% of adolescents, 53% of boys and 65% of girls, reported alcohol consumption, which increased with age in boys (91% when they were 18 years old), but remained constant in girls. The adolescents consumed alcohol mainly on weekends; average consumption was four drinks per drinking day, and the most consumed drinks were mild distilled spirits. The mother’s educational level and adolescents’ physical activity were negatively and significantly related to alcohol consumption, whereas the adolescents from occupational upper-class parents and non Majorcan/Balearic mothers were positively and significantly related to alcohol consumption. Conclusions: The increased penetration of alcohol into the adolescents’ environment may result in misuse of consumption. To give more information to parents and adolescents on considering alcohol to be a drug, and to promote physical activity among adolescents may be contributing factors towards decreased alcohol consumption among the latter age group.


    INTRODUCTION
 TOP
 FOOTNOTES
 ABSTRACT
 INTRODUCTION
 SUBJECTS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Adolescence is a time of rapid physiological, psychological and social development, and also a key period for the adoption of alcohol use. Alcohol, tobacco and other drug use and misuse are important problems that typically begin during adolescence. Alcohol-related behaviour in adolescents is influenced by intrapsychic factors, friends, attitudes of adults towards alcohol, and even general health policy (Bates and Labouvie, 1997Go). It is known that alcohol may be a facilitating factor of social relationships in adolescents (Paniagua et al., 2001Go), and therefore is consumed mainly at weekends (Rosado-Martín et al., 1997Go; Suárez-López de Vergara et al., 1999Go). Alcohol misuse in adolescents can be a sign of developmental problems and may predict antisocial development and alcohol-related problems in adulthood (Pape and Hammer, 1996Go; Duncan et al., 1997Go; Laukkanen et al., 2001Go). Social influences may account for initiation of and experimental alcohol use, whereas good family environment, positive self-esteem, and good social skills among peer groups have been shown to have a buffering effect for initiation of alcohol use and to be connected with a healthy lifestyle (Bates and Labouvie, 1997Go; Berg-Kelly and Kullander, 1999Go). Several studies have compared alcohol habits in young people with varying levels of physical activity, showing a negative correlation between them (Collingwood et al., 2000Go; Laaksonen et al., 2001Go; D’Amico and Fromme, 2002Go; Peretti-Watel et al., 2002Go).

Recent studies showed that alcohol consumption has increased in most developed countries since about 1990 (Bauman and Phongsavan, 1999Go), and adolescents from European Union countries showed high average consumption of alcohol (Rhem and Gmel, 2002Go). The drinking patterns of young people in Mediterranean countries can be characterized as innovative, having the volume of consumption and associated chronic consequences as its main health risk (Engels and Knibbe, 2000Go). The experimentation of Mediterranean youth with alcoholic beverages typically occurs during the early adolescence years, mainly within the family context (Vives et al., 2000Go), but also with the peers (Aubá and Villalbí, 1993Go; Rosado-Martín et al., 1997Go). Early studies on alcohol consumption in young people have been developed in other regions of Spain, mainly focused on early adolescence (11–14 years old), but also related to several factors influencing alcohol consumption, e.g. socio-economic status, weekly allowance available for personal expenses, patterns of usual consumption by both parents and friends, and physical activity level (Villalbí et al., 1991Go, 1995Go; Aubá and Villalbí, 1993Go; Martínez-Alvarez et al., 1996Go; Gascón-Jiménez et al., 1997Go; Rosado-Martín et al., 1997Go; Perula de Torres et al., 1998Go; Vives et al., 2000Go; Paniagua et al., 2001Go).

Palma de Mallorca, a Mediterranean city located in the Balearic Islands (east of Spain), is a well known tourist destination for Europeans. With the onset of tourism in the 1950s, a new population from other Spanish regions, other European countries, mainly Germany, Great Britain and Scandinavia, and other parts of the world, arrived in the Balearic Islands, introducing new socio-demographic and lifestyle factors, and, as a consequence, many new habits could have been introduced in the Balearic Islands and in Palma de Mallorca. No information has previously been pointed out on alcohol consumption among Mallorcan adolescents, and after the introduction of new Spanish, European and worldwide habits; this information could enhance our knowledge of the drinking patterns of Palma de Mallorca, Mediterranean and European adolescents, the effect of social factors on these patterns, the development of appropriate strategies to avoid or reduce alcohol misuse in adolescents, and thus decrease its risks and negative effects on adolescent health. An accurate knowledge of the attitudes, beliefs, environmental perceptions and behaviours of adolescents will be necessary for the design and evaluation of preventive interventions. Thus, the aim of this study was to describe alcohol consumption of adolescent boys and girls in Palma de Mallorca, and also to investigate its relationship with physical activity and socio-demographic factors.


    SUBJECTS AND METHODS
 TOP
 FOOTNOTES
 ABSTRACT
 INTRODUCTION
 SUBJECTS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Subjects
Adolescents (n = 461: 178 boys, 283 girls; 14–18 years old) were selected from the public and private school census (population 19 079) for Palma de Mallorca (population 350 000) using two-stage probability sampling, namely, random selection of individuals from school classes selected in turn from 10 secondary schools, representing more or less equally the age and sex categories, and also the proportion of public and private schools, in Palma de Mallorca. Study approval was obtained from local and state school authorities. All children, parents and teachers were thoroughly informed about the purpose and content of the study. Approximately 96% of the subjects addressed eventually participated in the study; thus, the final sample was 445 adolescents (171 boys and 274 girls). The study was developed in April 1998. As an inclusion criterion, the participants and the parents had to have lived in Mallorca for at least 2 years before the study; this criterion was adopted in order to be sure that individuals and their relatives were fully adapted to a regular lifestyle in Mallorca, developed usual activities and then had exchanged habits with the immediate environment.

Alcohol consumption survey
The habits of alcohol consumption of each participant were assessed using a semi-quantitative food frequency questionnaire described elsewhere (Puig et al., 2001Go). The questionnaires were completed by the adolescents in their classrooms and they had the opportunity to ask a well trained dietitian any questions; the dietitian also administered the survey measures, verified and quantified the alcohol consumption records and transformed the data into alcohol intake (g/day) using a self-made computerized program based on Spanish and European Food Composition Tables (Feinberg et al., 1991Go; Mataix et al., 1998Go; Moreiras et al., 1999Go), and complemented with food composition data available for Majorcan food items (Ripoll, 1992Go).

Alcohol use by adolescents was expressed as percentages of adolescents’ reported alcohol intake (at least one glass of an alcoholic beverage), frequency of individual alcohol intake data (>3/day, 2–3/day, 1/day, 5–6/week, 2–4/week, 1/week, 2–3/month, 1/month and never), contribution of main consumed drinks (soft distilled spirits, 20% alcohol, 30 ml per drink; distilled spirits, 40% alcohol, 50 ml per drink; beer, 3–5% alcohol, 200 ml per drink; and wine or champagne, 12% alcohol, 125 ml per drink) by drinking adolescents expressed as a percentage of consumption, and alcohol intake (g/day) of study participants.

Physical activity and socio-demographic factors
To quantify physical activity, an activity metabolic equivalent (Met) index was computed. One Met represents the ratio of energy expended (kcal/kg/min) during each specific activity to basal metabolic rate (Montoye et al., 1996Go). Physical activity was measured by a standardized activity interview conducted by the dietitian, retrospective over the last year before interview, which covered four areas: sedentary physical activity (no exercise), light physical activity (golf, walking, dancing, sailing), moderate physical activity (tennis, football, aerobic, basketball) and intense physical activity (squash, cycling, swimming, athletics), and conversely they were classified in four intensity levels: sedentary (<2.25 Met), light (2.25 Met), moderate (3.75 Met) and intense (5.25 Met). The physical activity score was calculated as the average weekly time (min) spent, multiplied by the level of Mets. This weighted energy expenditure was used as the physical activity score for each subject in each measurement.

Socio-demographic data were collected using a self-made questionnaire according to the following items: gender, mother’s level of education according to the highest grade completed (no studies, primary, secondary, university), father’s and mother’s occupational status (unemployed and those dependent on state assistance, active manual workers, self-employed and technicians, white-collar workers and upper management and professionals), and mother’s region of origin (Mallorca and the Balearic Islands, east of Spain, others from Spain, non-Spanish).

Statistics
Analyses were performed with SPSS version 9.0.1. Mean values and SD are shown. The degree of significance of differences between means was calculated using ANOVA: one-way ANOVA to find differences between genders, and two-way ANOVA to find significant effects of gender or age or interaction of gender and age. Sequential Bonferroni’s test was applied to control type I error (Holm, 1979Go). Multivariate logistic regression models and maximum likelihood estimation were used for evaluations of the associations between alcohol consumption of adolescents and physical activity and socio-demographic factors, with the calculations of corresponding age-adjusted odds ratios and 95% confidence intervals.


    RESULTS
 TOP
 FOOTNOTES
 ABSTRACT
 INTRODUCTION
 SUBJECTS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Percentages of adolescents’ reporting alcohol intake are listed in Table 1Go. About 60% of the adolescents, 53% of boys and 65% of girls, on average, reported alcohol intake. The percentage of boys reporting alcohol intake increased in proportion with age, 38% of 14-year-old boys drank alcohol whereas 91% of 18-year-old boys did. The percentage of girls drinking alcohol initially were higher than those of boys, but they did not change with age, being around 65% (minimum 56% of 15-year-old adolescents, and maximum 74% of 17-year-old girls).


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Table 1. Percentage of adolescents’ reported alcohol intake
 
The percentage of adolescents (mean values ± SD) showing various frequencies of individual alcohol intake show in Fig. 1Go. In spite of 46% of boys and 33% of girls reporting no alcohol consumption, within the drinking adolescents in Palma de Mallorca, the most common frequency was two to four times a week, mainly at weekends, and taking four drinks per drinking day as an average value; the proportion of adolescents consuming above four drinks per day was 16% of boys and 14% of girls (data not shown). No differences were observed between drinking boys and girls.



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Fig. 1. Percentage of adolescents showing various frequencies of individual alcohol intake. Values are means ± SD (bars).

 
Figure 2Go shows the contribution of different drinks consumed by male and female drinking adolescents, expressed as a percentage of consumption (mean values ± SD). Boys’ alcohol consumption was 33% mild distilled spirits, 26% distilled spirits, 24% beer and 15% wine or champagne. Girls alcohol consumption was 29% mild distilled spirits, 23% distilled spirits, 25% beer and 19% wine or champagne. No significant differences were observed between genders.



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Fig. 2. Consumed drinks of drinking adolescents in Palma de Mallorca, expressed as a percentage of consumption. Values are means ± SD (bars). {square}, Boys; {blacksquare}, Girls.

 
Figure 3Go shows the alcohol intake (g/day) of study participants. Use of alcohol increased from the age of 14 years (9 g/day), remained constant (20 g/day) between the ages of 15 and 17 years, but increased afterwards sharply in 18-year-old boys (56 g/day), but scarcely in 18-year-old girls (29 g/day). Differences between genders only were observed in 18-year-old adolescents (P < 0.05).



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Fig. 3. Alcohol intake (g/d) of drinking adolescents in Palma de Mallorca. Values are means ± SD (bars) (*P < 0.05, boys vs girls; #P < 0.05, 17-year-old vs 18-year-old boys; $P < 0.05, interaction of gender and age by two-way ANOVA).

 
Table 2Go shows the effects of age-adjusted socio-demographic and physical activity variables which contributed independently to alcohol consumption patterns in adolescents in Palma de Mallorca by means of multivariate logistic regression. An odds ratio of 1 denotes the respective reference category. A first glance at Table 2Go shows that boys were more influenced by socio-demographic variables than girls. The mother’s educational level and adolescents’ physical activity were negatively and significantly related to alcohol consumption. The higher the mother’s level of education, the lower was alcohol consumption in adolescents. Also, the higher the physical activity of the adolescents, the lower was alcohol consumption in adolescents. The mother’s region of origin is a socio-demographic variable that has proved to be an important influence on boys’ alcohol consumption, which was the highest the furthermost the mother’s region of origin was. The parents’ occupational status, however, did not have a clear or consistent effect on the adolescents’ alcohol consumption.


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Table 2. Odds ratios and 95% confidence intervals for alcohol consumption in adolescents according to age-adjusted physical activity and socio-demographic variables
 

    DISCUSSION
 TOP
 FOOTNOTES
 ABSTRACT
 INTRODUCTION
 SUBJECTS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
The results in the present study can be regarded as representative of the 14–18-year-old adolescents in Palma de Mallorca, because not only was the selected study group drawn from a representative population of students collected from a representative sample of public and private schools, but also the participation rate was high (96%).

The analysis of drinking habits showed a high consumption of alcohol among adolescents in Palma de Mallorca. About 60% of the adolescents reported consumption of alcohol, but intake showed different trends with age and gender. Boys began to drink alcohol later than girls, and markedly increased their alcohol consumption with age. These results are similar to those observed in other Spanish (Aranceta et al., 1993Go; López-Frías et al., 2001Go; Paniagua et al., 2001Go), European (Crawley, 1993Go; Hughes et al., 1997Go; Laukkanen et al., 2001Go; Paulus et al., 2001Go) and worldwide adolescents (York, 1999Go; Jonas et al., 2000Go; Kosterman et al., 2000Go).

Moreover, the habits of drinking adolescents in Palma de Mallorca showed that they are weekly drinkers, with an average consumption of alcohol of four drinks per drinking day, in boys and girls of all ages. This pattern of alcohol consumption in drinking adolescents has also been observed in the above-mentioned studies, and exhibits two main characteristics: (1) adolescents consumed alcohol mainly on weekends, which is closer to Scandinavian patterns (Laukkanen et al., 2001Go) than to Mediterranean (daily and moderate alcohol consumption) patterns (Paniagua et al., 2001Go); (2) boys and girls use alcohol consumption as a facilitator of social relationships. The number of drinks taken per drinking day may be sufficient to achieve disinhibition and an acceptable level of euphoria below one leading to drunkenness and often unpleasant consequences. Accordingly, there were also no differences between genders related to the mainly consumed drinks (spirits, beer, wine) by adolescents in the present study.

Due to these drinking habits, the adolescents in Palma de Mallorca showed alcohol consumption (g/day) higher than the recommended health objectives for the Spanish population in accordance with current scientific evidence (Serra-Majem and Aranceta, 2001Go). High alcohol consumption is a major contributor to deaths or injuries in young people, and potentiates severity of traumatic brain injuries among motor-vehicle crash victims (Cunnigham et al., 2002Go). In males, both drinking patterns and levels play an important role in causing death, and it can also be assumed that patterns also play a role in females (Rehm and Gmel, 2002). The earlier the age a person starts drinking, the more likely they are to report driving after excessive drinking and to become involved in a motor-vehicle crash because of their drinking (Hingson et al., 2002Go). The high levels of alcohol intake among the adolescents studied (from 8.8 g/day in 14-year-old boys to 55.8 g/day in 18-year-old boys and from 9.3 g/day in 14-year-old girls to 29.4 g/day in 18-year-old girls) may be related to the high number of traffic accidents among adolescents due to alcohol (30–50%), which occurred last year in Palma de Mallorca and the Balearic Islands (ESIB, 2001Go). At present, the effects of alcohol on the development of the adolescent’s central nervous system are not fully known (Aarons et al., 1999Go; Murgraff et al., 1999Go), but blood-alcohol concentrations equal to, or exceeding, 0.5 g/l (50 mg/dl) are positively associated with young men’s involvement in a crash during night time and at weekends, as well as an increased risk of higher trauma severity (Fabbri et al., 2002Go). Accordingly, Spanish traffic laws (BOE, 1998Go) have been changed to a lower blood-alcohol level (0.5 g per litre of blood; 0.25 mg per litre of exhaled air). It is hoped that these new measures will decrease excessive alcohol consumption, traffic accidents, and the rates of sudden deaths and injuries of young people.

A positive association between excessive alcohol intake and low physical activity has previously been described among adults. The likelihood of displaying a physically active lifestyle increases from abstinence to moderate drinking, then declines at heavier consumption in US citizens (Smothers and Bertolucci, 2001Go). The association between alcohol consumption, physical inactivity and unhealthy diet has been demonstrated in Finnish subjects (Laaksonen et al., 2001Go), and leisure physical activity was inversely associated with alcohol consumption in the French (Scali et al., 2002Go). The adolescents’ physical activity in Palma de Mallorca has been shown to be negatively and significantly related to alcohol consumption; the more intense the physical activity of adolescents, the lower was their alcohol consumption. These results are in accordance with previous results showing an association between unsafe drinking and physical inactivity in 18-year-old Australians, particularly in females, as was also the case for cardiovascular risk factors (Milligan et al., 1997Go). Therefore, promotion of physical activity among adolescents may be a good way of diminishing the consumption of alcohol, and also designing health promotion programmes appropriate for these young adults.

It is well known that adolescent alcohol consumption, as well as other habits, are influenced by their earlier social environment. Factors leading to alcohol consumption include experimenting (Engels and Knibbe, 2000Go), problems in human relations, family problems, an alcoholic parent (Gabel et al., 1998Go), and also belonging to a low socio-economic group (Villalbí et al., 1991Go; Lamminpaa, 1995Go). Accordingly, the study of the influence of socio-demographic factors on alcohol consumption of the adolescents was also considered worthy of study in Palma de Mallorca. The results obtained showed that alcohol drinking was more frequent in adolescents from homes with a low education level, suggesting that people with low cultural level, and also adolescents, may not consider alcohol as a drug, as described previously (Paniagua et al., 2001Go). Children of parents with low education may not necessarily have a low cultural level; however, to avoid the effect of social environment on adolescents’ alcohol consumption, more health education is needed to emphasize that alcohol is a drug.

When the association between country of birth and alcohol use was studied among adolescents, high alcohol misuse was observed mainly in natives (Chen et al., 2000Go; Blake et al., 2001Go; Turner and Gil, 2002Go) as well as immigrants and first-generation new citizens (Brindis et al., 1995Go; Ferron et al., 1997Go; Chien et al., 2002Go). Thus, alcohol consumption cannot be attributed to ethnic factors or the country of birth, but to cultural and social factors (Westermeyer, 1999Go). Alcohol consumption in adolescents in Palma de Mallorca has been shown to be related to the mother’s origin, especially in boys; the more remote the mother’s origin, and the more different the cultures and customs are, the higher the alcohol consumption registered. Similar results were obtained in Australian adolescents (Jonas et al., 2000Go), and in inter-country adoptees after reaching adolescence in western Europe and the USA, due to their social maladjustment to their new country (Hjern et al., 2002Go). However, alcohol consumption has also been described as a method with which adolescents can enhance social relationships in which they spend much time (Engels et al., 1999Go). Therefore, alternative preventive strategies may be required to reduce widespread consumption of alcohol in adolescents.


    FOOTNOTES
 TOP
 FOOTNOTES
 ABSTRACT
 INTRODUCTION
 SUBJECTS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
* Author to whom correspondence should be addressed. Back


    REFERENCES
 TOP
 FOOTNOTES
 ABSTRACT
 INTRODUCTION
 SUBJECTS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
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