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LITERATURE REVIEW
youths in some places such as karaoke & hugs, beer & hugs is the immediate access
to commercial sex workers and unsafe sexual behavior. Therefore, the consumption of
alcohol has been correlated with a higher prevalence for sexually transmitted diseases
including HIV/ AIDS as well as unwanted pregnancy in adolescents and youths in
Vietnam (Kaljee et al., 2005; Tho et al., 2007). Viet Nam has one of the world’s
highest abortion rates with an estimated rate of 83.3 per 1,000 women receiving
abortions including 300,000 abortions performed annually for women below 19 years
old. However, many abortions are performed in private clinics and are not reported to
the local government health department (Alan Guttmacher Institute, 1999). Moreover,
the harmful use of alcohol also results in theft, criminal damage, robbery, or selling
illegal drugs by Vietnamese adolescents (MOH, 2009). The prevalence of juvenile
crime is increasing in recent years. According to Ministry of Security Vietnam, there
were 15,589 juvenile crimes in Vietnam by the year 2007 (Nguyen, 2008).
Diseases and injuries attributed to alcohol kill millions and harm tens of
millions of people each year worldwide. The health and well-being of many young
people today are seriously threatened by the use of alcohol (WHO, 2004 b). But the
negative impacts of alcohol consumption can be reduced through prevention and
treatment policies that are shown to work - if governments will adopt and enforce
them (WHO, 2011 c). However, the effects of the drinking reaction policies in
Vietnam are still insignificant because in general these laws have not been
implemented (Alcohol Reports, 2009; HSPI, 2006; WHO, 2004 c, 2011 c).
strong association exists between alcohol consumption and HIV infection and
sexually transmitted diseases (Baliunas et al., 2010).
Psychological effects of alcohol consumption
Besides the numerous chronic and acute health effects, alcohol consumption
is also associated with widespread psychological consequences. Alcohol is implicated
in a variety of mental disorders, which are not alcohol-specific. While the causality of
the relation is hard to define, sufficient evidence now exists to assume alcohol’s
causal role in depression, a common mental disorder (WHO, 2004 b). Samokhvalov,
Irving, Mohapatra, and Rehm (2010) also indicated that neuropsychiatric disorders are
the most important disorders caused by alcohol consumption. Epilepsy is another
disease causally impacted by alcohol, over and above withdrawal-induced seizures
and many other neuropsychiatric disorders are associated with alcohol.
In the general population, alcohol dependence and major depression co-
occur over proportionally, on both a 12-month and a lifetime basis (Kessler et al.,
1996; Kessler et al., 1997; Lynskey, 1998). Among alcohol consumers in the general
population, higher volume of consumption is associated with more symptoms of
depression (Graham & Schmidt, 1999). Among patients in treatment for alcohol abuse
and dependence, the prevalence of major depression is higher than in the general
population (Lynskey, 1998). Higher prevalence of alcohol use disorders has also been
documented for patients in treatment for depression (Blixen, McDougall, & Suen,
1997). This suggests that alcohol use disorders are linked to depressive symptoms,
and that alcohol dependence and depressive disorders co-occur to a larger degree than
expected by chance. However, it is not clear in any individual case whether
depression leads to alcohol problems, or whether the alcohol consumption or alcohol
problems cause depression, or both could be attributed to a third cause (Vaillant,
1993).
There is also a direct link between alcohol abuse and other psychiatric
disorders, for instance, the drug abuse and dependence, other addictive disorders,
anxiety disorders, insomnia, memory problems, and suicide attempts. In addition,
overuse of alcohol causes lack of coordination, fatigue and weakness. It can
exaggerate antisocial behaviors such as irritability, anger and aggression (Larson,
1999).
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particular person. This, in turn, can affect the economic viability of a community that
depends on factory jobs. In this way, widespread heavy drinking can adversely affect
whole societies (Room et al., 2002). The economic consequences of expenditures on
alcohol are significant especially in high poverty areas. Besides money spent on
alcohol, a heavy drinker also suffers other adverse economic effects. These include
lowered wages, lost employment opportunities, increased medical expenses for illness
and accidents, legal cost of drink-related offences, and decreased eligibility of loans.
It is important to note that the alcohol-attributable costs go far beyond the health
sector costs; it is very costly for society as a whole, including the costs to
governments and citizens and, to a certain extent, to drinkers themselves (WHO, 2004
b).
Developmental effects of alcohol consumption
Alcohol is a physical and behavioral teratogen. At the earliest ages, young
people are vulnerable to the effects of the drinking of others. Children exposed to
alcohol during pregnancy are at risk for fetal alcohol syndrome, alcohol-related birth
defects, and alcohol-related neuro-developmental disorder. Alcohol consumption by
an expectant mother may cause fetal alcohol syndrome and pre-term birth
complication conditions, which are detrimental to the health and development of
neonates (WHO, 2011 b).
Whatever it is that leads children to begin drinking, once they start facing a
number of potential health risks. Although severe health problems associated with
harmful alcohol use are not as common in children as they are in adults, studies show
that young people who drink heavily may put themselves at risk for a range of
potential health problems (Jernigan, 2001). Heavy alcohol use at a young age is
predictive of a range of psychological and physical problems. Protracted and
continuous abuse of alcohol may be predictive of more severe health problems in
general for boys and girls (Aarons et al., 1999).
Scientists currently examine how alcohol affects the developing brain, but it
is a difficult task. Subtle changes in the brain may be difficult to detect but still have a
significant impact on long-term thinking and memory skills. Add to this fact,
adolescent brains are still maturing, and the study of alcohol’s effects becomes even
more complex. It is simply not known how alcohol will affect the long-term memory
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and learning skills of people who begin drinking heavily at adolescent age (White,
Jamieson-Drake, & Swartzwelder, 2002).
Alcohol use disorders during adolescence were associated with more health
problems: higher liver enzymes indicating some degree of liver damage and more
physical examination abnormalities (Clark, Lynch, Donovan, & Block, 2001).
Besides, young drinkers who are overweight or obese showed elevated liver enzymes
even with only moderate levels of drinking (Strauss, Barlow, & Dietz, 2000).
Regarding the growth and endocrine effects of alcohol consumption in
adolescents, Mauras, Rogol, Haymond, and Veldhuis showed that in both males and
females, puberty is a period associated with marked hormonal changes, including
increase in the sex hormones, estrogen and testosterone; these hormones, in turn,
increase production of other hormones and growth factors, which are vital for normal
organ development. Drinking alcohol during this period of rapid growth and
development (i.e., prior to or during puberty) may upset the critical hormonal balance
necessary for normal development of organs, muscles, and bones. Dees, Srivastava,
and Hiney (2001) also showed that consuming alcohol during puberty adversely
affects the maturation of the reproductive system. Alcohol impairs ovarian function
not only by interfering with hormonal communication between the brain, pituitary
gland, and ovaries but also by directly altering the function of regulatory systems
within the ovaries themselves.
There is a strong relationship between early onset of drinking and later
development of alcohol use disorders (Grant, Stinson, & Harford, 2001). Adolescents
who begin drinking at a younger age also tend to have lower self-esteem, be less
resistant to peer pressure and display anti-social features (Flory, Lynam, Milich,
Leukefeld, & Clayton, 2004).
Drinking by parents may also harm family life, leading to a variety of
deleterious effects on young people. Problems for the young people in such homes
may include instability or collapse of marriages and family structures, increased risk
of physical or sexual abuse, neglect, and strain on family finances. Such family
problems may in turn put young people at greater risk of developing anti-social
behaviors, emotional problems and problems in the school environment (Velleman,
1993).
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HRBs. Instead, the theory recognizes that inherited traits and personality dispositions
might also contribute to health-related decisions and behaviors. The personality can
be characterized along five basic dimensions, sometimes called “The Big Five”.
These are (1) behavioral control (e.g., behavioral constraint, impulsivity, task
persistence, hyperactivity, aggressiveness, and motivation to achieve); (2) emotional
control (e.g., psychological adjustment, emotional stability, neuroticism, and
emotional distress); (3) extraversion/introversion (e.g., social activity, social
adaptability, and assertiveness); (4) sociability (e.g., likability, friendliness,
compliance, and conformity); and (5) intellect or general intelligence (Flay &
Petraitis, 1994).
The dimensions of behavioral control and emotional control are thought to
contribute to HRBs by shaping health-related self determination. The TTI takes the
position that one’s general ability to control his or her behaviors and emotions might
affect one’s sense of self or self-concept (e.g., ego integration, self-esteem/
derogation, and self-image) such that people who can control their actions and moods
are likely to develop stronger self-esteems and more coherent self-concepts. In turn,
they are hypothesized to place greater value on self-determination when it comes to
HRBs. As a general rule, the TTI assumes that people with stronger self-
determination (i.e., will) should be more interested in planning, regulating, and
restraining their HRBs. By contrast, those who hold unfavorable or incoherent images
of themselves are assumed to be more prone to take risks, act impulsively, and not
care as much about the possible consequences of their HRBs. Similarly, the third and
fourth dimensions are thought to contribute to HRBs by shaping one’s health-related
skills. Introversion and weak sociability are two traits thought to affect adversely
one’s general social competence (e.g., academic skills, social interaction skills, and
general social skills). Poor social competence, in turn, is likely to affect a person’s
perceptions of his or her skills at performing HRBs, such that people who are
introverted and have trouble getting along in social situations might come to doubt
their ability to successfully complete a health-promoting behavior. The health-related
self-efficacy is shaped by self- determination or will to control behaviors in general,
and perceptions of personal skills in controlling HRBs in particular. People who have
the will to control their behaviors, and believe they have the skills to perform a given
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HRB should have stronger health-related self-efficacy and should be more likely to
decide to adopt health-promoting behaviors (Flay & Petraitis, 1994).
Two features of interstream paths are worth special attention. First, the
effects of interstream paths can be either additive or interactive. Additive paths are
those where a variable in one stream contributes to a variable in another stream.
Interactive paths, by contrast, are those where a variable in one stream modifies the
effect of a variable in another stream. Second, interstream pathways demonstrate the
overpowering importance of the most distal or “ultimate” causes of HRBs. Because
the effects of the streams flow both within and between streams, they contribute to
HRBs in innumerable ways (Flay & Petraitis, 1994).
In summary, The TTI is one of the most comprehensive and integrative
theories of health behavior to date and is actually relevant for behaviors of youths.
The TTI includes three primary streams of influence on health-related behaviors.
These streams independently and simultaneously influence decisions to act or not to
act in behaviors. All influences do not flow neatly down one stream or another;
therefore, the effects might also contribute to others. Moreover, the influences on
behavior comprise a dynamic process and any experiences with health-related
behavior feedback and change the original causes of that behavior. This theory also
involves both direct as well as indirect factors affecting HRBs and points to different
streams and levels of influences from the ultimate to distal and proximal level (Flay,
1999; Flay & Petraitis 1993; Flay & Petraitis, 1994; Flay et al., 2009).
Therefore, the TTI provides a broader framework for understanding the
alcohol drinking behaviors among adolescents. This study is not attempt to test TTI
framework, rather this framework will be used to guide the factors explaining the
alcohol drinking behaviors among Vietnamese adolescents.
2005; McCoy et al., 2010; Scholte et al., 2008). According to data from the 2010
Monitoring the Future study, an annual survey of U.S. adolescents, the results showed
that frequency of drinking and drinking problems increased with grade levels and
decreased with initial drinking age. 29.3% of 8th graders, 52.1% of 10th graders, and
65.2% of 12th graders had consumed alcohol. 11.5% of 8th graders, 29.9% of 10th
graders, and 44.0% of 12th graders had engaged in heavy episodic drinking (Johnston,
O’Malley, Bachman, & Schulenberg, 2010). Piastrelli et al. (2011) also indicated
alcohol consumption increased with age, significantly more 12th graders than 11th
graders had consumed alcohol (71.4% versus 54.3%; p = 0.002). In another study,
Begue and Roche (2009) revealed that age was a significant factor associated with
alcohol drinking behavior among adolescents. The researchers observed on 1,295
participants aged 14-19 years old in Grenoble City of France. Bivariate analyses
indicated that 13% among 14-15 years old had been drunk in the last year, 35%
among 16 -17 years old and 52% among 18-19 years old (χ2 = 133.28, p < 0.000).
This result is accordant with the results in several previous studies, such as study of
Fox et al. (2010), Hong et al. (2011), McCoy et al. (2010), Scholte et al. (2008).
In Khanh Hoa Province Vietnam, Kaljee et al. (2005) revealed that
adolescents who reported using alcohol were significantly older than those who
reported no alcohol use (t = -3.6, df = 478, p < 0.00). Researchers also suggested that
youths consumed more alcohol and at younger ages than in the past. In another study,
Tho et al. (2007) indicated that there was a strong association between age group and
alcohol use, alcohol consumption increased with older age group (p < 0.001).
Overall, several findings indicated that age was a significant factor related to
alcohol use among adolescents. Adolescent alcohol consumption increased with age.
This study would like to examine whether older adolescents are more likely to drink
than younger ones in Vietnam.
Gender Gender is also a significant factor associated with drinking alcohol
among adolescents. Many studies have consistently shown that male youths are more
likely than female youths in drinking alcohol (Begue & Roche, 2009; Brook &
Tepper, 2002; Htay et al., 2010; Kaljee et al., 2009; Simons et al., 2010). A study in
Thailand, Assanangkornchai, Pattanasattayawong, Samangsri, and Mukthong (2007)
examined 3-year trends and attitude towards substance use (alcohol, tobacco, and
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40.8% for males and 30.6% for females. In WHO South-East Asia Region, Thailand
showed 22% for males and 10% for females were alcohol drinking among
adolescents. In WHO Western Pacific Region, there were 17.7% for males and 8.6%
for females in China, and 19.6% for males and 12.9% for females who drank alcohol
in Philippines.
In Vietnam, Kaljee et al. (2005) revealed a significantly greater proportion
of males reported drinking alcohol (40.8%) as compared to female adolescents
(17.5%) (χ2 = 31.6, df = 1, p < 0.00). In other study, Han and Tam (2008) investigated
the prevalence and the factors results in drinking alcohol in students of the Ben Luc
private high school, and the relationship between drinking alcohol and its related factors;
where N = 384 private high school students in Ben Luc district, Long An, province,
Vietnam; the result showed that, there were the differences between males (44.3%) and
females (28.1%) of alcohol drinking. These results had accordance with the result in
the studies of Tho et al. (2007) in Nha Trang, Vietnam.
In conclusion, gender is a factor associated with alcohol drinking behavior. The
present study would like to examine whether male adolescents are more likely to drink
than female adolescents in Ho Chi Minh City or not.
Self-esteem According to Coopersmith (1981), self-esteem indicated the
extent to which the individual believes herself or himself to be capable, significant,
successful, and worthy. Self-esteem is also an important determinant for
psychological well-being that is particularly problematic during the adolescent life
stage (Rosenberg, 1989). Self-esteem has long been considered as an important factor
in individual drinking behavior. Alcoholics have, on the average, exhibited lower self-
esteem than nonalcoholics (Charalampous et al., 1976). Competence skills served as
protective factors; adolescents with higher level of self-esteem could be less likely to
engage in alcohol drinking (Donnelly et al., 2008, Lewis & O’Neill, 2000).
Additionally, Adolescents who begin drinking at a younger age also tend to have
lower self-esteem, be less resistant to peer pressure and display anti-social features
(Flory et al., 2004).
Adolescents experience low self-esteem and frequent self-derogation if they
repeatedly received negative evaluations from conventional others or they feel
deficient in any socially desirable attributes. In defense of their egos, they feel
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(RSES), developed by Rosenberg (1979), was used in this study to measure self-
esteem among Vietnamese adolescents.
Academic performance Academic performance is one way to indicate
general intelligence. Intelligence is one of the basic dimensions that characterizes
one’s personality and also contributes to health-related decisions and behaviors. For
instance, more intelligent people may acquire more knowledge about HRBs than less
intelligent people as well as more intelligent people may be less susceptible to the
health-related attitudes and behaviors of other people than less intelligent people (Flay
& Petraitis, 1994).
Several previous studies asserted that problem behaviors such as alcohol and
drug use are significant barriers to educational achievement. Adolescents with higher
academic scores in school were less likely to drink (Balsa et al., 2011; Bergen et al.,
2005; Diego et al., 2003; Kostelecky, 2005; YRBS, 2009). Balsa et al. (2011) studied
7th to 12th grade students in US. (N = 90,118), using data from the National
Longitudinal Study of Adolescent Health. Researchers revealed that increases in
alcohol consumption resulted in small yet statistically significant reductions in GPA
for male students and in statistically non-significant changes for females. For females,
however, higher levels of drinking resulted in self-reported academic difficulty. In
another study, Hayatbakhsh et al. (2010) stated there was inconsistent evidence about
the association between school performance and subsequent use of alcohol and
alcohol problems in adolescents and young adults. Data in this study were from a 21-
year follow-up of 3,478 Australian young adults from birth to the age of 21 years
when data on use of alcohol were collected. The results showed that children who had
lower school performance had increased risk of drinking more than two glasses of
alcohol per day in early adulthood (odds ratio = 1.7; 95% CI = 1.1-2.6).
However, more recent studies have suggested that the association between
alcohol misuse in adolescents and later academic attainment may not be causal
(Chatterji, 2006; Koch & Ribar, 2001). Aertgeerts and Buntinx (2002) investigated
the relationship between academic performance and alcohol drinking behavior; the
results showed that there was no significant association between alcohol abuse and
academic performance in students.
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generalized linear models with random intercept analysis indicated that several
significant interactions were found between refusal skill techniques, decision-making
skills, and perceived social benefits of drinking (Epstein et al., 2007).
In conclusion, a review of the literature suggests that adolescents with low
DRSE are more likely to drink alcohol than those with high DRSE. The Drinking
Refusal Self-Efficacy Questionnaire-Revised Adolescent Version (DRSEQ-RA),
developed by Young, Hasking, Oei, and Loveday (2007), was modified to use in this
study to assess Vietnamese adolescents’ belief in their ability to resist drinking
alcohol.
Attitudinal influence
Attitude towards alcohol drinking In general, behavioral attitudes defined
as the degree to which people hold favorable or unfavorable appraisals toward
behavior, are currently regarded as important predictors of a large variety of human
behaviors (Wallace, Paulson, Lord, & Bond, 2005). People who had the higher the
behavioral attitudinal relevance tended to have the stronger the relationship between
attitudes and behavior (Kim & Hunter, 1993). According to the TTI, the broad
sociocultural factors contribute indirectly to health-related beliefs and attitudes, by
contributing more directly to health-related knowledge, values, expectations, and
evaluations. Substance use is strongly related to both perceptions of personal risks and
personal values. In general, health-related beliefs and personal values converge to
shape attitudes toward HRBs. Additionally; expectations regarding the health,
financial, and social consequences of a given HRB; and evaluations of those
consequences shape most HRBs. An attitude is important predictor of a given
behavior such as alcohol drinking behavior (Flay & Pertraitis, 1994). Epstein et al.
(2007) revealed that students with a high expectation of their friends drinking alcohol
were at increased odds of current drinking than those who had lower expectations
(OR = 7.66, 95% CI = 5.63-10.42). Additionally, several other studies consistently
revealed strong associations between drinking attitudes and alcohol consumption
indicated that the more positive young people's attitudes toward alcohol use, the more
engagement in heavy alcohol use and the higher their drinking levels (Lehto et al.,
1994; Piastrelli et al., 2011; Stacy et al., 1994).
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Brook and Tepper (2002) studied about the consumption, knowledge and
attitudes towards alcohol use and alcohol dependence among 512 high school pupils
in Holon City, Israel. The findings showed that adolescents who had a lack of
knowledge about alcohol use tended to be related to an increased likelihood of
drinking, adolescents who had more positive attitude towards drinking had tended to
be related to an increased likelihood of drinking. Similarly, the results in a study in
Netherlands indicated that participants' attitudes toward alcohol showed positive
associations with the alcohol consumption (Roek et al., 2010). Promarak and
Laohasiriwong (2011) examined factors influencing alcohol use disorder among 878
first year students of Mahasarakham University, Thailand. The result showed that
attitude on alcohol use disorder control was factor statistically significant influencing
alcohol use disorder among students (OR = 2.64, 95% CI = 1.81-4.64). In another
study in Eastern of Thailand, Homsin and Srisuriyawet (2010) studied factors related
to alcohol drinking behavior among Thai youths (n = 887). The findings indicated that
attitude towards alcohol drinking was significantly associated with all stages of
alcohol drinking, for instance, at the susceptible precontemplation stage (OR = 1.09,
95% CI = 1.05-1.13), the tried stage (OR = 1.08, 95% CI = 1.05-1.12), and the
experimentation stage (OR = 1.16, 95% CI = 1.12-1.20).
Overall, several studies consistently revealed strongly associations between
drinking attitudes and alcohol consumption indicating that the more positive
adolescents’ attitudes toward alcohol use, the more adolescents engage in alcohol
consumption. The Alcohol Drinking Attitude Scale developed by Homsin and
Srisuriyawet (2010) was modified to measure attitude towards alcohol drinking
among adolescents in this study.
Interpersonal influences
Family structure Several previous studies have widely underlined the
contribution of family factors on teenage drinking. Adolescents from one-parent or
stepparent families are at higher risk for alcohol problems because of the stress
induced by parental conflict, lower income or other sociodemographic correlates.
Previous studies (Hong et al., 2010; Jablonska & Lindberg, 2007; Yeh & Chiang,
2005) showed that parental marital status had consistently been found to predict
adolescent alcohol consumption, with youth from single-parent families showed more
35
alcohol use than youth from two-parent families. Yeh and Chiang (2005) indicated
single-parent family was a significant predictor of alcohol consumption among Han
adolescents in Taiwan (OR = 2.12, 95% CI = 1.26-3.59). Htay et al. (2010) also
showed that adolescents living with a single parent were all significantly associated
with a higher likelihood of alcohol use and frequent binge drinking. These results
were in accordance with the results in study of Svensson (2010) in Sweden.
In summary, adolescents who live with both mother and father are less likely
to drink alcohol than others. Family structure is presumably considered to be the
factor related to alcohol drinking in this study.
Parental monitoring Parental monitoring is also a significant factor
associated to alcohol drinking behavior among adolescents. The results from the
studies (Breen et al., 2010; McCoy et al., 2010; Schulte et al., 2009) showed that
parental monitoring was negatively related to levels of alcohol use among
adolescents. Begue and Roche (2009) conducted a survey of 1,295 students between
14 and 19 years old in Grenoble City, France. Results of logistic regression analysis
indicated that parental monitoring was negatively significant to predict use of alcohol
among adolescents (OR = 0.83; 95% CI = 0.70-0.98). This result was accordant with
the result in the study of Freisthler, Byrnes, and Gruenewald (2009) in the U.S. In
another study, researchers concluded that parental monitoring showed a protective
effect on growth in volume of alcohol consumption by high school students.
Increasing levels of parental monitoring over time was associated with less growth
across the high school years (Capaldi et al., 2009). Thus, it has been posited that
parental monitoring is mainly driven by adolescent disclosure, which certainly is part
of the overall monitoring process (Stattin & Kerr, 2000). A study of adolescents in
South Korea by Kim et al., (2010) revealed that there was a negative relationship
between parental attachment and supervision and adolescent substance (alcohol and
tobacco) use. It indicated that as parental attachment and supervision increased the
frequency of substance use in adolescents decreased. Tobler and Komro (2010)
showed that students with high monitoring from parents were more likely to decrease
in alcohol consumption (OR = 3.29).
36
drinking age or those which had more effective law enforcement had lower rates of
alcohol use and binge drinking. The use of various sources of alcohol in a community
either expanded or contracted depending on levels of access and enforcement. This
evidence provides empirical support for the potential utility of local efforts to
maintain or increase enforcement to control alcohol access and possession. Moreover,
the price of alcohol and alcohol advertising are also related to alcohol consumption
among adolescents (WHO, 2011 c). Cheap or discounted alcohol was related to an
increase in the uptake of binge drinking (OR = 4.38; 95% CI = 2.95-6.56) (Weitzman
et al., 2003). A recent review of 112 studies of the effects of alcohol tax/ price
affirmed that when alcohol taxes went up, drinking went down, including among
problem drinkers and youths. Meta-analytical results document the highly significant
relationships (p < 0.001) between alcohol tax or price measures and indices of sales or
consumption of alcohol (aggregate-level r = -0.17 for beer, -0.30 for wine, -0.29 for
spirits and -0.44 for total alcohol) (Wagenaar, Salois, & Komro, 2009).
The WHO (2008, 2011 c) suggested some strategies to reduce alcohol
availability, for example, restriction of sales and consumption by people below a legal
drinking age; control of alcohol distribution and sales; regulation on the hours and
days of the sale of alcohol; increasing the price of alcohol; control of alcohol
advertising and marketing. An example of the regulation of alcohol is the
comprehensive control in Thailand through alcohol policies, for example, the Thai
Health Promotion Foundation (ThaiHealth) is an autonomous state agency, which was
established in 2001 as the first organization to use alcohol excise taxes for health
promotion in Asia. ThaiHealth supports the establishment of an enforcement
surveillance center for alcohol control regulations, and a research center on alcohol
consumption. It has also paid for advertising campaigns to reduce alcohol-related
traffic accidents, to encourage abstinence and to raise awareness of the links between
alcohol and domestic violence. ThaiHealth has helped persuade the government to
pass a national policy to control alcohol advertising and to establish a National
Committee for Alcohol Consumption Control. Drinking alcohol is still allowed in
Thailand. However, people cannot buy alcohol at all times of a day. Shops like
supermarkets and 7-Elevens are not allowed to sell alcohol between 2.00-5.00 P.M.
and after midnight. On given days (religious and national holidays, election days),
40
alcohol sales are banned altogether, and drinks cannot be served even in restaurants
and bars (which usually close on these days anyway). The legal minimum age to
purchase alcohol is until very recently 20 years (Thaiwebsites, 2010; WHO, 2011 c).
In summary, alcohol availability including alcohol resource service, alcohol
outlet density, legal alcohol drinking age, and price of alcohol are related to alcohol
drinking behavior in adolescents.
From the evidence presented and discussed in this chapter, it is expected that
the results from this study will improve understanding about the association between
alcohol drinking behavior among adolescents and studied factors including age,
gender, self-esteem, academic performance, drinking refusal self-efficacy, attitude
towards alcohol drinking, family structure, parental monitoring, parental drinking,
peer drinking, and perceived alcohol availability. Thus it enhances the development of
strategies for preventing and reducing alcohol consumption for adolescents and
reducing negative consequences related to adolescent alcohol drinking in the future.
To help clients to achieve optimal health and well-being means that the roles and
nursing strategies of community nurses should expand to include care for those
adolescents at risk.