Skip to main content
main-content

01.12.2011 | Research article | Ausgabe 1/2011 Open Access

BMC Public Health 1/2011

Current drinking and health-risk behaviors among male high school students in central Thailand

Zeitschrift:
BMC Public Health > Ausgabe 1/2011
Autoren:
Wisit Chaveepojnkamjorn, Natchaporn Pichainarong
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1471-2458-11-233) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

WC was involved in drafting the manuscript and revising it critically for important intellectual content. All authors were involved in the design of the study, statistical analysis and data interpretation. All authors have read and approved the final manuscript.

Background

It is well established that an increase in alcohol consumption leads to a higher proportion of persons with problem use and addiction. In 2007, the National Statistical Office of Thailand found 29.3% of Thais ≥ 15 years old consume alcohol. The proportion of male alcohol consumption in the age 25-59 years was 59.1%, 15-24 years 39.2% and over 60 years 29.4%, respectively [1]. It was found that the proportion of male drinkers increased from 55.4% in 1996 to 60.8% in 2003, but dropped to 50.3% in 2006 and 51.0% in 2007 [1, 2]. During 1996-2006, the proportion of male drinkers has risen in young people, particularly those aged 15-19 years (20.8% to 24.2%) and aged 20-24 years (56.0% to 58.1%) [2]. Reports from the National Statistical Office of Thailand in 2007 showed the major alcoholic risk groups were working people and youths. Alcohol drinking is frequently related to behavioral problems, which lead to a number of negative consequences, such as domestic violence and quarrels with neighbors, suicides and sexual assault and risky sexual behaviors. It also accounts for numerous accidents such as injuries and traffic accidents. Youths who drink have a greater tendency to develop those health-risk behaviors.
The aim of this study was to evaluate the characteristics of male high school students who drink, the drinking patterns among them, and the associations between current drinking and other health risk behaviors which focused on personal safety, violence-related behaviors, suicide and sexual behaviors.

Methods

Study design and population

A cross-sectional study was conducted from December 2007 to February 2008 in order to explore current drinking and health-risk behaviors among male high school students in central Thailand. The proposal was reviewed and approved by the Ethics Committee for Research in Human Subjects of Mahidol University (Ref.No. Mu 2007-243). A two-stage stratified sampling technique was used to select the 5,184 students from 10 provinces of central Thailand within the academic zones 5, 6, and 12. The primary sampling unit was province and the second was school. These provinces were randomly selected and represented characteristics of male adolescents in central Thailand. In each province, we randomly selected at least one school from the list of each of the three school categories: urban and rural public schools, and private schools. The selection of schools was based on a list of schools obtained from the Provincial Education Offices and willingness of school administrators to participate in the study. Selected schools could refuse to participate in the study. Altogether, 5,184 students from Mathayomsuksa School (MS) 1, 3 and 5 participated in the study (equivalent to grade 7, 9 and 11 of an ordinary school). In each school, 3 or fewer classes of each of these 3 educational levels were recruited from the same grade level. If there were more than three classes, three classes with students of mixed academic performance were randomly selected by their teachers. The study subjects were classified into 2 groups according to their alcohol intake during the 30 days preceding the survey (yes = 631, no = 4,553). Information was collected by a self administered, anonymous questionnaire which consisted of 3 parts, socio-demographics, health-risk behaviors during past year and alcohol drinking behavior with the help and supervision of well trained research assistants. Current drinking was defined as drinking at least one standard drink of an alcoholic beverage during the past 30 days of the survey. A standard drink was defined as a can (330 cc) of beer, a glass (100 cc) of wine, or a small glass (30 cc) of whisky or spirits. The health-risk behaviors questionnaire was modified from the questionnaire of the U.S. Youth Risk Behavior Surveillance System [3, 4] and focused on personal safety, violence-related behaviors, suicide and sexual behaviors. The Thai version was translated and verified by a bilingual English university lecturer, and it was reviewed by the experts (composed of psychiatrists, psychologists, nurse, social workers, school teachers and health promotion specialists). Details of the study were explained and an informed consent form was signed. Individual answers were kept confidentially.

Statistical analysis

Socio-demographic factors were given as a percentage, crude odds ratio, 95% CI of OR and p-value. Univariate analysis was performed using the Pearson's chi-square test to differentiate proportional exposures between drinkers and non-drinkers for categorical variables. Adjusted odds ratio and the 95% CI of OR were calculated from multiple logistic regression to examine associations between current drinking and health-risk behaviors, adjusted for socio-demographic factors. A criteria of p < 0.05 for statistical significance was applied.

Results

A total of 5,184 male high school students, their percents of alcohol consumption in the past 30 days were 12.17. Current drinking prevalence increased with increasing age (6.41% among less than 15 year-olds vs 26.54% among 18 years and older) and grade level (4.73% among 7th graders vs 22.08% among 11th graders).
Using a univariate analysis, the factors significantly associated with current alcohol drinking assessed by a Pearson's chi-square test (p < 0.05) were age group (OR 15-17 yrs = 2.92; 95% CI = 2.40-3.53; OR ≥18 yrs = 5.28, 95%CI = 3.59-7.76), educational level (OR MS 3 = 3.06, 95% CI = 2.38-3.95; OR MS 5 = 5.74, 95% CI = 4.46-7.40), residence (OR school dormitory = 1.82, 95% CI = 1.07-3.08), cohabitants (OR friend = 2.93, 95% CI = 1.76-4.87), as well as GPA (OR GPA < 2.0 = 1.36, 95% CI = 1.05-1.76; OR GPA > 3.0 = 0.42; 95% CI = 0.32-0.56), having a part time job (OR = 1.47, 95% CI = 1.22-1.76) and having family members with alcohol/drug problems (OR = 1.26, 95% CI = 1.05-1.51) (Table 1).
Table 1
Socio-demographic factors associated with current drinking of male high school students
Variables
No.drinker/total
%drinker
Crude OR
95%CI
p-value a
Age group (yrs) (n = 5184)
     
   <15
155/2419
6.41
1
  
15-17
433/2603
16.63
2.92
2.40-3.53
<0.001
   ≥ 18
43/162
26.54
5.28
3.59-7.76
<0.001
Educational level (n = 5184)
     
   MS 1
94/1987
4.73
1
  
   MS 3
252/1906
13.22
3.06
2.38-3.95
<0.001
   MS 5
285/1291
22.08
5.74
4.46-7.40
<0.001
Religion (n = 5169)
     
   Buddhist
615/5054
12.17
1
  
   Islam
4/33
12.12
0.98
0.29-2.94
1.000
   Others
10/82
12.19
0.99
0.48-1.99
0.973
Residence (n = 4673)
     
   House/Apartment of family
552/4534
12.18
1
  
   School dormitory
20/98
20.41
1.82
1.07-3.08
0.017
   Private dormitory
7/41
17.07
1.47
0.59-3.47
0.358
Cohabitants(n = 4943)
     
   Parent
500/4157
12.03
1
  
   Relative
75/638
11.76
0.96
0.74-1.25
0.761
   Friend
24/84
28.57
2.93
1.76-4.87
<0.001
   Alone
9/64
14.06
1.20
0.55-2.54
0.612
Grade point average. (n = 4461)
     
<2.0
99/535
18.50
1.36
1.05-1.76
0.016
   2.0-3.0
307/2125
14.45
1
  
>3.0
160/1801
8.88
0.42
0.32-0.56
<0.001
Part time job (n = 5120)
     
   No
411/3724
11.04
1
  
   Yes
213/1396
15.26
1.47
1.22-1.76
<0.001
Having family members with alcohol/drug problems (n = 4402)
     
   No
297/2607
11.39
1
  
   Yes
249/1795
13.87
1.26
1.05-1.51
0.014
a Pearson's chi-square test, OR = odds ratio, CI = confidence interval
MS 1 = 1st year of secondary school (equivalent to 7th grader), MS 3 = 3rd year of secondary school (equivalent to 9th grader, MS 5 = 5th year of secondary school (equivalent to 11th grader)
Other health risk behaviors were more common among current drinkers. After adjusting for socio-demographic factors (age, educational level, residence, cohabitants, GPA, having a part time job, and having family members with alcohol/drug problems), compared with non-drinkers, current drinkers were more likely to drive a car/bicycle after drinking alcohol (OR = 3.10, 95% CI = 1.88-5.12). For violence-related behaviors, often carrying a weapon (OR = 3.51, 95% CI = 2.27-5.42), often getting into a physical fight without injury (OR = 3.06, 95% CI = 1.99-4.70), and experience dating violence (OR = 2.58, 95% CI = 1.79-3.71) were proportionally higher among current drinking students than non-drinkers. In addition, sad feelings and attempted suicide, indicated that participants had seriously thought about suicide (OR = 2.07, 95% CI = 1.38-3.11) and making a suicide plan (OR = 2.10, 95% CI = 1.43-3.08) were also significantly associated with current drinking. In case of sexual behaviors, higher proportions of ever having sexual intercourse (OR = 5.62, 95% CI = 4.33-7.29), alcohol or drug use before last sexual intercourse (OR = 2.55, 95% CI = 1.44-4.53), and getting someone pregnant (OR = 3.99, 95% CI = 1.73-9.25) were found among current drinkers than among non-drinking students, as shown in Table 2.
Table 2
Percent, crude OR and adjusted OR of health-risk behaviors among male high school students according to drinking status
Health-risk behaviors
All Respondent
(n = 5184)
Nondrinkers
(4553)
Current drinkers
(n = 631)
 
%
%
Adjusted ORa
%
Crude OR
Adjusted OR
95%CI
p-value
Personal safety
        
Never or rarely wore bicycle helmets
67.76
67.95
1
66.49
0.93
1.19
0.96-1.48
0.113
Never or rarely wore seat belts
61.84
61.71
1
62.77
1.04
1.18
0.95-1.48
0.138
Often drove a car/motorcycle after drinking alcohol
2.24
1.61
1
6.74
4.43
3.10
1.88-5.12
<0.001
Violence-related behaviors
        
Often carried a weapon
3.38
2.61
1
8.82
3.61
3.51
2.27-5.42
<0.001
Often been threatened or injured with a weapon
1.39
1.29
1
2.13
1.66
1.14
0.53-2.46
0.737
Often got into a physical fight without injury
3.54
2.72
1
9.31
3.67
3.06
1.99-4.70
<0.001
Often got into a physical fight with serious injury
1.46
1.38
1
1.96
1.43
1.39
0.67-2.91
0.378
Dating violence
10.61
8.71
1
19.06
2.47
2.58
1.79-3.71
<0.001
Ever forced to have sexual intercourse
5.89
4.96
1
9.65
2.05
1.76
0.98-3.15
0.058
Sad feelings and attempted suicide
        
Seriously thought about suicide
4.02
3.40
1
8.49
2.66
2.07
1.38-3.11
<0.001
Made a suicide plan
4.51
3.80
1
9.62
2.69
2.10
1.43-3.08
<0.001
Sexual behaviors
        
Ever had sexual intercourse
8.73
5.68
1
30.58
7.32
5.62
4.33-7.29
<0.001
Had ≥ 4 sex partners during lifetime
28.02
24.62
1
33.67
1.56
1.29
0.80-2.09
0.288
Alcohol or drug use before last sexual intercourse
12.80
12.06
1
22.07
2.94
2.55
1.44-4.53
0.001
Condom use during last sexual intercourse
57.14
50.14
1
74.15
2.85
1.48
0.85-2.56
0.164
Birth control use before last sexual intercourse
58.88
52.29
1
72.82
2.44
1.26
0.79-2.02
0.337
Had got someone pregnant
6.58
4.84
1
11.11
2.46
3.99
1.73-9.25
0.001
a Adjusted for age gr., educational level, residence, cohabitants, GPA, part time job and family members with alcohol/drug problems
The majority of boys drank alcohol less than 3 times a month (59.83%) and they each consumed less than 3 standard drinks in the previous month (38.59%). Approximately 40% of boys drank more often than twice a month and 39% of them drank more than 4 standard drinks each time. Alcohol consumption was more common when joining a party (45.68%) but a high proportion of boys drank at home/dormitory (36.33%). Nearly 70% of respondents experienced binge drinking within 2 weeks and nearly half of them admitted to being intoxicated during the 30 days prior to participating in this study, as shown in Figure 1, 2, 3, 4 and 5.

Discussion

The present study found an increased risk of health-risk behaviors, including intentional injury-related behaviors, suicidal behaviors and premature sexual behaviors among drinking and non-drinking students. This study is one of a few studies on underage drinking among high school students in a developing country of the South-East Asian region. Our findings demonstrated that approximately 12% of male high school students reported that they drank alcohol during the 30 days preceding the survey. This figure was also lower than the studies of Miller et al, 2007 [5], Johnston et al, 2008 [6] and Assanangkornchai et al, 2007 [7]. Even more alarming, we found that among students who drink, almost 70% reported binge drinking (drinking ≥ 5 drinks of alcohol in a row at least once during the past 2 weeks) and half of them had experienced drunkenness. Heavy episode drinking in adolescence is associated with several serious consequences; such as motor vehicle injuries, suicide, sexual assault and risky sexual behaviors with the danger to acquire sexual transmitted diseases and unwanted pregnancies [8]. Adolescence is a vulnerable period and facilitates the start of risk behaviors, for instance consuming alcohol, cigarette smoking and substance use. This study confirmed that older boys drank more than the younger ones [5, 913]. Non-drinkers had lower rates of health risk behaviors compared with current drinkers. This study also confirmed that current drinking is associated with driving a vehicle which corresponds with the results of the study of Domingues et al, 2009 [14]. Eaton found 10% of high school students had driven a car or other vehicle one or more times when they had been drinking alcohol [15]. Alcohol is associated with much of the mortality and morbidity among youth. In addition, alcohol drinking and drunk driving are a major factor causing road traffic accidents. The percentage of Thai male drunk drivers has risen from 36.6 in 2001, to 48.2 in 2002 and 44.1 in 2006 [2]. In aspect of violence-related behaviors, current drinkers are at higher risk of often carrying a weapon [1618], getting into a physical fight without injury [5] and dating violence [5, 1921]. In addition, according to the present study (see table 2 above) drinkers are at higher risk of seriously thinking about suicide and making a plan how they would attempt suicide. This corresponds with the results of the previous studies [5, 2224]. In sexual behaviors, this study also confirmed that higher levels of alcohol consumption are associated with ever having sexual intercourse [5, 20, 25], alcohol/drug use before last sexual intercourse [5, 26] and getting someone pregnant [5, 22, 27].

Limitation of the study

Some limitations of this study should be noted. First, the study was a cross-sectional study, therefore, a temporal relationship cannot be established between alcohol consumption and the health-risk behaviors. A longitudinal study would be needed to examine causal effects of drinking on subsequent drinking. Second, all data were obtained through self-reports, which may lead to inaccuracies of alcohol drinking [2831] and other health-risk behaviors.

Conclusions

An increased risk of health-risk behaviors, including driving vehicles after drinking, violence-related behaviors, sad feelings and attempted suicide, and sexual behaviors was higher among drinking students that led to various health problems. The results from this study show prevention of underage drinking is needed. Law enforcement, namely minimum age of purchasing alcohol ≥ 20 years, increasing the penalty of drunk driving, and limiting the availability and accessibility of alcohol through restrictions of times and places should be done strictly. The results suggested that effective intervention strategies among adolescents should be implemented to prevent underage drinking. Applications of the health promoting school model of WHO [32] should be utilized to develop the effective school health programmes to relieve these problems. Some papers showing the effectiveness of Health Promoting School in minimising health-risk behaviors [3339]. Therefore attempts should be made to limit youth access to alcohol in order to reduce accidents, injuries, violence and alcohol-related health problems [40]. A campaign mentioning the adverse health effects and social consequences to the risk groups, and encouraging parental and community efforts to prevent youth drinking and other health-risk behaviors would reduce the proportion of new and current drinkers and other adverse consequences. The results obtained from this study indicate that to prevent drinking among adolescents need a rather sophisticated approach and more studies to explore the cultural and socio-economic background of current youth drinkers.

Acknowledgements

The authors would like to express sincerely thanks for their valuable participation in the study given by the high school students and the practical support of the health staff and the staff of the participating high schools. We also thank those who are not mentioned for their kindness and encouragement. This study was a part of the surveillance of drinking behaviors and other health-risk behaviors among high school students in Thailand and was supported by a grant from the Center for Alcohol Studies (CAS), Thailand and was supported for publication by the China Medical Board (CMB) Faculty of Public Health, Mahidol University, Bangkok, Thailand. The authors would finally like to thank Eric Curkendall of the Office of International Affairs, Faculty of Public Health, Mahidol University for editing this paper.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://​creativecommons.​org/​licenses/​by/​2.​0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

WC was involved in drafting the manuscript and revising it critically for important intellectual content. All authors were involved in the design of the study, statistical analysis and data interpretation. All authors have read and approved the final manuscript.
Zusatzmaterial
Authors’ original file for figure 1
12889_2010_3004_MOESM1_ESM.pdf
Authors’ original file for figure 2
12889_2010_3004_MOESM2_ESM.pdf
Authors’ original file for figure 3
12889_2010_3004_MOESM3_ESM.pdf
Authors’ original file for figure 4
12889_2010_3004_MOESM4_ESM.pdf
Authors’ original file for figure 5
12889_2010_3004_MOESM5_ESM.pdf
Literatur
Über diesen Artikel

Weitere Artikel der Ausgabe 1/2011

BMC Public Health 1/2011 Zur Ausgabe