Heavy episodic drinking and soccer practice among high school students in Brazil: the contextual aspects of this relationship

Heavy episodic drinking (HED) or binge drinking (consumption of five or more drinks on the same occasion) among adolescents is related to several problems such as impaired memory, academic issues, violence, unprotected sex, getting hurt or injured, damaging properties and dangerous driving [1‐3]. In spite of this, data from the 2009 National Youth Risk Behavior Survey indicated that 60.9% of United States high school students who are current drinkers reported HED in the last month [4]. In Europe a study showed that 43% of adolescents reported HED in the last month [5]. In Brazil, approximately one third of students from private schools of São Paulo reported this pattern of use [6].

Some studies have suggested the importance of sports or physical activities in intervention programs in order to prevent or reduce alcohol consumption among high school students [7, 8]. In contrast, other authors have indicated that high school students engaged in sports or physical activities are more likely to report alcohol use, including HED [9‐11]. Furthermore, adolescents playing team sports are more likely to report alcohol use and intoxication than those playing individual sports [10, 11].

Another sport characteristic suggested as a differentiating factor for alcohol use is the frequency of sport practice [11, 12]. Peretti-Watel and colleagues [13] observed that high school students who practiced sports at a higher frequency reported at least one episode of drunkenness in the last month compared to students with a lower frequency of practice. However results are still insufficient for a conclusion about which frequencies are more related with a lower or higher level of alcohol consumption. In addition, both motivation for sports participation and for drug use were also suggested as important parameters in the relationship between sports and drug use [14]. However most of the studies explored only the motivation for the substance consumption, not for the sport practice [15, 16].

Prior studies pointed out the importance of social aspects of sports practice on drug use among adolescents [17, 18]. In this sense, some studies used Bronfenbrenner’s Ecological Systems Theory, involving the multiple levels of the surrounding milieu [19, 20] as theoretical grounding for studying substance abuse among adolescents [21, 22]. Brazilian culture is strongly associated to soccer and its practice is wide spread, which has led to Brazil being called “The country of soccer”. Moreover, soccer is one of most practiced sports in Brazilian high school physical education classes [23] and is an important opportunity for social interaction among adolescents. On the other hand, alcoholic beverages are commonly associated with sports in some countries. A prior study suggested that the relationship between sports and alcohol seems to be particularly strong to soccer (or football, as called in other countries) [24]. For example, in The United States, beer advertising is culturally associated with baseball and American football, in Brazil, it is linked to soccer [25].

Further research exploring the involvement of the population with the practice is necessary to expand the understanding about the relationship between sports and alcohol consumption, especially in developing nations [9, 26]. This knowledge is important to design preventive programs for adolescents, which take into account the contextual diversity [27]. This study aims to explore the relationship between HED and contextual factors of soccer practice among high school students, with a representative sample from all the 27 state capitals of Brazil, the largest country of Latin America. Taking into account the fact that Brazilian culture is strongly associated to soccer and that this sport is related to alcohol consumption, especially when practiced in a pleasure context, our hypothesis is that soccer practice is particularly associated to HED. Furthermore, this relationship also should be influenced by frequency of and motivation for practice.

Our data indicates that playing soccer was more associated to HED in the previous month compared to non-playing sports. Compared to other team sports, soccer practice was also more related to HED. Yet compared to other team sports, soccer players with the lowest and highest frequencies of practice as well as those motivated for pleasure and for profession were more prone to report HED. This data confirmed our primary expectations of soccer players being associated to HED and that frequency and motivation for practice are differential factors when predicting HED. Regarding preferred beverages, drinking partners and places for drinking, subtle differences were observed in our study. All groups studied reported beer as the most preferred beverage, drinking mostly with friends and nightclubs or bars being the most common setting.

Soccer was more associated with HED in the last month when compared to non-practicing sports. Similar results were observed by previous studies that pointed to a high level of alcohol consumption among high school students who played sports or practiced physical activities [9‐11]. The importance of social contexts of sports practice for drug use were highlighted recently by other another study [29]. Socialization aspects of adolescent development may exert some influence on the relationship between sports practice and alcohol use. Studies showed that peer norms have an important role in physical activity behavior among adolescents [30] and peer group pressure is a predictor of substance abuse [31]. Accordingly, it is expected that once alcohol consumption is a part of normative culture, the adolescent could behave in a similar manner to that of their peers in order to promote the social bonds. Possibly when practicing soccer, adolescents are involved with older peers, and being involved with older friends or acquaintances allows easier access to beverages from this social source [32], favoring alcohol consumption, especially because in Brazil the legal drinking age is 18. Therefore, future studies should compare team and individual sports in order to explore collectivity and peer roles as an influence on alcohol consumption related to sports practice.

A previous study indicated that the induced sociability could be a more important factor than the sport practiced in relation to alcohol use [13]. In team sport practice, the individual could be influenced by normative attitudes of the group. On the other hand, our data suggests that the practice of a team sport and its socialization aspects are not the only reason for higher HED reporting among adolescents. Soccer players were more likely to report HED than other team sports players. Soccer and beer are highly associated in Brazilian culture and this relationship apparently plays a fundamental role in alcohol consumption by adolescents. Even though partaking in sports is usually regarded as a healthy practice, there is evidence that culture exerts influence on sports players drug use, and its practice is often accompanied by alcohol use [33]. Thus, the possible socialization induced by team sport practice itself cannot be directly assumed as a unique factor associated with the risk of HED, it being important to consider other aspects as cultural issues of the sports practice.

In our data, playing soccer for pleasure compared to team sports was associated with HED. A previous study that recreational physical activity does not provide much protection in terms of alcohol use [34]. Pleasure, as a recreational motivation, is related to a lower commitment to the sport practice. Once the practitioner is not concerned about how much their performance will be impaired by alcohol consumption this could possibly promote drug use. On the other hand, adolescents who reported playing soccer as a profession also reported more HED than those with the same motivation and practicing other team sports. In contrast with those who play for pleasure, players with professional motivation for the practice tend to be more devoted to the practice. This motivation presumes a higher commitment to the sport. Therefore, these more athletic students could experience more stress and pressure associated with maintaining their dual activity, which could increase the risk for alcohol use [35].

Both highly active practitioners and those with the lowest frequency of practice of soccer were related to more HED. Independently of being highly or slightly active, soccer players were more prone to report HED. These results reinforce the idea of the strong cultural bond between soccer and alcohol. This connection seems to be so strong that regardless of the motivation (pleasure or as a profession) or frequency (1 to 5 days or 20 or more days per month), HED is more frequent among soccer than in other team sports.

In regard to HED characteristics, students independently of being non-players, soccer or team sports players reported beer as the most frequent beverage consumed. This beverage was previously reported as the predominant drink among adolescents in Brazil and several others countries [5, 36]. The beverages preferences among youth could promote a better understanding of related factors and more effective interventions could be tailored [37]. Soccer players reported drinking more frequently than non-players or team sports students. Thus, they possibly could experience more the consequences of HED and be more likely to engage in risky behaviors.

Our results also indicated that all three student groups usually drink with their friends and at nightclubs or bars. It is also interesting to note that the adolescents also frequently drink with their relatives. Several studies pointed out the influence of parents and relatives behaviors and practices on adolescents drinking behaviors [38‐40], including parents drinking behaviors [41]. As parents and relatives are generally the most involved with the adolescents, their approval on drinking behavior may be important in explaining their alcohol use [40].

Several other authors have suggested sports-based interventions programs for specific groups, including high school students [7, 8, 42, 43]. Our study results suggest the need to consider the associated aspects of sports practice such as motivation, frequency and especially the culture, for intervention programs among this population. A recent study showed that sports clubs using accredited programs to reduce alcohol risk have a reduction in short and long-term risky drinking among members whereas clubs not using such programs have higher levels of alcohol consumption [44]. This data suggests that tailored programs could be useful for reducing alcohol use, and our data could be integrated to improve future adolescent programs which aim to reduce alcohol consumption.

Sports are usually related to healthy habits in several contexts, but this study concludes that this assumption cannot be adopted for the relationship between soccer and heavy episodic drinking among Brazilian adolescents. The association between soccer and HED seems stronger than in other team sports. Our study highlighted that the practice of a team sport and its socialization aspects are not the only reason for more HED report among adolescents. Cultural influence could play an important role in alcohol consumption behavior among adolescents, especially in Brazil, where soccer is a highly important sociocultural determinant. Thus, the type of sport and its cultural meaning in the population must be taken into account. Other fundamental variables such as frequency and motivation for practice should also be considered. These data should be integrated into future studies and into prevention or intervention programs for alcohol use that aim for a better approach with students.