Drunkenness and its association with health risk behaviors among adolescents and young adults in three Asian cities: Hanoi, Shanghai, Taipei
Introduction
As one of the most common health risk behaviors among adolescents and young adults, alcohol use seriously threatens their health and well-being. Alcohol is now the leading risk factor contributing to disability-adjusted life years in 10–24-year-olds globally (Fiona et al., 2011). According to a report by the World Health Organization (2011), alcohol is a factor in almost 10% of deaths among young people. The three most frequent forms of mortality among adolescents–accidental death, homicide, and suicide–are associated with alcohol use (Balogun et al., 2014). Its use among adolescents and young adults, especially excessive drinking, often leading to drunkenness, has become a major public health concern.
Adolescence is the time when alcohol use typically begins and escalates. Alcohol is thought to be important in adolescent development and socialization as it helps young people to integrate with their peers and to negotiate their passage into the adult world (Hughes et al., 1997). Hughes et al. (1997) reported that children aged 12 and 13 years used alcohol to experience the adult world and to satisfy their curiosity, and those aged 14 and 15 were testing out their limits and getting drunk to share the experience with others. In the 2003 National Youth Risk Behavior Survey, Miller et al. (2007) found 44.9% of US high school students reported drinking alcohol during the past 30 days, and 28.8% reported binge drinking. A Web-based survey from ten North Carolina universities revealed 63.6% of students described themselves as current (past 30 days) drinkers, and 35% reported getting drunk at least once a week (O’Brien et al., 2006). Although excessive drinking has been a relatively common behavior among adolescents in western countries, little is known about adolescent drunkenness in Asia. To fill this gap, we conducted a cross-sectional study to evaluate drunkenness among adolescents and young adults in three Asian cities – Hanoi, Shanghai, and Taipei – which have shared the same Confucian-based culture for thousands of years. With an emphasis on moderation, Confucianism has likely provided some constraint to excessive drinking (Iris and James, 1989, Weatherspoon et al., 2001) and may possibly mitigate the risk associated with alcohol use. However, in the past several decades, Hanoi, Shanghai, and Taipei have been undergoing marked sociocultural change in the wake of modernization, rapid industrialization, and globalization, accompanied by the adoption of more Western lifestyles. The gradual erosion of traditional Confucian values influences attitudes toward drinking and alcohol consumption; consequently, western drinking practices are gradually becoming accepted, especially among young people. As these three cities have opened to the West at different times (Taipei has the longest exposure to the West, Hanoi's exposure is the most recent, and Shanghai is between the two), traditional values may have eroded to different extents, and western drinking patterns, especially excessive alcohol consumption leading to drunkenness, may also have been adopted at different levels. We hypothesize that the prevalence of drunkenness varies across the three cities; specifically, the longer the city has been exposed to the West, the higher the prevalence of drunkenness.
Adolescence is an important transition period when many adolescents can get involved in different problem behaviors such as smoking, alcohol use, and fighting (Guilamo et al., 2005). According to Jessor's problem behavior theory (Jessor and Jessor, 1977), adolescents’ involvement in any one problem behavior or health behavior increases the likelihood of involvement in others because they share many common causes. Concern about alcohol consumption among adolescents and young adults has led to increased exploration of the association of alcohol use with other health risk behaviors, often finding positive relationship. For example, research found that alcohol drinking and smoking had a high probability of co-occurrence (Istvan and Matarazzo, 1984). Adolescent internalizing anxiety and suicide were found to be related to adolescent alcohol use (Juan et al., 2010, Trim et al., 2007). Miller et al. (2007) reported that binge drinkers were 10.8 times more likely to ride with a driver who had been drinking alcohol than nondrinkers, and were 4.4 times more likely to be involved in a physical fight. Research has also suggested positive relationship between alcohol use and risky sexual behaviors, such as premarital sex, multiple sexual partners, and pregnancy (or getting a partner pregnant)(Lin et al., 2005, Miller et al., 2007, Stickley et al., 2013). Most of this research has been conducted in western countries, with a paucity of studies exploring these relationships in Asian cities. Therefore, this study will examine whether the association of drunkenness with a variety of different health risk behaviors exists, and if it do then we explore the extent to which this relationship varies across the three cities. We hypothesize that drunkenness is associated with health risk behaviors across the sites. Research (Donohew et al., 2000) has found sensation-seeking plays a crucial role in adolescents’ susceptibility to alcohol use and other risky behaviors. When drunkenness is more prevalent, it may not meet adolescents’ need for novelty and sensation, making them more likely to seek alternative sources of stimulation such as fighting or sexual behaviors. Therefore, we also hypothesize that the strength of the association between drunkenness and other health risk behaviors will vary across cities–being strong in Taipei, and relatively weak in Hanoi.
Section snippets
Sampling and data collection
Data for this study were drawn from the Three-city Collaborative Study of Adolescent Health by a team of researchers from the Johns Hopkins Bloomberg School of Public Health, the Population and Health Research Center in Taiwan's Bureau of Health Promotion, the Shanghai Institute for Planned Parenthood Research and the Hanoi Institute for Family and Gender Studies. This was a cross-sectional survey conducted in metropolitan Hanoi, Shanghai, and Taipei, including both their urban and surrounding
Results
Alcohol drinking, drunkenness and health risk behaviors by city are shown in Table 1. Significant differences between cities were found across all variables. In all three cities, more than half of the respondents reported having a history of alcohol use in their lifetimes, with the highest in Taipei and the lowest in Hanoi. The prevalence of alcohol drinking in the past month varied from a low of 27.95% in Shanghai to a high of 34.45% in Hanoi. The highest prevalence of drunkenness was found in
Discussion
This study estimated and compared alcohol drinking and drunkenness among 15–24 years olds across Hanoi, Shanghai and Taipei, and examined the extent to which the relationship between drunkenness and health risk behaviors varied across the three cities. Drunkenness was defined by the subjective appraisal of respondents rather than measured with specific numbers of drinks (usually set at 5+) for these reasons – the number of drinks needed to become drunk was influenced by many factors, such as
Role of funding source
Funding for this study was provided by Bill and Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, USA (grant no. 979-2020).
Contributors
Qianqian Zhu wrote the first draft of the manuscript and undertook the statistical analysis. Chaohua Lou, Ersheng Gao and Laurie S. Zabin were responsible for obtaining funding, implementation of the survey and quality control during field work. Yan Cheng participated in the implementation of the survey and supervision of fieldwork. Mark R. Emerson made a significant intellectual contribution to the study design and the statistical analysis. All authors contributed to and have approved the
Conflict of interest
All authors declare that they have no conflicts of interest.
Acknowledgements
We thank the Bill and Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, USA, who provided financial support for the study. We would also like to sincerely thank all the researchers at the Hanoi Institute of Family and Gender Studies, the health Research Center in Taiwan's Bureau of Health Promotion and the Shanghai Institute of Planned Parenthood Research for their contributions to the project.
References (40)
- et al.
Alcohol consumption and psychological distress in adolescents: a multi-country study
J. Adolesc. Health
(2014) - et al.
Adolescent alcohol use and alcohol use disorders in Mexico City
Drug Alcohol Depend.
(2014) - et al.
Early alcohol experiences and adolescent mental health: a population-based study in Taiwan
Drug Alcohol Depend.
(2008) - et al.
Sensation seeking, impulsive decision-making, and risky sex: implications for risk-taking and design of interventions
Personal. Individ. Differ.
(2000) - et al.
The associations between health risk behaviors and suicidal ideation and attempts in an urban Chinese sample of adolescents
J. Affect. Disord.
(2010) - et al.
Alcohol intoxication and sexual risk behaviors among rural-to-urban migrants in China
Drug Alcohol Depend.
(2005) - et al.
Early adolescent sexual initiation as a problem behavior: a comparative study of five nations
J. Adolesc. Health
(2010) - et al.
Driving after binge drinking
Am. J. Prev. Med.
(2009) - et al.
Adolescent binge drinking and risky health behaviours: findings from northern Russia
Drug Alcohol Depend.
(2013) - et al.
The relationship between sexual behavior and nonsexual risk behaviors among unmarried youth in three Asian cities
J. Adolesc. Health
(2012)
A family study of homeland Korean alcohol use
Addict. Behav.
Drunken Behaviour, Expectancies and Consequences Among European Students. Youth Drinking Cultures-European Experiences
Understanding alcohol misuse and comorbid psychiatric disorders
Curr. Opin. Psychiatry
The impact of drinking pattern on alcohol-related violence among adolescents: an international comparative analysis
Drug Alcohol Rev.
China Bans Under-age Drinking
School violence: prevalence and intervention strategies for at-risk adolescents
Adolescence
Global burden of disease in young people aged 10–24 years: a systematic analysis
Lancet
Patterns of alcohol consumption and alcohol-impaired driving in the United States
Alcohol. Clin. Exp. Res.
Risky sexual behavior and alcohol use among young adults: results from a national survey
Am. J. Health Promot.
Prevention programs for reducing adolescent problem behaviors: implications of the co-occurrence of problem behaviors in adolescence
J. Adolesc. Health
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