published_or_final_version / Public Health / Master / Master of Public Health

M.A. (Sociology) / Please refer to full text to view abstract

Thesis (Phd)-- Stellenbosch University, 2012. / ENGLISH ABSTRACT: Introduction: Adolescents are recognised as a nutritionally at-risk group, as they have high nutritional demand for growth and development, poor eating behaviour as well as a propensity for unhealthy behaviours. Heavy alcohol use, particularly in the form of binge drinking, is typical for an alarming proportion of school-going adolescents and is a plausible contributor to the nutritional challenges in adolescents, but this has not yet been fully investigated. Aim: This study investigated the potential influences of alcohol use on the nutritional status of adolescents with alcohol use disorders (AUDs), specifically with regards to their eating behaviour and dietary intake, growth and weight status, iron status, as well as vitamin D and calcium status. Methods: Substance use, physical activity, eating behaviour, dietary intake, growth and weight status, iron status and vitamin D and calcium status were assessed and compared in heavy drinking adolescents (meeting DSM-IV criteria for AUDs) (n=81) and in light/non-drinking adolescents without AUDs (non-AUDs)(n=81), matched for age, gender, language, socio-economic status and education. Observed dietary intake distributions were adjusted statistically to obtain usual nutrient intake distributions. Regression-adjusted differences between the groups were assessed using multi-level mixed effects linear regression, adjusting for potential confounders. Results: Lifetime alcohol dose in standard drinks of alcohol was orders of magnitude higher in the AUDs group compared to the non-AUDs group. AUDs adolescents had a binge alcohol use pattern and a “weekends-only” style of alcohol consumption. Poor eating patterns (breakfast skipping and frequent snacking), poor food choices (energy-dense and nutrient-poor foods) and low fruit and vegetable intake (non-AUDs 90 [42.4-153.3]; AUDs 88.3 [30.0-153.0] grams per day) in both groups were reflected in the poor nutritional quality of the diet. More than half of adolescents in both groups were at risk of inadequate intakes of folate (non-AUDs 97.5%; AUDs 98.8%), vitamin C (non-AUDs 65%; AUDs 67.5%), vitamin A (non-AUDs 80%; AUDs 82.5%), vitamin E (non-AUDs 78.8%; AUDs 51.3%), magnesium (non-AUDs 98.8%; AUDs 97.5%), and phosphorus (non-AUDs 76.3%; AUDs 73.8%) and all participants were at risk of inadequate calcium and vitamin D intakes. AUDs adolescents had a greater intake of unhealthy foods (energy-dense nutrient-poor) and a significantly greater energy intake than non-AUDs adolescents (p<0.001) that exceeded energy requirements. AUDs adolescents consumed foods high in unhealthy fats significantly more frequently (p=0.037) than the non-AUDs adolescents and had ensuing greater total fat (p<0.001), saturated fat (p<0.001) and cholesterol (p=0.009) intakes. Frequency of intake of sodium-rich foods was significantly higher in AUDs adolescents (p=0.001) and prevalence of risk of excessive sodium intake was significantly greater in the AUDs adolescents (45%) compared to non-AUDs adolescents (18.8%) (p<0.001). Anthropometric indices of growth and weight status were comparable between the groups and in line with that of the South African adolescent population. Female AUDs adolescents had increased odds (OR 2.42) of being overweight/obese compared to non-AUDs females. Physical activity in both groups was well below the WHO global recommendation. Iron store depletion (serum ferritin < 20 μg/L) was evident in a quarter of adolescents in both groups (non-AUDs 23.5%; AUDs 24.7%), with biochemical iron status measures (serum iron and total iron binding capacity) indicating a greater risk of iron store depletion in the AUDs group. Biochemical vitamin D insufficiency/deficiency (serum 25-hydroxyvitamin D < 30 ng/mL) was prevalent in both groups (non-AUDs 70.4%; AUDs 88.8%), although this was significantly greater in the AUDs group (p=0.013), with significantly lower serum 25-hydroxyvitamin D levels in the AUDs group compared to the non-AUDs group (p=0.038). Conclusions: Heavy alcohol use in the form of binge drinking in adolescents may have the following nutrition-related influences: increased intake of energy; unhealthy fats and sodium, increased risk of overweight/obesity in females; increased risk of iron store depletion; and increased risk of vitamin D insufficiency/deficiency. Persistence of heavy alcohol use, poor food choices and dietary intake may increase the risk for adverse nutrition-related health outcomes in the AUDs adolescents. / AFRIKAANSE OPSOMMING: Inleiding: Adolessente het 'n verhoogde risko vir wanvoeding as gevolg van hul hoë voedingbehoeftes vir groei en ontwikkeling, swak eetgedrag, asook 'n geneigdheid tot verdere ongesonde gedrag. Swaar alkohol gebruik in die vorm van “binge” drinkery kom toenemend onder skoolgaande adolessente voor. Hierdie gedrag kan moontlik bydra tot die verhoogde voeding risiko in dié ouderdomsgroep. Hierdie moontlikheid is egter nog nie ten volle ondersoek nie. Doel: Hierdie studie het die potensiële invloed van alkohol gebruik op die voedingstatus van adolessente met alkohol gebruik versteurings (AGVs) ondersoek, spesifiek met betrekking tot hul eetgedrag en dieetinname, groei en gewigstatus asook yster-, vitamien D- en kalsiumstatus. Metodes: Swaar drinkende adolessente wat voldoen aan DSM-IV kriteria vir AGVs (n=81) en lig/nie-drinkende adolessente sonder AGVs (nie-AGVs) (n=81), wat afgepaar is vir ouderdom, geslag, taal, sosio-ekonomiese status en opvoedingsvlak is gewerf vir deelname aan die studie. Middel gebruik, fisiese aktiwiteit, eetgedrag, dieetinname, groei en gewigstatus, ysterstatus en vitamien D- en kalsiumstatus is tussen die twee groepe vergelyk. Waargenome dieetinname verspreidings is statisties aangepas om gewoontelike nutriëntinname te verkry. Regressie-aangepaste verskille tussen die groepe is met behulp van ’n meervoudige gemengde effekte liniêre regressie model getoets, waartydens daar vir moontlike gestrengelde faktore aangepas is. Resultate: Leeftyd alkohol dosis, gemeet in standaard alkohol drankies, was beduidend hoër in die AGVs groep in vergelyking met die nie-AGVs groep. Alkohol gebruik in die AGVs adolessente het ‘n “binge” patroon en ‘n “slegs naweke” styl getoon. Swak eetgewoontes (oorslaan van ontbyt en gereelde peuselgewoontes), swak voedsel keuses (energie-dig en laag in nutriënte) en lae groente en vrugte inname (nie-AGVs 90.0 [42.4-153.3]; AGVs 88.3 [30.0-153.0] gram per dag), in beide groepe, is gereflekteer in die swak voeding kwaliteit van die dieet. ‘n Risiko vir onvoldoende inname van folaat (nie-AGVs 97.5%; AGVs 98.8%), vitamien C (nie-AGVs 65%; AGVs 67.5%), vitamien A (nie-AGVs 80%; AGVs 82.5%), vitamien E (nie-AGVs 78.8%; AGVs 51.3%), magnesium (nie-AGVs 98.8%; AGVs 97.5%), en fosfor (nie-AGVs 76.3%; AGVs 73.8%) was teenwoordig in meer as helfte van adolessente in beide groepe, asook Inleiding: Adolessente het 'n verhoogde risko vir wanvoeding as gevolg van hul hoë voedingbehoeftes vir groei en ontwikkeling, swak eetgedrag, asook 'n geneigdheid tot verdere ongesonde gedrag. Swaar alkohol gebruik in die vorm van “binge” drinkery kom toenemend onder skoolgaande adolessente voor. Hierdie gedrag kan moontlik bydra tot die verhoogde voeding risiko in dié ouderdomsgroep. Hierdie moontlikheid is egter nog nie ten volle ondersoek nie. Doel: Hierdie studie het die potensiële invloed van alkohol gebruik op die voedingstatus van adolessente met alkohol gebruik versteurings (AGVs) ondersoek, spesifiek met betrekking tot hul eetgedrag en dieetinname, groei en gewigstatus asook yster-, vitamien D- en kalsiumstatus. Metodes: Swaar drinkende adolessente wat voldoen aan DSM-IV kriteria vir AGVs (n=81) en lig/nie-drinkende adolessente sonder AGVs (nie-AGVs) (n=81), wat afgepaar is vir ouderdom, geslag, taal, sosio-ekonomiese status en opvoedingsvlak is gewerf vir deelname aan die studie. Middel gebruik, fisiese aktiwiteit, eetgedrag, dieetinname, groei en gewigstatus, ysterstatus en vitamien D- en kalsiumstatus is tussen die twee groepe vergelyk. Waargenome dieetinname verspreidings is statisties aangepas om gewoontelike nutriëntinname te verkry. Regressie-aangepaste verskille tussen die groepe is met behulp van ’n meervoudige gemengde effekte liniêre regressie model getoets, waartydens daar vir moontlike gestrengelde faktore aangepas is. Resultate: Leeftyd alkohol dosis, gemeet in standaard alkohol drankies, was beduidend hoër in die AGVs groep in vergelyking met die nie-AGVs groep. Alkohol gebruik in die AGVs adolessente het ‘n “binge” patroon en ‘n “slegs naweke” styl getoon. Swak eetgewoontes (oorslaan van ontbyt en gereelde peuselgewoontes), swak voedsel keuses (energie-dig en laag in nutriënte) en lae groente en vrugte inname (nie-AGVs 90.0 [42.4-153.3]; AGVs 88.3 [30.0-153.0] gram per dag), in beide groepe, is gereflekteer in die swak voeding kwaliteit van die dieet. ‘n Risiko vir onvoldoende inname van folaat (nie-AGVs 97.5%; AGVs 98.8%), vitamien C (nie-AGVs 65%; AGVs 67.5%), vitamien A (nie-AGVs 80%; AGVs 82.5%), vitamien E (nie-AGVs 78.8%; AGVs 51.3%), magnesium (nie-AGVs 98.8%; AGVs 97.5%), en fosfor (nie-AGVs 76.3%; AGVs 73.8%) was teenwoordig in meer as helfte van adolessente in beide groepe, asook

Teen problem-d1inking is a pervasive problem in our society. Teens with drinking problems utilize treatment centers and then return to school attempting to stay sober. However, many return to affiliate with problem drinkers instead of with non-drinkers, and risk for relapse is high. One explanation may be that teens without drinking problems do not accept teen problem drinkers into their peer group due to negative reactions toward problem drinkers. One way to examine their attitudes is to examine differences between teen problem drinkers and non-drinkers regarding causal attributions. Attribution theory proposes that various attributions will elicit different emotional reactions and will motivate teens to behave in certain ways. The purpose of this study was to determine if teens with prior experience in treatment (problem drinkers) and teens without that experience (non-problem drinkers) make different causal attributions for teen problem drinking. Furthermore, group differences in emotional reactions, beliefs about how to offset the problem, and help-giving behaviors were also examined. This study also sought to determine whether there was a predictable link between attributions and emotional reactions, and between emotional reactions and helpgiving behaviors. One hundred twenty-one teenagers aged 13 to 20 were recruited as subjects, 79 from Portland area schools and 42 from treatment centers. Subjects completed a written survey measuring causal attributions for teen problem drinking, emotional reactions toward teen problem drinkers, beliefs regarding how to offset the problem, and help-giving behaviors. Four MANOYAs were used to determine group differences. Results revealed group differences on causal attributions, emotional reactions, and offset controllability, but not on help-giving behaviors. Two multiple regressions were used to determine whether attributions predicted emotional reactions and whether emotional reactions predicted help-giving behaviors; results revealed no link. Although results revealed group differences, these were found not to be consistent with the hypothesis based on attribution theory. Results did reveal positive outcomes regarding attitudes toward teen problem drinkers by nonproblem drinkers, which is important as it suggests that teens without prior experience in treatment may be more accepting of teen problem drinkers than was expected.

Adolescent Alcohol Use (AAU) is widespread and potentially harmful to the health of youth. Substantial research and theoretical development suggest that both violence exposure and internalizing and externalizing problems of adolescents are associated with AAU. The primary purpose of this study was to examine the roles of internalizing and externalizing problems in adolescents to determine if the two types of symptoms are differential mediators of the link between violence exposure and AAU for females and males. Using Developmental Systems Theory as a framework, three primary hypotheses were examined: 1) Increased violence exposure at home and in the community are associated with increased AAU in both females and in males; 2) Internalizing problems mediate the relationship between home/community violence exposure and AAU for females; and 3) Externalizing problems mediate the relationship between home/community violence exposure and AAU for males. The secondary dataset that was utilized to test the hypotheses is a product of the 1995 National Survey of Adolescents in the United States. It includes a national probability sample of 3,161 adolescents and a probability oversample of 862 adolescents residing in urban areas for a total of 4,023 adolescents between the ages of 12 and 17. The data were collected by telephone interviews with the adolescents. The findings indicated that, for the most part, witnessing and experiencing physical and sexual violence across home and community contexts were associated with increased levels of AAU for both females and males. Internalizing problems mediated the relationship between sexual abuse and AAU for both females and males. Externalizing problems did not mediate the relationship between violence exposure and AAU for males or females. The findings suggest that internalizing and externalizing problems may play similar roles in females and males. The findings also indicated that home violence exposure accounts for unique variance in AAU beyond community violence exposure, but that community and home violence exposure do not interact to contribute to the highest level of AAU. Both number of different types of sexual victimization and number of different types of physical victimization at home were related to AAU. Implications for social work are discussed. The primary implication for Development Systems Theory is that differential pathways for females and males from environmental stress, in particular violence exposure, to increases in AAU may not be needed. Social work programs aimed at preventing and intervening in AAU should include components that address not only the use itself, but also the level of violence the adolescent has been exposed to, as well as any internalizing problems the adolescent may be experiencing. Future research should continue to examine how risk factors operate to influence AAU.

Background: Although parental drinking is associated with adolescent drinking, the impacts of parental alcohol-related actions were controversial. The present study aims to 1) examine the prevalence of parental pro-drinking practices (PPDPs), 2) examine the association between PPDPs and parental drinking, 3) identify the factors associated with PPDPs among adolescents with drinking parents, 4) examine the association between PPDPs and adolescent drinking, and 5) explore the experience of PPDPs and alcohol use in adolescents and parents qualitatively. Methods: A cross-sectional survey was conducted among 2200 secondary 1 to 6 students from 4 randomly selected local schools. Students were asked if they have experienced each of 9 PPDPs including 1) saw parents drank and being drunk; 2) heard parents saying benefits of drinking and certain alcohol tasted good; 3) helped parents buy alcohol, open bottle and pour alcohol; and 4) parental action in encouraging drinking and training of drinking capacity. Logistic regression was used to compute the adjusted odds ratios (AORs) and 95% confidence interval (95% CI) of each PPDP by the number of drinking parents, and the drinking frequency of each parent adjusting for socio-demographic variables. Moreover, correlates of PPDPs were identified among students with at least one drinking parent. Furthermore, the AORs and 95% CI of student drinking and drinking intention by each PPDP were computed. A total of 40 families (33 student-parent pairs, 6 students and 1 parent) were then selected for telephone interview. Results: Overall, 67.5% of students experienced at least 1 PPDP with the prevalence of PPDPs ranging from 9.3% for hearing the benefits of drinking to 51.0% for seeing parents drank. The prevalence of PPDP increased dramatically with the number of drinking parents (none 38.8%, either 81.6%, both 89.0%). PPDPs were associated with parental drinking frequency and various socio-demographic factors. For instance, adolescent girls (AOR: 2.28) were more likely to have received parental training of drinking capacity than boys. Frequent paternal and maternal drinking were most strongly associated with helping parents buy alcohol (AOR: 6.55) and training of drinking capacity (AOR: 5.14), respectively. In general, most PPDPs were significantly associated with ever drinking and monthly drinking in students. Both ever and monthly drinking in adolescents were strongly associated with parental training of drinking capacity with AORs of 6.20 and 8.20, respectively. Similarly, each PPDP was significantly associated with adolescent drinking intention with AORs ranging from 1.50 for helping parents buy alcohol to 3.53 for being encouraged by parents to drink. Consistent with quantitative data, the interviews revealed that almost half the students reported PPDPs (N=17/39) and it was common for students to see parents drink (N=7). Of the 17 families reporting involvement in PPDPs, all had at least one drinking parent. Conclusions: Most students experienced PPDPs and its prevalence increased with the number of drinking parents. In drinking parents, PPDPs were associated with socio-demographic factors and parental drinking frequency. Most PPDPs were associated with adolescent drinking and intention to drink. These results suggested that parents should avoid PPDPs to prevent adolescent drinking. / published_or_final_version / Public Health / Master / Master of Philosophy

Adolescents from nine intact health classes from two high schools participated either in a traditional lecturebased alcohol prevention intervention or a nontraditional experiential-based intervention. The nontraditional intervention focussed on attitudes toward drinking and the misperceptions associated with alcohol consumption norms. Subjects completed several self-report measures on attitudes toward drinking (own, perceived friends', and perceived school's), perceived ranking of alcohol consumption compared to closest friends and compared to the school, intent to drink, and actual reporting of alcohol consumption. For the nontraditional intervention, it was hypothesized that students would change their perceptions of others' attitudes toward drinking and their perception of the norm enough to decrease their alcohol consumption. Results indicated the intervention changed the perceived attitude of the school, but not enough to significantly change consumption levels. These findings confirm that misperceptions occur and that they influence alcohol consumption. / Department of Psychological Science

Typescript. / Thesis (Ph. D.)--University of Hawaii at Manoa, 1990. / Includes bibliographical references (leaves 138-151) / Microfiche. / ix, 151 leaves, bound 29 cm

M.Ed. / Please refer to full text to view abstract

Alcohol consumption among adolescents is an important issue because of its link to many negative social and health problems, including depression, suicide, and aggression. Drawing from Hirschi’s social bonding theory and Agnew’s general strain theory, this study examines the effects of family relations on alcohol consumption among Turkish adolescents. Social bonding theory suggests that individuals with stronger social bonds are less likely to use alcohol than individuals with weaker social bonds. General strain theory, on the other hand, proposes that individuals with higher levels of strain due to financial difficulties and/or negative relationships are more likely to consume alcohol compared to individuals with lower levels of strain. In particular, this study proposes to examine how parental attachment, parental monitoring, time spent with family, parents’ religiosity, family economic strain, and negative life events in the family predict alcohol consumption among adolescents in Turkey. 2008 Youth in Europe (YIE) project data is used in the study. In general, the results indicate that social bonding and strain factors have significant effects on the adolescents’ alcohol consumption patterns. These findings will help to inform prevention programs aimed at reducing adolescent alcohol risk behaviors by explaining the importance of family relationships.