1. 1. 3rd National Alcohol Forum Conference The Best Available Evidence Supporting the Implementation of Local Solutions to Reduce Alcohol Consumption and Alcohol Harms
2. 2. Welcome Chairperson Opening Address: Prof Thomas Collins
3. 3. Minister for Health Dr Leo Varadkar Ministerial Address:
4. 4. Dr Thomas Babor Looking Upstream : Evidenced based solutions for Alcohol related problems in the Community
5. 5. Looking Upstream: Evidenced based solutions for alcohol-related problems in the Community Thomas Babor Dept. of Community Medicine University of Connecticut Farmington, CT, USA
6. 6. Disclosure Statement Listed below are all my commercial relationships during the past year: None
7. 7. Alcohol: No Ordinary Commodity and the Public Health Approach
8. 8. Looking upstream Ultimately, the value of approaching alcohol problems within a public health framework is that it draws attention to the upstream sources of the damage as opposed to attributing alcohol- related problems exclusively to the personal behavior of the individual drinker.
9. 9. Upstream sources of the damage Affordable prices Easy availability A culture of universal heavy and episodic drinking supported by aggressive marketing Lack of regulatory controls
10. 10. Pricing and taxation measuresRegulating the physical availability of alcohol Modifying the drinking context Drinking-driving countermeasures Regulating alcohol promotion Education and persuasion strategies Treatment and early intervention services Strategies and interventions to reduce alcohol-related harm upstream and downstream Upstream Downstream
11. 11. Pricing and Taxation People increase their drinking when prices are lowered, and decrease their consumption when prices rise. Adolescents and problem drinkers are no exception to this rule. Increased alcohol taxes and prices are related to reductions in alcohol-related problems, including crime, traffic accidents and mortality rates Alcohol taxes are thus an attractive instrument of alcohol policy because they can be used both to generate direct revenue and to reduce alcohol-related harm. The most important downside to raising alcohol taxes is smuggling and illegal in- country alcohol production. Political opposition from the alcohol industry and the hospitality industry, as well as trade harmonization policies, make tax interventions difficult to implement and maintain.
12. 12. Other pricing measures Minimum prices Bans on happy hours Smart prices - taxation to shift consumption towards weaker types of alcohol
13. 13. Regulating Alcohol Availability Restrictions on availability can have large effects in nations or communities where there is popular support for these measures. For young people, laws that raise the minimum legal drinking age reduce alcohol sales and problems The cost of restricting alcohol availability is cheap relative to the costs of health consequences related to drinking, especially heavy drinking. Adverse effects include increases in informal market activities (e.g., cross-border purchases, home production, illegal imports)
14. 14. Regulating Alcohol Availability Through Minimum Legal Purchase Age (MPLA) In 1984 the US Congress passed the National Minimum Purchase Age Act, which encouraged states to adopt the age 21 purchase standard The number of young people who died in a crash when an intoxicated young driver was involved has declined by almost 63% Could age restrictions be better enforced in Ireland and even increased gradually?
15. 15. Closing time: Effects on homicides in Diadema, Brazil (1995-2005)
16. 16. Regulating Alcohol Marketing The marketing of alcohol is a global industry Promotion through: Television, radio, billboards print media, point-of-sale promotions, the Internet, product placements in movies and TV, sports sponsorships, etc.
17. 17. Drinking-Driving Countermeasures Strategy or Intervention Effectiveness Supporting Research Cross-National Testing Sobriety check points ++ +++ +++ Random breath testing +++ ++ ++ Lowered BAC limits +++ +++ +++ Administrative license suspension ++ ++ ++ Low BAC for young drivers (zero tolerance) +++ ++ ++ Graduated licensing for novice drivers ++ ++ ++ Designated drivers and ride services 0 + + Severity of punishment 0/+ ++ ++
18. 18. Modifying the Drinking Context Monitor or change the environments where alcohol is typically sold and consumed (e.g., bars and restaurants) Such changes can reduce alcohol-related aggression and intoxication Options include training bar staff, imposing voluntary house policies to refuse service, enforcement of regulations, community mobilization to influence problem establishments
19. 19. Treatment and Early Intervention Services During the past 50 years there has been a steady growth in high income countries in the provision of specialized medical, psychiatric, behavioral and social services to people with alcohol use disorders More than 40 therapeutic approaches have been developed Systems of specialized services are now typical of many industrialized countries
20. 20. Treatment and Early Intervention Services In general, exposure to any treatment is associated with significant reductions in alcohol use and related problems, regardless of the type of intervention used. Randomized controlled trials (conducted in a variety of settings) indicate that clinically significant changes in drinking behavior and related problems can follow from brief interventions with non-alcoholic heavy drinkers.
21. 21. Education Strategies The impact of education and persuasion programs tends to be small at best. When positive effects are found, they do not persist. Among the hundreds of studies, only a few show lasting effects (after 3 years) Even comprehensive programs may not be sufficient to delay initiation of drinking or sustain small reductions after program Programs with multiple interactive components that resemble family therapy and brief intervention seem to have some potential Many programs shown to be ineffective continue to be used
22. 22. Community action opportunities Advocate for minimum pricing policy Increase enforcement on alcohol laws youth access, distance sales, secondary purchasing, serving intoxicated customers, drink-driving Limit drinking in public places through local bye laws. Monitor compliance with industry marketing codes and advocate for statutory regulations Support treatment and early intervention services Support the Public Health (Alcohol) Bill
23. 23. Public Health (Alcohol) Bill Minimum pricing Regulation of alcohol marketing Health labelling of alcohol products Enforcement powers in relation to sale, supply and consumption of alcohol products
24. 24. Policy Environment Score and Adult Binge Drinking Prevalence, U.S. States
25. 25. Policy Environment Score and Youth Drinking Prevalence, U.S. States
26. 26. Public Health Model of Corporate-borne Diseases Agent: alcohol industry Environment: Where exposure occurs Host: Vulnerable Populations
27. 27. Political Factors (Government) Government Policies Corporations Corporate decisions aimed at profits Conduits (SAPROs) Corporate pressures on environment Environment of hosts- Retailers Modified environment Hosts Consumption and profits Hosts Alcohol related problems; disability; disease The Epidemiologic Cascade Applied to Alcohol
28. 28. Tobacco Alcohol Gambling Industries Public Good Chain Politicians Public Consultation Government Officials
29. 29. ADDICTION EDITORIAL: Diageo, University College Dublin and the integrity of alcohol science On 6 April 2006 Diageo Ireland, a subsidiary of the worlds largest distributor of alcoholic beverages, announced the awarding of a grant of 1.5 million euros to the University College Dublins (UCD) As reported in the Irish Times, Diageo CEO Paul Walsh said the issue was, for Diageo, a simple one the company did not want problems with binge drinking to lead governments to place higher taxes on its products and thus eat into revenues. The UCD research funding is thus the perfect example of enlightened self-interest, particularly in light of the taxes placed on alcopops over recent years.
30. 30. Corporate Practices that Influence Alcohol Misuse Product design: increases alcohol content, drinkability, sales to young people, Marketing: increase sales to vulnerable groups such as women and youth Retail distribution: makes alcohol more accessible to consumers Pricing: increases sales, profits, and market share Political influence: affects the policy environment
31. 31. The triangle that moves the mountain Relevant knowledge - science A Social Movement - advocacy Political support/ involvement
32. 32. The Future of Community Action: Global Health Policy Networks (Schmitz, in press) Networks of individuals and organizations working at a global level and linked by a shared concern for a particular health issue (e.g., tobacco addiction, polio, TB, alcohol misuse) Includes scientists, health professionals, policymakers, victim groups, survivors, NGOs, faith groups, etc. Could play a crucial role in agenda-setting, issue framing, and translating science into policy Begins with local community action, but is linked to national and international initiatives
33. 33. What is needed to build a stronger global alcohol health policy network? A clear pro-active strategy to recruit new members, prioritize actions and frame campaign goals Mobilize powerful membership organizations (e.g., AA, treatment organizations, scientific societies, drink-driving groups, NGOs) Frame issues in ways that can be understood by civil society and policymakers (i.e., prevention of fetal damage, domestic violence, youth binge drinking, and relapse in alcoholics) Build a broader coalition through strategic alliances with tobacco control, obesity prevention, NCDs, etc. Financial support for core activities A positive message and proactive strategy, rather than just responses to aggressive industry tactics that compromise or threaten public health globally
34. 34. Conclusions Alcohol problems can be minimized or prevented using a coordinated, systematic policy response. Alcohol policies that limit access to alcoholic beverages, discourage driving under the influence of alcohol, reduce the legal purchasing age for alcoholic beverages, limit marketing exposure and increase the price of alcohol, are likely to reduce the harm linked to drinking In most countries, regulation of affordability, physical availability, and alcohol promotions are the most cost-effective strategies, but enforcement of drink driving laws and provision of treatment and early intervention are also needed Effective interventions produce a favorable health return for cost incurred in policy implementation
35. 35. Mid-Morning Break 11:15 11:35
36. 36. Prof David H. Jernigan Alcohol Marketing & Youth: Global Evidenceand Community Response
37. 37. Alcohol Marketing and Youth: Global Evidence and Community Responses David H. Jernigan Ph.D. Associate Professor Department of Health, Behavior and Society and Director, Center on Alcohol Marketing and Youth Johns Hopkins Bloomberg School of Public Health
38. 38. Health
39. 39. Alcohols role in the global burden of disease for 15-24 year-olds Source: Gore et al., Lancet 2011; 377:2093-2102
40. 40. Alcohol and Youth in Ireland More than half of Irish 16 year-olds have been drunk, and one in five is a weekly drinker (HBSC). 1 in 4 deaths among Irish youth is caused by alcohol The average age of first alcohol use in children decreased from 15 for those born in 1980 to 14 for those born in 1990. .
41. 41. The Consequences (US data) Young people who begin drinking before age 15 are five times more likely to develop alcohol problems later in life than those who wait until they are 21. (OSG) They are: Four times more likely to develop alcohol dependence (Grant & Dawson, 1997) Six times more likely to be in a physical fight after drinking; More than six times more likely to be in a motor vehicle crash because of drinking; Almost five times more likely to suffer from other unintentional injuries after drinking. (Hingson et al, 2009)
42. 42. Brain activity in 15 year-olds during a memory task Heavy use of alcohol during adolescence can impair brain development, causing loss of memory and other skills.
43. 43. Alcohol advertising and youth: adolescent brain research Brain imaging research has found that teens with alcohol use disorders show greater activity in areas of the brain previously linked to reward, desire, positive affect and episodic recall in response to alcoholic beverage advertisements. The highest degree of brain response was in youths who consume more drinks per month and report greater desires to drink. (Tapert et al., 2003)
44. 44. Why do young people drink? In the USA, at the state level, highly correlated with adult drinking Price and availability of alcohol Religious and cultural factors Exposure to alcohol marketing
45. 45. Alcohol Advertising and Youth: Published systematic reviews Anderson et al. 2009 (Alcohol and Alcoholism): 13 longitudinal studies following up more than 38,000 young people Longitudinal studies consistently suggest that exposure to media and commercial communications on alcohol is associated with the likelihood that adolescents will start to drink alcohol, and with increased drinking amongst baseline drinkers Smith and Foxcroft 2009 (BMC Public Health): 7 cohort studies following up more than 13,000 young people aged 10 to 26 years data from prospective cohort studies suggest there is an association between exposure to alcohol advertising or promotional activity and subsequent alcohol consumption in young people. Inferences about the modest effect sizes found are limited by the potential influence of residual or unmeasured confounding. Anderson et al., Alcohol Alcohol 2009:44:229-43
46. 46. Alcohol Marketing A Major Risk Factor for Underage Drinking Forms of alcohol advertising and marketing that predict drinking onset among youth Alcohol advertisements in magazines Beer advertisements on television Alcohol advertisements on radio Alcohol advertisements on billboards In-store beer displays and sports concessions Alcohol use in movies Ownership of alcohol promotional items Alcohol companies have moved rapidly into social media research has not kept up 51 Collins et al., Journal of Adolesc Health 2007:40:527-34; Snyder et al.,Arch Pediatr Adolesc Med 2006:160:18-24; Stacy et al., Am J Health Behav 2004:38:498-509 Pasch et al. J Stud Alcohol Drugs 2007:68:586-596; McClure et al., Am J Prev Med 2006:30:277-83; Stoolmiller et al., BMJ Open 2012:Feb 20;2:e000543; Sargent et al, J Stud Alcohol. 2006:67:54-65; Henriksen et al., J Adolesc Health 2008:42:28-35
47. 47. Published since 2008 52 Eight longitudinal studies All found significant associations between exposure to, awareness of, engagement with and/or receptivity to alcohol marketing at baseline, and initiation of alcohol use, initiation of binge drinking, drinking in the past 30 days, and/or alcohol problems at follow-up Three RCTs (experimental) Two of three find immediate effects on drinking of exposure to alcohol advertisements embedded in commercial breaks in films 23 cross-sectional studies All find significant associations between exposure to alcohol marketing and youth drinking, but cannot address causality
48. 48. Peer Drinking Peer Approval Intend to Drink Beer Next Year Intend to Drink Beer Adult Positive Expectancies Negative Expectancies Current Drinking Overall Liking Scaled 2 (795) = 899.36, p < .01 NFI = .85, Robust CFI = .96 RMSEA = .036 Exposure Attention Music People Story Humor .28 .18 .21 .13 .61 .15 .37.22 .24 .22 .49 .16 .13 .25 (R2=.73) (R2=.60) (R2=.41) Effects of Alcohol Advertising on Drinking Beliefs and Behaviors (5th 11th Graders) Source: Grube et al., 2005
49. 49. Music, people, story
50. 50. Model of marketing receptivity Source: McClure et al., ACER, 2013
51. 51. Facebook Brand Posts Cumulative Posts by Brand 0 200 400 600 800 1000 1200 1400 1600 1800 2000 Ju n -0 8S ep-0 8D ec-0 8M ar-0 9Ju n -0 9S ep-0 9D ec-0 9M ar-1 0Ju n -1 0S ep-1 0D ec-1 0M ar-1 1Ju n -1 1S ep-1 1D ec-1 1M ar-1 2Ju n -1 2S ep-1 2D ec-1 2M ar-1 3 BUD LIGHT SMIRNOFF ICE BUDWEISER SMIRNOFF VODKA COORS LIGHT JACK DANIELS CORONA MIKES CAPTAIN ABSOLUT Source: CrowdTangle and Facebook
52. 52. Facebook Likes Cumulative Likes by Brand 0 2000000 4000000 6000000 8000000 10000000 12000000 Jun-08 S ep-08 D ec-08 M ar-09 Jun-09 S ep-09 D ec-09 M ar-10 Jun-10 S ep-10 D ec-10 M ar-11 Jun-11 S ep-11 D ec-11 M ar-12 Jun-12 S ep-12 D ec-12 M ar-13 BUD LIGHT SMIRNOFF ICE BUDWEISER SMIRNOFF VODKA COORS LIGHT JACK DANIELS CORONA MIKES CAPTAIN ABSOLUT Source: CrowdTangle and Facebook
53. 53. Facebook Likes Average Number of Likes per Brand Post by Month 0 5000 10000 15000 20000 25000 30000 35000 40000 45000 Jun-08 Aug-08 Oct-08 Dec-08 Feb-09 Apr-09 Jun-09 Aug-09 Oct-09 Dec-09 Feb-10 Apr-10 Jun-10 Aug-10 Oct-10 Dec-10 Feb-11 Apr-11 Jun-11 Aug-11 Oct-11 Dec-11 Feb-12 Apr-12 Month AverageLikesperPost BUD LIGHT SMIRNOFF ICE BUDWEISER SMIRNOFF VODKA COORS LIGHT JACK DANIELS CORONA MIKES CAPTAIN ABSOLUT Source: CrowdTangle and Facebook
54. 54. Facebook Shares Cumulative Shares by Brand 0 100000 200000 300000 400000 500000 600000 700000 800000 900000 Jun-09S ep-09D ec-09M ar-10 Jun-10S ep-10D ec-10M ar-11 Jun-11S ep-11D ec-11M ar-12 Jun-12S ep-12D ec-12M ar-13 BUD LIGHT SMIRNOFF ICE BUDWEISER SMIRNOFF VODKA COORS LIGHT JACK DANIELS CORONA MIKES CAPTAIN ABSOLUT Source: CrowdTangle and Facebook
55. 55. Facebook Shares Source: CrowdTangle and Facebook Average Number of Shares per Brand Post by Month 0 500 1000 1500 2000 2500 3000 3500 Ju n -0 9A u g -0 9O ct-0 9D ec-0 9Feb-1 0A pr-1 0Ju n -1 0A u g -1 0O ct-1 0D ec-1 0Feb-1 1A pr-1 1Ju n -1 1A u g-1 1O ct-1 1D ec-1 1Feb-1 2A p r-1 2Ju n -1 2A u g-1 2O ct-1 2D ec-1 2Feb-1 3 BUD LIGHT SMIRNOFF ICE BUDWEISER SMIRNOFF VODKA COORS LIGHT JACK DANIELS CORONA MIKES CAPTAIN ABSOLUT
56. 56. Facebook User Engagement Source: CrowdTangle and Facebook User Photos 0 1000 2000 3000 4000 5000 6000Ju n -0 9S ep-0 9D ec-0 9M ar-1 0Ju n -1 0S ep-1 0D ec-1 0M ar-1 1Ju n -1 1S ep-1 1D ec-1 1M ar-1 2Ju n -1 2S ep-1 2D ec-1 2M ar-1 3 BUD LIGHT SMIRNOFF ICE BUDWEISER SMIRNOFF VODKA COORS LIGHT JACK DANIELS CORONA MIKES CAPTAIN ABSOLUT
57. 57. Facebook User Engagement
58. 58. Behavior and consumption Is there evidence that alcohol promotion in digital media (either specifically branded or not) influences behaviour or increases consumption? Seven documents identified All of them reported primary data; all find in favour of hypothesis that exposure to alcohol marketing in digital media is associated with a greater risk of earlier initiation or more drinking None longitudinal or controlled so direction of causality cannot be established One presents evidence that digital marketing can undermine regulations that restrict traditional (e.g. TV) advertising
59. 59. Promotional methods used What methods of promotional marketing are used, and what are the extent of and trends in their use? 19 studies reporting nature and magnitude of promotional alcohol marketing on digital media These interactions make brands a part of everyday conversations on Facebook and allow [the brands] to become part of the continuous flow of content in the news feeds of their followers. With each interaction, brand content appears in the news feeds of their followers friends.
60. 60. Exposure of specific populations Is there evidence that specific population groups are targeted or attracted? And is there quantitative evidence of their exposure levels? Nine studies were found which gave evidence of high levels of exposure to digital alcohol marketing in certain age groups There is a shortage of direct evidence showing that youth or, particularly, underage consumers are specifically targeted. Brand owners state that they target young adults, and the material they provide is designed to appeal to that age group
61. 61. Marketing code violations Is there evidence of marketing code violations and especially of underage access to alcohol marketing promoted through digital media? Ten papers provided evidence of various forms of code violation. All of these papers give evidence that under-age users are gaining access to alcohol advertising through digital media, in violation of voluntary code provisions Particular platforms are especially problematic, e.g. YouTube Industry innovation and movement of youth audiences across platforms pose challenges for regulation
62. 62. CAMY Survey: Research Questions Research Question 1: What proportion of youth ages 13 to 20 recall being exposed to alcohol promotion on television, radio, in magazines, on billboards or public displays, and on the internet, and how frequently do they recall being exposed? How does this compare with adults ages 21 and older? Research Question 2: What proportion of youth ages 13 to 20 report engagement with alcohol in social media, including viewing, endorsing or liking, sharing, and posting?
63. 63. Recruitment methods Adults: from pre-recruited Internet panel of 50,000 (18+) adults and 3,000 teens (13-17) Panel members invited on average 4 times per month to complete surveys Teens recruited by contacting adults in the panel, securing parental permission Due to brevity of survey (6 Scoring Audit refer to page 19 Midwives Handbook Message: NO alcohol in pregancy Positively reinforce where the mother no longer consumes alcohol
64. 194. 28 week follow up questions 1. Did you read the leaflet Alcohol and Pregnancy Dont Mix? Y/N 2. Before you read the leaflet, did you know that the recommendation is not to drink at all when pregnant? Y/N 3. Did you find the leaflet useful? Y/N 4. If yes in what way was it useful? 5. Do you think this leaflet should be available to all pregnant women? Y/N Any other comments/suggestions?
65. 195. Evaluation Report Pending May 2015 Quantitative Measures: Number of screenings completed Number of brief advice offered Number of follow-up at 28 weeks on the benefits/impact of the same. Number of referrals to specialist services Qualitative measures: Mothers experience: information and advice at 12 weeks follow-up at 28 weeks on the benefits/impact of the same. Consultant/ Midwives experience of training Consultant / Midwives experience of delivery in practise Consultant / Midwives experience of toolkit
66. 196. Master class on Alcohol and Pregnancy 3RD APRIL 2014 M O U NT E R R I G A L HO TE L L E TTE R KE NNY 6. 30 P M 9. 00 P M
67. 197. International Interest in the Pilot Project An Expression of interest has been received from Professor Jane Halliday, PhD Group Leader, Public Health Genetics Genetics Royal Childrens Hospital Australia to share our findings and results.
68. 198. Real investment in our future Our children are our greatest treasure. They are our future. Nelson Mandela
69. 199. Thank you
70. 200. References National Substance Misuse Steering Group Report 2012: RCOG Statement 5 March 2006 UK; Prevalence, predictors and perinatal outcomes of peri-conceptional alcohol exposure- retrospective cohort study in an urban obstetric population in Ireland (2011); Chief Medical officer Guidance; European Charter on Alcohol (1995). Alcohol and Pregnancy: Information for Midwives (No-FAS UK 2004) : BMA 2007; Drug Scope Substance Misuse in Pregnancy ; Alcohol and Pregnancy Patient Information Leaflet (Alcohol Focus Scotland); integrated care pathways Guide 8: Drug Misuse in pregnancy and Reproductive Health) ; www.ichr.uwa.edu.au/alcoholand pregnancy; Babor et al The Alcohol, Use disorders Identification Test Guidelines for Use in Primary Care WHO (2001); Sheehan et al The effectiveness of a Brief Intervention to reduce alcohol consumption in pregnancy: a controlled trail HSE (2013); Children First: National Guidance for the Protection & Welfare of Children (2011) National Institute for Health and Clinical Excellence (2008) Antenatal Guidelines NSW Clinical Guidelines SOAR Model for the Introduction of Screening and Brief Intervention (SBI) for Hazardous Harmful Use of Alcohol in the Emergency Department, HSE 2009
71. 201. Eimear Murphy & Ian OSullivan Alcohol Consumption: Does the Apple fall far from the tree?
72. 202. Alcohol Consumption: Does the apple fall far from the tree? Eimear Murphy & Ian OSullivan
73. 203. Alcohol plays a complex role in Irish society Recent figures from the World Health Organisation (WHO) highlight that the European Region (E.U.) is the heaviest drinking region in the world. Noteworthy the Irish population consume more alcohol when compared to the E.U. average
74. 204. In European countries adolescents report increased levels of alcohol consumption In Ireland, young adults report being drunk more often than those in most other European countries.
75. 205. The majority of individuals typically start using alcohol at some point during adolescence or early adulthood. A number of factors influence this: Peers Societal Parental
76. 206. Previous research on the subject of parent child relationship and alcohol use have found inconclusive or weak evidence. Thus the aim of this current research is to investigate the relationship between parental attitudes and alcohol consumption and adolescent alcohol consumption
77. 207. Methodology Survey Design A cross-sectional survey was undertaken. This involved distributing a questionnaire to a representative sample of second-level students in the Kanturk-Mallow local electorate area.
78. 208. Sampling Our sample consisted of fifth and sixth year students from the Kanturk-Mallow local electorate area. The area has a spread of socioeconomic classes and incomes. The locality contained eight secondary schools all of which were sampled. This gave us a sample size of 982 fifth and sixth year students. We received a response from 360 pupils and their parents. This gave us a response rate of 37%.
79. 209. Questionnaire A number of existing validated instruments were used to create the questionnaire used in this research. Topics included in this survey were: Alcohol use, Self- reported height and weight Smoking status Mental health and well-being
80. 210. Data Analysis The data was entered in an excel document and transferred to IBM SPSS Statistics 20 for statistical analysis. Analysis included descriptive analysis, frequency analysis and binary logistic regression analysis
81. 211. Results Male Female Total Adolescent Gender Male 159 (44.2%) Female 201 (55.8%) Hazardous Drinking Non-Hazardous 96 (60.4%) 141 (70.1%) 237 (65.8%) Hazardous 63 (39.6%) 60 (29.9%) 123 (34.2%) School Year Fifth year 99 (62.3%) 114 (56.7%) 213 (59.2%) Sixth year 60 (37.7%) 87 (43.3%) 147 (40.8%) BMI Categories Normal weight 141 (88.7%) 172 (85.6%) 313 (86.9%) Overweight 15 (9.4%) 20 (10%) 35 (9.7%) Obese 3 (1.9%) 9 (4.5%) 12 (3.3%) Smoked Yes 17 (10.8%) 16 (8%) 33 (9.2%) No 141 (89.2%) 184 (92%) 325 (90.8%) Currently Current Smoker 9 (56.2%) 14 (100%) 23 (66.7%) An ex- smoker 7 (43.8%) 0 (0%) 7 (23.3%) Minimum Maximum Mean Age 15 19 16.89 Well-being Score (/80) 13 80 61.75
82. 212. Parent Father Mother Gender 268 (100%) 339 (100%) Hazardous Drinking Non-Hazardous 134 (50%) 179 (52.8%) Hazardous 134 (50%) 160 (47.2%) Education Status Primary Level 23(6.4%) 9 (2.7%) Second Level 196 (54.6%) 140 (41.3%) Third Level 140 (39%) 190 (56%) Marital Status Single 5 (1.9%) 13 (3.8%) Cohabiting 8 (3%) 13 (3.8%) Married 245 (91.4%) 280 (82.6%) Separated 7 (2.6%) 13 (3.8%) Divorced 2 (0.7%) 10 (2.9%) Widowed 1 (0.4%) 10 (2.9%) Smoked Yes 125 (47%) 156 (46.3%) No 141 (53%) 181 (53.7%) Currently Smoker 38 (29.5%) 50 (31.5%) An ex- smoker 91 (70.5%) 109(68.6%) BMI Category Normal weight 86 (32.1%) 208 (61.4%) Overweight 138 (51.5%) 87 (25.7%) Obese 44 (16.4%) 44 (13%)
83. 213. Fathers attitudes Mothers attitudes Childs drinking pattern Hazardous drinking Non- hazardous drinking p-value Hazardous drinking Non- hazardous drinking p-value Its ok for my adolescent to get drunk sometimes Disagree/Neutral 76 (85.4%) 173 (97.2%) P=