Early Drunkenness – why government in the UK needs to take notice

New research with young people from across Europe and North America suggests that early drunkenness increases the risks for a group of adolescent problem behaviours at the age of 15.

The researchers have examined the results of the Health Behaviours in School aged Children (HBSC) survey giving them a sample of over 40,000 15 year olds from over 38 countries where the young people have had some experience of alcohol.

What they find is a positive correlation between those who had experienced early drunkenness and 5 other risky behaviours – smoking, cannabis use, injuries, fights, and low academic performance.  Interestingly they report that when a child first uses alcohol to the time they are first drunk did not predict problem behaviours – suggesting perhaps that early drunkenness, rather than the first drink itself, should be a concern for prevention practitioners.

This blog looked at the results from the HBSC survey when they were published last year and there were details about the level of drunkenness experienced by young people in Europe.  In the survey young people were asked at what age they first got drunk. The findings presented were for 15-year-olds only and show the proportions who reported first getting drunk at age 13 or younger.

Looking at the results what we see is that the UK has results that should worry our policy makers.

Scotland has the 6th highest level of drunkenness, Wales comes in 8th and England is a place behind in 9th.

HBSC - drunk

It seems to me that it is this sort of data that ought to be driving a proper prevention strategy, and is why across the UK there is a need for a commitment to proper resources for evidence based prevention, and (to be parochial) in England we need:

  • the Department of Health to publish their response to the Children’s Health Outcomes Forum which published their report in July 2012.
  • the DfE to report on their proposals for health education, first announced in November 2010; and
  • NICE to be allowed to finish their guidance on sex and relationship guidance and alcohol education, suspended in May 2010.
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Alcohol Strategy

The government have recently launched a consultation on the plans they have for delivering their alcohol strategy which runs until the 6 February next year.

The consultation is across 5 areas that the government are planning to take action on:

  • A ban on multi-buy promotions in shops and off-licences to reduce excessive alcohol consumption;
  • A review of the mandatory licensing conditions, to ensure that they are sufficiently targeting problems such as irresponsible promotions in pubs and clubs;
  • Health as a new alcohol licensing objective for cumulative impacts so that licensing authorities can consider alcohol related health harms when managing the problems relating to the number of premises in their area;
  • Cutting red tape for responsible businesses to reduce the burden of regulation on responsible businesses while maintaining the integrity of the licensing system; and,
  • Minimum unit pricing, ensuring for the first time that alcohol can only be sold at a sensible and appropriate price.

We will clearly want to respond but I thought it might be useful to provide some global context from which we can draw out the importance of preventative strategies beyond the controls on price and licensing that the government have agreed on.

The World Health Organisation tell us:

  • The harmful use of alcohol results in 2.5 million deaths each year.
  • 320 000 young people between the age of 15 and 29 die from alcohol-related causes, resulting in 9% of all deaths in that age group.

Global youth deaths alcohol - WHOWith such shocking figures it is unsurprising that they have developed a global strategy to reduce the harmful use of alcohol.

The strategy was published in 2010 but it is worth looking at to be able to judge whether the current alcohol national strategies are in line with what was signed up to at the WHO.

The strategy says:

The harmful use of alcohol can be reduced if effective actions are taken by countries to protect their populations. Member States have a primary responsibility for formulating, implementing, monitoring and evaluating public policies to reduce the harmful use of alcohol. Such policies require a wide range of public health-oriented strategies for prevention and treatment.

It also says:

They should also ensure that planning and provision of prevention and treatment strategies and interventions are coordinated with those for other related health conditions with high public health priority such as illicit drug use, mental illness, violence and injuries, cardiovascular diseases, cancer, tuberculosis and HIV/AIDS.

The areas for action at the national level that the WHO draw out are:

  • leadership, awareness and commitment;
  • health services’ response;
  • community action;
  • drink-driving policies and countermeasures;
  • availability of alcohol;
  • marketing of alcoholic beverages;
  • pricing policies;
  • reducing the negative consequences of drinking and alcohol intoxication;
  • reducing the public health impact of illicit alcohol and informally produced alcohol;
  • monitoring and surveillance.

In the section on leadership the strategy calls for governments to coordinate work between different levels of government and with other inter-related strategies.

It is interesting to note that the Chief Medical Officer in England was arguing in her annual report that this balance hasn’t been found between alcohol and drug policies – arguing that alcohol treatment doesn’t receive the same level of resources as drugs.

The WHO also suggest that national governments leadership role includes:

ensuring broad access to information and effective education and public awareness programmes among all levels of society about the full range of alcohol-related harm experienced in the country and the need for, and existence of, effective preventive measures

Whether this includes school programmes isn’t made entirely clear – the document doesn’t include any mention of schools unlike, for example, primary health care or social services.

A nation of boozers and bingers?

 

This paper from the WHO has figures about adult drinking in the UK and other European states.

What I found interesting was that it undercuts the idea that continental drinking culture is a less risky way of dealing with alcohol.

We should also think about whether out conception of ourselves as a heavy drinking nation is a healthy way to represent ourselves, particularly as it sets social norms for our children.

Evidence, which interpretation is better..

Harry Egg by paulhurleyuk
Harry Egg, a photo by paulhurleyuk on Flickr.

The World Health Organisation have just published two report which have different very different interpretations of the state of prevention research.

Writing for the WHO about alcohol in the EU, Peter Anderson, Lars Møller and Gauden Galea have this to say about school-based programmes:

Many systematic reviews have evaluated school-based education and concluded that classroom-based education is not effective in reducing alcohol-related harm (Foxcroft et al., 2003; Jones et al., 2007).

They underplay the positive findings of a later Foxcroft meta review by pointing to the number of reviews that showed no effect, and that it was impossible to tell what the active ingredients were in the trials that did show effect.

So how to square that with the Health Behaviour in School Age Children report from the same organisation that found:

School-based intervention programmes focusing specifically on alcohol use and targeting adolescents and their parents have considerable effects. Generic, psychosocial and developmental, school-based prevention programmes focusing on life skills and a healthy lifestyle in general are also effective and could be considered as policy and practice options.

Last month writing in the Lancet Richard Catalano, director of the University of Washington’s Social Development Research Group said:

Prevention science and the effectiveness of prevention is one of the best-kept secrets in the world.

While the interpretation of the evidence is so wildly different as these WHO’s documents set out it is easy to see why it remains difficult to secure large scale investment in prevention programmes.

Social determinants of health and well-being among young people

memories [explored #50] - photo by Flickr user Manu✰As well as giving us information about substance use by young people the Health Behaviours in School Aged Children survey also gives some very helpful insight into the ’causes of the causes’, to borrow a phrase.

Risk and Protective Factors

These include reflections from young people about how easy it is to talk to their mothers and fathers, their friendships and how often they spend time with them, whether they have a positive relationship with school, and how often they need medical attention as a result of injuries.

As Claire suggested in her piece about parental monitoring having a positive relationship are seen as critical protective factor.  These findings suggest that fathers are seen as less approachable than mothers, and that Scottish parents are less likely to be seen as easy to talk to.

She also noted that knowing where our children are can also protect them from harms.  The WHO survey suggests that young people from the UK spend more time with their friends in the evening than their Western European counterparts, with the exception of the Spanish.

Perhaps just as importantly, it would appear that our children are rapidly turned off school and are amongst the least likely in Europe to describe themselves as enjoying school, and the most likely to describe themselves as feeling pressured by schoolwork.

The survey also looks at the proportions who eat breakfast – not doing so being associated with smoking and alcohol use – and found that, by the time our children are 15 years old, more than 1 in 3 boys and 1 in 2 girls don’t eat breakfast every school day.

Health Behaviour in School Aged Children

Taking The World By Storm - photo by Flickr user JD Hancock
The World Health Organisation have just published the findings from the Health Behaviour in School Aged Children survey, which focuses on the social determinants of health and well-being among young people, including their drug and alcohol use.

The survey has comparable data from young people in England, Wales and Scotland as well as from across Europe.

As you’ll see there are a number of policy reflections that the authors have which are useful collateral for us.

Alcohol

The report says:

School-based intervention programmes focusing specifically  on alcohol use and targeting adolescents and their parents  have considerable effects. Generic, psychosocial and  developmental, school-based prevention programmes  focusing on life skills and a healthy lifestyle in general are  also effective and could be considered as policy and  practice options.

They also report that family interventions are effective in delaying the onset of drinking and reducing the frequency of drinking.

Cannabis

As with alcohol the report is clear that school based prevention programmes can be effective:

Interventions in schools that focus on  increasing drug knowledge, decision-making  skills, self-esteem and resistance to peer  pressure effectively reduce cannabis use.

They also say that Motivational Interviewing has been effective in working with young people who have started to use cannabis.