Proposal Final
Content
CHAPTER 1 THE PROBLEM AND ITS SETTING
INTRODUCTION
The roots of education are bitter but its fruit is sweeter. - Aristotle
The quote reminds us that in our everyday life, not all stages in life are easy. We have to undergo trials in life in order to reach our goals. Some teenagers nowadays don’t like studying – instead, they go out to computer shops and malls or spend their nights drinking with friends. As students, teenagers should work towards becoming a successful individual, but also be able to balance school and a social life at the same time. The teenage years are a transitional stage from childhood to adulthood. It is also thought to be a prime time to test your independence and maturity. According to World Health Organization (WHO) (2013), it is the period of life between 10 and 19 years of age. This is the stage in where you identify your real self, in where you belong and feel comfortable. Teenagers thought to be primary consumer of alcohol in the U.S (Dryden-Edwards, 2014). Kneisl and Trigoboff (2009) states that alcohol is a common accessible substance that has just as much destructive power as any other substance that is abused. According to WHO, alcohol use causes as much death and disability as measles, malaria, tobacco, and illegal drugs. Dryden-Edwards (2014) stated that alcohol is most frequently used by teenagers in the United States. Significant statistics regarding alcohol use in teenagers state that about half of junior high and senior high school students drink alcohol on a monthly basis, and 14% of teens have been intoxicated at least once in the past year. Nearly 8% of teens who drink say they drink at least 5 or more alcoholic drinks in a row. It is also involved in nearly half of all violent deaths. Each
1
year, almost 2000 people under the age of 21 die in a vehicular accidentwhere underage drinking is involved. According to Fuller-Thomson (2013), a study was conducted at Canadian Community Health Survey in where one in every eight teens aged 15–17 binge drank monthly. The odds of alcohol use were higher among males. Unlike male, female prefers to stay home to watch television or study for school. There are several factors that contribute in alcohol use. Schaffer (2011) noted that family is one of the major causes of alcohol use. This includes low level of parental supervision or communication, family conflicts, inconsistent or severe parental discipline, and a family history of alcohol or drug abuse (Dryden-Edwards, 2014). Problems managing impulses, emotional instability, thrill-seeking behaviors, and perceiving the risk of using alcohol to be low can also influence a teenager to become an alcohol user. According to Baer (2009), peer pressure also plays a major influence. There are also factors why teenagers do not drink. Eybergen (2011) stated that strict parents are a factor for alcohol non-users because they were taught about the consequences alcohol has to an individual’s body and health. Others don’t drink because of financial problems and because alcohol is strictly prohibited for teenagers below 18 years old. Alcohol use also affects the behavior of a teenager. Reda (2012) stated that alcohol use can lead to poor academic performance and absenteeism. They are also likely to engage in sexual activities (unprotected sex, sex with stranger, rape). Excess alcohol use will make the person anxious and depressed,which can lead them to drug use or suicide compared to those who are non-users, who are stable. Studies about factors relating to alcohol users and non-users among teenagers are rarely being done. For this reason, we the researchers aim to discover and elaborate on the factors that contribute to alcohol use and non-use in order to prevent negative outcomes among teenage students. In this study, we are may find the respondents cooperative in the discussion about the factors contributing to alcohol use and non-use, and that the gathered information may help the current situation that affects their current behavior towards alcohol use. The cooperation of the respondents can lead to further understanding of the situation in order to promote nursing education. The researchers may also aid the family to gain knowledge, focus, and help their
2
children minimize or prevent alcohol use. The administration of the participating schools can also be made aware of the issues and attitudes regarding alcohol use and non-use among their teenage students; this can help improve their way of interaction and dealing with teenagers. The study may also provide additional information and serve as a baseline data in planning future studies in certain educational processes that may be conducted in order to tend to the needs of teenagers. This increases their knowledge and skills towards the enforcements to be done upon the condition of teenagers. The future researchers may be able to pursue further research regarding the factors contributing to alcohol use and non-use among teenagers.
3
CONCEPTUAL FRAMEWORK The teenage students with alcohol use and non-use are linked on the concept of influence. With the concept, the researchers can have the foundations on comparative study on the factors contributing to use and non-use of alcohol among teenagers. Influence refers to the power to change or affect someone or something or it refers to a person or a thing that affects someone or something in an important way (Merriam-Webster Dictionary, 2012). Influence is defined as “a force one person (the agent) exerts on someone else (the target) to induce a change in the target, including changes in behaviors, opinions, attitudes, goals, needs and values” and “the ability to affect the behavior of others in a particular direction’’ (Hall, 2009). Influence can be with people, things or events. Strength and effectiveness of influence can vary. When an individual is influenced, there is change in the behavior that one person causes, intentionally or unintentionally, as a result of the way the changed individual perceives themselves in relationship to the influencer, other people and society in general. The concept of influence plays a major role in the study because it serves as a main force that could provoke a teenager in using or not using alcohol.
4
PARADIGM OF THE STUDY Intervening Variables Demographic Profile: Age Gender Educational Level Type of School
Independent Factors Attitude towards Use and Non-use of Alcohol in Terms of Contributing Factors: I. Environment II. Problems/Stress III. Peer Pressure IV. Depression V. Lack of Social Support VI. Access to Alcohol VIII. Alcohol Marketing IX. Health Affectation X. Parental Approval XI. Legalization
Dependent Factors
Classification of Alcohol Use and Non-use
Comparative Study on the Factors Contributing to Use and Non-use of Alcohol
Figure 1. Comparative Study on the Factors Contributing to Use and Non-use of Alcohol
5
The paradigm of the study is presented in a Combined Variables Model. The boxes contain the variables namely, the independent factors, intervening factors, dependent factors and its relationship with each other. The box containing the independent factors is the attitude towards use and non-use of alcohol in terms of contributing factors. Independent factors involves; environment, problems/stress, peer pressure, depression, lack of social support, alcohol access, alcohol marketing, health affectation, parental approval and legalization. Intervening factors are composed of factors like demographic data; age, gender, educational level and type of school The second box contains the dependent factors that are the classification of alcohol use and non-use. Under the intervening variables we have the demographic profile that includes the age, gender, educational level and type of school of the respondents. Lastly, the third box corresponds to the output of the study which is the Comparative Study on the Factors Contributing to Use and Non-use of Alcohol.
6
STATEMENT OF THE PROBLEM MAIN PROBLEM The study aims to identify a comparative study on the factors contributing to use and non-use of alcohol. SUB PROBLEMS Specifically, it seeks to answer the following sub problems: 1. How may the respondents’ demographic profile be described as to: a. Age b. Gender c. Educational Level d. Type of School 2. How may the respondents’ classification in terms to alcohol be described as to: a. User b. Non-user 3. What are the respondents’ attitude towards the use and non-use of alcohol in term of the following contributory factors: a. Environment b. Stress/Problems c. Depression d. Lack of Social Support e. Access to Alcohol f. Alcohol Marketing
7
g. Health Affectation h. Parental Approval i. Legalization 3. Is there a significant difference between the respondents’ attitude towards use and nonuse of alcohol in terms of the independent factors? 4. Is there a significant difference between environment and age? 5. Is there a significant difference between stress/ problems and age? 6. Is there a significant difference between depression and age? 7. Is there a significant difference between lack of social support and age? 8. Is there a significant difference between access to alcohol and age? 9. Is there a significant difference between alcohol marketing and age? 10. Is there a significant difference between health affectation and age? 11. Is there a significant difference between parental approval and age? 12. Is there a significant difference between legalization and age? 13. Is there a significant difference between environment and gender? 14. Is there a significant difference between stress/ problems and gender? 15. Is there a significant difference between depression and gender? 16. Is there a significant difference between lack of social support and gender? 17. Is there a significant difference between access to alcohol and gender? 18. Is there a significant difference between alcohol marketing and gender? 19. Is there a significant difference between health affectation and gender?
8
20. Is there a significant difference between parental approval and gender? 21. Is there a significant difference between legalization and gender? 22. Is there a significant difference between environment and educational level? 23. Is there a significant difference between stress/ problems and educational level? 24. Is there a significant difference between depression and educational level? 25. Is there a significant difference between lack of social support and educational level? 26. Is there a significant difference between access to alcohol and educational level? 27. Is there a significant difference between alcohol marketing and educational level? 28. Is there a significant difference between health affectation and educational level? 29. Is there a significant difference between parental approval and educational level? 30. Is there a significant difference between legalization and educational level? 31. Is there a significant difference between environment and type of school? 32. Is there a significant difference between stress/ problems and type of school? 33. Is there a significant difference between depression and type of school? 34. Is there a significant difference between lack of social support type of school? 35. Is there a significant difference between access to alcohol and type of school? 36. Is there a significant difference between alcohol marketing and type of school? 37. Is there a significant difference between health affectation and type of school? 38. Is there a significant difference between parental approval and type of school? 39. Is there a significant difference between legalization and type of school?
9
NULL HYPOTHESES 1. There is no significant difference between environment and age. 2. There is no significant difference between stress/ problems and age. 3. There is no significant difference between depression and age. 4. There is no significant difference between lack of social support and age. 5. There is no significant difference between access to alcohol and age. 6. There is no significant difference between alcohol marketing and age. 7. There is no significant difference between health affectation and age. 8. There is no significant difference between parental approval and age. 9. There is no significant difference between legalization and age. 10. There is no significant difference between environment and gender. 11. There is no significant difference between stress/ problems and gender. 12. There is no significant difference between depression and gender. 13. There is no significant difference between lack of social support and gender. 14. There is no significant difference between access to alcohol and gender. 15. There is no significant difference between alcohol marketing and gender. 16. There is no significant difference between health affectation and gender. 17. There is no significant difference between parental approval and gender. 18. There is no significant difference between legalization and gender. 19. There is no significant difference between environment and educational level. 20. There is no significant difference between stress/ problems and educational level.
10
21. There is no significant difference between depression and educational level. 22. There is no significant difference between lack of social support and educational level. 23. There is no significant difference between access to alcohol and educational level. 24. There is no significant difference between alcohol marketing and educational level. 25. There is no significant difference between health affectation and educational level. 26. There is no significant difference between parental approval and educational level. 27. There is no significant difference between legalization and educational level. 28. There is no significant difference between environment and type of school. 29. There is no significant difference between stress/ problems and type of school. 30. There is no significant difference between depression and type of school. 31. There is no significant difference between lack of social support type of school. 32. There is no significant difference between access to alcohol and type of school. 33. There is no significant difference between alcohol marketing and type of school. 34. There is no significant difference between health affectation and type of school. 35. There is no significant difference between parental approval and type of school. 36. There is no significant difference between legalization and type of school.
11
SCOPE AND DELIMITATIONS The present study will focus on the comparative factors contributing to use and non-use of alcohol among teenagers. The following are involved in the study: age, gender, educational level, and type of school. The respondents of the study will be teenage students attending private and public high school and colleges. The study will be conducted in Angeles City. The represented schools will be chosen through fishbowl technique where in researchers will facilitate discussion with the different representative members of private and public schools, while the respondents themselves will be chosen through a simple random sampling technique where each member has equal probability of being chosen in the study. Students must be between the ages of at least 13 to 19 years old and must be currently enrolled and attending either a private or public high school or college located in Angeles City. The researchers will utilize a letter of permission on obtaining the teenagers who engage in alcohol use.
DEFINITION OF TERMS Alcohol. It is an ethanol especially when considered as the intoxicating agent in fermented and distilled liquors (Merriam-Webster Dictionary 2012). In the present study, it refers to the substance use by the respondents.
Alcohol Use. It is when drinking leads to problems but not physical addiction (http://www.nlm.nih.gov/medlineplus/ency/article/000944.htm). In the present study, it refers to the consumption of the substance alcohol.
Comparative. It is relating to the scientific or historical comparison of different phenomena, institutions, or objects, such as languages, legal systems, or anatomical structures, in
12
an effort to understand their origins or relationships(http://www.thefreedictionary.com/comparative). In the present study, it refers to the degree having a relation or connection to another.
Contribute. It is to give or supply in common with others (Merriam-Webster Dictionary 2012). In the present study, it refers to the significant part that influences the respondents.
Factors. It is a substance that functions in or promotes the function of a particular physiological process or bodily system (Merriam-Webster Dictionary 2012). In the present study, it refers to the number that contributes to the result.
Respondent.It is one who answers in various legal proceedings (Merriam-Webster Dictionary 2012). In the present study, it refers to the one supplying information for a survey.
Teenagers. It is of, being, or relating to people in their teenagers age 13-19 years old (Merriam-Webster Dictionary 2012). In the present study, it refers to the people between 13-19 years old; adolescent.
13
CHAPTER 2 REVIEW RELATED LITERATURE AND STUDIES This chapter provides identification, analysis, and summary of written materials that contain information on the proposed research problem which were taken from published sources such as books, journals, and the internet for the purpose of providing specific insights and perspectives that will facilitate the research process. The theme approach is used to organize and present the related literature, and the chronological approach is used in the presentation of the related studies.
RELATED LITERATURE AGE OF TEENAGERS The teenage years serve as a transition between childhood and young adulthood that mostly described as to the physiologic, psychological, and sociologic changes an individual goes through. There can be a sense of pressure felt by a teenager during this time since they feel they are mature in some aspects but still young in others. During these years, the teenage will go through Erikson’s Theory of Psychosocial Development of identity versus role confusion, where they are left unsure of what kind of person they are and uncertain about what kind of person they can become if they are unable to bring themselves together as a whole. “Teenagers watch adults carefully during this period, searching for good role models with whom they can identify” (Pillitteri, 2010). If a teenager were to be around family and friends who drink alcohol, they are likely to be influenced by those who are close to them and begin to drink as well. Kohlberg’s Theory of Moral Development, specifically the postconventional
development stage, can also appear during this time. Under this stage, a teenager is able to understand the importance of doing the right thing to do (Pillitteri, 2010). If they are told by their parents and family that drinking alcohol is bad, then it would be their response to not consume alcohol because of the sole reason that it is bad for them.
14
GENDER During the teenage years, an individual develops coping mechanisms in order to help deal with the stress and changes happening around them. Between males and females, the coping mechanisms used vary. One of those coping mechanisms that teenagers usually turn to is the use of alcohol. According Hart et al. (2009), males are more likely to drink alcohol than females. “On average, more men than women drink. However, for the 12 to 17 year old age range, more females than males reported drinking” (Payne, Hahn, & Lucas, 2010). For females, it is common for them to connect more with their feelings than males. Being more sensitive to emotional and mental stress, teenage girls tend to turn to alcohol as a means of avoiding problems and relieving stress, while teenage boys see drinking alcohol as a means of socialization (Dailey, 2010).
EDUCATIONAL LEVEL In a study done by researchers at Washington University School of Medicine in St. Louis on male twins, it was seen there is a relationship between substance abuse and educational level. “We can’t say that substance dependence or early substance use causes lower educational achievement, but we do see a strong association” (Grant, 2012). But according to Dryden (2012), there is a direct relationship between substance abuse and educational attainment. Those who began drinking and using drugs at an early age are less likely to finish college than those who do not. Drugs and substance abuse affect many milestones in life such as employment, relationships, and parenthood. These milestones play a vital role in life and could greatly affect an individual’s educational achievement.
EDUCATIONAL SECTOR Alcohol use is an important risk factor for morbidity, mortality, and social harm among 13 to 19 year olds. There is a lack of data on alcohol use among high school students in a public school in Ethiopia. This study aimed to identify the factors associated with alcohol use among high school students in Ethiopia. There is a high level of alcohol use among high school students in this area. The involvement of parents, workers and school authorities are necessary to prevent
15
the problem. Specifically, their involvement in awareness to work in an active way and peer education training are very important to encourage students to avoid alcohol use. Alcohol consumption at a young age increases the risk of developing alcohol-related problems. Among teenagers, drinking exists with other problem behaviors such as poor academic performance and absenteeism which may weaken or damage healthy development(Reda et al, 2012). The consumption of alcoholic drinks by teenagers is a behavior common to different cultures and countries. A study performed in a private school in Europe showed that there are students aged 15 and 16 years old reported using alcohol. Although most teenagers use alcohol, its effect on health depends on the pattern and frequency of use. At the present time, alcohol use among teenagers considered most risky. Alcohol use might vary by socioeconomic status, gender and age. Gender and age differences in alcohol use have been observed and the commonness of both heavy drinking and binge drinking is higher among older and male teenagers. The lack of detailed information on the private school constitutes a significant gap for public policy. The aim of this study is to describe the alcohol use among private teenager students, to evaluate the system of alcohol use according to socioeconomic status, gender and age(Locatelli et al, 2012).
HOME ENVIRONMENT According to Schafer (2011), alcohol and other drug addiction is a growing societal problem that contributes to the destruction of families and communities. Research has identified a strong connection between disrupted family relationships and alcohol and other drug addictions. The family is seen as one of the cause of alcohol use among teenagers, and the family members plays an important role in the lives of the teenagers specially those who are expose to alcohol use. However, others are engaging in alcohol because of the behavior between the family systems, emotional withdrawal, and guilt. A teenager also has an impact of drinking on family roles and social life. This study defines the effects of alcohol use on the teenager and family system.
16
SOCIAL ENVIRONMENT According to Shaw (2010), it includes the culture that the individual was educated or lives in, and the people and institutions with whom they interact. Despite anti-drinking campaigns and education through educational institutions, environmental factors may play a part in alcoholism when a community is threatened by drinking temptations outside the school and home. It can be difficult for people to stay away from bad drinking habits when surrounded by an atmosphere of drinking or drugs in the neighborhood or community. Adults can develop a pattern of drinking in bars and parties within the community that promote drinking and influence the younger generations. Although occasional drinking may be harmless for many people, others can be led to excessive drinking. Drinking is often glamorized in movies, on television and the Internet, and through advertising. Sometimes it may even signal that it is fine to drink in excess, which can have a dramatic impact on everyone, but especially young people who may begin drinking earlier on to imitate the people they see enjoying themselves without the negative consequences. A person predisposed to alcoholism may fall victim to the portrayal of drinking being a big part of a romantic and adventurous life. The teenage years are marked by social activity with much student drinking occurring at small and large parties.The social environment on school campuses and social processes appear to play a critical role in influencing drinking in school life (Baer,2009). Pressure to be active and to do well in school can lead to drinking if a teenager is unable to cope with stress in healthy ways (Bolyn, 2010).
PEERS As an essential part of any teenager’s life, peers can be an influence when it comes to making decisions in an individual’s life. During the transitional period from high school to college, a teenager may feel the need to fit in with those around them as a coping mechanism to the changes going on in their life. Increased involvement with peers can lead to an influence in increased peer pressure. “Prior research has shown that peer influence is one of the most
17
important predictors of alcohol use in adolescence” (Teunissen, 2012).Peer pressure can result in a child drinking at a young age, especially if the main reason is for them to fit in with their group of friends. According to Shaw (2010), peers who consume alcohol may influence a teenager to drink more.Parents can play a role in warning teenagers about alcoholic hazards and using disciplinary measures to prevent problems that develop outside the home. The influence of peers can also be shown through Erikson’s Theory of Psychosocial Development of identity versus role confusion, where a teenager can be left unsure of what kind of person they are if they are able to connect themselves as a whole (Pillitteri, 2010).
TEENAGE ALCOHOL USE Alcoholic beverages are consumed largely for their physiological and psychological effects, but they are often consumed within specific social contexts. Because of the effects that alcohol has on the body and on behavior. Factors that can influences that increase the likelihood alcohol are like Age of onset, Alcohol and drug use tends to begin in mid-to-late adolescence, though it is greater among individuals who experience early puberty. Peers alcohol consumption, Associating alcohol-using peers, or being rejected by peers, can create problem behaviors and influence attitudes and norms related to substance use (O'Connell et al, 2009)Youth access and availability, The majority of alcohol consumed by youth is obtained through social sources, such as parents and friends, at underage parties and at home. Availability of alcohol leads to increased use. Poor school achievement and low school bonding, Adolescents who have a low commitment to school or do poorly are more likely to become alcohol involved (Birckmayer et al., 2010).Parental monitoring, Adolescents who report low parental monitoring are significantly more likely to use a variety of substances (Shillington et al., 2009).
TEENAGE ALCOHOL NON-USE A survey of high school students in the United States shows that three out of four (77 percent) of teenagers do not drink alcohol. According to the September 2013 survey of 695 high
18
school students nationwide, the top reasons why teens choose not to drink is because first, it has an effect on health; second, it can interfere with school especially with grades; third, parents do not approve underage drinking; and lastly, it is illegal. In addition, over half of the teens surveyed said that they would be less likely to be friends with, or date, someone who drinks underage. The respondents of the survey were chosen based on applications showing their dedication to underage drinking prevention in their communities. (Mothers Against Drunk Driving (MAAD) & State Farm, 2013). Protective factors appear to balance and buffer the negative impact of existing risk factors. These factors, such as solid family bonds and the capacity to succeed in school, help safeguard youth from substance abuse (Hawkins et al., 2009).Increasing the availability of protective resources will help to reduce substance abuse and create healthier individuals and communities (O'Connell et al., 2009).
RELATED STUDIES LITERATURE REVIEW: SOCIAL SUPPLY OF ALCOHOL TO MINORS The ability of minors to access alcohol via social sources is an important public health concern; this is because social supply of alcohol is an important source of alcohol for younger drinkers and may be linked to early consumption. This so-called “social supply” refers to any alcohol obtained with permission. One significant issue that concerns most parents/caregivers is the willingness of other adults to provide alcohol to minors. There is growing evidence that the early onset of drinking is associated with the development of alcohol-related problems (Greenaway et al., 2009).
19
TEENAGE DRINKING, ALCOHOL AVAILABILITY, AND PRICING: A CROSS-SECTIONAL STUDY OF RISK AND PROTECTIVE FACTORS FOR ALCOHOL-RELATED HARMS IN SCHOOL CHILDREN According to Bellis et al. (2009), there is a lack of empirical analyses examining how alcohol consumption patterns in teenagers could relate to harm. They have mentioned that misuse of alcohol by teenagers is an international problem that needs immediate attention. In their study, an opportunistic survey of 15-16 year olds (n = 9,833) in North West England was undertaken to determine alcohol consumption patterns, drink types consumed, drinking locations, methods of access and harms encountered. Cost per unit of alcohol was estimated based on a second survey of 29 retail outlets. Associations between demographics, drinking behaviors, alcohol pricing and negative outcomes (public drinking, forgetting things after drinking, violence when drunk and alcohol-related regretted sex) were examined. Their aim is to determine the drinking behaviors of alcohol-consuming 15-16 year olds and their significance with a range of adverse alcohol-related outcomes. The result showed that even low levels of alcohol intake cannot be considered safe for teenagers, violence when drunk and drinking in public places were more common amongst boys, alcohol-related regretted sex and forgetting things after drinking were more commonly reported by girls. Correlation was used to examinewhether intake of lower priced drinks were related to greater percentages of consumers experiencing negative alcohol-related outcomes. Results suggest a strong relationship between consumption of cheaper alcohol products and increased proportions of respondents reporting violence when drunk, alcohol-related regretted sex and drinking in public places.
ALCOHOL
MARKETING
AND
DRUNKENNESS
AMONG
STUDENTS
IN
THE
PHILLIPPINES: FINDINGS FROM THE NATIONALLY REPRESENTATIVE GLOBAL SCHOOL-BASED STUDENT HEALTH SURVEY According to Swahn et al. (2013), there is a high significance between mass media marketing of alcohol and teenage alcoholism and drunkenness in the Philippines. Many alcohol marketing practices are aimed directly to the youth and those that are outside of the home (e.g.,
20
billboards, advertisements at sports events and concerts, buildings, newspapers and magazines, and on the internet) pose particular concerns because parents cannot typically shield their children from these exposures. High prevalence of exposure of minors to different alcohol marketing ads put them at a higher risk of actually consuming alcohol. The aim of their study is to determine the prevalence of alcohol marketing exposure in a nationally representative sample of minors in Philippines and to examine if there are significant relationship between alcohol marketing and drunkenness among Filipino youth. Cross-sectional analyses were used to examine the Global School-based Student Health Survey (GSHS) conducted in Philippines (2011). The self-administered questionnaires were accomplished by students within 13 to 16 years of age (N = 5290). Three statistical models were computed to test the associations between alcohol marketing and alcohol consumption, while controlling for possible confounding factors. The findings in their study highlight the need to put policies into effect that restrict alcohol marketing practices as an important prevention strategy for reducing alcohol use and its dire consequences among vulnerable youth.
EVERYONE SAYS IT’S OK: ADOLESCENTS’ PERCEPTIONS OF PEER, PARENT, AND COMMUNITY ALCOHOL NORMS, ALCOHOL CONSUMPTION, AND ALCOHOL-RELATED CONSEQUENCES According to the study of Eun-Young Song et. al (2012) majority of American adolescents have already taken alcohol, and many report that they have been drunk at least once. Among eighth-grade students in the United States, data from 2008 indicate that 39% ingested alcohol at least once in their lifetime, 16% had an alcoholic drink in the past 30 days, 5% had been drunk in the past 30 days, and less than 1% drank alcohol daily (Johnston, O’Malley, Bachman, & Schulenberg, 2009). Rates are higher among 12th graders, with 72% reporting at least one alcoholic drink during their lifetime, 43% reporting at least one drink in the past 30 days, 28% reporting drunkenness in the past 30 days, and 3% reporting daily use of alcohol (Centers for Disease Control and Prevention, 2008; Johnston et al., 2009). The aim of their study was to examine how peer, parent, and community norms are related to teenage drinking behaviors. The result of their study showed that teenage drinking behaviors are strongly related
21
to ones own perceptions of several sets of inputs: peers, parents, and community. Teenagers who reported attending religious services regularly were less likely to consume alcohol than teenagers who rarely attended religious service. Being older, being male, and being White were each associated with greater likelihood of most drinking behaviors. Adolescents living with both parents had lower odds of DUI or riding with a drinking driver.
ALCOHOL ABSTINENCE AND DRINKING AMONG AFRICAN WOMEN: DATA FROM THE WORLD HEALTH SURVEYS According to the study of Priscilla Martinez et al. (2011), alcohol use is increasing among women in Africa, and comparable information about women’scurrent alcohol use is needed to inform national and international health policies relevant to the entire population.This study aimed to provide a comparative description of alcohol use among women across 20 African countries. Data were collected as part of the WHO World Health Survey using standardized questionnaires. In total 40,739 adult women were included in the present study. Alcohol measures included lifetime abstinence, current use (≥1 drink in previous week), heavy drinking (15+ drinks in the previous week) and risky single-occasion drinking (5+ drinks on at least one day in the previous week). Country-specific descriptions of alcohol use were calculated, and Kmeans clustering was performed to find countries with similar characteristics. A total of 33,841 (81%) African women reported lifetime abstinence. Current use ranged from 1% in Malawi to 30% in Burkina Faso. Among current drinkers, heavy drinking varied between 4% in Ghana to 41% in Chad, and risky single-occasion drinking ranged from <1% in Mauritius to 58% in Chad. Increasing age was associated with increased odds of being a current drinker in about half of the countries.A variety of drinking patterns are present among African women with lifetime abstention the most common. Countries with hazardous consumption patterns require serious attention to mitigate alcohol-related harm. Some similarities in factors related to alcohol use can be identified between different African countries,although these are limited and highlight the contextual diversity of female drinking in Africa.
22
SIMILARITIES AND DIFFERENCES OF THE PRESENT STUDY AND PREVIOUS STUDIES The previous studies relating to alcohol use among teenagers focus more on the social influences and easy accessibility to alcohol. When it comes to studies relating to alcohol use, the main topic at hand is related to older respondents and their alcohol consumption, which may be related to alcoholism. For the present study, the researchers have decided to focus on a younger age group. Researches are usually being done in every state in the United States, whereas in the Philippines, researches are usually done in Manila. Also in the present study, the research locale is Angeles City, a setting in which a study on alcohol use among teenagers has not yet been done. Previous studies have also neglected to study the factors that contribute the non-use of alcohol among teenagers, whereas the present study explores those factors and then compares them to the factors that contribute to the use of alcohol.
23
CHAPTER 3 RESEARCH METHODS AND PROCEDURES This chapter provides the research method and procedure that will be used by the researchers in the present study. It serves as the overall plan that tells how the researchers will collect and analyze the data in order to answer the research problem. Contained in this chapter are the research design, research locale, respondents of the study, instruments, procedure, and statistical treatment of the data.
RESEARCH DESIGN The researcher will use a comparative descriptive research design a type of research design. This design is utilized to compare two or more groups that occur naturally in a setting and describe and observe a certain phenomenon as they naturally occur. There will be no manipulation on the independent variables for they have already occurred. The study examines variables in a situation that has already occurred or currently occurring. A comparative descriptive research design will be used to compare the relationship of factors contributing to use and non-use of alcohol among teenagers.
RESEARCH LOCALE The researchers will conduct the study on students in selected public or private high schools or colleges located in Angeles City. This location is chosen by the researchers because of certain environmental factors including the presence of nightlife establishments and due to the accessibility and proximity of nightclubs or bars.
24
RESPONDENTS The chosen respondents of the study will be students attending either a private or publichigh school or college in Angeles City. The schools will be selected through fish bowl technique, while the students will be selected through simple random sampling technique. The respondents must meet the following criteria: age 13-19 years old and currently attending a private or public high school or college in Angeles City. The researchers will orient the respondents as to their role in the study and will be given ample time to answer the questionnaire. The researchers will inform the respondents that the gathered data will be kept confidential to ensure the reliability of the data to be gathered.
INSTRUMENTS This section contains the detail description of the uses and content of tools or technique for data collection. The researchers will use a fishbowl technique in the selection of schools and they will use simple random sampling technique for the respondents. In conducting the study,the researchers will utilize a pre-survey in using a questionnaire in gathering data in order to obtain information needed. The type of questionnaire use is classified as under semi-structured type that is using of a topic guides to the respondents. The first part of questionnaire will require filling up with the respondents of the personal data such as name, age, gender, and educational level. The second part will contain the statements wherein the respondents are identifying factors in use and non-using alcohol. And lastly, they are using a Guttman scale in order to analyze and shows the responses of all the respondents on all of the items. In order to validate an instrument, the researchers use a face and content validation. According to (Polit and Beck, 2012), Face validity refers to measuring the target construct and it is evaluate technicalities such as grammar teacher and appropriate word to use. While content validity is adequacy of coverage of content area being measure include expert or professional
25
etc. As a process, validation involves collecting and analyzing data to assess the accuracy of an instrument.
PROCEDURE PHASE 1: In this phase the researchers identified the different problems in the community of Angeles City. Each of the group shared their insights of the different problems they observed. Different titles were identified and presented to the group and decided to pick the most interesting and applicable in the community of Angeles City.
PHASE 2: After they identified the topic, the researchers gathered related studies and related literature in the university library of Angeles University Foundation. The researchers found books and journals that are related with the study. Elton B. Stephens Company, also known as EBSCO, was also utilized in searching for related studies that were needed regarding the present study. Then the researchers decided to have their research locale in Angeles City, Specifically public and private high schools and colleges within the said locale.
PHASE 3: After identifying the research locale, the researchers will prepare for the tools needed in the study. The researchers decided to have a pilot study on selected schools in Angeles City. The researchers will conduct a pre-survey to test the validity of the tool prior to having the actual study. The responses made by the students from the pre-survey will be used in the composition of questionnaire. The tool will be validated by a grammar teacher, statistician, and a psychometrician.
26
PHASE 4: This phase will be about how the researchers are to gather their respondents. The researchers will use fish bowl technique in selecting the private and public high schools and colleges, and then will use simple random sampling in getting their respondents.
PHASE 5: Prior to the gathering of data, the researchers will send a letter of approval to the selected schools and colleges in the locale. After being granted approval, the researchers will go to the selected high schools and colleges to conduct the actual study. The questionnaire will be distributed to the respondents.
PHASE 6: After gathering all of the necessary data, the researchers will ensure that all collected data will be kept confidential. The collected data will be interpreted and compared as to which factors contribute to use and non-use of alcohol among teenagers in Angeles City.
STATISTICAL TREATMENT OF DATA The data that will be gathered from the questionnaire will be tallied and subjected to an appropriate statistical method to answer questions that will be presented in Chapter I. The questionnaire is answerable by checking the box below the scale based on their response. Upon getting all the data, the researchers will compute the mean to determine the average of the respondents regarding their alcohol use and non-use as teenagers attending school in Angeles City. Each item of the questionnaire will be based on a five point scale.
27
SLOVIN’S FORMULA The researchers will use Slovin’s formula to figure out the sample size of the population of the respondents.
Where: n = Number of samples e = Error margin N = Total population
FREQUENCY DISTRIBUTION Frequency distribution is used to organize numeric data. A frequency distribution is a systemic arrangement of values from lowest to highest, together with a count of the number of times each value was obtained. (Polit & Beck 2012).
Where:
f = frequency in each class of category N = total number of responses
28
PERCENTAGE DISTRIBUTION It is usually useful to display percentages for each value. Just as the sum of all frequencies should equal N, the sum of all percentages should equal 100 (Polit & Beck 2012).
Where:
f = frequency in each class category N= total number of responses %= Percentage frequency
a. Cumulative relative frequency b. Divide the cumulative frequency by N and multiply by 100.
GUTTMAN SCALE The researchers will use Guttman scale in making statements for the questionnaires that will be answered by the selected respondents. The Guttman scale measures to what degree a person has a positive or negative attitude to something. It makes use of a series of statements that are growing or descending in how positive or negative a person is towards the subject. If for instance on a scale with seven statements the respondent agrees with the fifth statement, it implies that he or she also agrees with the first four statements, but not with statement number six and seven.
29
CHI-SQUARE TEST The chi-square statistic is computed by comparing observed frequencies and expected frequencies. It enables the researcher to decide whether a difference in proportions of this magnitude is likely to reflect to a real treatment effect or only chance fluctuations (Polit & Beck 2012).
30
REFERENCES
Baer, J. (2009). High-risk drinking in college: What we know and what we need to learn. Retrieved from http://www.collegedrinkingprevention.gov/niaaacollegematerials/panel01/highrisk_05.as px Bolyn, M. (2010, March 23). What are the causes of teenage drinking?. Retrieved from http://www.livestrong.com/article/96232-causes-teenage-drinking/ Birckmayer, JD, Holder, HD, Yacoubian, GS, & Friend, KB. (2010). A general causal model to guide alcohol, tobacco, and illicit drug prevention: Assessing the research evidence. Journal of Drug Education, 34(2), 121-153. Dailey, K. (2010, June 29). Report shows teen girls are drinking more than boys, for different reasons. Retrieved from http://www.foodhealthnews.com/2010/07/report-shows-teengirls-are-drinking-more-than-boys-for-different-reasons/ Dryden-Edwards, R. (2013, December 10). Alcohol and teens. Retrieved from http://www.medicinenet.com/alcohol_and_teens/article.htm Gardner, A. (2012, August 22). Many teens drinking, taking drugs during school: survey. Retrieved from http://health.usnews.com/health-news/news/articles/2012/08/22/manyteens-drinking-taking-drugs-during-school-survey Giskes, K., et al. Individual and household-level socioeconomic position is associated with harmful alcohol consumption behaviours among adults. Australian and New Zealand Journal of Public Health, 2011, 35(3), 270-277. Grant, J. D. (2012, May 17). Early drug and alcohol use associated with lower levels of educational attainment. Retrieved from http://www.news-
31
medical.net/news/20120517/Early-drug-and-alcohol-use-associated-with-lower-levels-ofeducational-attainment.aspx Greenaway, S., Huckle, T., Casswell, S., & Jelley, S. (2009). Literature review: social supply of alcohol to minors. (Master's thesis, Massey University, Auckland)Retrieved from http://www.ahw.org.nz/resources/Research/Social Supply Literature Review FINAL.pdf Hall, Anita (2009). The bases of social power. In D. Cartwright (Ed.), Studies in social power (7th ed.). Ann Arbor: University of Michigan, Institute for Social Research. Hart, C. L., Ksir, C., & Ray, O. (2009). Drugs, society, and human behavior. (13th ed., pp. 205206). New York, NY: McGraw-Hill. Hawkins, J. D., M. W. Arthur, et al. (2009). Preventing substance abuse From Building a Safer Society: Strategic Approaches to Crime Prevention, Volume 19, P 343-427, 2009, Michael Tonry & David P Farrington, eds. United States
Locatelli, D. (2012). Socioeconomic influences on alcohol use patterns among private school students in são paulo. (2 ed., Vol. 34). São Paulo, Brazil: Retrieved from http://www.scielo.br/scielo.php?pid=S1516-44462012000200012&script=sci_arttext Manalo, P. (2010, August 18). Why teenagers are addicted to alcohol use. Retrieved from http://www.parenthood360.com/index.php/why-are-teenagers-addicted-to-alcohol-use8571/ Martinez et al. Alcohol abstinence and drinking among African women: data from the World Health Surveys. BMC Public Health 2011, 11:160. Retrieved from
http://www.biomedcentral.com/1471-2458/11/160 Mothers Against Drunk Driving. (2013, October 21). Most teens don’t drink alcohol, according to red ribbon week survey by madd and state farm. Retrieved from http://www.madd.org/media-center/press-releases/2013/most-teens-dont-drink.html
32
O'Connell, M. E., Boat, T., & Warner, K. E., Eds. (2009). Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth and Young Adults, Institute of Medicine. Washington, DC: National Academies Press. Payne, W., Hahn, D., & Lucas, E. (2010). Understanding your health. (11th ed., Vol. 1, pp. 212229). Pillitteri, A. (2010). Maternal & child health nursing. (6 ed., Vol. 2, pp. 796-804). Philadelphia, PA: Lippincott Williams & Wilkins. Reda, A. (2012). Alcohol drinking patterns among high school students in ethiopia: a crosssectional study. Ethiopia: Retrieved from http://www.biomedcentral.com/14712458/12/213 Schafer, G. (2011). Family functioning in families with alcohol and other drug addiction. (37 ed.). DOI: file:///C:/Users/phillip/Desktop/Family functioning in families with alcohol and other drug addiction - Ministry of Social Development.htm Shaw, J. (2010). Environment factors of alcoholism. Livestrong.com. Retrieved from http://www.livestrong.com/article/89758-environmental-factors-alcoholism/ Shillington, A. M., S. Lehman, et al. (2009). Parental monitoring: Can it continue to be protective among high-risk adolescents? Journal of Child & Adolescent Substance Abuse, 15(1), 1-15. Teunissen, H. (2012, April 16). Peers influence adolescent drinking, but not always how you might expect. Retrieved from http://www.eurekalert.org/pub_releases/2012-04/acepia040812.php
33
INTRODUCTION
The roots of education are bitter but its fruit is sweeter. - Aristotle
The quote reminds us that in our everyday life, not all stages in life are easy. We have to undergo trials in life in order to reach our goals. Some teenagers nowadays don’t like studying – instead, they go out to computer shops and malls or spend their nights drinking with friends. As students, teenagers should work towards becoming a successful individual, but also be able to balance school and a social life at the same time. The teenage years are a transitional stage from childhood to adulthood. It is also thought to be a prime time to test your independence and maturity. According to World Health Organization (WHO) (2013), it is the period of life between 10 and 19 years of age. This is the stage in where you identify your real self, in where you belong and feel comfortable. Teenagers thought to be primary consumer of alcohol in the U.S (Dryden-Edwards, 2014). Kneisl and Trigoboff (2009) states that alcohol is a common accessible substance that has just as much destructive power as any other substance that is abused. According to WHO, alcohol use causes as much death and disability as measles, malaria, tobacco, and illegal drugs. Dryden-Edwards (2014) stated that alcohol is most frequently used by teenagers in the United States. Significant statistics regarding alcohol use in teenagers state that about half of junior high and senior high school students drink alcohol on a monthly basis, and 14% of teens have been intoxicated at least once in the past year. Nearly 8% of teens who drink say they drink at least 5 or more alcoholic drinks in a row. It is also involved in nearly half of all violent deaths. Each
1
year, almost 2000 people under the age of 21 die in a vehicular accidentwhere underage drinking is involved. According to Fuller-Thomson (2013), a study was conducted at Canadian Community Health Survey in where one in every eight teens aged 15–17 binge drank monthly. The odds of alcohol use were higher among males. Unlike male, female prefers to stay home to watch television or study for school. There are several factors that contribute in alcohol use. Schaffer (2011) noted that family is one of the major causes of alcohol use. This includes low level of parental supervision or communication, family conflicts, inconsistent or severe parental discipline, and a family history of alcohol or drug abuse (Dryden-Edwards, 2014). Problems managing impulses, emotional instability, thrill-seeking behaviors, and perceiving the risk of using alcohol to be low can also influence a teenager to become an alcohol user. According to Baer (2009), peer pressure also plays a major influence. There are also factors why teenagers do not drink. Eybergen (2011) stated that strict parents are a factor for alcohol non-users because they were taught about the consequences alcohol has to an individual’s body and health. Others don’t drink because of financial problems and because alcohol is strictly prohibited for teenagers below 18 years old. Alcohol use also affects the behavior of a teenager. Reda (2012) stated that alcohol use can lead to poor academic performance and absenteeism. They are also likely to engage in sexual activities (unprotected sex, sex with stranger, rape). Excess alcohol use will make the person anxious and depressed,which can lead them to drug use or suicide compared to those who are non-users, who are stable. Studies about factors relating to alcohol users and non-users among teenagers are rarely being done. For this reason, we the researchers aim to discover and elaborate on the factors that contribute to alcohol use and non-use in order to prevent negative outcomes among teenage students. In this study, we are may find the respondents cooperative in the discussion about the factors contributing to alcohol use and non-use, and that the gathered information may help the current situation that affects their current behavior towards alcohol use. The cooperation of the respondents can lead to further understanding of the situation in order to promote nursing education. The researchers may also aid the family to gain knowledge, focus, and help their
2
children minimize or prevent alcohol use. The administration of the participating schools can also be made aware of the issues and attitudes regarding alcohol use and non-use among their teenage students; this can help improve their way of interaction and dealing with teenagers. The study may also provide additional information and serve as a baseline data in planning future studies in certain educational processes that may be conducted in order to tend to the needs of teenagers. This increases their knowledge and skills towards the enforcements to be done upon the condition of teenagers. The future researchers may be able to pursue further research regarding the factors contributing to alcohol use and non-use among teenagers.
3
CONCEPTUAL FRAMEWORK The teenage students with alcohol use and non-use are linked on the concept of influence. With the concept, the researchers can have the foundations on comparative study on the factors contributing to use and non-use of alcohol among teenagers. Influence refers to the power to change or affect someone or something or it refers to a person or a thing that affects someone or something in an important way (Merriam-Webster Dictionary, 2012). Influence is defined as “a force one person (the agent) exerts on someone else (the target) to induce a change in the target, including changes in behaviors, opinions, attitudes, goals, needs and values” and “the ability to affect the behavior of others in a particular direction’’ (Hall, 2009). Influence can be with people, things or events. Strength and effectiveness of influence can vary. When an individual is influenced, there is change in the behavior that one person causes, intentionally or unintentionally, as a result of the way the changed individual perceives themselves in relationship to the influencer, other people and society in general. The concept of influence plays a major role in the study because it serves as a main force that could provoke a teenager in using or not using alcohol.
4
PARADIGM OF THE STUDY Intervening Variables Demographic Profile: Age Gender Educational Level Type of School
Independent Factors Attitude towards Use and Non-use of Alcohol in Terms of Contributing Factors: I. Environment II. Problems/Stress III. Peer Pressure IV. Depression V. Lack of Social Support VI. Access to Alcohol VIII. Alcohol Marketing IX. Health Affectation X. Parental Approval XI. Legalization
Dependent Factors
Classification of Alcohol Use and Non-use
Comparative Study on the Factors Contributing to Use and Non-use of Alcohol
Figure 1. Comparative Study on the Factors Contributing to Use and Non-use of Alcohol
5
The paradigm of the study is presented in a Combined Variables Model. The boxes contain the variables namely, the independent factors, intervening factors, dependent factors and its relationship with each other. The box containing the independent factors is the attitude towards use and non-use of alcohol in terms of contributing factors. Independent factors involves; environment, problems/stress, peer pressure, depression, lack of social support, alcohol access, alcohol marketing, health affectation, parental approval and legalization. Intervening factors are composed of factors like demographic data; age, gender, educational level and type of school The second box contains the dependent factors that are the classification of alcohol use and non-use. Under the intervening variables we have the demographic profile that includes the age, gender, educational level and type of school of the respondents. Lastly, the third box corresponds to the output of the study which is the Comparative Study on the Factors Contributing to Use and Non-use of Alcohol.
6
STATEMENT OF THE PROBLEM MAIN PROBLEM The study aims to identify a comparative study on the factors contributing to use and non-use of alcohol. SUB PROBLEMS Specifically, it seeks to answer the following sub problems: 1. How may the respondents’ demographic profile be described as to: a. Age b. Gender c. Educational Level d. Type of School 2. How may the respondents’ classification in terms to alcohol be described as to: a. User b. Non-user 3. What are the respondents’ attitude towards the use and non-use of alcohol in term of the following contributory factors: a. Environment b. Stress/Problems c. Depression d. Lack of Social Support e. Access to Alcohol f. Alcohol Marketing
7
g. Health Affectation h. Parental Approval i. Legalization 3. Is there a significant difference between the respondents’ attitude towards use and nonuse of alcohol in terms of the independent factors? 4. Is there a significant difference between environment and age? 5. Is there a significant difference between stress/ problems and age? 6. Is there a significant difference between depression and age? 7. Is there a significant difference between lack of social support and age? 8. Is there a significant difference between access to alcohol and age? 9. Is there a significant difference between alcohol marketing and age? 10. Is there a significant difference between health affectation and age? 11. Is there a significant difference between parental approval and age? 12. Is there a significant difference between legalization and age? 13. Is there a significant difference between environment and gender? 14. Is there a significant difference between stress/ problems and gender? 15. Is there a significant difference between depression and gender? 16. Is there a significant difference between lack of social support and gender? 17. Is there a significant difference between access to alcohol and gender? 18. Is there a significant difference between alcohol marketing and gender? 19. Is there a significant difference between health affectation and gender?
8
20. Is there a significant difference between parental approval and gender? 21. Is there a significant difference between legalization and gender? 22. Is there a significant difference between environment and educational level? 23. Is there a significant difference between stress/ problems and educational level? 24. Is there a significant difference between depression and educational level? 25. Is there a significant difference between lack of social support and educational level? 26. Is there a significant difference between access to alcohol and educational level? 27. Is there a significant difference between alcohol marketing and educational level? 28. Is there a significant difference between health affectation and educational level? 29. Is there a significant difference between parental approval and educational level? 30. Is there a significant difference between legalization and educational level? 31. Is there a significant difference between environment and type of school? 32. Is there a significant difference between stress/ problems and type of school? 33. Is there a significant difference between depression and type of school? 34. Is there a significant difference between lack of social support type of school? 35. Is there a significant difference between access to alcohol and type of school? 36. Is there a significant difference between alcohol marketing and type of school? 37. Is there a significant difference between health affectation and type of school? 38. Is there a significant difference between parental approval and type of school? 39. Is there a significant difference between legalization and type of school?
9
NULL HYPOTHESES 1. There is no significant difference between environment and age. 2. There is no significant difference between stress/ problems and age. 3. There is no significant difference between depression and age. 4. There is no significant difference between lack of social support and age. 5. There is no significant difference between access to alcohol and age. 6. There is no significant difference between alcohol marketing and age. 7. There is no significant difference between health affectation and age. 8. There is no significant difference between parental approval and age. 9. There is no significant difference between legalization and age. 10. There is no significant difference between environment and gender. 11. There is no significant difference between stress/ problems and gender. 12. There is no significant difference between depression and gender. 13. There is no significant difference between lack of social support and gender. 14. There is no significant difference between access to alcohol and gender. 15. There is no significant difference between alcohol marketing and gender. 16. There is no significant difference between health affectation and gender. 17. There is no significant difference between parental approval and gender. 18. There is no significant difference between legalization and gender. 19. There is no significant difference between environment and educational level. 20. There is no significant difference between stress/ problems and educational level.
10
21. There is no significant difference between depression and educational level. 22. There is no significant difference between lack of social support and educational level. 23. There is no significant difference between access to alcohol and educational level. 24. There is no significant difference between alcohol marketing and educational level. 25. There is no significant difference between health affectation and educational level. 26. There is no significant difference between parental approval and educational level. 27. There is no significant difference between legalization and educational level. 28. There is no significant difference between environment and type of school. 29. There is no significant difference between stress/ problems and type of school. 30. There is no significant difference between depression and type of school. 31. There is no significant difference between lack of social support type of school. 32. There is no significant difference between access to alcohol and type of school. 33. There is no significant difference between alcohol marketing and type of school. 34. There is no significant difference between health affectation and type of school. 35. There is no significant difference between parental approval and type of school. 36. There is no significant difference between legalization and type of school.
11
SCOPE AND DELIMITATIONS The present study will focus on the comparative factors contributing to use and non-use of alcohol among teenagers. The following are involved in the study: age, gender, educational level, and type of school. The respondents of the study will be teenage students attending private and public high school and colleges. The study will be conducted in Angeles City. The represented schools will be chosen through fishbowl technique where in researchers will facilitate discussion with the different representative members of private and public schools, while the respondents themselves will be chosen through a simple random sampling technique where each member has equal probability of being chosen in the study. Students must be between the ages of at least 13 to 19 years old and must be currently enrolled and attending either a private or public high school or college located in Angeles City. The researchers will utilize a letter of permission on obtaining the teenagers who engage in alcohol use.
DEFINITION OF TERMS Alcohol. It is an ethanol especially when considered as the intoxicating agent in fermented and distilled liquors (Merriam-Webster Dictionary 2012). In the present study, it refers to the substance use by the respondents.
Alcohol Use. It is when drinking leads to problems but not physical addiction (http://www.nlm.nih.gov/medlineplus/ency/article/000944.htm). In the present study, it refers to the consumption of the substance alcohol.
Comparative. It is relating to the scientific or historical comparison of different phenomena, institutions, or objects, such as languages, legal systems, or anatomical structures, in
12
an effort to understand their origins or relationships(http://www.thefreedictionary.com/comparative). In the present study, it refers to the degree having a relation or connection to another.
Contribute. It is to give or supply in common with others (Merriam-Webster Dictionary 2012). In the present study, it refers to the significant part that influences the respondents.
Factors. It is a substance that functions in or promotes the function of a particular physiological process or bodily system (Merriam-Webster Dictionary 2012). In the present study, it refers to the number that contributes to the result.
Respondent.It is one who answers in various legal proceedings (Merriam-Webster Dictionary 2012). In the present study, it refers to the one supplying information for a survey.
Teenagers. It is of, being, or relating to people in their teenagers age 13-19 years old (Merriam-Webster Dictionary 2012). In the present study, it refers to the people between 13-19 years old; adolescent.
13
CHAPTER 2 REVIEW RELATED LITERATURE AND STUDIES This chapter provides identification, analysis, and summary of written materials that contain information on the proposed research problem which were taken from published sources such as books, journals, and the internet for the purpose of providing specific insights and perspectives that will facilitate the research process. The theme approach is used to organize and present the related literature, and the chronological approach is used in the presentation of the related studies.
RELATED LITERATURE AGE OF TEENAGERS The teenage years serve as a transition between childhood and young adulthood that mostly described as to the physiologic, psychological, and sociologic changes an individual goes through. There can be a sense of pressure felt by a teenager during this time since they feel they are mature in some aspects but still young in others. During these years, the teenage will go through Erikson’s Theory of Psychosocial Development of identity versus role confusion, where they are left unsure of what kind of person they are and uncertain about what kind of person they can become if they are unable to bring themselves together as a whole. “Teenagers watch adults carefully during this period, searching for good role models with whom they can identify” (Pillitteri, 2010). If a teenager were to be around family and friends who drink alcohol, they are likely to be influenced by those who are close to them and begin to drink as well. Kohlberg’s Theory of Moral Development, specifically the postconventional
development stage, can also appear during this time. Under this stage, a teenager is able to understand the importance of doing the right thing to do (Pillitteri, 2010). If they are told by their parents and family that drinking alcohol is bad, then it would be their response to not consume alcohol because of the sole reason that it is bad for them.
14
GENDER During the teenage years, an individual develops coping mechanisms in order to help deal with the stress and changes happening around them. Between males and females, the coping mechanisms used vary. One of those coping mechanisms that teenagers usually turn to is the use of alcohol. According Hart et al. (2009), males are more likely to drink alcohol than females. “On average, more men than women drink. However, for the 12 to 17 year old age range, more females than males reported drinking” (Payne, Hahn, & Lucas, 2010). For females, it is common for them to connect more with their feelings than males. Being more sensitive to emotional and mental stress, teenage girls tend to turn to alcohol as a means of avoiding problems and relieving stress, while teenage boys see drinking alcohol as a means of socialization (Dailey, 2010).
EDUCATIONAL LEVEL In a study done by researchers at Washington University School of Medicine in St. Louis on male twins, it was seen there is a relationship between substance abuse and educational level. “We can’t say that substance dependence or early substance use causes lower educational achievement, but we do see a strong association” (Grant, 2012). But according to Dryden (2012), there is a direct relationship between substance abuse and educational attainment. Those who began drinking and using drugs at an early age are less likely to finish college than those who do not. Drugs and substance abuse affect many milestones in life such as employment, relationships, and parenthood. These milestones play a vital role in life and could greatly affect an individual’s educational achievement.
EDUCATIONAL SECTOR Alcohol use is an important risk factor for morbidity, mortality, and social harm among 13 to 19 year olds. There is a lack of data on alcohol use among high school students in a public school in Ethiopia. This study aimed to identify the factors associated with alcohol use among high school students in Ethiopia. There is a high level of alcohol use among high school students in this area. The involvement of parents, workers and school authorities are necessary to prevent
15
the problem. Specifically, their involvement in awareness to work in an active way and peer education training are very important to encourage students to avoid alcohol use. Alcohol consumption at a young age increases the risk of developing alcohol-related problems. Among teenagers, drinking exists with other problem behaviors such as poor academic performance and absenteeism which may weaken or damage healthy development(Reda et al, 2012). The consumption of alcoholic drinks by teenagers is a behavior common to different cultures and countries. A study performed in a private school in Europe showed that there are students aged 15 and 16 years old reported using alcohol. Although most teenagers use alcohol, its effect on health depends on the pattern and frequency of use. At the present time, alcohol use among teenagers considered most risky. Alcohol use might vary by socioeconomic status, gender and age. Gender and age differences in alcohol use have been observed and the commonness of both heavy drinking and binge drinking is higher among older and male teenagers. The lack of detailed information on the private school constitutes a significant gap for public policy. The aim of this study is to describe the alcohol use among private teenager students, to evaluate the system of alcohol use according to socioeconomic status, gender and age(Locatelli et al, 2012).
HOME ENVIRONMENT According to Schafer (2011), alcohol and other drug addiction is a growing societal problem that contributes to the destruction of families and communities. Research has identified a strong connection between disrupted family relationships and alcohol and other drug addictions. The family is seen as one of the cause of alcohol use among teenagers, and the family members plays an important role in the lives of the teenagers specially those who are expose to alcohol use. However, others are engaging in alcohol because of the behavior between the family systems, emotional withdrawal, and guilt. A teenager also has an impact of drinking on family roles and social life. This study defines the effects of alcohol use on the teenager and family system.
16
SOCIAL ENVIRONMENT According to Shaw (2010), it includes the culture that the individual was educated or lives in, and the people and institutions with whom they interact. Despite anti-drinking campaigns and education through educational institutions, environmental factors may play a part in alcoholism when a community is threatened by drinking temptations outside the school and home. It can be difficult for people to stay away from bad drinking habits when surrounded by an atmosphere of drinking or drugs in the neighborhood or community. Adults can develop a pattern of drinking in bars and parties within the community that promote drinking and influence the younger generations. Although occasional drinking may be harmless for many people, others can be led to excessive drinking. Drinking is often glamorized in movies, on television and the Internet, and through advertising. Sometimes it may even signal that it is fine to drink in excess, which can have a dramatic impact on everyone, but especially young people who may begin drinking earlier on to imitate the people they see enjoying themselves without the negative consequences. A person predisposed to alcoholism may fall victim to the portrayal of drinking being a big part of a romantic and adventurous life. The teenage years are marked by social activity with much student drinking occurring at small and large parties.The social environment on school campuses and social processes appear to play a critical role in influencing drinking in school life (Baer,2009). Pressure to be active and to do well in school can lead to drinking if a teenager is unable to cope with stress in healthy ways (Bolyn, 2010).
PEERS As an essential part of any teenager’s life, peers can be an influence when it comes to making decisions in an individual’s life. During the transitional period from high school to college, a teenager may feel the need to fit in with those around them as a coping mechanism to the changes going on in their life. Increased involvement with peers can lead to an influence in increased peer pressure. “Prior research has shown that peer influence is one of the most
17
important predictors of alcohol use in adolescence” (Teunissen, 2012).Peer pressure can result in a child drinking at a young age, especially if the main reason is for them to fit in with their group of friends. According to Shaw (2010), peers who consume alcohol may influence a teenager to drink more.Parents can play a role in warning teenagers about alcoholic hazards and using disciplinary measures to prevent problems that develop outside the home. The influence of peers can also be shown through Erikson’s Theory of Psychosocial Development of identity versus role confusion, where a teenager can be left unsure of what kind of person they are if they are able to connect themselves as a whole (Pillitteri, 2010).
TEENAGE ALCOHOL USE Alcoholic beverages are consumed largely for their physiological and psychological effects, but they are often consumed within specific social contexts. Because of the effects that alcohol has on the body and on behavior. Factors that can influences that increase the likelihood alcohol are like Age of onset, Alcohol and drug use tends to begin in mid-to-late adolescence, though it is greater among individuals who experience early puberty. Peers alcohol consumption, Associating alcohol-using peers, or being rejected by peers, can create problem behaviors and influence attitudes and norms related to substance use (O'Connell et al, 2009)Youth access and availability, The majority of alcohol consumed by youth is obtained through social sources, such as parents and friends, at underage parties and at home. Availability of alcohol leads to increased use. Poor school achievement and low school bonding, Adolescents who have a low commitment to school or do poorly are more likely to become alcohol involved (Birckmayer et al., 2010).Parental monitoring, Adolescents who report low parental monitoring are significantly more likely to use a variety of substances (Shillington et al., 2009).
TEENAGE ALCOHOL NON-USE A survey of high school students in the United States shows that three out of four (77 percent) of teenagers do not drink alcohol. According to the September 2013 survey of 695 high
18
school students nationwide, the top reasons why teens choose not to drink is because first, it has an effect on health; second, it can interfere with school especially with grades; third, parents do not approve underage drinking; and lastly, it is illegal. In addition, over half of the teens surveyed said that they would be less likely to be friends with, or date, someone who drinks underage. The respondents of the survey were chosen based on applications showing their dedication to underage drinking prevention in their communities. (Mothers Against Drunk Driving (MAAD) & State Farm, 2013). Protective factors appear to balance and buffer the negative impact of existing risk factors. These factors, such as solid family bonds and the capacity to succeed in school, help safeguard youth from substance abuse (Hawkins et al., 2009).Increasing the availability of protective resources will help to reduce substance abuse and create healthier individuals and communities (O'Connell et al., 2009).
RELATED STUDIES LITERATURE REVIEW: SOCIAL SUPPLY OF ALCOHOL TO MINORS The ability of minors to access alcohol via social sources is an important public health concern; this is because social supply of alcohol is an important source of alcohol for younger drinkers and may be linked to early consumption. This so-called “social supply” refers to any alcohol obtained with permission. One significant issue that concerns most parents/caregivers is the willingness of other adults to provide alcohol to minors. There is growing evidence that the early onset of drinking is associated with the development of alcohol-related problems (Greenaway et al., 2009).
19
TEENAGE DRINKING, ALCOHOL AVAILABILITY, AND PRICING: A CROSS-SECTIONAL STUDY OF RISK AND PROTECTIVE FACTORS FOR ALCOHOL-RELATED HARMS IN SCHOOL CHILDREN According to Bellis et al. (2009), there is a lack of empirical analyses examining how alcohol consumption patterns in teenagers could relate to harm. They have mentioned that misuse of alcohol by teenagers is an international problem that needs immediate attention. In their study, an opportunistic survey of 15-16 year olds (n = 9,833) in North West England was undertaken to determine alcohol consumption patterns, drink types consumed, drinking locations, methods of access and harms encountered. Cost per unit of alcohol was estimated based on a second survey of 29 retail outlets. Associations between demographics, drinking behaviors, alcohol pricing and negative outcomes (public drinking, forgetting things after drinking, violence when drunk and alcohol-related regretted sex) were examined. Their aim is to determine the drinking behaviors of alcohol-consuming 15-16 year olds and their significance with a range of adverse alcohol-related outcomes. The result showed that even low levels of alcohol intake cannot be considered safe for teenagers, violence when drunk and drinking in public places were more common amongst boys, alcohol-related regretted sex and forgetting things after drinking were more commonly reported by girls. Correlation was used to examinewhether intake of lower priced drinks were related to greater percentages of consumers experiencing negative alcohol-related outcomes. Results suggest a strong relationship between consumption of cheaper alcohol products and increased proportions of respondents reporting violence when drunk, alcohol-related regretted sex and drinking in public places.
ALCOHOL
MARKETING
AND
DRUNKENNESS
AMONG
STUDENTS
IN
THE
PHILLIPPINES: FINDINGS FROM THE NATIONALLY REPRESENTATIVE GLOBAL SCHOOL-BASED STUDENT HEALTH SURVEY According to Swahn et al. (2013), there is a high significance between mass media marketing of alcohol and teenage alcoholism and drunkenness in the Philippines. Many alcohol marketing practices are aimed directly to the youth and those that are outside of the home (e.g.,
20
billboards, advertisements at sports events and concerts, buildings, newspapers and magazines, and on the internet) pose particular concerns because parents cannot typically shield their children from these exposures. High prevalence of exposure of minors to different alcohol marketing ads put them at a higher risk of actually consuming alcohol. The aim of their study is to determine the prevalence of alcohol marketing exposure in a nationally representative sample of minors in Philippines and to examine if there are significant relationship between alcohol marketing and drunkenness among Filipino youth. Cross-sectional analyses were used to examine the Global School-based Student Health Survey (GSHS) conducted in Philippines (2011). The self-administered questionnaires were accomplished by students within 13 to 16 years of age (N = 5290). Three statistical models were computed to test the associations between alcohol marketing and alcohol consumption, while controlling for possible confounding factors. The findings in their study highlight the need to put policies into effect that restrict alcohol marketing practices as an important prevention strategy for reducing alcohol use and its dire consequences among vulnerable youth.
EVERYONE SAYS IT’S OK: ADOLESCENTS’ PERCEPTIONS OF PEER, PARENT, AND COMMUNITY ALCOHOL NORMS, ALCOHOL CONSUMPTION, AND ALCOHOL-RELATED CONSEQUENCES According to the study of Eun-Young Song et. al (2012) majority of American adolescents have already taken alcohol, and many report that they have been drunk at least once. Among eighth-grade students in the United States, data from 2008 indicate that 39% ingested alcohol at least once in their lifetime, 16% had an alcoholic drink in the past 30 days, 5% had been drunk in the past 30 days, and less than 1% drank alcohol daily (Johnston, O’Malley, Bachman, & Schulenberg, 2009). Rates are higher among 12th graders, with 72% reporting at least one alcoholic drink during their lifetime, 43% reporting at least one drink in the past 30 days, 28% reporting drunkenness in the past 30 days, and 3% reporting daily use of alcohol (Centers for Disease Control and Prevention, 2008; Johnston et al., 2009). The aim of their study was to examine how peer, parent, and community norms are related to teenage drinking behaviors. The result of their study showed that teenage drinking behaviors are strongly related
21
to ones own perceptions of several sets of inputs: peers, parents, and community. Teenagers who reported attending religious services regularly were less likely to consume alcohol than teenagers who rarely attended religious service. Being older, being male, and being White were each associated with greater likelihood of most drinking behaviors. Adolescents living with both parents had lower odds of DUI or riding with a drinking driver.
ALCOHOL ABSTINENCE AND DRINKING AMONG AFRICAN WOMEN: DATA FROM THE WORLD HEALTH SURVEYS According to the study of Priscilla Martinez et al. (2011), alcohol use is increasing among women in Africa, and comparable information about women’scurrent alcohol use is needed to inform national and international health policies relevant to the entire population.This study aimed to provide a comparative description of alcohol use among women across 20 African countries. Data were collected as part of the WHO World Health Survey using standardized questionnaires. In total 40,739 adult women were included in the present study. Alcohol measures included lifetime abstinence, current use (≥1 drink in previous week), heavy drinking (15+ drinks in the previous week) and risky single-occasion drinking (5+ drinks on at least one day in the previous week). Country-specific descriptions of alcohol use were calculated, and Kmeans clustering was performed to find countries with similar characteristics. A total of 33,841 (81%) African women reported lifetime abstinence. Current use ranged from 1% in Malawi to 30% in Burkina Faso. Among current drinkers, heavy drinking varied between 4% in Ghana to 41% in Chad, and risky single-occasion drinking ranged from <1% in Mauritius to 58% in Chad. Increasing age was associated with increased odds of being a current drinker in about half of the countries.A variety of drinking patterns are present among African women with lifetime abstention the most common. Countries with hazardous consumption patterns require serious attention to mitigate alcohol-related harm. Some similarities in factors related to alcohol use can be identified between different African countries,although these are limited and highlight the contextual diversity of female drinking in Africa.
22
SIMILARITIES AND DIFFERENCES OF THE PRESENT STUDY AND PREVIOUS STUDIES The previous studies relating to alcohol use among teenagers focus more on the social influences and easy accessibility to alcohol. When it comes to studies relating to alcohol use, the main topic at hand is related to older respondents and their alcohol consumption, which may be related to alcoholism. For the present study, the researchers have decided to focus on a younger age group. Researches are usually being done in every state in the United States, whereas in the Philippines, researches are usually done in Manila. Also in the present study, the research locale is Angeles City, a setting in which a study on alcohol use among teenagers has not yet been done. Previous studies have also neglected to study the factors that contribute the non-use of alcohol among teenagers, whereas the present study explores those factors and then compares them to the factors that contribute to the use of alcohol.
23
CHAPTER 3 RESEARCH METHODS AND PROCEDURES This chapter provides the research method and procedure that will be used by the researchers in the present study. It serves as the overall plan that tells how the researchers will collect and analyze the data in order to answer the research problem. Contained in this chapter are the research design, research locale, respondents of the study, instruments, procedure, and statistical treatment of the data.
RESEARCH DESIGN The researcher will use a comparative descriptive research design a type of research design. This design is utilized to compare two or more groups that occur naturally in a setting and describe and observe a certain phenomenon as they naturally occur. There will be no manipulation on the independent variables for they have already occurred. The study examines variables in a situation that has already occurred or currently occurring. A comparative descriptive research design will be used to compare the relationship of factors contributing to use and non-use of alcohol among teenagers.
RESEARCH LOCALE The researchers will conduct the study on students in selected public or private high schools or colleges located in Angeles City. This location is chosen by the researchers because of certain environmental factors including the presence of nightlife establishments and due to the accessibility and proximity of nightclubs or bars.
24
RESPONDENTS The chosen respondents of the study will be students attending either a private or publichigh school or college in Angeles City. The schools will be selected through fish bowl technique, while the students will be selected through simple random sampling technique. The respondents must meet the following criteria: age 13-19 years old and currently attending a private or public high school or college in Angeles City. The researchers will orient the respondents as to their role in the study and will be given ample time to answer the questionnaire. The researchers will inform the respondents that the gathered data will be kept confidential to ensure the reliability of the data to be gathered.
INSTRUMENTS This section contains the detail description of the uses and content of tools or technique for data collection. The researchers will use a fishbowl technique in the selection of schools and they will use simple random sampling technique for the respondents. In conducting the study,the researchers will utilize a pre-survey in using a questionnaire in gathering data in order to obtain information needed. The type of questionnaire use is classified as under semi-structured type that is using of a topic guides to the respondents. The first part of questionnaire will require filling up with the respondents of the personal data such as name, age, gender, and educational level. The second part will contain the statements wherein the respondents are identifying factors in use and non-using alcohol. And lastly, they are using a Guttman scale in order to analyze and shows the responses of all the respondents on all of the items. In order to validate an instrument, the researchers use a face and content validation. According to (Polit and Beck, 2012), Face validity refers to measuring the target construct and it is evaluate technicalities such as grammar teacher and appropriate word to use. While content validity is adequacy of coverage of content area being measure include expert or professional
25
etc. As a process, validation involves collecting and analyzing data to assess the accuracy of an instrument.
PROCEDURE PHASE 1: In this phase the researchers identified the different problems in the community of Angeles City. Each of the group shared their insights of the different problems they observed. Different titles were identified and presented to the group and decided to pick the most interesting and applicable in the community of Angeles City.
PHASE 2: After they identified the topic, the researchers gathered related studies and related literature in the university library of Angeles University Foundation. The researchers found books and journals that are related with the study. Elton B. Stephens Company, also known as EBSCO, was also utilized in searching for related studies that were needed regarding the present study. Then the researchers decided to have their research locale in Angeles City, Specifically public and private high schools and colleges within the said locale.
PHASE 3: After identifying the research locale, the researchers will prepare for the tools needed in the study. The researchers decided to have a pilot study on selected schools in Angeles City. The researchers will conduct a pre-survey to test the validity of the tool prior to having the actual study. The responses made by the students from the pre-survey will be used in the composition of questionnaire. The tool will be validated by a grammar teacher, statistician, and a psychometrician.
26
PHASE 4: This phase will be about how the researchers are to gather their respondents. The researchers will use fish bowl technique in selecting the private and public high schools and colleges, and then will use simple random sampling in getting their respondents.
PHASE 5: Prior to the gathering of data, the researchers will send a letter of approval to the selected schools and colleges in the locale. After being granted approval, the researchers will go to the selected high schools and colleges to conduct the actual study. The questionnaire will be distributed to the respondents.
PHASE 6: After gathering all of the necessary data, the researchers will ensure that all collected data will be kept confidential. The collected data will be interpreted and compared as to which factors contribute to use and non-use of alcohol among teenagers in Angeles City.
STATISTICAL TREATMENT OF DATA The data that will be gathered from the questionnaire will be tallied and subjected to an appropriate statistical method to answer questions that will be presented in Chapter I. The questionnaire is answerable by checking the box below the scale based on their response. Upon getting all the data, the researchers will compute the mean to determine the average of the respondents regarding their alcohol use and non-use as teenagers attending school in Angeles City. Each item of the questionnaire will be based on a five point scale.
27
SLOVIN’S FORMULA The researchers will use Slovin’s formula to figure out the sample size of the population of the respondents.
Where: n = Number of samples e = Error margin N = Total population
FREQUENCY DISTRIBUTION Frequency distribution is used to organize numeric data. A frequency distribution is a systemic arrangement of values from lowest to highest, together with a count of the number of times each value was obtained. (Polit & Beck 2012).
Where:
f = frequency in each class of category N = total number of responses
28
PERCENTAGE DISTRIBUTION It is usually useful to display percentages for each value. Just as the sum of all frequencies should equal N, the sum of all percentages should equal 100 (Polit & Beck 2012).
Where:
f = frequency in each class category N= total number of responses %= Percentage frequency
a. Cumulative relative frequency b. Divide the cumulative frequency by N and multiply by 100.
GUTTMAN SCALE The researchers will use Guttman scale in making statements for the questionnaires that will be answered by the selected respondents. The Guttman scale measures to what degree a person has a positive or negative attitude to something. It makes use of a series of statements that are growing or descending in how positive or negative a person is towards the subject. If for instance on a scale with seven statements the respondent agrees with the fifth statement, it implies that he or she also agrees with the first four statements, but not with statement number six and seven.
29
CHI-SQUARE TEST The chi-square statistic is computed by comparing observed frequencies and expected frequencies. It enables the researcher to decide whether a difference in proportions of this magnitude is likely to reflect to a real treatment effect or only chance fluctuations (Polit & Beck 2012).
30
REFERENCES
Baer, J. (2009). High-risk drinking in college: What we know and what we need to learn. Retrieved from http://www.collegedrinkingprevention.gov/niaaacollegematerials/panel01/highrisk_05.as px Bolyn, M. (2010, March 23). What are the causes of teenage drinking?. Retrieved from http://www.livestrong.com/article/96232-causes-teenage-drinking/ Birckmayer, JD, Holder, HD, Yacoubian, GS, & Friend, KB. (2010). A general causal model to guide alcohol, tobacco, and illicit drug prevention: Assessing the research evidence. Journal of Drug Education, 34(2), 121-153. Dailey, K. (2010, June 29). Report shows teen girls are drinking more than boys, for different reasons. Retrieved from http://www.foodhealthnews.com/2010/07/report-shows-teengirls-are-drinking-more-than-boys-for-different-reasons/ Dryden-Edwards, R. (2013, December 10). Alcohol and teens. Retrieved from http://www.medicinenet.com/alcohol_and_teens/article.htm Gardner, A. (2012, August 22). Many teens drinking, taking drugs during school: survey. Retrieved from http://health.usnews.com/health-news/news/articles/2012/08/22/manyteens-drinking-taking-drugs-during-school-survey Giskes, K., et al. Individual and household-level socioeconomic position is associated with harmful alcohol consumption behaviours among adults. Australian and New Zealand Journal of Public Health, 2011, 35(3), 270-277. Grant, J. D. (2012, May 17). Early drug and alcohol use associated with lower levels of educational attainment. Retrieved from http://www.news-
31
medical.net/news/20120517/Early-drug-and-alcohol-use-associated-with-lower-levels-ofeducational-attainment.aspx Greenaway, S., Huckle, T., Casswell, S., & Jelley, S. (2009). Literature review: social supply of alcohol to minors. (Master's thesis, Massey University, Auckland)Retrieved from http://www.ahw.org.nz/resources/Research/Social Supply Literature Review FINAL.pdf Hall, Anita (2009). The bases of social power. In D. Cartwright (Ed.), Studies in social power (7th ed.). Ann Arbor: University of Michigan, Institute for Social Research. Hart, C. L., Ksir, C., & Ray, O. (2009). Drugs, society, and human behavior. (13th ed., pp. 205206). New York, NY: McGraw-Hill. Hawkins, J. D., M. W. Arthur, et al. (2009). Preventing substance abuse From Building a Safer Society: Strategic Approaches to Crime Prevention, Volume 19, P 343-427, 2009, Michael Tonry & David P Farrington, eds. United States
Locatelli, D. (2012). Socioeconomic influences on alcohol use patterns among private school students in são paulo. (2 ed., Vol. 34). São Paulo, Brazil: Retrieved from http://www.scielo.br/scielo.php?pid=S1516-44462012000200012&script=sci_arttext Manalo, P. (2010, August 18). Why teenagers are addicted to alcohol use. Retrieved from http://www.parenthood360.com/index.php/why-are-teenagers-addicted-to-alcohol-use8571/ Martinez et al. Alcohol abstinence and drinking among African women: data from the World Health Surveys. BMC Public Health 2011, 11:160. Retrieved from
http://www.biomedcentral.com/1471-2458/11/160 Mothers Against Drunk Driving. (2013, October 21). Most teens don’t drink alcohol, according to red ribbon week survey by madd and state farm. Retrieved from http://www.madd.org/media-center/press-releases/2013/most-teens-dont-drink.html
32
O'Connell, M. E., Boat, T., & Warner, K. E., Eds. (2009). Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth and Young Adults, Institute of Medicine. Washington, DC: National Academies Press. Payne, W., Hahn, D., & Lucas, E. (2010). Understanding your health. (11th ed., Vol. 1, pp. 212229). Pillitteri, A. (2010). Maternal & child health nursing. (6 ed., Vol. 2, pp. 796-804). Philadelphia, PA: Lippincott Williams & Wilkins. Reda, A. (2012). Alcohol drinking patterns among high school students in ethiopia: a crosssectional study. Ethiopia: Retrieved from http://www.biomedcentral.com/14712458/12/213 Schafer, G. (2011). Family functioning in families with alcohol and other drug addiction. (37 ed.). DOI: file:///C:/Users/phillip/Desktop/Family functioning in families with alcohol and other drug addiction - Ministry of Social Development.htm Shaw, J. (2010). Environment factors of alcoholism. Livestrong.com. Retrieved from http://www.livestrong.com/article/89758-environmental-factors-alcoholism/ Shillington, A. M., S. Lehman, et al. (2009). Parental monitoring: Can it continue to be protective among high-risk adolescents? Journal of Child & Adolescent Substance Abuse, 15(1), 1-15. Teunissen, H. (2012, April 16). Peers influence adolescent drinking, but not always how you might expect. Retrieved from http://www.eurekalert.org/pub_releases/2012-04/acepia040812.php
33
