tag:theconversation.com,2011:/id/topics/adolescent-drinking-19472/articlesAdolescent drinking – The Conversation2019-05-21T10:01:20Ztag:theconversation.com,2011:article/1173372019-05-21T10:01:20Z2019-05-21T10:01:20ZA global survey sheds new light on how bad events affect young people<figure><img src="https://images.theconversation.com/files/275613/original/file-20190521-23820-c080bv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Burnt shacks after a fire in a Mumbai slums. Adolescents are deeply affected by traumatic events in their lives.</span> </figcaption></figure><p>The percentage of the world’s population that’s aged between 10 and 24 is growing exponentially. It currently <a href="https://www.unfpa.org/publications/state-world-population-2013">makes up a quarter</a> of the world’s population: that’s 1.8 billion people. So it’s increasingly important to understand how people in this age group are affected by events. </p>
<p>A <a href="https://static1.squarespace.com/static/54431bbee4b0ba652295db6e/t/5ce2b9b53fdc1e0001552ec8/1558362550220/ACEs+Paper.pdf">major new study</a> based on surveys done in multiple countries – ranging from Vietnam, China, Bolivia, Egypt, India and Kenya to the UK and the US – across five continents provides groundbreaking insights into the impact that adverse events have on children. The study catalogued the adverse childhood experiences suffered by 1,284 adolescents aged 10 to 14 in “low-income urban settings” around the world. These adverse events include physical and emotional neglect, violence, and sexual abuse. </p>
<p>This is the first global study to investigate how a cluster of adverse childhood experiences work together to cause specific health issues in early adolescence – and have terrible, life-long consequences. </p>
<p>The research found remarkably common experiences with trauma, and very similar impacts, regardless of where the children lived. It found that there was a strong association with both adolescent depression and violence perpetrated by young people. </p>
<p>Other findings included that young girls often suffer significantly. But, contrary to common belief, boys reported even greater exposure to violence and neglect. This makes them more likely to be violent in return.</p>
<p>The study was a major collaboration between the World Health Organisation and the Bloomberg School of Public Health. It aimed to understand more about the development of gender stereotypes in early adolescence and their impact on adolescent health around the world. </p>
<p>The findings buttress a <a href="https://www.geastudy.org/new-blog/bellagioreport">soon to be released report</a> reflecting the assessment of 22 experts from 15 countries. They argue that the world will never achieve gender equality by focusing on girls and women alone and excluding boys and men. This has major implications for both international and national policies.</p>
<h2>The research</h2>
<p>Overall, the study found that 46% of young adolescents reported experiencing violence, 38% suffered emotional neglect and 29% experienced physical neglect. </p>
<p>Consistent with the <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/207725">literature</a>, we observed that girls tend to exhibit greater internalising behaviours. These include depression and contemplation. Boys tend to show greater externalising behaviours, such as poor behaviour regulation and aggression.</p>
<p>Boys stood out in several categories. They were more likely to report physical neglect, sexual abuse and violence victimisation. </p>
<p>For both boys and girls, the more adversity they experienced, the more likely they were to engage in violent behaviour. This included bullying, threatening or hitting someone. </p>
<p>But the effect of the adversity was more pronounced for boys than girls: boys were 11 times more likely to be engaged in violence, while girls were four times more likely to be violent. The study also found that, in general, the cumulative effect of their traumas tended to produce higher levels of depressive symptoms among girls than boys. Boys, meanwhile, tended to show more external aggression than girls.</p>
<p>In many countries, adolescent boys are <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0136321">more likely to smoke and drink</a>. They are also more prone to both unintentional and intentional injury and death in the second decade of life than their female counterparts. </p>
<p>Conversely, one quarter of adolescent girls worldwide are married by age 18 years. And two million births annually are to girls aged younger than 15 years, while girls’ secondary school education still lags behind boys (56%-63%). Also, social and vocational opportunities are frequently more constrained for girls.</p>
<h2>The whole story</h2>
<p>But these statistics tell only part of the story. </p>
<p>While the data are cast in terms of gender disadvantage, that disadvantage is not equally distributed across the socioeconomic spectrum. In low- and high-income countries alike, those at the bottom of the ladder are more likely to leave school earlier, have children earlier, and marry earlier. </p>
<p>Poverty and gender inequality together conspire to disadvantage large segments of the adolescent population. To achieve gender equality, we need to redefine the problem as a “gender”, not women’s and girls’, issue. And, as we point out in the report, the evidence is strong that the </p>
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<p>links between gender equality and life satisfaction among adults suggest that men as well as women benefit from high levels of societal gender equality. </p>
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<h2>Conclusion</h2>
<p>Our study offers a unique multinational examination of adverse childhood experiences in early adolescence. Its findings show high rates of exposure experienced by young adolescents in resource poor neighbourhoods in low and middle-income countries. Similarly, it shows strong associations between adverse childhood experiences and both depressive symptoms and violence perpetration. </p>
<p>Interventions are often focused on behaviours (such as violence) or clinical symptoms (such as depression). But this new research suggests there’s a need to understand childhood exposure to adversity. We conclude that adverse childhood experiences should be included routinely in behavioural research of adolescents. </p>
<p>The study also suggests that research, practice, and policy efforts to address adverse childhood experiences in early adolescence may be critical to reducing adolescent morbidities and to achieving the United Nations Sustainable
Development Goals and the <a href="https://www.who.int/maternal_child_adolescent/topics/adolescence/framework-accelerated-action/en/">World Health Organisation’s Accelerated Action for the Health of Adolescents</a>.</p><img src="https://counter.theconversation.com/content/117337/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Robert W. Blum does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The data suggest that boys experience as much disadvantage as girls.Robert W. Blum, Director, Johns Hopkins Urban Health Institute, Johns Hopkins UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1044822018-12-04T18:52:39Z2018-12-04T18:52:39ZHow parents and teachers can identify and help young people self-medicating trauma with drugs and alcohol<figure><img src="https://images.theconversation.com/files/242689/original/file-20181029-76387-82f3mu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">When adolescents develop stress from trauma and a reliance on drugs or alcohol, both conditions maintain and exacerbate the other.</span> <span class="attribution"><span class="source">www.shutterstock.com</span></span></figcaption></figure><p>Some <a href="http://journals.sagepub.com/doi/10.1177/1524838012447698">80% of young people</a> will experience a traumatic event by the time they become an adult. Rates of exposure to trauma peak during adolescence. The stress from traumatic events can result in a loss of interest in school, friends, hobbies, and life in general.</p>
<p>The types of traumatic events include a wide range of terrifying and life-threatening experiences such as physical or sexual assault, witnessing violence, motor vehicle and other serious accidents, and natural disasters. They may be one-off events like car accidents, or prolonged as is often the case with childhood abuse and domestic violence.</p>
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Read more:
<a href="https://theconversation.com/children-with-severe-trauma-can-be-fostered-and-recover-with-the-right-treatment-and-care-94397">Children with severe trauma can be fostered, and recover with the right treatment and care</a>
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<p>Many young people keep their feelings hidden and try to cope with it themselves, sometimes by self-medicating with alcohol or other drugs. These young people often experience a range of difficulties at home and school. Without identification and treatment of the underlying issues, developmental and educational trajectories can be severely disrupted and these problems may persist into adulthood. It’s estimated between 30-50% of adolescents with PTSD also <a href="http://journals.sagepub.com/doi/10.1177/1524838012447698">abuse or are dependent on</a> alcohol.</p>
<p>There are several signs parents and teachers can look for to identify young people at risk and treatment options are available.</p>
<h2>How does trauma impact young people?</h2>
<p><a href="https://www.sciencedirect.com/science/article/pii/S2468266717301184">Traumatic stress</a> and <a href="https://www.sciencedirect.com/science/article/abs/pii/S0306460315300435">alcohol or other drug use</a> during adolescence have been linked to a range of physical and psychological health problems, poorer performance at school and work, family and social problems, aggression, and criminal behaviour.</p>
<p>Adolescence is a critical developmental window where a person experiences profound <a href="https://linkinghub.elsevier.com/retrieve/pii/S1054139X12002613">social, biological, and neurological</a> changes. During this period, a person is particularly vulnerable to the impact of trauma. Trauma during adolescence has been associated with <a href="https://www.sciencedirect.com/science/article/pii/S0306452216001457?via%3Dihub">significant changes</a> in the structure and functioning of the brain. </p>
<p>Adolescents who have experienced trauma have also <a href="http://journals.sagepub.com/doi/10.1177/1524838012447698">been found to have</a> higher rates of anxiety, depression and suicidal ideation, be in poorer physical health, and have difficulties with relationships with family, friends or classmates. Increases in aggression and risk-taking behaviours are also common. Of concern, these problems are linked with increased risk for <a href="https://www.ajpmonline.org/article/S0749-3797(09)00506-6/fulltext">illness and premature death</a> in adulthood.</p>
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<img alt="" src="https://images.theconversation.com/files/244484/original/file-20181108-74751-19jqkmy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/244484/original/file-20181108-74751-19jqkmy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/244484/original/file-20181108-74751-19jqkmy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/244484/original/file-20181108-74751-19jqkmy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/244484/original/file-20181108-74751-19jqkmy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/244484/original/file-20181108-74751-19jqkmy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/244484/original/file-20181108-74751-19jqkmy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Young people may isolate themselves to avoid talking about traumatic events they have experienced.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
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<p>It’s common for a young person to experience changes in their thoughts, feelings and behaviour after a traumatic event, but everyone responds differently. Some of the most common reactions to trauma are increases in feelings of fear and anxiety. </p>
<p>Many young people will try to avoid thinking and talking about what happened, and stay away from people, places and things that remind them of what happened. They may be constantly on-edge and on the look-out for danger. Trouble sleeping and concentrating are also common. These feelings are a normal response to an abnormal event.</p>
<p>Many adolescents will feel much better within a few months after the event, but symptoms will persist for approximately <a href="http://journals.sagepub.com/doi/10.1177/1524838012447698">one in seven adolescents</a>, developing into post traumatic stress disorder (PTSD). Some reactions may also be delayed, appearing months or even years after the event. </p>
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Read more:
<a href="https://theconversation.com/explainer-what-is-post-traumatic-stress-disorder-11135">Explainer: what is post-traumatic stress disorder?</a>
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<p>Regardless of whether a person does develop PTSD, traumatic events are often life-changing and can redefine a person’s views of themselves. This includes feeling weak, bad, worthless, or to blame for what happened, the world around them is not safe, or that people cannot be trusted. These beliefs can become particularly well-entrenched in those who have experienced childhood trauma.</p>
<h2>Why do young people self-medicate?</h2>
<p>Because many young people keep the event (and/or their feelings and reactions to it) a secret, the extent of child and adolescent trauma has been referred to as a <a href="https://www.doctorportal.com.au/mjainsight/2013/46/nick-kowalenko-silent-epidemic/">“silent” or “hidden” epidemic</a>. Because many adolescents who have experienced trauma may not be inclined to talk openly about these experiences, it’s not always obvious to parents and teachers that post-traumatic stress may be a key reason these young people struggle at school.</p>
<p>In the absence of support from family, teachers and peers (either because these resources are not available to the young person, or they choose not to access them), young people try to cope with what has happened them, sometimes by <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1360-0443.2009.02675.x">self-medicating with alcohol or other drugs</a>. </p>
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<img alt="" src="https://images.theconversation.com/files/244483/original/file-20181108-74769-19sfwot.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/244483/original/file-20181108-74769-19sfwot.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/244483/original/file-20181108-74769-19sfwot.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/244483/original/file-20181108-74769-19sfwot.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/244483/original/file-20181108-74769-19sfwot.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/244483/original/file-20181108-74769-19sfwot.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/244483/original/file-20181108-74769-19sfwot.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">One warning sign is if a young person starts or increases their drug or alcohol intake.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
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</figure>
<p>As with trauma, the adolescent brain is particularly susceptible to the <a href="https://link.springer.com/article/10.1007/s11065-010-9146-6">neurotoxic effects</a> of alcohol and other drugs. Adolescents who are self-medicating can find themselves in a vicious cycle where they need increasingly large amounts of alcohol or other drugs to try and combat increasing symptoms of traumatic stress. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-childhood-trauma-changes-our-hormones-and-thus-our-mental-health-into-adulthood-84689">How childhood trauma changes our hormones, and thus our mental health, into adulthood</a>
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<p>Once established, both problems maintain and exacerbate the other. </p>
<h2>How can parents and teachers help?</h2>
<p>The <a href="https://tgn.anu.edu.au/wp-content/uploads/2014/10/Signs-of-possible-trauma-in-children-and-adolescents_02.pdf">Australian National University Trauma and Grief Network</a> and <a href="https://www.betterhealth.vic.gov.au/health/HealthyLiving/trauma-and-teenagers-common-reactions">Victorian government</a> have developed a detailed list of signs of trauma in children and adolescents. This may help parents and teachers identify young people who may be at risk. These signs include: </p>
<ul>
<li>strong emotions such as sadness, anger, fear, anxiety and guilt</li>
<li>repetitively thinking about the traumatic event and talking about it often</li>
<li>disturbed sleeping patterns and/or nightmares</li>
<li>emotional, behavioural and personality changes </li>
<li>withdrawing from family and friends and wanting to spend more time alone</li>
<li>self-absorption</li>
<li>being very protective of family and friends</li>
<li>returning to younger ways of behaving </li>
<li>increased need for independence</li>
<li>increased risk-taking behaviour</li>
<li>initiation or increased use of alcohol or other drugs</li>
<li>loss of interest in school, friends, hobbies, and life in general </li>
<li>deterioration in school performance</li>
<li>pessimistic outlook on life, being cynical and distrusting of others</li>
<li>depression and feelings of hopelessness</li>
<li>difficulties with short-term memory, concentration and problem solving.</li>
</ul>
<p>Evidence-based psychological therapies are available for traumatic stress among adolescents. <a href="https://www.phoenixaustralia.org/wp-content/uploads/2015/03/Phoenix-Parents-Guide.pdf">Trauma-focused cognitive behavioural therapy</a> is the recommended first line treatment. </p>
<p>A good starting point for accessing these services is through a GP. After first talking to a young person about how they feel after experiencing a trauma themselves, parents and teachers can arrange an appointment and encourage the young person to speak to a GP about what may be bothering them. The GP can then refer the young person to a psychologist or other mental health professional who is experienced in working with children and adolescents who have experienced trauma.</p>
<p>The <a href="https://www.copea.org.au/">Centre of Research Excellence in Mental Health and Substance Use</a> in Sydney is conducting a world-first trial of integrated psychological therapy for traumatic stress <em>and</em> substance use among adolescents aged 12-18 years. We hope the findings from this study will improve our understanding of how best to treat adolescents experiencing traumatic stress and substance use and prevent the chronic health problems associated with these conditions.</p><img src="https://counter.theconversation.com/content/104482/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katherine Mills receives funding from the National Health and Medical Research Council, the Australian Government Department of Health, New South Wales Health, Primary Health Networks, and the Paul Ramsay Foundation.</span></em></p><p class="fine-print"><em><span>Natalie Peach does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Some 80% of young people will experience a traumatic event by the time they become an adult. Here’s how teachers and parents can support them.Katherine Mills, Associate Professor at The Matilda Centre for Research in Mental Health and Substance Use, University of SydneyNatalie Peach, Postdoctoral Research Fellow, The Matilda Centre for Research in Mental Health and Substance Use, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/904842018-01-25T13:35:08Z2018-01-25T13:35:08ZAfter school clubs aren’t always safe spaces: what should be done about it<figure><img src="https://images.theconversation.com/files/202823/original/file-20180122-46235-1s57rnx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Getting involved in after-school sports can be positive, but it comes with risks too.</span> <span class="attribution"><span class="source">Reuters/David Gray</span></span></figcaption></figure><p>Young people around the world are encouraged to get involved in extracurricular activities. These range from choirs and drama clubs to sports teams, with many other options available depending on the school. These activities are important for several reasons.</p>
<p>Sports and other physical activities, such as drama clubs, <a href="https://www.researchgate.net/publication/251678774_Extracurricular_sport_participation_A_potential_buffer_against_social_anxiety_symptoms_in_primary_school_children">support</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/16802902">the development</a> of young people into healthy adults. For parents who work long days, these activities are a productive way to keep their children busy when nobody is at home to supervise them. Finally, these activities often differ from what children are taught in class, so they encourage new interests beyond school work.</p>
<p>But, as research I’ve just published with my colleagues <a href="http://www.tandfonline.com/doi/full/10.1080/02673843.2017.1423505">shows</a>, after school clubs can also be risky environments because they’re not always properly supervised. This can present opportunities for risky sexual behaviour and drug use. Our study focused on South Africa, and bears out an extensive global body of research that’s <a href="https://www.ncbi.nlm.nih.gov/pubmed/27565582">found an association</a> between young people’s participation in sport and their use of drugs and alcohol.</p>
<p>South Africa’s Department of Sports and Recreation <a href="http://www.kzndsr.gov.za/LinkClick.aspx?link=GIS/Participation+patterns+in+sport+and+recreation+activities+in+SA.pdf">has found</a> that 51.7% of the country’s young people participate in sports and recreational activities.</p>
<p>This is not to suggest that after-school clubs and teams should be scrapped in South Africa. Rather, greater supervision is needed; parents need to get more involved so they know exactly what their children are doing in their after-school time and policies must be created that better monitor and evaluate extracurricular activities. </p>
<h2>Risky business</h2>
<p>Risky behaviour, including sexual and illicit drug use, have devastating health consequences. Some of these relate to health: young women may fall pregnant and contracting HIV is a real risk especially in a country with such <a href="https://www.statssa.gov.za/publications/P0302/P03022015.pdf">high prevalence rates</a> of the disease.</p>
<p>There’s also a real risk of young people becoming addicted to drugs or alcohol.
They may also be separated from their families, lose out on future and current employment or even end up in jail.</p>
<p>To many parents, after-school activities are a way to prevent their children from engaging in risky behaviour. The idea is that if youth are kept “busy” during their leisure periods they will not have time to experiment in these behaviours. They also believe that their kids will benefit from the social interaction and physical exercise. And research <a href="https://www.researchgate.net/publication/251678774_Extracurricular_sport_participation_A_potential_buffer_against_social_anxiety_symptoms_in_primary_school_children">has confirmed</a> that these benefits exist.</p>
<p>But after-school clubs are not always entirely safe. They can be spaces where young people try their first cigarette or experiment with alcohol for the first time.</p>
<p>Our study concentrated on young people aged between 10 and 22 – in South Africa, it’s not unusual for those <a href="https://www.ncbi.nlm.nih.gov/pubmed/19248721">aged between 18 and 22</a> to still be in the secondary school system. This is usually because of prolonged absence through illness, the responsibility of caring for an ill relative, pregnancy and grade repetition.</p>
<p>Our statistical analysis of the <a href="http://www.cjcp.org.za/uploads/2/7/8/4/27845461/monograph_6_-_running_nowhere_fast_-_2008_youth_lifestyle.pdf">South African Youth Lifestyle Survey 2009</a> controlled for a number of factors. These included age, sex, race, whether they lived in an urban or rural area, the number of income earners in the household, food security in the household and whether or not the youth had set goals for their future. </p>
<p>We found an association between sports participation and youth group involvement and risky sexual behaviour as well as illicit drug use. The risks were higher for females and those who live in the country’s rural areas; they were lower for those who’d identified predefined goals for their future and those involved in choirs or drama groups. </p>
<h2>Finding solutions</h2>
<p>Several things can be done to tackle the issues raised in our research. For starters, there’s a clear need for better supervision and organisation of after-school activities so that they don’t become enabling environments for risky behaviour.</p>
<p>Young people who participate in sports and other clubs should not be left unattended. And supervisors, coaches and other authority figures should be monitored to ensure that they’re not allowing anyone to engage in risky behaviour on their watch. </p>
<p>Parent involvement is also key. Parents should attend practices and events to meet the people who supervise these clubs, and ask their children about their activities. Of course, it can be tough for parents who work long hours to make time for this; other adult relatives could be asked to get involved here.</p>
<p>National policies and programmes also need to be aware of these issues. Policymakers must broaden their scope to include the monitoring and evaluation of after-school programmes. </p>
<p>This will allow South Africa to protect its young people from peer and adult pressure to engage in acts which risk their health and social well-being.</p><img src="https://counter.theconversation.com/content/90484/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole De Wet receives funding from the National Research Foundation Thuthuka Post-Doc Grant.</span></em></p>When after-school clubs aren’t properly monitored, they can become risky spaces.Nicole De Wet- Billings, Senior Lecturer, Demography and Population Studies, Schools of Social Sciences and Public Health, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/808922017-07-20T01:57:22Z2017-07-20T01:57:22ZThree ways to help your teenage kids develop a healthier relationship with alcohol<figure><img src="https://images.theconversation.com/files/178560/original/file-20170718-19023-1xl6c6a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Parents play an important role in when their teenage children start drinking and their drinking patterns as they grow.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/633035360?size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>Lauren, a 15 year old school student, goes to a party at a friend’s house where the parents have supplied alcohol. She drinks too much and vomits in the car on the way home. </p>
<p>While this type of story may be common, it’s not inevitable. Our <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5461699/">new research</a> suggests parents have more of a positive influence on their teenagers’ relationship with alcohol than they realise.</p>
<p>What parents say, how they behave and the messages they send to their teenagers can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4108600/">help delay</a> when their teenage kids start drinking, which is critical if they are to avoid the harmful and life-long effects of alcohol on the developing brain.</p>
<p>Parental influences also set the path to better <a href="https://www.ncbi.nlm.nih.gov/pubmed/15585043">drinking patterns (and reduced rates of alcohol dependence)</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/11775078">as their teenage kids</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/16818840">grow up</a>.</p>
<h2>Why are we so concerned about teenage drinking?</h2>
<p>Teenagers’ brains are <a href="http://www.sciencedirect.com/science/article/pii/S0010945212001839">still developing</a> key pathways for memory, learning, judgement and impulse control. So, damage from alcohol misuse at this critical time in development can lead to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3960066/">cognitive issues</a> like memory problems and learning difficulties.</p>
<p>This is one reason Australian guidelines <a href="https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/ds10-alcohol.pdf">recommend</a> people under 18 avoid drinking alcohol altogether and delay starting for as long as possible.</p>
<h2>How big a problem is it?</h2>
<p>Out-of-control teenage parties often make the <a href="http://www.brisbanetimes.com.au/queensland/sunshine-coast-teen-parties-spiral-out-of-control-20161007-grx20r.html">news headlines</a>, so it’s easy to think teenage drinking is a growing problem. </p>
<p>But two <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2016/key-findings/">national</a> <a href="http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/Publishing.nsf/content/E9E2B337CF94143CCA25804B0005BEAA/$File/National-report_ASSAD_2014.pdf">surveys</a> have confirmed drinking rates among school students (aged 12-17) and young adults (aged 18-24) are declining.</p>
<p>So, while young people may think drinking is the norm, <a href="http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/Publishing.nsf/content/E9E2B337CF94143CCA25804B0005BEAA/$File/National-report_ASSAD_2014.pdf">this is not the case</a>, especially for those under the age of 15 where fewer than 15% report having drunk alcohol in the past month and 8% in the past week.</p>
<p>Nevertheless, alcohol contributes to four of the top five leading causes of death in 15-24 year olds, including <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129552757">suicide</a>, <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129552762">traffic accidents</a>, <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129552765">accidental poisoning</a> and <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129552768">assault</a>. Alcohol in this age group can also lead to <a href="http://www.jsad.com/doi/abs/10.15288/jsa.1998.59.71">sexual risk-taking</a> and is often associated with <a href="http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/Publishing.nsf/content/E9E2B337CF94143CCA25804B0005BEAA/$File/National-report_ASSAD_2014.pdf">trying smoking or taking illicit drugs</a>.</p>
<p>It’s easy to think our efforts as parents to foster healthier drinking habits in our teenage children is futile. But evidence shows exactly how parents can make a difference. Here are three things you can do to help your teenage kids develop a healthier relationship with alcohol.</p>
<h2>1. Limit availability of alcohol</h2>
<p>Many parents <a href="https://www.ncbi.nlm.nih.gov/pubmed/22763230?dopt=Abstract">believe</a> supplying their children with alcohol in the safe environment of their home teaches them to drink responsibly.</p>
<p>In fact, an <a href="http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/Publishing.nsf/content/E9E2B337CF94143CCA25804B0005BEAA/$File/National-report_ASSAD_2014.pdf">Australian survey found</a> parents were the most common source of alcohol with 38% of 12-17 year olds who had drunk in the past week indicating their parents gave them their last drink.</p>
<p>Unfortunately, parental supply – whether deliberate or if teenagers drink their parent’s supply behind their back – is associated with <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-017-4472-8">heavier teen drinking</a>. And <a href="https://www.ncbi.nlm.nih.gov/pubmed/20105420">a study from the Netherlands</a> found the more adolescents drank at home, the more they were likely to drink outside of the home, which predicted future problem drinking.</p>
<p>Our study <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5461699/">also found</a> if adolescents thought they could buy alcohol easily, they were more likely to drink regularly. And the more spending money 16-17 year olds had, the more likely they were to drink.</p>
<p>The weight of the evidence is now clear. Allowing children to drink underage and supplying them with alcohol, including at parties, even under the supervision of a parent, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4108600/">is not recommended</a>.</p>
<h2>2. Set boundaries and clear expectations</h2>
<p>Parents have a vital role to play in setting boundaries and clear expectations about drinking alcohol. Discuss alcohol with your kids and the fact <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2016/key-findings/">not everyone drinks</a>, even though it might seem like they do.</p>
<p>Talk about upcoming activities, including parties, and discuss expectations about acceptable and unacceptable behaviour. Talk to other parents and let them know your expectations as it’s important to set <a href="https://www.ncbi.nlm.nih.gov/pubmed/25343647">clear social norms and expectations</a>.</p>
<p>Our study <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5461699/">found</a> adolescents who thought their parents would disapprove of them drinking alcohol were much less likely to drink. This was the case across the whole age spectrum of 12-17 years. </p>
<h2>3. Be a good role model</h2>
<p>Alcohol is the <a href="http://www.aic.gov.au/crime_types/drugs_alcohol/drug_types/alcohol.html">most widely</a> used recreational drug in Australia and most adult drinking (80%) is done <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129549848">in the home</a>. So, we also need to think about our own drinking in front of our children, however uncomfortable the prospect.</p>
<p>Parents are <a href="http://journals.sagepub.com/doi/pdf/10.1080/00048674.2010.501759">important role models</a> for kids when it comes to alcohol. Setting a good example by limiting drinking in front of kids where possible, not making alcohol and drinking a key focal point, having alcohol-free events and cutting back on your own binge drinking are all significant.</p>
<p>This is important because kids who live in families where parents drink on a regular basis around their children <a href="http://journals.sagepub.com/doi/pdf/10.1080/00048674.2010.501759">are more likely</a> to drink more heavily themselves and start at an earlier age.</p>
<h2>Parents are not the only influence, but are still important</h2>
<p>While parents can play a vital role in their children’s relationship with alcohol, they are not the only factor to influence teenage drinking. </p>
<p>Alcohol is <a href="http://fare.org.au/policy/pricing-taxation/">more affordable </a> in Australia than it has been in the past 30 years, and the number of premises selling alcohol has <a href="http://nceta.flinders.edu.au/files/8713/5226/7677/EN463_LLReport_Exec_summary.pdf">increased substantially</a> in the past 15 years. Throw <a href="http://www.theage.com.au/comment/the-age-editorial/excessive-alcohol-advertising-in-sport-is-out-of-bounds-20160522-gp0x0m.html">advertising</a> and <a href="http://www.abc.net.au/news/2017-01-22/doctors-call-for-ban-on-alcohol-sponsorship-of-cricket/8198706">sports sponsorship</a> into the mix and we have some very strong messages that drinking alcohol is the norm. </p>
<p>Yet, the evidence shows parents can make significant and substantial difference in their teenage children’s relationship with alcohol, particularly in not giving them alcohol before they turn 18 and helping them set good behavioural patterns around alcohol now and for later life.</p><img src="https://counter.theconversation.com/content/80892/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jacqueline Bowden receives funding from SA Government. </span></em></p><p class="fine-print"><em><span>The research centre Robin Room heads receives funding from federal government research bodies, the Foundation for Alcohol Research and Education, VicHealth, Australian state government commissions, the U.S. National Institutes of Health and the World Health Organization. </span></em></p>Teenagers pick up cues about drinking from you and your family. Here’s how you can help them develop a healthier relationship with alcohol.Jacqueline Bowden, PhD candidate, School of Psychology, University of Adelaide and Manager, Population Health Research, South Australian Health & Medical Research InstituteRobin Room, Professor and Director, Centre for Alcohol Policy Research, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/435672015-08-14T03:57:24Z2015-08-14T03:57:24ZWhat needs to be done to end South Africa’s status as a nation of heavy drinkers<figure><img src="https://images.theconversation.com/files/91595/original/image-20150812-18080-2joitb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">South Africans consume more than five billion litres of alcohol each year. The Department of Trade and Industry is introducing a new alcohol policy to change the country's drinking habits.</span> <span class="attribution"><span class="source">Sara Hylton/Reuters </span></span></figcaption></figure><p>Globally, there has been an increase in the amount of alcohol being consumed. <a href="http://apps.who.int/iris/bitstream/10665/112736/1/9789240692763_eng.pdf">Research</a> suggests that this trend is driven by an increase in drinking in India and China. In Africa, the alcohol consumption trend has not increased since 2006. </p>
<p>South Africa, however, has some of the worst drinking habits in the world. While only 60% of South Africans drink alcohol – higher than the worldwide average of 52% – the level of alcohol consumed amounts to each citizen drinking between ten and 12.4 litres of pure alcohol a year. Worldwide consumption is, on average, <a href="http://apps.who.int/iris/bitstream/10665/112736/1/9789240692763_eng.pdf">6.2 litres</a>.</p>
<p>Alcohol is estimated to cost South Africa <a href="http://www.scielo.org.za/scielo.php?pid=S0256-95742014000200023&script=sci_arttext">R37.9 billion</a> annually. This includes costs around health care, crime and social welfare, alcohol treatment and prevention and road traffic accidents. And this does not include intangible costs such as premature morbidity, morality and absenteeism from work. </p>
<h2>South Africa’s new liquor laws</h2>
<p>Alcohol is a legal substance, used in a reasonably safe manner by some South Africans. It is also an industry that creates employment along the value chain. The question the country faces is: how can the harm associated with alcohol be mitigated?</p>
<p>In May, Trade and Industry Minister Rob Davies gazetted a new <a href="http://www.gov.za/sites/www.gov.za/files/38808_gen446.pdf">policy</a> for public comment. The policy recommends:</p>
<ul>
<li><p>increasing the drinking age from 18 to 21;</p></li>
<li><p>stipulating that premises selling alcohol have to be 500m away from schools, churches, recreational and rehabilitation facilities; and</p></li>
<li><p>restricting alcohol advertising as well as prohibiting sponsorship and promotions associated with alcohol.</p></li>
</ul>
<p>According to minister’s <a href="http://www.gov.za/sites/www.gov.za/files/38808_gen446.pdf">discussion paper</a> there are more than 230,000 liquor outlets across the country and South Africans consume more than five billion litres of alcohol each year. Foetal alcohol syndrome cases in South Africa increased from between 41 and 46 for ever 1000 children in 1997 to between 75 and 74 for every 1000 children in 1999. Separately, 46% of people who died in accidents had alcohol in their bloodstream, equal or above the legal drinking limit.</p>
<h2>Global interventions that work</h2>
<p>Globally, there are a basket of interventions that have shown to decrease the harmful use of alcohol. These include: </p>
<ul>
<li><p>increasing the price which particularly affects young people who are price sensitive;</p></li>
<li><p>banning advertising and sponsorship of alcohol; and </p></li>
<li><p>restricting trading by imposing limits on when and where alcohol is sold.</p></li>
</ul>
<p>According to the <a href="http://apps.who.int/iris/bitstream/10665/112736/1/9789240692763_eng.pdf">World Health Organisation</a>, these three intervention are considered “best buys” as they are highly cost-effective in reducing alcohol-attributable deaths and disabilities. </p>
<p>In addition, changing how alcohol is sold can also mitigate harm. For example, selling food where alcohol is sold, serving soft drinks and water in addition to alcohol and ensuring adequate lighting, space and security all decrease incidents of violence. Refusing to serve drunk people has also been found to mitigate the harm of alcohol. </p>
<h2>What would work in South Africa</h2>
<p>In South Africa, similar interventions could be beneficial on many fronts, especially as the interventions are aimed at decreasing alcohol consumption and changing drinking behaviour. </p>
<p>The challenge for South Africa is that there are both regulated and unregulated alcohol outlets on every corner, and often near every school. The drunkenness spills out into the street, with violence hovering over ordinary people’s lives. Drinking places are unsuitable for children to live near, but that is exactly where they live and go to school. </p>
<p>Many argue that given the high number of unregulated outlets it would be impossible to police safer drinking places. Raising the cost of alcohol, which is also a very effective way to decrease adolescent drinking, and earmarking that money for alcohol control could be a way this to solve this. </p>
<p>Increasing the age at which a person can legally drink is an excellent option in a country where there is such a high road accident morbidity and mortality of drivers and pedestrians. The lethal combination of getting a driver’s licence and drinking alcohol is best delayed until the brain is a bit more mature.</p>
<p>And restrictions on advertising and sponsorship would go a long way to contributing to the denormalisation of drunkenness in our society – something that has to be done to create a society in which alcohol doesn’t wreak the havoc it does in South Africa. </p>
<h2>The power of the industry</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/91446/original/image-20150811-11110-j1h25t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/91446/original/image-20150811-11110-j1h25t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/91446/original/image-20150811-11110-j1h25t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=392&fit=crop&dpr=1 600w, https://images.theconversation.com/files/91446/original/image-20150811-11110-j1h25t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=392&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/91446/original/image-20150811-11110-j1h25t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=392&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/91446/original/image-20150811-11110-j1h25t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=493&fit=crop&dpr=1 754w, https://images.theconversation.com/files/91446/original/image-20150811-11110-j1h25t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=493&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/91446/original/image-20150811-11110-j1h25t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=493&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Many of the national sports teams are sponsored by alcohol brands, such as Castle Lager.</span>
<span class="attribution"><span class="source">Anthony Phelps/Reuters</span></span>
</figcaption>
</figure>
<p>The alcohol industry has a direct interest in increasing the amount of alcohol consumed. It argues that it is each person’s responsibility to decrease harm around alcohol.</p>
<p>The industry is also behind a number of campaigns aimed at reducing the harmful effects of alcohol consumption. But some are directed at the wrong problem while others are misplaced.</p>
<p>For example, its contribution to educating people around the harmful effects of alcohol takes the form of promoting the dangers of <a href="http://www.sab.co.za/sablimited/content/underage-drinking-programme">underage drinking</a>, foetal alcohol syndrome and drinking and driving. But these interventions account for less than 25% of alcohol-attributable harm in South Africa – and will not affect their <a href="https://www.thedti.gov.za/business_regulation/docs/nla/other_pdfs/dna_economics_nla_act.pdf">bottom lines</a>. </p>
<p>The industry focuses on <a href="http://www.ara.co.za/family-and-teenagers/alcohol-intake-during-pregnancy/">foetal alcohol syndrome</a> by promoting messages that pregnant women should not drink. But it is missing the point. The greatest harm that alcohol does to the foetus is in the first eight weeks of a pregnancy when most women are not aware that they are <a href="http://www.cdc.gov/ncbddd/fasd/documents/redalcohpreg.pdf">pregnant</a>. To address foetal alcohol syndrome, binge drinking among young girls and women needs to decrease. And the use of contraception should be promoted. </p>
<p>While the focus on drinking and driving will mitigate harm, the <a href="http://www.ara.co.za/projects/member-campaigns/castle-designated-driver-campaign-kicks-drunk-driving-to-the-curb/">“designated driver approach”</a> suggests that drinking too much is accepted as long as you do not get behind the wheel. Many advertisements normalise this behaviour.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/4N8pNq1Mav0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Some drunk driving adverts promote drinking as long as you have a designated driver.</span></figcaption>
</figure>
<p>Despite these campaigns, the industry pours huge amounts of money into sports <a href="http://www.worldofbeer.co.za/content/page/sab-brands">sponsorship</a> through rugby, soccer and cricket. Various teams are sponsored by South African breweries. It has also invented alcopops to persuade young people – particularly boys – that alcohol is desirable. </p>
<p>The reality is that South Africa must take steps to address alcohol-related harm. This can improve safety at the population level as well as redirect much needed resources to the fiscus.</p><img src="https://counter.theconversation.com/content/43567/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan Goldstein receives funding from the Department of Health, The Centre for Diseases Control and the Global Fund for HIV, AIDS, Malaria and TB Control through Soul City Institute</span></em></p>With South Africa’s consumption levels higher than the worldwide average, interventions to change the country’s drinking habits are critical.Susan Goldstein, Honorary Senior Lecturer at the School of Public Health, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.