ORIGINAL ARTICLE

 

Physical violence and alcohol drinking consumption among teenagers

 

 

Amanda Pacheco de Carvalho; Carolina da Franca; Valdenice Aparecida de Menezes

Universidade de Pernambuco (UPE) - Recife (PE), Brasil

Correspondence

 

 

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ABSTRACT

INTRODUCTION: Adolescence is a period of transition, between childhood and adulthood marked by biological, psychological and social changes. These changes characterize the situations of vulnerability to which these individuals are exposed.
OBJECTIVE: The aim of this study was to examine the association between alcohol consumption and involvement in physical violence among adolescent students in the city of Olinda, Pernambuco, Brazil
METHODS: This was a pilot, cross-sectional, study conducted with adolescents enrolled in high school. The Youth Risk Behavior Survey questionnaire was applied in the classroom and questions were taken from the modules on alcohol consumption, violence and socioeconomic data. Analysis of associations was performed using the Chi-square test, or Fisher's exact test when the Chi-square parameters were not met.
RESULTS: Involvement in physical altercations was associated with male gender (p = 0.001), alcohol consumption in the last 30 days (p = 0.019), binge drinking (p = 0.022) and higher maternal education (p = 0.037).
CONCLUSION: There was an association between the consumption of alcohol by adolescents and physical violence. These results are an indication of the vulnerability to which this population is exposed and is a warning of the need for further studies to investigate this issue

Keywords: alcohol drinking, violence, adolescent.

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INTRODUCTION

Adolescence is a transition period between childhood and adult life marked by biological, psychological and social changes¹. These changes highlight the position of vulnerability to which these individuals are exposed².

Interpersonal violence is considered a public health problem. It is defined as the use of physical force or power over another individual and can result in injury, death, psychological damage and developmental problems³. One of manifestations of interpersonal violence is fighting⁴. In North America and Europe, the prevalence of involvement in fights among adolescents ranges from 37% to 69% for boys, and from 13% to 32% for girls⁵. In Brazil these percentages can vary between 17% and 32% for boys and 8.9% and 13% among girls^6,7. Many factors may be considered to be determinants of their involvement in situations of violence, such as the consumption of alcoholic beverages and other drugs⁸.

The prevalence of alcohol consumption in the last 30 days among Brazilian adolescents is high, varying between 19% and 26%⁶. This percentage reaches 66.6% when considering at least once instance of alcohol consumption in their lives^5-7. Considering that alcohol is the drug most consumed by adolescents and physical aggression is the main cause of mortality due to external factors in Brazilian adolescents, the objective of this study was to analyze whether there was an association between consumption of alcoholic beverages and physical violence among adolescents.

 

METHODS

This was a cross-sectional study, which was part of the larger project titled "Integral Attention to Adolescent Health in Public Services in Olinda".

The selection of participants was carried out randomly, using 2 stratified stages; in the first stage, the schools were drawn and in the second, the classes. Five schools and twelve classes were selected for this study, in order to guarantee heterogeneity of data. The draw of schools and classes was carried out using the Randomizer program.

A 95% confidence interval, a power of 80%, an odds ratio of 1.5, a delineation effect of 1.2 and a frequency of 50%, were considered for the sample calculation of the larger project, as a result of the various risk conduit variables involved, and a 10% increase in losses, resulting in a final sample of 1,077 adolescents. For this pilot study, 16% of the total sample of high school students of the state public network of the city of Olinda, in the state of Pernambuco, Brazil, was enrolled.

Data collection took place in April 2014 by administering the validated version of the Youth Risk Behavior Survey in the classrooms⁹. The questionnaires were applied by previously trained researchers. Participants were informed that their written responses were guaranteed to be anonymous. The time for application of the questionnaire was between 30 and 60 minutes, and it occurred without the presence of the teacher.

Alcohol consumption was analyzed based on the age of first consumption, alcohol consumption in the last 30 days and binge drinking, defined as the act of ingesting ≥ 5 measures of alcohol on a single occasion. According to the V National survey on the use of psychotropic drugs among primary and secondary school students in 7 Brazilian capitals, the average age of onset of alcohol use is close to 12 years, so this was the age adopted for this variable¹⁰.

Involvement in situations of violence was analyzed based on carrying of weapons in the last 30 days, involvement in fighting in the last 12 months and involvement in fighting with serious injury (health care needed) in the last 12 months.

Data were tabulated with double input using Epidata 3.1 software. Descriptive and inferential statistical analyses were performed. Pearson's Chi-square test or Fisher's exact test were used for association analysis when the Chi-square parameters were not met. For both tests, significance was considered for values of p<0.05. Data analysis was performed using the Statistical Package for the Social Sciences program (SPSS) for Windows, Version 19.0 (IBM Corp., Armonk, NY, USA).

This study was approved by the Ethics Committee of the University of Pernambuco under the opinion nº 568.996.

 

RESULTS

For this pilot study, participants were 175 adolescents regularly enrolled in high schools of the state education network, in the city of Olinda, Pernambuco, Brazil. The majority of adolescents were enrolled in regular schools (80.7%), were between the ages of 14 and 17 (71.9%), had a family income of up to 2 x the minimum wage (59.1%) and were female (57.0%).

Regarding gender, there was no statistical difference in the consumption of alcoholic beverages, although the boys presented with a higher percentage of consumption than the girls. As to involvement in violence, male gender was associated with the carrying of a weapon (p = 0.02) and involvement in physical altercations in the last 12 months (p = 0.001; Table 1).

Adolescents who had consumed alcohol in the last 30 days or had at some point consumed by binging showed almost twice the prevalence of involvement in physical altercations compared to those who did not consume alcohol (Table 2).

Of the adolescents whose mothers had a higher level of schooling, 39.1% who consumed alcohol in the last 30 days were involved in a physical altercations, which represented a significant association (p = 0.037). Despite a similar percentage of adolescents who had consumed alcohol in the last 30 days among those whose maternal schooling was of a lower level (34.8%), a similar association was not found (Table 3).

 

DISCUSSION

In general, alcohol consumption in the last 30 days and binge drinking are associated with involvement in teenage fights. Individually these risky behaviors also showed alarming percentages.

Alcohol consumption among adolescents from Olinda was high (27.9%), and higher still among boys (31.1%), although the gender association was not statistically significant (p = 0.420). These percentages are in agreement with the findings of the National School Health Survey (PeNSE)⁶, where 25.4% of adolescents in schools in the city of Recife had consumed alcoholic beverages in the last 30 days; the levels among males and females were 26% and 24.9%, respectively⁵. Souza et al.¹¹. showed that 71% of adolescents had consumed alcohol at some point and 13.4% could be classified as having some degree of alcoholism.

Binge drinking was not associated with gender, demonstrating that high amounts of alcohol were consumed by both girls and boys. In the present study, one in 5 adolescents reported having taken part in binge drinking, which was less than half that found by Donath in a study of German adolescents, where one in 2 exhibited this behavior¹². By comparison, binge drinking in Australian adolescents was much lower, at around 4.8%¹³. This finding is alarming, excessive drinking can lead to intoxication, which in turn can increase the participation in risk taking, which can extend to behavioral problems with family, school and friends¹⁴.

Although alcohol in Brazil is prohibited for children under 18 years of age, 61.6% of the adolescents in this study had already had their first contact with alcoholic beverages, with 24.5% having consumed before the age of 12 years. This result showed that experience with alcohol consumption was occurring earlier than observed in the National Survey on the Patterns of Alcohol Consumption in the Brazilian Population that found that the first contact with alcohol occurred on average at 13.6 years of age¹⁵. The prevalence of alcoholic beverage consumption tends to increase linearly with age¹¹. Adolescents are drinking alcohol prematurely and the age of 10 - 13 years has been shown to be the most common time for the first experience with alcohol¹⁶.

To estimate the occurrence of physical violence among the respondents, 2 situations were examined. The carrying of a weapon was used as a measure of likely incitement to violence. The prevalence of gun possession was associated with males, with 10.9% of the boys reporting carrying a gun in the last 30 days. According to PeNSE⁶, 6.4% of Brazilian adolescents were involved in a violent situation where one person carried a firearm and 7.3% had a white weapon⁵. These data highlight the vulnerability to which these adolescents are exposed, reinforced by the fact that homicides represent an important percentage in the morbimortality of this group.

Involvement in fights was also a situation associated with male gender, consistent with the study by Coutinho et al.⁷. Boys are roughly twice as likely to engage in fights with physical violence, compared to girls⁸. These findings suggest that boys use violence as a way of resolving conflict and it reflects our cultural norms, where fighting is seen as acceptable behavior for boys¹⁷.

The association between alcohol consumption and fighting was also found in other studies conducted in South America^2,7-9. Drinking alcohol can trigger violence and escalate violent situations among adolescents². Adolescents who consume alcohol are on average twice as likely to engage in a fight as those who do not consume^3,18. A study conducted in Mato Grosso, Brazil, found that this value could be higher than 4 times¹⁹. Among adolescents who did not consume alcohol in the last month, 18.5% became involved in fights. Among those who consumed alcohol, this percentage was approximately double (35.4%), and this relation was significant (p=0.019). Similar percentages were found in a study of Malaysian adolescents, where 40.8% of those who consumed alcohol became involved in a fight, while among those who did not drink the percentage it was 25.7%³. These results reinforce the need for better targeting of public policies aimed at this population, including discussion of this issue in schools, aiming at health promotion and prevention of alcohol consumption and physical violence.

The patterns of alcohol consumption and involvement in situations of violence are influenced by socioeconomic factors. In the present study, the association between fighting and alcohol consumption was significant for adolescents whose mothers had more years of academic study. Historically, adolescent boys, those with darker skins, and those from low socioeconomic levels are the most vulnerable to risk behaviors related to violence³. However, studies have already shown a change in this pattern, where alcohol consumption is high in all social strata and has a significant association with violence among adolescents, including middle-upper-class adolescents^12,13.

The results of this study demonstrated that adolescent alcohol consumption was independent of gender, though males were more likely to be involved in fights. Current alcohol consumption and binge drinking were factors associated with involvement in fights. The existence of this association with these diseases is an indication of the vulnerability to which adolescents are exposed when they adopt risky behaviors.

The National Policy on Health Promotion has among its points of reference the reduction of morbimortality due to the use of alcohol and other drugs, and the prevention of violence and the encouragement of a culture of peace. Therefore, studies that seek to explain the association between conditions such as alcohol abuse and aberrant behaviors, such as violence, help in determining direct action that can be taken to promote the health of adolescents.

 

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Correspondence:
amandapdc@gmail.com

Manuscript received: August 2018
Manuscript accepted: October 2018
Version of record online: November 2018