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Social Normative Perceptions of Alcohol Use and Episodic Heavy Drinking Among Central and Eastern European Adolescents

Randy M. Page a; Ferenc Ihasz b; Iacob Hantiu c; Jaromir Simonek d; Renata Klarova e a Department of Health Science, Brigham Young University, Provo, Utah, USA b Department of Physical Education, Apaczai College of Education, University of West Hungary, Gyor, Hungary c Faculty of Physical Education and Sport, University of Oradea, Oradea, Romania d Department of Physical Education and Sports, University of Constantine the Philosopher, Nitra, Slovakia e Department of Sports Education, Faculty of Sports Studies, Masaryk University, Brno, Czech Republic Online Publication Date: 01 February 2008 To cite this Article: Page, Randy M., Ihasz, Ferenc, Hantiu, Iacob, Simonek, Jaromir and Klarova, Renata (2008) 'Social Normative Perceptions of Alcohol Use and Episodic Heavy Drinking Among Central and Eastern European Adolescents', Substance Use & Misuse, 43:3, 361 - 373 To link to this article: DOI: 10.1080/10826080701202866 URL: http://dx.doi.org/10.1080/10826080701202866

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Substance Use & Misuse, 43:361–373 Copyright © 2008 Informa Healthcare USA, Inc. ISSN: 1082-6084 (print); 1532-2491 (online) DOI: 10.1080/10826080701202866

Perceptions: Adolescent Drinking

Social Normative Perceptions of Alcohol Use and Episodic Heavy Drinking Among Central and Eastern European Adolescents RANDY M. PAGE,1 FERENC IHASZ,2 IACOB HANTIU,3 JAROMIR SIMONEK,4 AND RENATA KLAROVA5 1

Department of Health Science, Brigham Young University, Provo, Utah, USA Department of Physical Education, Apaczai College of Education, University of West Hungary, Gyor, Hungary 3 Faculty of Physical Education and Sport, University of Oradea, Oradea, Romania 4 Department of Physical Education and Sports, University of Constantine the Philosopher, Nitra, Slovakia 5 Department of Sports Education, Faculty of Sports Studies, Masaryk University, Brno, Czech Republic 2

This study examined alcohol use and related social normative perceptions among a sample of 1,886 Central-Eastern European high school students. The youth represented in the study averaged 16.5 years of age and were from several localities in the countries of Hungary, Slovakia, Czech Republic, and Romania. Data for the study were collected through a school-based alcohol use survey that was completed in June 2005. Our results support the hypothesis that drinking was related to perception of the prevalence of alcohol use by schoolmates and by the number of friends who drink and/or engage in episodic heavy drinking. Specific implications of findings in terms of substance use prevention are discussed. In addition, the need for future research and the limitations of the current research are discussed. This study was largely financially supported through an international grant from the College of Health and Human Performance, Brigham Young University. Keywords social norms; alcohol use; adolescents; substance use prevention; peer behavior; risk-taking; episodic heavy drinking

Address correspondence to Randy M. Page, Department of Health Science, Brigham Young University, 221 Richards Building, Provo, UT 84602. E-mail: randy [email protected] ∗ The authors of this article are concerned about and are aware that the youth involved in this study are not very likely to benefit directly from their participation but this issue was not part of the research design. Editor’s note.

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Introduction Health problems associated with drinking (e.g., cancer, cardiovascular disease, cirrhosis) in Central and Eastern Europe are high and are largely attributable to changing patterns of alcohol and tobacco consumption (Bray, Brennan, and Boffetta, 2000; Szucs, Attila, McKee, ´ and Adany, 2005). Drinking patterns often develop during the adolescent years that persist into adulthood (Chassin, Pitts, and Prost, 2002). Alcohol use is associated with substantial mortality and morbidity during adolescence and young adulthood (Bonnie and O’Connell, 2004; Jernigan and Mosher, 2005) and can progresses to alcohol problems and dependence later in life (Chassin et al., 2002; DeWitt, Adlaf, Offord, and Ogborne, 2000; Jernigan and Mosher, 2005; Rhode, Lewinsohn, Kahler, Seeley, and Brown, 2001). According to the World Health Organization, alcohol use caused 285,000 deaths and the loss of nearly 2.2 million disability-adjusted life years (DALYs) in young people aged 15–29 years in 2002 (Rehm et al., 2004). The percentage of deaths caused by alcohol among 15- to 29-year-olds is higher in Eastern Europe (Belarus, Estonia, Hungary, Kazakhstan, Latvia, Lithuania, Republic of Moldova, Russian Federation, Ukraine) than any other region of the world (Rehm et al., 2004).

Purpose of the Study The purpose of this study was to assess among a sample of Central-Eastern European high school students the estimated number of friends who drink, estimated drinking prevalence of schoolmates, and whether these estimations were related to self-reported frequency of personal alcohol use. Previous research in adolescent populations showing a connection between adolescent risk-taking behaviors and social normative perceptions led us to hypothesize that these estimations would be associated with students’ self-reported alcohol use (Berkowitz, 2004; Gibbons and Buunk, 1999; Miller-Day and Barnett, 2004). This study is important because it addresses the congruence between these adolescents’ estimations of peer drinking and self-reported alcohol use. According to Piko (2001), adolescents’ estimates of their peers’ risk behavior prevalence can influence their own behavior. She and others (Piko, Luszczynska, Gibbons, and Tekozel, 2005; Unger and Rohrbach, 2002) explain that as youth are motivated to conform to peer norms, this tendency to overestimate the prevalence of peers’ behavior represents a high-risk factor for adolescents. Risk behaviors often become a habit in the company of peers who engage in these behaviors (Ennett and Bauman, 1994; Maxwell, 2002). Adolescents often evaluate their personal behavior in comparison to their perception of the behaviors of peers. This process of social comparison helps young people to adjust to peer norms and behaviors (Gibbons and Buunk, 1999).

Method Faculty members from four Central-Eastern European universities used an alcohol use questionnaire to collect local data about alcohol use in specific secondary schools where they worked as physical education teacher trainers and mentors or through their work as student teaching supervisors. These questionnaire administrations were conducted between September 2004 and June 2005. In most cases, the questionnaire was administered in selected physical education classes by the classroom teacher or graduate students from the universities. Although the intent of these data collection efforts is to provide data for local areas, it was decided to pool the data from these 22 schools to provide a sample of CentralEuropean adolescents of sufficient size to have the statistical power to meet the purposes of the current study. In the strictest sense the data from this sample are generalizable only to the

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individual high schools and localities from which data was pooled. However, the pooling of the data created a unique opportunity to study a larger cross section of youth living in this region of Europe. The data pooling from this study clearly is not representative of all CentralEastern high school students but does provide an opportunity to explore the relationship of estimations of friends’ and schoolmates’ drinking behavior with self-reports of the frequency of personal alcohol use in a large sample of youth from several localities in four different Central-Eastern European countries (Hungary, Slovakia, Czech Republic, Romania). The schools provide a mix of schools from urban as well as rural areas. The schools were primarily public (state-supported) schools. These faculty contacted administrative officials and classroom teachers (mostly physical education) in each school to secure approval of the study and to work out details for survey administration and obtained necessary human subject protocols from their respective universities and data collection requirements of the local schools. The survey administration resulted in a total of 1,886 completed surveys. Table 1 includes a background characteristics of the sample. The alcohol use questionnaire consisted of 10 items, 6 of which assessed alcohol use and 4 assessed estimations of alcohol use by friends and schoolmates. Alcohol use status was determined by asking “How often do you drink alcohol?” Episodic heavy drinking was determined by asking “How often do you drink 5 or more drinks of alcohol in a row (within a couple of hours)?” Current alcohol use was determined by calculating the frequency of students reporting drinking alcohol in the past 30 days. This is also the operational definition of current alcohol use used in the U.S. Centers for Disease Control and Prevention’s Youth Risk Behavior Survey (Grunbaum et al., 2004). Weekly alcohol use was also determined by calculating the frequency of students reporting drinking alcohol in the last week. Two other alcohol use measures were included in the survey: (a) How many drinks of alcohol did you drink in the past week? and (b) How many times did you have five or more drinks of alcohol in a row within a couple of hours during the past month? Social norms theory (Berkowitz, 2004) provided the theoretical framework and underpinnings for this study and as such the survey instrument included certain social normative perception variables. The estimate of the number of friends who drink alcohol and estimate of the number of friends who are episodic heavy drinkers were assessed by similar items to that used in previous research by Piko (2001). The estimate of the number of friends who drink alcohol variable was assessed by asking “How many of your friends drink alcohol?” and the estimate of the number of friends who are episodic heavy drinkers variable was assessed by asking “How many of your friends drink 5 or more drinks of alcohol in a row (within a couple of hours)?” Estimations of the prevalence of drinking among schoolmates was assessed by having respondents give the estimated percentage of students in their high school whom they say drank alcohol in the past week. They were asked to give separate estimations for male and female students. These items focus on the role of normative beliefs as potential determinants of risk behavior. Social norms theory posits that individuals align many of their health and social behaviors with their beliefs about the prevalence and acceptability of the same behaviors in their environment (Olds, Thombs, and Tomasek, 2005). Directions on the survey instrument alerted students to the fact that the survey was anonymous and instructed them not to write their name anywhere on the survey. Students were also informed that their participation was voluntary and that the decision to participate would not affect their grade in the class. There were no reports of students declining to participate. It is not known if this was related to each country’s school culture. Descriptive statistics were used describe alcohol use and estimations of use. Chi-square and ANOVA tests were used to determine relationship between prevalence of drinking and estimations of drinking among friends and schoolmates. These tests were calculated

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Page et al. Table 1 Selected background characteristics of sample members %(f)

Gender Male Female Did not report gender Age 13 14 15 16 17 18 19 20 21 23 Country Hungary Czech Republic Slovakia Romania

Comments

44.1 (829) 55.9 (1,050) (7) Mean age was 16.5 (SD = 1.2) 0.3 (5) 1.1 (21) 17.3 (325) 28.5 (537) 29.7 (559) 17.0 (321) 5.0 (94) 0.9 (17) 0.2 (3) 0.1 (1) See information below for location of schools 48.6 (917) 15.9 (300) 17.7 (333) 17.8 (336)

Hungarian schools were located in the following cities: Gyor (4 schools), Mosonmagyarovar (3 schools), Papa (1 school), Pecs (1 school), and Miskolc (1 school). Miskolc is located in eastern Hungary and is the third largest city in the country after Budapest and Debrecen. Pecs, in the southwest, is the fourth largest city in Hungary (160,000 population) and Gyor, in the northwest near the Austria and Slovakian borders, is the sixth largest city in Hungary (130, 000 population). Papa (65,000 population) and Mosonmagyarovar (59,000 population) lie near Gyor in the northwest corner of the country. Slovakian schools included one in the capitol city of Bratislava (480,000 population), three in Nitra (90,000 population), one in Sahy (8,000 population), and one in Levice (39,000 population). Each of these cities are in the western part of Slovakia, in close proximity to Hungary and Austria. The data pool included one school in the Czech Republic, located in the city of Brno (420,000 population), which is near the Slovakian border. Brno is the political and a cultural hub of the South Morovian Region. Romanian schools were all located in the city of Oradea, Romania (207,000 population), which is located in the western part of Romania in the Western Transylvania region. Socioeconomic factors were not assessed in the survey.

separately for boys and girls. Chi-square tests and t-tests were also used to determine whether male and female students differed significantly (p < .05) on prevalence of alcohol use/episodic heavy drinking, estimates of the number of friends who are drinkers, and mean estimations of the prevalence of drinking among schoolmates.

Results Self-reported alcohol use is presented in Table 2. Frequency of alcohol use (χ 2 11.83, df = 3, p < .01), prevalence of current alcohol use (χ 2 = 9.90, df = 1, p < .01), use in the past week (χ 2 = 18.86, df = 1, p < .0001), frequency of episodic heavy drinking (χ 2 = 61.00,

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Table 2 Self-reports of alcohol use and estimations of use among schoolmates by gender

Frequency of alcohol use∗ Never used Used in my life but not within the last 30 days Used in the last 30 days, but not in the last week Used in the last week, but not daily Used daily Prevalence of current alcohol use∗ Prevalence of alcohol use in past week∗ Frequency of episodic heavy drinking∗ Never used Used in my life but not within the last 30 days Used in the last 30 days, but not in the last week Used in the last week, but not daily Used daily Prevalence of episodic heavy drinking in the past month∗ No. of drinks of alcohol in past week∗ Times engaging in episodic heavy drinking in past month∗ Estimated % of male students drinking alcohol in past week Estimated % of female students drinking alcohol in past week ∗

% Boys ( f )

% Girls ( f )

16.8 (138) 24.6 (202) 21.4 (176)

21.3 (222) 27.4 (286) 23.5 (245)

33.3 (274) 3.9 (32) 58.1 (482) 36.9% (306)

26.2 (273) 1.5 (16) 50.8 (534) 27.5 (289)

45.7 (374) 18.2 (149) 14.8 (121)

60.5 (629) 18.8 (195) 9.7 (101)

18.1 (148) 3.3 (27) 35.7 (296)

9.6 (100) 1.3 (14) 20.5 (215)

Boys M (SD) 4.6 (9.1) 1.6 (3.1)

Girls M (SD) 2.2 (5.6) 1.1 (3.0)

65.3 (25.2)

65.1 (23.6)

50.6 (26.2)

53.1 (24.7)

Boys and girls differed significantly on chi-square or t-test ( p < .05).

df = 4, p < .0001), prevalence of episodic heavy drinking in the past month (χ 2 = 54.26, df = 1, p < .0001), number of drinks of alcohol in the past week (t = 6.87, df = 1854, p < .0001), and times engaging in episodic heavy drinking in the past month; and estimated percentage of female students drinking alcohol in the past week (t = 2.07, df = 1841, p < .05) differed between boys and girls. Boys and girls did not differ on estimated percentage of male students drinking alcohol in the past week (t = 0.15, df = 1846, p = .8804). Table 3 presents estimates of the number of friends who drink and estimation of drinking prevalence of schoolmates. Boys and girls differed significantly on estimate of number of friends who drink (χ 2 = 10.12, df = 4, p < .05) and estimate of number of friends who are episodic heavy drinkers (χ 2 = 27.51, df = 4, p < .0001). There was no gender difference on estimation of drinking prevalence in the past week among male schoolmates (χ 2 = 3.86, df = 3, p = .2761) and among female schoolmates (χ 2 = 5.23, df = 3, p = .1554). In both genders, alcohol use variables were significantly associated with estimated number of friends who drink and estimated number of friends engaging in episodic heavy drinking. Among boys, the prevalence of current alcohol use (χ 2 = 205.26, df = 4, p < .0001) and the number of drinks of alcohol in the past week (F(4, 809) = 35.04, p