Binge drinking and alcohol-related behaviours amongst Pacific youth: a national survey of secondary school students

Pacific children and youth are a priority population in New Zealand's Child Health Strategy because they tend to experience poorer health outcomes.1 Alcohol consumption has been identified by the latest Ministry of Health's Pacific youth health report as a high risk behaviour,2 particularly because it is associated with other risky behaviours such as injury and unprotected sex.3,4In general, youth are considered to be at increased risk of harm from alcohol use than older adults as they bear the greatest risk of injury related to alcohol use, have an increased risk of alcohol dependence, and a lower tolerance to alcohol than older adults.Much of the physical and social harm associated with alcohol results from heavier drinking occasions or binge drinking.5,6 Binge drinking increases the risk of acute health effects—in particular unintentional injury, motor vehicle accidents, violence, criminality, self-harm and increased risk of chronic diseases such as liver cirrhosis.7-10Pacific people experience a disproportionate burden of alcohol-related harm compared to the general population.11 Alcohol is more frequently consumed by Pacific peoples in New Zealand than in their Island nations, possibly due to it being more readily available and having increased disposable income.12,13Previous surveys of Pacific peoples' alcohol use indicate that Pacific peoples tend to be polarised as either non/occasional drinkers or heavy drinkers.14-17 As a whole, fewer Pacific New Zealanders drink alcohol compared to the general population, but those who do drink alcohol tend to drink larger quantities of alcohol on a typical occasion.Pacific youthThe first national survey of the health and wellbeing of New Zealand youth in 2000, reported that Pacific youth drinking habits were similar to adults, with high proportions of non-drinkers, but also high numbers of youth who were binge drinkers.18 Pacific youth were less likely to report drinking at home and with their families than New Zealand European youth.The usual drinking places were reported as outdoor places including parks, malls, streets, parties or bars/nightclubs.19 This indicates that for Pacific youth, drinking often takes place away from family surroundings and family monitoring. Binge drinking behaviours were also associated with being male, attendance at higher SES schools and being NZ-born.20 A qualitative investigation into factors that support abstinence or responsible drinking amongst Pacific youth living in New Zealand, found parental and church/religious influences, a previous negative experience with alcohol, and peer group influences supported abstinence or responsible drinking.21Variance between Pacific communitiesNew Zealand's Pacific populations are diverse. They are complex and heterogeneous with distinct cultural, language and lifestyle differences both between Island groups and within each ethnic group category (for example, NZ-born Samoans and Island-born Samoans).22There are also significant differences in alcohol use and views about alcohol amongst these diverse groups.12 Available data suggests Cooks Island Māori and Niuean groups are more likely to consume alcohol compared to Samoan and Tongan groups,19 with this trend also observed for Pacific youth.20The objective of this paper is to further explore the prevalence of binge drinking among Pacific students by age, gender, NZDep, specific Pacific ethnicities; describe the context around binge drinking for Pacific students and determine the cultural, spiritual, home and neighbourhood environment characteristics of Pacific binge and non-binge drinkers.Method Survey background—Data for the current study were collected as part of Youth'07, a nationally representative sample of the health and wellbeing of secondary school students in New Zealand. First, 115 schools were randomly selected and 96 agreed to participate in the survey, representing an 84% response rate for schools. The participating schools reflected the general characteristics of secondary schools in New Zealand.23 From the participating schools, students (n=12,355) were randomly selected from the school roll and invited to participate. Of these, a total of 9,107 students formed the final Youth'07 sample, representing a 74% response rate. On the day of the survey, students were asked to come to a designated room. Upon arrival students were given an anonymous login code to access the survey. The survey included a 622 item multimedia questionnaire administered on a Nokia internet tablet and identification of their census meshblock number (based on their residential address) to determine the extent of their neighbourhood deprivation. The multimedia nature of the questionnaire meant that all students could read each question and fixed-response options themselves, while listening to the questions and responses being read aloud through headphones. The University of Auckland Human Subject Ethics Committee granted ethical approval for the study. School principals consented to participation in the survey on behalf of the Boards of Trustees. Students and their parents were provided with information sheets about the survey. Students consented themselves to participate in the study on the day of the survey. A more detailed description of the research methodology can be obtained elsewhere.23 Secondary analysis of the data provided by Pacific students (13% of the total sample) was undertaken. Ethnicity was recorded using New Zealand 2006 Census ethnicity question whereby participants select all of the ethnic groups that they identified with from one of 5 major ethnic groups using Statistics New Zealand Ethnic prioritisation method.24 All students who self-identified any of their ethnic groups as Samoan, Cook Islands, Tongan, Niue, Tokelauan, Fijian, or Other Pacific Peoples are included in these analyses (n=1190). Of the Pacific students in the sample, 53.7% were female and 67.7% were 15 years or younger. Intra-Pacific ethnicity analyses required ranking multi-ethnic students in the following order: Niuean, Tongan, Cook-Island Māori, and Samoan. Outcome measures—Binge drinking was measured by a series of branching questions. First, students were asked if they had ever drunk alcohol (not counting a few sips) and continued to drink alcohol by asking thefrequency of alcohol consumption in the last 4 weeks. If they responded yes, they were asked "In the past 4 weeks, how many times did you have 5 or more alcoholic drinks in one session within 4 hours?" with response categories "none at all', "once in the past 4 weeks", "two or three times in the past 4 weeks", "every week", or "several times a week". Those who reported drinking 5 or more alcohol drinks in one session at least once in the last 4 weeks were classed as binge drinkers. Non-binge drinkers were students who did not currently drink (n=506) or who had not drunk 5 or more drinks in a session in the last 4 weeks (n=157). Context around drinking—Students were asked to indicate the source of their alcohol when drinking; types of alcohol more commonly consumed; people that they would normally drink with; reasons for drinking alcohol; to report whether they experienced any alcohol related problems and whether they were worried about their alcohol consumption. Demography—Age, gender and ethnicity were determined by self-report. Small area deprivation (NZDep) was determined using the 2006 New Zealand Deprivation Index.25 For descriptive purposes, the NZDep Index deciles were categorized into three groups reflecting low deprivation (1-3), middle levels of deprivation (4-7), and high deprivation (8-10). Three items were used as proxy measures of household deprivation, including; thenumber of times moved home in the last 12 months; perceiving parents or caregivers worrying about havingenough money to buy food and places other than bedrooms used as bedrooms as a proxy measure of household overcrowding. Pacific cCultural factors—Five items were chosen to assess Pacific cultural factors, three were related to use of a Pacific language (e.g., Samoan, Tongan, Fijian, Niuean, Cook Islands Māori) by a parent (or caregiver) and by the student. Students were also asked whether they could understand their respective Pacific spoken language. A cultural identity item asked students how important it was to be recognized as Niuean, orTongan, or Cook Island or Samoan. A cultural maintenance item asked students to reflect about their level of comfort at Niuean, or Tongan, or Cook Island or Samoan social events or gatherings. Spiritual factors—Three items were chosen to assess spiritual factors; attending a place of worship, the importance of spiritual beliefs or religious faith and a question that asked specifically how much spiritual faith or beliefs affect daily life choices including activities like sex, taking drugs or drinking alcohol. Home and environment factors—Home environment items used in analyses were the number of parents (or caregivers) present in the home, and parents' knowledge of the student's friends, whereabouts after school,and whereabouts at night time. Items used to assess environment factors included the number of secondary schools a student may have attended since entry into high school (year 9), students feeling safe in their neighbourhood, and extra-curricular engagement via taking part in a sports teams or clubs outside of school time. Analysis—Frequencies and 95% confidence intervals were used to describe the characteristics of students who reported binge drinking and the context around binge drinking. Chi square tests were used to test for differences between those who reported binge drinking and those who did not. Chi-square tests were used to investigate the univariate associations between binge drinking and hypothesised demographic, cultural, home and environment factors. Using factors that reached a significance level of 0.1, a logistic regression model was used to investigate the associations between binge drinking and demographic, cultural, home and environment factors, after controlling for other variables in the model. All analyses were conducted using the survey procedures in the SAS software v9.2 (Cary, NC) to account for the weighted and clustered design of the data. Results Information on binge drinking was available for 974 (81.8%) students (209 did not answer the alcohol section and 7 said they had drunk alcohol but gave no further information). Of these 974 students, 31.6% (n=308) reported binge drinking in the last 4 weeks. There were no gender differences in binge drinking behaviours, but there was a significant association with age, with almost half (47.1%) of all older students (17 years) binge drinking compared to only 15.2% of younger students (13 years) (see Table 1). Table 1. The association of binge drinking with key demographic variables amongst Pacific students Variables Binge drinkers Non-binge drinkers n % (95% CI) n % (95% CI) Gender Males Females 154 154 30.6 (24.8-36.3) 33.0 (28.6-37.4) 351 315 69.4 (63.7-75.2) 67.0 (62.6-71.4) Age 13 14 15 16 17 37 61 68 79 63 15.2 (9.3-21.1) 29.5 (23.6-35.4) 34.0 (25.6-42.5) 42.2 (35.0-49.4) 47.1 (39.5-54.6) 207 148 132 108 71 84.8 (78.9-90.7) 70.5 (64.6-76.4) 66.0 (57.5-74.4) 57.8 (50.6-65.0) 52.9 (45.4-60.5) NZDep low medium high 31 93 177 34.5 (24.2-44.7) 37.2 (30.5-43.8) 28.7 (24.6-32.9) 60 158 440 65.5 (55.3-75.8) 62.8 (56.2-69.5) 71.3 (67.1-75.4) NZDep=New Zealand [socioeconomic] Deprivation Index. Students living in the most deprived neighbourhoods were less likely to binge drink than those from the least and medium deprived areas. Assigning to a single specific Pacific ethnicity resulted in 10.4% Niuean; 18.5% Tongan; 20.4% Cook-Island Māori; 35% Samoan and 15.6% Other Pacific distinct ethnic groups. By specific Pacific ethnicity, Cook Island students appeared to have a higher prevalence of binge drinking (38.5%), compared to Niuean (31.7%), Tongan (29.9%) and Samoan (29.9%) students (data not shown). Context around drinking—Students who were binge drinkers were asked to indicate the source of their alcohol when drinking 5 or more alcoholic drinks in one session. Most students who reported binge drinking got their alcohol from "friends" (71%); got "someone else to buy it" (43%) or got it from their "brothers/sisters" (34%). Approximately a quarter of students reported getting it from "another adult they know" (29%); their "parents" (26%) or "buying it themselves" (22%). Fewer students sourced alcohol by "taking it from home" (17%) or by stealing it (11%). With regards to types of alcohol they usually drink a high proportion of Pacific students (42%) preferred ready-made alcoholic drinks (or RTDs ready-to drink), followed by beer (26%); spirits (17%); other (10%) and preferred wine the least (5%). Students reported they normally drank alcohol with "friends" (88%), and then "family" (52%), "other people" (40%) and 11% "by myself". Having fun and socialising with their friends were the most common reasons for consuming alcohol. Eighty-one percent of students drank alcohol to have fun (81%) and to enjoy parties (60%). Almost half of students (47%) reported they consumed alcohol "to get drunk" and "to relax" (45%). Over a third (36%) drunk alcohol because they were "bored" or "to forget about things" (35%). Nearly a quarter of students drank "because my friends do" (23%) and "to make me feel more confident" (23%). Of concern, almost one in four students experienced alcohol-related harm. The most commonly reported alcohol-related problems for Pacific students were: doing things that could get them into trouble (29%), having unsafe sex (28%), having friends and family talk with them about cutting down on their alcohol use (26%), and getting an injury as a result of their alcohol use (25%). One in five students (20%) reported that their performance at school or work was affected by alcohol use and that they had caused an injury to someone else (19%). High risk was also reported with 14% reported having unwanted sex, 8% were injured requiring medical treatment and 5% experienced a car crash through alcohol use. However, the majority of students reported not being worried about their alcohol consumption (59%). The relationships between binge drinking and socioeconomic, cultural, spiritual and environment factors are described in Table 2. Among the socioeconomic variables, students who lived in homes where other rooms were used as bedrooms were more likely to binge drink than students who do not live in crowded homes. Most of the cultural and all of the spirituality/religious variables appeared to be inversely associated with binge drinking, such that students with strong Pacific cultural and spiritual/religious competencies were less likely to binge drink. From the seven variables used to assess home and environment factors, only parents' knowledge of students' whereabouts after-school and at night time was significantly associated with less binge drinking. Table 2. Binge drinking by selected SES, cultural, spiritual/religious, home and environment variables amongst Pacific students Variables Binge-drinkers (n=308) Non-binge drinkers (n=666) n % (CI) n % (CI) P-value Socioeconomic status (SES) Times moved home in the last 12 months None Once or more 236 71 31.0 (26.8-35.1) 34.8 (26.4-43.1) 530 133 69.0 (64.9-73.2) 65.2 (56.9-73.6) 0.349 Parents' worried about having enough money to buy food Never Occasionally/sometimes Often/All the time 127 113 48 32.7 (27.8-37.5) 31.1 (25.5-36.6) 31.6 (23.3-39.9) 264 252 104 67.3 (62.5-72.2) 68.9 (63.4-74.5) 68.4 (60.1-76.7) 0.881