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The consequences of underage drinking can range from short-term and acute like accidental injury, to long-term addiction and damage to the brain, heart, liver, and stomach (U.S. Department of Health and Human Services, 2017).
Drinking habits in youth can be modeled and predicted by Albert Bandura’s Social Cognitive Theory (SCT) (Connor, 2005). SCT suggests, an individual’s behavior is explained by triadic reciprocity of dynamic, cognitive, behavioral, and environmental factors, which perpetually influence each other (McLeod, 2016). Consequently, an individual’s relationship with alcohol is determined by their knowledge surrounding alcohol and their environment. As such, influencing these factors provide an effective means of targeting underage drinking. The environment, health literacy, and personal values of youth are predominantly determined by parents, hence, by implementing a health-initiative targeting parent, underage drinking can be successfully curbed at a community level (Gross, 2016). Moreover, targeting parents aligns with the Ottawa Charter action area “supportive environments” as informed and healthy parents are essential to a supportive environment (Hurley, 2016).
Insight into barriers, enablers, current drinking trends and available community resources regarding underage drinking is necessary to holistically consider how to decrease it at a community level.
Analyzing secondary data and pre-existing trends regarding underage alcohol misuse will help direct and specify the aim of the health initiative. In 2017, 41% of students aged 12-17 reported drinking in the past year, 23% in the past month, and 14.5% in the past week (Alcohol Think Again, 2017). On the other hand, the average age of first alcohol consumption has gradually risen from 14.8 years in 1995 to 16.1 years in 2016 (AIHW, 2019). These statistics convey the effectiveness of currently provided community resources in influencing youth to drink at an older age. However, current resources cannot effectively reduce harmfully high underage alcohol consumption once it has begun, as evident in the 14.5% underage weekly alcohol consumption. Hence, a relevant health initiative will aim to reduce the amount of alcohol consumed by teenagers, rather than promote drinking at an older age. These critically high underage drinking rates indicate a significant presence of barriers and a lack of enablers in adolescents’ lives.
Identifying key determinants, barriers and enablers will help determine the most effective method to reduce underage drinking. The determinants of health most pertinent to underage drinking were identified as culture, family, and health literacy, as these factors directly relate to the social cognitive theory (Gerran, 2017). Personal and behavioral factors are directly influenced by the knowledge of the individual, thus health literacy will influence one’s personal/behavioral tendencies toward alcohol (Chin, 2018). Furthermore, the most significant factors contributing to a teenager’s environment include family and culture (Youth.gov, n.d.). Depending on the condition of these three determinants, they can each assume the role of a barrier or enabler.
Our heavy drinking culture is a barrier to healthy underage drinking practices due to alcohol being heavily connected to social situations and promoted in sporting events (Gerrans, 2017). As alcohol consumption is endorsed to adolescence from a young age, it is likely many may adopt these romanticized attitudes toward drinking. This is due to the theory of observational learning. The theory suggests that one learns from and adopts their own values, attitudes, and beliefs from their environment (Schwartz, 2015). Hence, a teenager brought up in a heavy drinking culture will be more encouraged to drink than one that isn’t exposed to said culture. This conclusion is supported by the World Health Organisation, stating “many factors contribute to affect the health of individuals. Whether people are healthy or not, is determined by their circumstances and environment” (WHO, 2019). Furthermore, per the social cognitive theory, as drinking culture is a significant component of a youth’s environment, it will incline them personally and behaviourally toward alcohol consumption, due to the reciprocal relationship between these factors. To offset this barrier it is essential that the second determinant of health pertinent to one’s environment is an enabler – parents.
Parents have the unique ability to shape a teenager’s environment and personal values toward alcohol from birth. This is reinforced by a study review conducted in 2016 stating “Almost all prospective studies on this topic have found that parental drinking predicts drinking behavior in their children,” (Rossow, 2016). Consequently, whether children observe parental drinking significantly determines their own drinking habits. For parents to be considered an enabler and protective factor for teenagers, minimal observed parental drinking is paramount. As such, unhealthy drinking habits in parents are critical barriers to a child’s own healthy drinking behaviors as supported by The American Addiction Centres stating “children who grow up with an alcoholic parent run a higher risk of becoming alcoholics themselves” (The America Addiction Centres, 2019). Similar to parents, health literacy can act as both a barrier and an enabler, depending on the extent of the individual’s knowledge. High health literacy acts as an enabler as it deters underage drinking by allowing youth to make more informed decisions (Gordon, 2016). According to the theory of observational learning, parents would be the most effective means of instilling sufficient health literacy into teenagers as they have been observing their parents since birth.
Currently, there are numerous national health campaigns that have been implemented to decrease underage drinking e.g. “I need to you say no – alcohol think again” (Alcohol Think Again, n.d.). Though somewhat effective (as evident in the increase of the average first drink age) these resources do not target a specific community and haven’t sufficiently decreased the rate of underage drinking (14.5%). Clearly, an initiative needs to be put forth to meet the alcohol-related needs of adolescents. Adolescents need an initiative that offsets barriers like drinking culture while promoting enablers such as health literacy and a minimal-alcohol environment. The overall analysis of barriers, enablers, resources, and trends demonstrates the effectiveness of reducing underage drinking by targeting parents, hence, the initiative needs to develop parent-based resources. As supported by the theory of observational learning, the initiative will aim to reduce observed parental drinking and provide parents with health literacy-based resources.
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