Alcohol use and physically risky behavior among adolescents

Alcohol Health & Research World, Summer, 1991 by M. Fe Caces, Frederick S. Stinson, Thomas C. Harford

The authors examined the relationship between alcohol use and physically risky behavior, using a national sample of 8th- and 10th-grade students. Although conclusions as to whether alcohol use leads to risky behavior, or vice versa, are not possible from the survey data, the data do clearly demonstrate that alcohol use and physically risky behavior tend to occur together.

Adolescence is generally regarded as a period of heightened exploration of various behaviors, including physically risky activities such as hitchhiking or carrying a weapon. In addition, adolescence is often the time when alcohol use begins, and the time when drinking patterns may become established. Linkages between alcohol and other drug use and risk-taking behavior patterns among adolescents have been suggested (Jessor et al. 1980; Donovan and Jessor 1985), but there has been little systematic investigation of these relationships. To examine the relationship between alcohol use and physically risky behavior, we studied data from a national sample of 8th- and 10th-grade students.

DATA SOURCE

The National Adolescent Student Health Survey (NASHS) was a comprehensive cross-sectional study designed to yield national baseline data on health-related behaviors of 8th- and 10th-grade students. The study focused on a number of health areas, including alcohol use, as well as risky behavior and violence. A national sample survey was conducted from November 1987 to January 1988 under the sponsorship of the American School Health Association (ASHA), the Association for the Advancement of Health Education (AAHE), and the Society for Public Health Education (SPHE). Funding was provided by the Department of Health and Human Services' Office of the Assistant Secretary of Health, the Center for Health Promotion and Education of the Centers for Disease Control, and the National Institute on Drug Abuse. The resulting publication, NASHS: A Report on the Health of America's Youth (ASHA/ AAHE/SPHE 1989), provides a summary of the survey findings, broken down by sex and by grade level. Details of the study design are presented in this report and in a related publication (Centers for Disease Control 1989). Brief background information is provided here.

Three questionnaires, each containing a distinct set of topics, were administered to a national sample of 12,067 students drawn from 217 junior and senior high schools. The three questionnaires were administered to selected classrooms, and students responded to one of the three questionnaires randomly assigned. The Form 2 questionnaire, completed by 3,789 8th- and 10th-graders, contained all questions relating to violent or physically risky behavior, as well as questions on alcohol or other drug use, and tobacco use. This sample of 3,789 students was weighted to reflect a nationally representative sex and grade distribution.

The term "physically risky behavior," as used in this Epidemiologic Bulletin, includes involvement in a physical fight (defined as "when two people hit each other or attack each other with weapons, not when they yell or shout"), carrying a weapon at school, and a series of specific behaviors, including the following:

* going to places that are known to be

dangerous

* talking to strangers who tried to keep

the respondent (R) from going on his

or her way

* letting people see how much money R

was carrying

* going on a blind date with someone R

hardly knew

* going out alone to sell items door-to-door

* hitchhiking

* walking alone through unsafe neighborhoods

* riding on empty buses or train cars

* walking outside alone late at night.

Respondents were asked the number of occasions they had engaged in each of these activities in the past year. Alcohol use was determined from reports of the number of occasions the survey respondents had used alcoholic beverages in any form during the last 30 days, during the last 12 months, and in their lifetime. In addition, each respondent was asked how many times in the past 2 weeks he or she had consumed five or more drinks on any one occasion.

ANALYSIS AND LIMITATIONS OF THE DATA

Percentages, the basis of our comparisons, were generated from weighted sample data. Sample weights allow estimations of national distribution. Abstainers and alcohol users were compared for each of the risky behaviors surveyed. All tables reflect weighted data and, where appropriate, the sample size on which the estimate is based.(1) In sample sizes of fewer than 30 cases, percent estimates are considered unstable and are not interpreted.

The main limitation of these data is that the direction of causality (i.e., whether alcohol use leads to physically risky behavior or whether physically risky behavior leads to alcohol use) cannot be established. All of the findings pertain to associations between physically risky behavior and alcohol use, as reflected in students' responses. This sample excludes students who were absent on the day of the survey, estimated at 9.4 percent of the enrolled students. To the extent that the absent group may overrepresent problem students (who may be more likely to use alcohol, or to engage in physically risky behavior, or both), some bias toward underestimating both behaviors might be present. Self-reported data on sensitive subjects, such as drinking, also may relfect some reporting bias.