The rising culture of non-drinking: are we getting sick of getting sick?

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The rising culture of non-drinking: are we getting sick of getting sick?

Welcome to UCL’s Lunch Hour Lecture series I’m very pleased to be introducing today’s lecture Our speaker today is Dr Noriko Cable Dr Cable specialised in clinical psychiatric nursing She then went on to do research work, graduating with a PhD in Nursing from the Medical College of Georgia, in Augusta in the United States She then moved to the UK and began working at UCL in 2002 First of all, at the Institute of Child Health, and then she moved on to the Department of Epidemiology and Public Health She has been working there for many years She is currently a Senior Research Fellow Dr Cable’s main research area is the risk and protective factors associated with mental health and wellbeing across the life course As part of this, she’s had a focus on alcohol use and misuse in adolescence and adulthood It’s no surprise that the lecture today draws on her research on drinking and wellbeing Over to Dr Cable, who will talk about the rising culture of non-drinking Are we getting sick of being sick? Thank you, Noriko Thank you, Amanda for introducing me to the audience I’m Noriko Cable, and I work at the International Centre for Lifecourse Studies in Society and Health It’s really masterful but before we move onto that, please allow me to talk about what ICLS does What does ICLS do? ICLS works to produce and share research evidence to reduce the negative health impacts due to the associated disadvantages among people at all ages The booklets we produce are a good example You can download it via our website As Amanda mentioned, my main work is in the area of mental health I’ve been looking at risk and protective factors for mental health at the population level That includes alcohol use and my work also appears in Chapter 3 of either booklet I’m also convenor for UCL Alcohol Research Interest Group We were founded to do work looking at non-drinking in the UK I am delighted to share some of the work with you today I’m honoured and delighted to give you a lecture today Let me start with the talk, titled ‘The rising culture of non-drinking: are we getting sick of being sick?’ For a starter, I investigate youth drinking patterns over time, which is the motivation of my talk, drinking and non-drinking Following on, to think about the factors associated with non-drinking, we also have to think about factors associated with drinking That is the second part of the talk What influences youth drinking behaviours Followed by possible driving forces to stay being non-drinkers Many of you know that peer drinking is the main driving factor for youth drinking For this section, I will explain the role of peer drinking My talk will end with a brief summary followed by a discussion of the future implications What we can do to help children stay non-drinkers Let me start with the first part of the talk,

demographic trends on alcohol use and misuse among youth over time in the UK Before getting into the subject matter, I’d like to ask you this question We have no technology today, so I’ll have to ask you to show your hands The question is when was the first time you had alcohol, not a sip? Please raise your hand if it was less than ten years old Okay Between 10 – 14? What about 15-16? Between 17-19? And over 19 years old? That kind of shows predominantly 10 -14 and 17 – 19 is the important time to start drinking That brings us to the assumption that maybe today’s youth are drinking There’s no drinking Let’s see how this changed over time I would like to show you in this graph that average alcohol consumption, in mean units, at all age groups, is declining over time, from 2005 to 2010 Especially among the age group 16 – 24 That is shown by the thick, blue line with the arrow That went from 16.9 units to 11 That is roughly 6 units What does 6 units mean? By definition, 1 unit of alcohol contains 8g of pure ethanol That is around half a pint of standard cider or beer, 76ml of standard wine, a single shot of standard whiskey, and nearly a bottle of alcopop There was about 6 units less weekly, which is roughly 3 pints of beer or cider, 2/3 of a standard bottle of wine of 750ml, 6 shots of spirits or 6 bottles of alcopop That is quite a significant reduction in weekly consumption According to UK guidelines, men shouldn’t drink more than 4 units, and 3 units for women, per day These guidelines have changed now We shouldn’t exceed 14 units of alcoholic drink per week for both men and women We also need to have drinking free days in between Next, I’d like to talk about binge drinking I’m sure you’ve heard this term It’s a health risk By definition, it is excess drinking or drinking to get drunk ONS defines such excess drinking as 8 units for men and 6 for women on a single occasion In this figure In this figure, we can see above the guidelines, that is the black line, and binge drinking is the red line They reduced over time for men aged 16-24 What about women?

They are pretty similar to men in the same age group The trend is a bit stagnant towards the end What about non-drinking? I’ll show you in the next slide This is work my colleague and I did, which we were funded to do so Looking at the Health Survey for England we looked at non-drinking groups in the age group 16-24 In this figure, we can see the rise of non-drinking in this age group, from 18 to 29%, that is shown in the blue line Most interestingly, the proportion of people who have never drunk, shown in the green, is also increasing, from 9 to 17% To recap for now, alcohol unit consumption is declining over time It is more prevalent in 16-24 age group In this age group, there are declines in not sensible and binge drinking over time There is also a sharp rise of lifetime non-drinkers Moving on, let me explain what influences youth drinking This is important to help us understand how we can stop children engaging with alcohol in the first place Looking around, there are many images of drinking In the UK, many TV soaps like EastEnders and Coronation Street, probably some of you know The Nag’s Head from Only Fools and Horses, soap stories revolve around pubs Even in the US, the famous sitcom, the Simpsons, there is a bar called Moe’s Place That’s where Homer and his friends gather around What messages are sent to young children with this? This is the children’s perception of drinking called alcohol expectancies Alcohol expectancy is defined as expectations of physical or psychological effects induced by drinking alcohol This can be learnt from adult behaviours and messages from the media There are two types of alcohol expectancy: they are positive and negative The positive expectancy is feeling good from drinking and the negative expectancy is the experience of vomiting or hangover The study showed that positive alcohol expectancy relates to children drinking The negative alcohol expectancies are stopping children from drinking Let’s see what we found in this aspect of children, and the bond in different times Aged 16 children, who were born in 1970 the positive alcohol expectancy was related to boys drinking, if they are sensible, binge drinking, heavily drinking daily, but it had a modest effect on girls’ drinking Negative alcohol expectancy, like the expectation of getting sick or hungover, was not a significant determinant But when we looked at aged 11 children born around the new millennium, among them, positive alcohol expectancy was related to their drinking,

while negative alcohol expectancy protected children from drinking These are two examples looking at children born in different times They show you that positive alcohol expectancies relate to children’s drinking This alcohol expectancy can be shaped as early as age 11 Another main driving factor for shaping children’s drinking behaviour is parental health related behaviours Again, we looked at age 16 children who were born in 1970 and age 11 children who were born around the new millennium In both studies, maternal drinking determined the child’s drinking, but not father’s That reminds me of the social learning theory by Bandura He did a famous experiment using a Bobo doll It showed that behaviours could be learnt from observation, imitation and modelling Is this really the case? We asked, would children’s risky health related behavioural patterns be shaped by adults’ behaviours in the household that are similar to them? For this, we used the Household Panel Survey, sampling around 40,000 households in the UK, called ‘Understanding Society’ We used drinking, smoking, physical activities and diet from both adults 16 and over in the household, and children aged 10 -15 With this information, four adult behavioural patterns were identified: healthy, lightly risky, moderately risky and risky For the children, there were two, either healthy or risky The children’s risky behavioural patterns were less likely to be determined by the same patterns of the adults’ Why can we say that? Risky patterns of adult behaviour only had a smaller chance compared to the moderately risky, that was not significant When we look at this moderately risky adult behaviour in the household, it showed 8 times greater chance for children being in the group of the risky health behavioural pattern In this study, parental ethnicity and other factors were accounted for What about non-drinking? What helps children to not drink and stay that way? For this study, we looked at the same dataset, that is ‘Understanding Society’, and we looked at the possible protective factors They are happiness, greater awareness of harm by alcohol or cigarette use, and an emotionally supportive friend network They looked at how these factors are associated with children’s continuous persistent non-drinking patterns What are the factors? Our results showed increased happiness and greater harm awareness both predicted children’s persistent non-drinking status But not supportive friendship networks, that was not significant Why is that? Why does having helping friends not help stop children drinking? What’s going on? That brings us to the question of the role of peer drinking Before I move on to talking more about the role of peer drinking, I’d like to ask you some questions If someone is refusing your drink and sticking to his/her non-alcohol beverage, what would be your response?

Could you show your hands if your response is to try again by offering another alcoholic drink that he/she may like, none Could you show your hand if you insist they have at least a sip? Maybe one C) Get upset and leave the scene? You guys are very liberal Could you show your hand if your response is to stay with the person but keep my alcoholic drink? Most of you The last one, switch my alcoholic drink to a non-alcoholic one? Very liberal! The reason I ask this is because I come from Japan Japan is bad in terms of peer pressure We tend to encourage or force others to drink Like trying again, or offering another, or insisting they have a sip, or maybe like another one better They don’t really take no for an answer, especially if the offer is coming from a superior and the person refusing is inferior to them For example, if my boss is Japanese, if I say no to his/her drink, he/she would probably be angry, more likely he, why do you not want my drink? It’s my order that you drink, so you must drink It’s indirectly causing you to drink What can we see here? There is pressure to drink even if you do not want to That’s something I would like to show you with research evidence That clearly shows a relation between peer drinking and children’s drinking at the same children born in different times: children aged 16 in 1970 and, equally, aged 11 children born in the new millennium Bringing everything to the context of youth drinking, as I said before, positive alcohol expectancies are related to all types of boy’s drinking, but they only had a modest effect on girls What does this mean? What does alcohol expectancy and peer drinking mean? Can we put them together and interpret the picture of youth drinking? What does it tell you? Probably boys drink because they expect to be emotionally high and feel good by drinking and as everyone, so that suggests there is room for alcohol education to change their perception so they are less likely to drink On the other hand, girls are likely to drink because everyone drinks, despite having high harm awareness, or less positive alcohol expectancy, but it is possible they cannot say no What can we do about it? This is coming to examples of public initiatives to counter youth drinking They are ID checks and Dry January This ID check is called Challenge 25 I think some of you will have seen this in the supermarket, ‘Under 25?’ This is a public initiative from the Retail Alcohol Standards Group, that says that anyone older than 18 but looks younger than 25,

they ask to produce a proper ID, if they want to buy alcohol That is an initiative to control underage drinking This is now law in Scotland This Challenge 25 was implemented in 2009 Prior to that, a similar initiative called Challenge 21 was implemented in 2005 In this graph, we divided non-drinking by age group That is under legal age and legal age Under legal age is in green The legal age is the red line There are clearly some points, it’s not analysis, but it coincides with the Challenge 21, which was implemented in 2005, and Challenge 25, implemented around 2009 The ongoing trends of the proportion non-drinking is growing in this under legal age group Next, I’d like to talk about another initiative: Dry January This was initiated by Alcohol Concern in around 2013 Again, this same graph shows you around 2014, the proportion of non-drinking in this age group, was slightly increasing This isn’t analysis but it really coincides That’s showing that public initiatives to counter youth drinking are really effective My son often says that it shouldn’t have to be cool to socialise often with alcohol It’s a vehicle to being in a social circle Maybe those days can be over if the children think it is cool not to drink We can support it That brings me to the end of my talk In summary, youth non-drinking is increasing Children’s alcohol use is likely to be driven by their own expectations of alcohol Happiness and harm awareness can stop children from drinking and stay non-drinkers That partially offers the answer to the title of my talk Children are probably getting sick of being sick, having knowledge of the alcohol harm and being happier about staying on it With the recent research evidence, that it can be threatened by peer drinking, especially among girls, that is a great danger for non-drinkers That is why the culture of non-drinking needs to be supported Most importantly, this kind of evidence cannot be produced without series of birth cohort data using similar questions, and longitudinal household panel studies, like Understanding Society, using similar questions I am very grateful that this data is available to researchers That concludes my talk I would like to thank colleagues from ICLS, Alcohol Research Interest Group, and my Department of Epidemiology and Public Health, for their feedback and the funder, the ESRC and the Alliance House Foundation, for supporting this work Thank you Thank you, Noriko It’s now time for some questions A little bit of housekeeping first Can you wait for the roaming microphones to get to you before you ask your question? Could you just ask one question and not overload Noriko with questions

Thanks for the talk Have you done a study which has found drug use among that age group decreasing as well? Is there a parallel between non-drinking or less drinking and drug taking? I’m sorry that I didn’t look at drug use Number one, the data is unreliable for this health report Mainly for this, I look at alcohol Thank you I want to challenge you because you’ve described the decline in drinking among adolescents but I’m not sure you explained why you thought that was happening? That is the Sheffield Group’s study That’s why From the Understanding Society youth group study, the happiness and the alcohol harm awareness increases the likelihood of them being non-drinkers They are having more positive effects from education Children are equipped to know what the harm is so they should stop doing it Also, they are more comfortable doing it and not drinking, because they are happy about it They will probably be supported by a similar crowd not drinking, so they can stay happy and not drinking together There’s one at the back there and the one here Thank you One quick question Did you find any relationship between non-drinking religious or ethnic backgrounds? For this particular study, the religion and ethnicity are controlled, meaning we took out all these effects We all know there are some certain ethnic groups and religious groups that don’t allow anybody to drink It’s balanced I’d like to challenge your conclusion that the initiative of Dry January has had an impact I didn’t say that, possibly it’s important I’d like to challenge the assumption that it’s potentially important, given the graph you showed where it looked that for under 18s, the increase had begun prior to 2014, which is when the Dry January initiative began, and for the age group 18-24, it looked as though there had been a plateau in recent years That’s my point, it’s not a conclusion or a definite answer By showing that increase, it’s something we can talk about how not-drinking is healthy and can make you feel good to promoting the culture The data only shows the two year pattern, we need more data to see a steady increase or decline to support the points I think we could use more data A separate point is to what extent do you think the changes you’ve observed are due to a change in the reporting of drinking? Could you repeat it? What extend do you think the changes you’ve seen in non-drinking is due to a change or increase in the willingness to report alcohol consumption among young people? It’s early days to say, because they are growing trends We cannot pinpoint yet, that is why we started looking at it to see what can be related So far, I can share that it’s not so much the ethnic groups or religion

or where you live or health status it’s happening across all groups regardless of your background or health status That’s something we ruled out, the background factors, we are going to look beyond this for the next step It’s not really a question I’m interested in the economics For example, increased alcohol prices in Scotland, and the idea that we had an economic crash in 2008 globally, and alcohol does cost money In the same way that cigarettes have gone up and up, people aged 16-24 have a limited income, and you see things like the government taking away funding for college, I just wonder if you’re going to look at the economy? There is an economic question there about how people afford to have fun, if you want to call drinking fun I don’t think the government would like to hear that the children are spending the government funds on drinking, but to come back to your questions, the Sheffield Group does all this, the minimum price, I think you can look at it, I’m not an economist There’s some research evidence showing in Scotland, consumption itself is gradually declining It’s having a positive effect by implementing that policy In this country, it’s not happening yet The results they are showing are based on England so I think that you can do without the minimum pricing effect Yes, possibly the economic crisis and taking the vouchers away However, I think the most important thing is we are strict about underage drinking or talk about the positive effects of not drinking I think that’s gradually getting into people’s minds Unless there’s any other questions, I’d like to thank Noriko again Please join me in thanking her for her interesting talk