ANALYSI S OF THE ALCOHOL CONSUMPTI ON PHENOMENON AMONG ADOLESCENTS:
STUDY CARRI ED OUT W I TH ADOLESCENTS I N I NTERMEDI ATE PUBLI C EDUCATI ON
Ter esa Bar r oso1 Aida Mendes2 Ant ónio Bar bosa3
Barroso T, Mendes A, Barbosa A. Analysis of t he alcohol consum pt ion phenom enon am ong adolescent s: st udy carried out wit h adolescent s in int erm ediat e public educat ion. Rev Lat ino- am Enferm agem 2009 m aio- j unho; 17( 3) : 347- 53.
This study aim ed to evaluate the alcohol consum ption phenom enon in public schools in Coim bra, Portugal ( 7th, 8th and 9th grades) for the im plem entation of a preventive program of alcohol use/ abuse. This is a quantitative, descr ipt ive and cor r elat ional st udy. The sam ple included 654 st udent s ( 51.5% fem ale) bet w een 12 and 18 y ear s of age. The Alcohol Ex pect ancy Quest ionnair e – Adolescent for m ( AEQ- A) and t he Quest ionnair e of Know ledge on Alcohol w er e used for dat a collect ion. Result s show t hat posit iv e ex pect ancy on alcohol is discrim inative of consum ption and occurrence of intoxication. Positive expectancy exists even before adolescents have significant experiences wit h alcohol consum pt ion and increases wit h age, which reinforces t he need for ear ly pr ev ent iv e effor t . These r esult s per m it t ed t o im pr ov e t he pr ev ent ion pr ogr am included in t he school curriculum of t he 7t h grade st udent s.
DESCRI PTORS: adolescent ; alcoholism ; healt h prom ot ion
ANÁLI SI S DEL FENÓMENO DEL CONSUMO DE ALCOHOL ENTRE ADOLESCENTES:
ESTUDI O REALI ZADO CON ADOLESCENTES DEL 3 º CI CLO DE ESCUELAS PÚBLI CAS
Est e est udio t iene com o obj et ivo evaluar el fenóm eno del consum o de alcohol en las escuelas públicas de la ciudad de Coim bra ( 7º ,8º y 9º ) para im plem ent ar, en la práct ica, un program a de prevención del uso/ abuso del consum o alcohólico excesivo. Es un est udio del t ipo cuant it at ivo, descript ivo y de correlación. La m uest ra incluy ó 654 est udiant es ( 51. 5% del sex o fem enino) , con edades ent r e 12 y 18 años. El Cuest ionar io de Ex pect at iv as r ef er en t es al Alcoh ol de est u dian t es - For m at o Adolescen t es ( CEA- A) y el cu est ion ar io del conocim ient o referent e al alcohol fueron ut ilizados para obt ener los dat os. Los result ados dem ost raron que las expect at ivas posit ivas referent es al alcohol hacen una diferencia ent re el consum o de alcohol y la ocurrencia de la em br iaguez; inclusiv e, est a discr im inación ex ist e ent r e los adolescent es ant es de t ener ex per iencias significat iv as con el consum o de alcohol y aum ent an con la edad. Refor zando la necesidad de desar r ollar pr ecozm en t e esf u er zos pr ev en t iv os. Est os r esu lt ados per m it ier on el per f eccion am ien t o del pr ogr am a de prevención que fue int egrado al plan de est udios de la escuela de los est udiant es del 7º año.
DESCRI PTORES: adolescent e; alcoholism o; prom oción de la salud
ANÁLI SE DO FENÔMENO DO CONSUMO DE ÁLCOOL EM ADOLESCENTES: ESTUDO
REALI ZADO COM ADOLESCENTES DO 3 º CI CLO DE ESCOLAS PÚBLI CAS
Este estudo teve com o obj ectivo a avaliação do fenóm eno do consum o de álcool em escolas públicas da cidade de Coim bra ( 7º , 8º e 9º ) para a im plem entação de um program a de prevenção de uso/ abuso de álcool. É um estudo do tipo quantitativo descritivo- correlacional. A am ostra incluiu 654 estudantes ( 51,5% do sexo fem inino) , com idades com preendidas entre 12 e 18 anos. Utilizou- se para a colheita de dados o Questionário de Expectativas acerca do Álcool - Form at o Adolescent es ( AEQ- A) e o Quest ionário de Conhecim ent os acerca do Álcool. Os r esult ados m ost r ar am que as ex pect at iv as posit iv as acer ca do álcool são discr im inat iv as do consum o e da ocorrência de em briaguez. Essas exist em nos adolescent es m esm o ant es de experiências significat ivas com o consum o de álcool, e aum entam com a idade. Reforçando a necessidade de os esforços preventivos terem que ser desenvolvidos precocem ent e. Esses result ados perm it iram o refinam ent o do program a de prevenção que foi int egrado ao curriculum escolar dos est udant es do 7º ano.
DESCRI TORES: adolescent e; alcoolism o; prom oção da saúde
1RN, Doctoral student, Universidade de Lisboa, Portugal, Adj unct Professor, Escola Superior de Enferm agem de Coim bra, Portugal, e-m ail: tbarroso@esenfc.pt; 2RN, Doct or in Educat ion, Facult y, Escola Superior de Enferm agem de Coim bra, Port ugal, e- m ail: am endes@esenfc.pt ; 3Physician, Doct or in Psychiat ry,
Faculty, Faculdade de Medicina da Universidade de Lisboa, Port ugal, e- m ail: abarbosa@net cabo.pt .
I NTRODUCTI ON
A
l co h o l i s o n e o f t h e m o st co n su m e d psychoactive substances in the world and the one that causes the m ost severe consequences to public health, cu r r en t l y co n si d er ed t h e m a i n l i f e st y l e- r el a t ed det erm inant of healt h( 1). The burden of diseases andm orbidities attributed to alcohol varies between 8 and 10% in countries in the European Union(2).
Portugal is one of the largest alcohol consum ers in the world and has recently changed its consum ption pat t er ns. These new pat t er ns ar e v er y concer ning because they refer to a population group of particular v u ln er ab ilit y an d of t r ad it ion al low con su m p t ion : adolescent s( 3). I n fact , research has showed t hat t he
p er cen t ag e of ad ol escen t s w h o con su m e al coh ol progressively increases wit h age and t hat t he onset age is 12 years old(4).
At the sam e tim e, scientific evidence suggests t hat ear ly onset is associat ed t o fut ur e behav ior al problem s in adolescence, including violence related to alcohol, accidents, driving under influence, absenteeism at school and work and increased risk t o use ot her d r u g s, an d also f u t u r e alcoh ol ab u se( 5 ). Becau se
ad olescen ce is an im p or t an t p er iod of t r an sit ion , m arked by com plex biological, physical, behavioral and social transform ations, alcoholic behavior in this phase of life results in the developing adolescent’s encounter with a substance of harm ful effects in a situational and encouraging cont ext t hat prom ot es consum pt ion.
On the other hand, there is a relation between adolescents’ critical periods of behavioral developm ent and the possibility of im plem enting effective preventive m easures. Thus, it is essential that these are developed before the onset of alcohol consum ption( 6).
Research developed in recent years regarding the explicative factors of adolescents’ consum ption of alcohol and other drugs identifies several risk as well as pr ot ect iv e fact or s( 7), such as: sociocult ur al ( e.g.
so ci o d e m o g r a p h i c f a ct o r s) , f a m i l y ( e . g . a l co h o l co n su m p t i o n b y p a r e n t s, p a r e n t a l m o n i t o r i n g ) , in v olv in g social en v ir on m en t ( e. g. alcoh ol access, con n ect ion t o sch ool, m ass m edia in f lu en ce, peer p r essu r e) , ex p ect an cy ( e. g . at t it u d es an d b elief s r egar ding alcohol consum pt ion, peer s’ ex pect at ions and perception), social and personal com petences (e.g. d e ci si o n - m a k i n g , st r e ss m a n a g e m e n t a b i l i t i e s, co m m u n i ca t i o n a b i l i t i e s, a sse r t i v e n e ss) a n d psy ch ological ( e. g. self- efficacy, self- est eem ) . Th e different effects these factors can produce depend on
in div idu al ch ar act er ist ics, dev elopm en t ph ase an d env ir onm ent .
Hist or ical an aly sis r ev eals t h at pr ev en t ion p r o g r a m s o n t h e u se o f su b st a n ce s h a v e b e e n dev eloped in t he last decades based on t he social influence m odel, including the developm ent of personal and social com petences(8-9) and the use of one or m ore
of the following com ponents: knowledge on substances, resistance to social pressure, training of personal and social com petences, correction of peers’ perception on alcohol consum pt ion, safe at t it udes and expect ancy regarding subst ances( 9).
Pr e v e n t i o n ca n b e d e v e l o p e d i n d i v e r se con t ex t s an d w it h sp ecif ic g r ou p s. An or g an ized approach is possible in the school context, involving a large num ber of children and adolescents at high- risk age to initiate substance consum ption.
Despit e t hese advant ages, school prevent ion in Portugal is still incipient, infrequent and dependent on the sensitiveness of teachers and support they ask to health local centers or other health institutions(10).
I n a country like Portugal, where there is great so ci a l a n d cu l t u r a l p er m i ssi v en ess t o a l co h o l consum ption, preventive efforts should focus on hating alcohol consum ption through the developm ent of safe expect ancy regarding alcohol and personal and social abilities, which are essential to resist the pressure for the inopportune consum ption of alcohol and responsible decision- m aking( 9).
Healt h prom ot ion in t he school environm ent should be seen as an ongoing developm ent process. For pr ev ent iv e int er v ent ions t o be efficacious, t hey have t o be based on scient ific evidence, t ailor- m ade t o t he t arget cont ext and developed by professionals wit h specific knowledge on t he healt h area t o which education and health area relate.
This study aim ed to analyze the phenom enon of alcohol consum ption am ong adolescents from 12 to 1 8 y ear s of ag e, st u d en t s in in t er m ed iat e p u b lic e d u ca t i o n i n Co i m b r a , Po r t u g a l , w i t h a v i e w t o im proving a preventive program on alcohol use/ abuse t o be included in t he school curricula of int erm ediat e st udent s.
METHOD
know ledge and expect ancy of 7t h, 8t h and 9t h- gr ade
students at public schools in Coim bra? Are knowledge an d ex pect an cy r elat ed t o st u den t s’ con su m pt ion , occurrence of int oxicat ion, age and gender?
Sam p le
The sam ple included 654 st udent s from t he 7t h, 8t h and 9t h grades in public schools in Coim bra,
Port ugal, bot h genders, 51.5% ( n= 337) was fem ale, between 12 and 18 years old ( average [ SD] = 13.55 [ 1.13] age) ; 37% at t ended t he 7th grade, 33.8% t he
8th and 29.3% the 9th grade.
Dat a collect ion procedure
Af t er co m p l y i n g w i t h f o r m a l a n d et h i ca l recom m endations, the instrum ent was applied to 654 students from the 7th, 8th and 9th grades, interm ediate
public education in Coim bra, Portugal, between March and April 2006. The quest ionnaire was dist ribut ed in class t o all st udent s w hose educat ional r esponsible provided writ t en aut horizat ion.
I nst r um ent s
Th e dat a collect ion in st r u m en t in clu ded a s e t o f s o c i o d e m o g r a p h i c q u e s t i o n s a n d c h a r a c t e r i z a t i o n o f a l c o h o l c o n s u m p t i o n : t h e Qu e st i o n n a i r e o f k n o w l e d g e o n Al co h o l ( QKA) , co m p o sed o f 4 0 d i ch o t o m o u s st a t em en t s ( t r u e/ f a l s e ) a i m e d t o e v a l u a t e u se f u l k n o w l e d g e o n alcohol ( scor es fr om 0 t o 40 and 1 point is at t r ibut ed t o e a c h c o r r e c t s t a t e m e n t ) a n d t h e A l c o h o l Ex p e c t a n c y Qu e s t i o n n a i r e – A d o l e s c e n t s f o r m ( AEQ- A)( 1 1), a dich ot om ou s in st r u m en t t h at aim ed
t o ev alu at e adolescen t s’ ex pect an cy ( 1 2 - 1 9 y ear s old) in sev en dim ensions: Fact or I – global posit iv e t r a n sf o r m a t i o n s; Fa ct o r I I – ch a n g e s i n so ci a l b e h a v i o r ; Fa ct o r I I I – i m p r o v e d co g n i t i v e a n d m ot or ab ilit ies; Fact or I V – sex u al en h an cem en t ; Fact or V – cognit iv e and m ot or im pair m ent ; Fact or VI – in cr eased ar ou sal an d Fact or VI I – r elax at ion an d t en sion r edu ct ion .
The AEQ- A global score in t he sam ple under st udy ( n= 654) r ev ealed Kuder Richar dson v alue of .90, which shows t he inst rum ent ’s good consist ency. However, a great variability was found in the analysis of t h e in st r u m en t fact or s. Fact or V pr esen t s good int ernal consist ency ( K20= .80) , Fact or I ( K20= .78) ,
Fa ct o r I I ( K2 0 = . 7 3 ) a n d Fa ct o r VI I ( K2 0 = . 7 6 ) pr esent ed accept able consist ency, alt hough Fact or s I I I ( K20= .64) and I V ( K20= .65) revealed low internal consistency and Factor VI ( K20= .33) very low internal consist ency.
St at ist ical processing and used soft ware
Dat a an aly sis w as car r ied ou t w it h SPSS ( Statistical Package for Social Sciences) version 14.0. The following analyses were carried out : descript ive analyses t hat involved descr ipt ion of dist r ibut ion of t he st udy variables; Chi- square of t he difference of pr opor t ion s t o ev alu at e associat ion of cat egor ical v ar iables; St udent ’s t - t est t o com par e av er ages of con t in u ou s v ar iables an d becau se t h e AEQ- A is a dichot om ous inst rum ent , Kuder Richardson coefficient was used t o evaluat e it s int ernal consist ency.
RESULTS
Mo st ad o l escen t s h ad al r ead y co n su m ed a l c o h o l ( 6 5 . 1 % ) . O f t h o s e w h o r e p o r t e d consum pt ion of alcohol, 67.1% w er e fem ale, t hough t her e w er e no significant differ ences bet w een boy s and gir ls ( Chi- squar e= 1.13, 1df, p= .29) . Regar ding co n su m p t i o n p a t t e r n s: 7 . 7 % r e p o r t e d h a b i t u a l consum pt ion ( at least once a m ont h) of beer, 7 % h a b i t u a l co n su m p t i o n o f h a r d l i q u o r a n d 1 . 2 % h a b i t u a l co n su m p t i o n o f w i n e ; 4 6 . 9 % r e p o r t e d occasion al ( on ce in a w h ile or r ar e) con su m pt ion o f b eer, 7 3 . 2 % o cca si o n a l co n su m p t i o n o f h a r d liquor and 26. 9% occasional consum pt ion of w ine. Co n s i d e r i n g t h o s e w h o h a d a l r e a d y c o n s u m e d alcoh ol, w e v er if ied t h at 8 1 . 6 % r epor t ed dr in k in g on e or t w o glasses per occasion , 1 8 . 4 % r epor t ed dr ink ing m or e t han t hr ee glasses per occasion and 1 8 . 8 % r epor t ed t h e occu r r en ce of in t ox icat ion .
a) The alcohol used in alcoholic beverage is “ et hyl” , like t he alcohol used t o disinfect t he skin and which is sold in pharm acies ( C1)
b) Alcohol consum pt ion is only harm ful if people drink everyday ( C4)
c) When alcohol is consum ed during m eals, it is not harm ful because it aids digest ion ( C9) d) Alcohol is digest ed t oget her wit h foods ( C11)
e) When alcohol passes int o t he blood it first goes t o part s of our organism wit h t he highest concent rat ion of wat er ( C12)
f) When water or soft drinks are m ixed with alcohol, t he quant it y of alcohol consum ed is sm aller ( C15) g) The effect alcohol causes on people depends only on t he quant it y consum ed ( C16)
h) Drinking m oderat ely m eans drinking so as t o not feel dizzy or sick ( C23) i) Beer is good to kill your thirst ( C24)
j) The alcohol cont ained in alcoholic beverages is “ burned” in your liver ( C25) l) Alcohol effects depend on the person’s age ( C26)
m) When alcohol passes int o t he blood, it rapidly goes t o t he brain ( C27) n) Alcohol encourages people and m akes t hem feel always well- disposed ( C28) o) Alcohol warm s ( C34)
p) Alcohol effect s vary according t o gender ( C37)
q) Aft er alcohol is consum ed, it rapidly passes from st om ach t o blood ( C38)
r) One can drink t he sam e quant it y of alcohol drinking different alcoholic beverages ( C39) .
Figure 1 – Percent age of incorrect answers relat ed t o knowledge on alcohol
I n the evaluation of knowledge on alcohol, a st at ist ically significant difference was found ( t = 3.57, 652gl, p= .00) according to the age range. The average knowledge on alcohol of the youngest ( from 12 to 14 years of age) was superior to the average knowledge of t he oldest st udent s ( m ore t han 15 years of age) . St at ist ically significant differences were not found in the level of knowledge on alcohol am ong adolescents w ho report ed having already consum ed alcohol and t hose w ho had nev er dr unk ( t = .74, 652gl, p= .46) . St at ist ically sig n if ican t d if f er en ces w er e f ou n d in relation to the occurrence of intoxication; adolescents who report ed int oxicat ion were t hose who present ed t h e low est av er age k n ow ledge ( t = 2 . 5 0 , 1 0 2 . 0 5 gl, p= .01) .
The influence of consum ption expectancy was verified by the statistically significant difference found b e t w e e n t w o g r o u p s: t h o se w h o h a d a l r e a d y con su m ed alcoh ol an d t h ose w h o h ad n ot . Th u s, a d o l escen t s w h o r ep o r t ed h a v i n g a l r ea d y d r u n k present ed expect at ions regarding alcohol significant ly higher in the global score ( t= 5.81, 652gl, p= 00) and in all factors of positive expectancy [ ( Factor I t= 4.51, 507.43gl p= .00) ; ( Fact or I I t = 10.58, 606.45gl, p= .00) ; ( Factor I I I t= 3.38, 564.34gl p= .00) ; ( Factor I V t= 4.35, 652gl, p= .00) ; ( Fact or VI t = 4.47, 449.52gl, p= .00) and ( Factor VI I t= 3.86, 652gl, p= .00) ] . I n relation to t he occurrence of int oxicat ion, t he adolescent s w ho
r epor t ed t he occur r ence of int ox icat ion w er e t hose w h o pr esen t ed sign if ican t ly h igh er ex pect an cy on alcoh ol in t h e global an d in all fact or s of posit iv e expect ancy ( t = - 6.94, 424gl, p= .00; t = - 6.27, 424gl, p= . 0 0 ; t = - 1 2 . 2 4 , 4 2 4 gl, p= . 0 0 ; t = - 4 . 8 7 , 8 8 . 3 8 gl, p= .00; t = - 5.05, 424gl, p= .00; t = - 3.34, 424gl, p= .00; t= - 2.78, 424gl, p= .01 global and factors I , I I , I I I , I V, VI and VI I , respect ively) .
No st at ist ically significant differ ences w er e found in relat ion t o gender and posit ive expect ancy r e g a r d i n g a l co h o l , e x ce p t f o r Fa ct o r I I I – b oy s presented significantly higher expectancy of im proved cognitive and m otor abilities ( t= 2.64, 570.18gl, p= .01) – and Factor VI I – girls presented significantly higher expect ancy of relaxat ion and t ension reduct ion ( t = -2.54, 652gl, p= .01) .
Fi n a l l y, i n t h e a n a l y si s o f ex p ect a n cy i n relation to age groups, we found statistically significant differ ences bet w een age gr oups for fiv e of t he six f act or s of posit iv e ex pect an cy : Fact or I ( t = - 4 . 0 7 , 652gl, p= .00) ; Fact or I I ( t = - 7.95, 171.94gl, p= .00) ; Fact or I I I ( t = 5.20, 142.44gl, p= .00) ; Fact or I V ( t = -3.18, 652gl, p= .00) and Fact or VI I ( t = - 2.22, 652gl, p= .03) , t he oldest st udent s ( m ore t han 15 years of age) were t hose who present ed t he highest posit ive ex p ect an cy, w h i l e t h e y ou n g est w er e t h ose w h o present ed t he highest negat ive expect ancy ( t = 2.57, 176.31gl, p= .01) .
0 20 40 60 80 100
a b c d e f g h i j l m n o p q r
DI SCUSSI ON
The large m aj orit y of st udent s from t he 7t h,
8t h and 9t h grades in t he st udy sam ple, bet ween 12
and 18 y ear s old, av er age [ SD] 13.55 [ 1.13] , had a l r e a d y co n su m e d a l co h o l a n d n o st a t i st i ca l l y significant differences were found bet ween boys and girls. These findings confirm results already presented in n at ion al r esear ch r ep or t s on t h e lif e st y les of Po r t u g u e se a d o l e sce n t s( 4 ) a n d a l so i n t h e
d issem in at ion of r esear ch ex clu siv ely ad d r essin g adolescents’ alcohol consum ption( 12). I n fact, not only
dat a on general consum pt ion seem t o be consist ent w it h t hese findings, but also part ial dat a relat ed t o different variables that characterize the phenom enon, reinforcing findings of other studies( 4,12). Thus, for the
m aj or it y of t he par t icipant s, t he fir st consum pt ion occur r ed in t he fam ily cont ex t and/ or on a fest iv e occasion ; t h e con su m pt ion pat t er n w as occasion al f or t h e m aj or it y an d h ar d liq u or w as t h e ch osen bev er age t o t h e det r im en t of beer ; on e f ou r t h of a d o l e sce n t s r e p o r t e d d r i n k i n g m o r e t h a n t h r e e g l a s s e s o n t h e s a m e o c c a s i o n a n d a l s o t h e o ccu r r en ce o f i n t o x i cat i o n . Th ese r esu l t s r ef l ect changes in consum pt ion pat t er ns and m odes, w it h increased consum ption of hard liquor to the detrim ent of beer, and also increased frequency of int oxicat ion wit h sim ilar behavior am ong boys and girls.
Kn ow ledge sh ow ed by adolescen t s in t h is study reflects im portant gaps. On the one hand, wrong ideas regarding alcohol, linked t o m yt hs and/ or false concept s t r adit ionally associat ed t o it , st ill per sist , nam ely: t hey believe t hat “ alcohol warm s” ( 64.1% ) , “ k i l l s y o u r t h i r st ” ( 3 0 . 7 % ) a n d “ a i d s d i g est i o n ” ( 4 7 . 6 % ) . On t he ot her hand, a lack of k now ledge r elat ed t o scien t if ic k n ow ledge, associat ed t o t h e p h a r m a co l o g i ca l e f f e ct s o f a l co h o l , a ct i o n a n d consequences on the organism em erges, for exam ple: t h ey d o n ot k n ow t h at “ t h e alcoh ol con t ain ed in alcoholic bev er ages is et hy l” ( 8 6 . 1 % ) , or y et t hat “ when alcohol pass into the blood it first goes to parts of our or ganism w it h t he highest concent r at ion of wat er” ( 49.8% ) .
T h i s l a c k o f k n o w l e d g e , e s p e c i a l l y r egar ding t he m et abolism of alcohol and it s r elat ion w it h t he per for m ance of a per son under it s influence is par t icu lar ly dan ger ou s. I n f act , m ist ak es lik e – believ ing t hat “ t he effect alcohol causes on people depends only on t he quant it y consum ed” ( 68.5% ) ; “ w hen w at er or soft dr ink s ar e m ix ed w it h alcohol,
t h e q u a n t i t y o f a l c o h o l c o n s u m e d i s s m a l l e r ” ( 4 9 . 1 % ) ; “ dr in k in g m oder at ely m ean s dr in k in g so as not t o feel dizzy or sick ” ( 55.8% ) , or not k now ing t h a t “ a l co h o l e f f e ct s v a r y a cco r d i n g t o g e n d e r ” ( 6 3 . 3 % ) ar e m ist ak es t h at can p ot en t ially f av or d i m i n i sh ed p er cep t i o n o f r i sk r el at ed t o al co h o l co n su m p t i o n .
The r elat ion bet w een know ledge on alcohol and its consum ption is com plex. On the one hand, we v er ified t hat adolescent s w ho had m or e k now ledge a b o u t a l co h o l w e r e t h o se w h o d i d n o t r e p o r t int oxicat ion. Thus, t his knowledge is present ed as a prot ect ion fact or. On t he ot her hand, no st at ist ically significant differ ences w er e found bet w een lev el of knowledge on alcohol and it s consum pt ion.
Anot her r elev ant aspect is t hat , w hile one would expect that knowledge increases with age, this fact is not confir m ed since t he y oungest ( 12 t o 14 y e a r s o f a g e ) a r e t h o se w h o p r e se n t e d b e t t e r knowledge on alcohol. This apparent loss of knowledge due t o age should be considered t aking int o account several aspect s. The report ed result s do not em erge from a cohort study and, even though a generational change cannot be foreseen considering the short tim e in which this investigation occurs, results present the possibilit y of ot her ex t er nal int er fer ences. Anot her explanat ion should consider t hat int oxicat ion occurs m ore frequently in this age range ( m ore than 14 years of age) . Thus, there is a hypothesis that knowledge is o ccasi o n al l y al t er ed b ased o n p ast ex p er i en ces. Hen ce, p a r t o f t h e st a t em en t s ch o sen b y t h ese adolescent s m ight depend on t heir need t o const ruct rationales that do not devalue their behavior, so as to not cause cognit ive dissonance.
Fin ally, t h e r esu lt s of t h is st u dy ar e v er y r e l e v a n t b e ca u se t h e y sh o w t h a t e x p e ct a t i o n s regarding alcohol are st rong discrim inat ive fact ors of co n su m p t i o n . Th u s, a d o l e sce n t s w h o co n su m e d alcohol and those who reported intoxication presented higher levels of expect ancy on alcohol, in t he global score as well as in all fact ors of posit ive expect ancy. These results are in agreem ent with several em pirical st udies t hat show t hat ex pect ancy on alcohol is a m ediat ing fact or of consum pt ion( 11- 13).
No differences were found bet ween genders in term s of expectancy, both in the global score and in t he m aj or it y of fact or s, w hich r eflect s t he cur r ent t endency of conv er ging behav ior bet w een gir ls and boy s. The st at ist ically significant differ ences found bet ween genders for Fact or I I I – im proved cognit ive and m ot or abilit ies – higher for boys, and for Fact or VI I – relaxation and tension reduction – higher for girls, reflect som e developm ent al specificit y. Som e st udies in the area appoint that boys have a higher tendency t o ext ernalize and girls t o int ernalize( 14). Thus, boys
t end t o view alcohol as a st im ulus for act ion, while girls see it as a com ponent that prom otes relaxation. I t i s a l so w o r t h m e n t i o n i n g t h a t w e consist ent ly verified, except for Fact or VI ( increased arousal) , t hat t he oldest adolescent s were t hose who present ed t he highest posit ive expect ancy regarding alcohol, while the youngest were those who presented t h e h ig h est n eg at iv e ex p ect an cy. I n f act , sev er al r esear cher s appoint t he pot ent ial r ole age play s in ex p ect an cy r eg ar d i n g al co h o l an d h i g h l i g h t t h at e x p e ct a n cy o n a l co h o l i n cr e a se s w i t h a g e a n d becom es m ore hom ogeneous and st able( 11).
Ov e r m o r e t h a n t w o d e ca d e s, se v e r a l t r ansv er sal and longit udinal st udies( 11- 13) ev idenced
clarifying results on the power of expectancy on alcohol as a p r ed ict or of alcoh ol con su m p t ion on set an d problem s relat ed t o alcohol in adolescent s. Hence, in the light of these findings, we consider it essential not only t o include expect ancy on int ervent ion program s i n t h e a r e a , b u t a l so t h a t su ch p r o g r a m s a r e im plem ent ed in an appropriat e developm ent al phase,
b ef or e ex p ect at ion s b ecom e st ab le an d t h er ef or e m ore resist ant t o change.
CONCLUSI ON
Th e r esu lt s of t h is st u d y r ev eal t h at t h e m aj or it y of adolescent s in t he sam ple had alr eady consum ed alcohol, alt hough r egular consum pt ion is not com m on am ong adolescents from the 7th, 8th and
9t h g r a d e s. H o w e v e r, a b o u t o n e f o u r t h o f t h e
participants had already been intoxicated at least once and r epor t ed t he consum pt ion of m or e t han t hr ee d r i n k s i n t h e sa m e o cca si o n . Th e m a j o r i t y o f adolescents initiated alcohol consum ption at hom e with fam ily, in fest iv e occasions. Such pat t er n of onset co n su m p t i o n i n t h e f a m i l y co n t e x t i s t y p i ca l o f Medit er r anean count r ies.
Al t h o u g h t h e r esu l t s p o i n t t o a co m p l ex r e l a t i o n b e t w e e n k n o w l e d g e o n a l co h o l a n d i t s con su m pt ion , t h e iden t if ied “ m ist ak es” pot en t ially f av or d im in ish ed p er cep t ion of r isk in r elat ion t o alcohol consum ption. Moreover, results suggest altered k now ledge ( loss of k now ledge) due t o ex per iences wit h alcohol, which appoint s t he need t o include t his com ponent in current prevent ive program s.
Th e se r e su l t s a l so r e v e a l t h a t p o si t i v e ex p ect an cy r eg ar d in g alcoh ol ex ist s ev en b ef or e significant experiences wit h alcohol consum pt ion and that positive expectancy increases with age, while no differences between genders were found in the global and in t he m aj orit y of expect ancy fact ors. The need t o develop early prevent ion program s, including bot h genders, so t hey are successful is reinforced.
Despite the study lim itations – only students whose educat ional responsible gave aut horizat ion t o participate in the study – the high num ber of students in v olv ed per m it t ed ev alu at in g adolescen t s’ n eeds, essential to im prove a preventive program on alcohol use/ abuse, w hich w as lat er included in t he school curricula for 7t h grade st udent s at a public school in
Coim br a, Por t ugal.
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