Cent Eur J Public Health 2013; 21 (4): 202–206
Objective: The aim of our study was to identify and analyze selected factors influencing alcohol use among primary school children aged 8
to15 years in the academic year 2009/10.
Methods: The sample consisted of children from 28 primary schools. Data of this cross-sectional study were collected using questionnaires.
Chi-Square test was used to test differences in proportions of observed phenomena between boys and girls. Multiple logistic regression analysis
was performed to identify the influence of selected factors on the variable “child’s alcohol drinking per week”.
Results: The sample consisted of 2,494 respondents (52% of boys, 48% of girls). In the study group 78% of all respondents (95% CI=76−80)
drank alcohol infrequently (less than once a week) or did not drink alcohol at all, and 22% of respondents (95% CI=20−24) drank alcohol at least
once a week.
More boys than girls considered alcoholic beverages such as beer, wine and spirit as quite easily available. We performed the model of multi-
variate logistic regression analysis using the independent variables: age of respondents, gender of respondents, mother’s alcohol drinking, father’s
alcohol drinking, sibling’s alcohol drinking, parental rules, parental control, and mental support from parents (if their children have problems) to
identify their effect on the dependent variable − child’s alcohol drinking per week. We found out that mother’s alcohol drinking and a lack of mental
support from parents did not have a statistically significant influence on child’s alcohol drinking per week.
Conclusion: The results of our study point to the fact that it is necessary to focus on the prevention of alcohol drinking in general and among
school children in particular. We recommend greater control of the sale of alcoholic beverages, so as to prevent the purchase by people under
18 years of age.
Key words: alcohol drinking, primary school children, risk factors, parents, alcoholic beverages, public health
Address for correspondence: V. Rehorčíková, Department of Public Health, Faculty of Health Care and Social Work, Trnava University, Univer-
zitné námestie 1, 918 43 Trnava, Slovakia. E-mail: email@example.com
IMPACT OF FAMILY LEVEL FACTORS ON ALCOHOL
DRINKING IN PRIMARY SCHOOL CHILDREN
Veronika Rehorčíková1, Eva Nemčovská1, Zuzana Sklenárová1, Andrej Kállay2, Daniela Kállayová1, Alexandra
Bražinová1, Miriam Slaná2
1Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovakia
2Department of Social Work, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovakia
In recent decades, many social, political and economic
changes have taken place facilitating implementation of inter-
ventions in the field of medicine and public health. They caused
the change of the profile of young people’s health throughout
the world. At the forefront of negative social, behavioural and
environmental factors hazardous to health are smoking, alcohol
consumption and drug use (1). The World Health Organization
(WHO) warns that alcohol drinking among young people is now
becoming a growing public health problem in many countries.
Its harmful effect – mainly the loss of self-control increases
the risk of accidents (including traffic), violence (domestic
violence) and early death (2). Nowadays, children are exposed
to drugs at a younger age and the prevention should therefore
start in the primary school (3). Children are interested especially
in drugs that are easily accessible to them – financially, cultur-
ally or otherwise – such as alcohol, tobacco or medicaments.
Alcohol occupies the prominent position amongst psychoactive
substances with milder effects compared to other drugs. The ad-
diction develops gradually, but its excessive consumption tends
to be more dangerous than “hard drugs“ (4). In Slovakia, the
surveys about drug use in children are predominantly carried
out in schools, due to the fact that the school survey is a key in-
dicator usually investigated at the national level in all European
Union Member States (5). The results of the Slovak survey 1
TAD – Tobacco, Alcohol, Drugs in children aged 11 to 14 years
showed that in comparison with the 1994 figures, there was a
decrease in the percentage of excessive drinkers in the family,
nevertheless, since 2002 it has still represented about one fifth
of adults. Consumption of beer and wine remained at about the
same level, but the consumption of spirits has increased (6).
Youths, therefore, rank amongst the most vulnerable popula-
tion with regard to protection against drugs and drug abuse.
Children aged 8 to15 years acquire many skills and habits they
could observe within their families. Thus, it is important to
know which preventable factors can affect the substance abuse.
In the Slovak Republic, there are not many surveys targeting
primary school children. Therefore, the aim of our study was
to identify and analyze selected factors influencing alcohol
abuse among primary school children aged 8 to15 years in the
academic year 2009/10.
MATERIALS AND METHODS
Characteristics of the Sample
This study was based on the project entitled “Cross-sectional
study of attitudes, habits and awareness about drugs among pri-
mary school children aged 8 to 15 years in Slovakia in the school
year 2009/10” and it was one of the projects supported by the grant
of the Slovak Government to promote the anti-drug activities.
Locations for selecting primary school children were determined
using the Global Youth Tobacco Survey (GYTS) methodology (7).
The number of schools in different regions of Slovakia was taken
into account as well as their population and a number of children.
In the second phase, within these schools, the third − nine grade
classes were selected randomly. The sample consisted of children
from 28 primary schools situated in towns and villages from all
parts of Slovakia. The total number of respondents was 2,538. After
subsequent cleaning of data in the database, 2,494 respondents
(98%) were included to conduct comprehensive analysis. This se-
lection methodology applies the principle of external validity. This
constitutes a representative sample of the population of Slovakia.
Method of Data Collection
Data of this cross-sectional study were collected from 31 May
2010 to 11 June 2010 using questionnaires. The children filled
in the questionnaires anonymously, without the presence of their
teacher. Before completing questionnaires, respondents were in-
structed about the importance of the study and the confidentiality
of data processing. Used questionnaires were based on proven
tools created by the European Monitoring Centre for Drugs and
Drug Addiction (EMCDDA).
We used Chi-Square test to test differences in proportions
of observed phenomena between boys and girls. The statistic
analysis was carried out using the R-project (open source statistical
software). Confidence interval for all results was 95%. Multiple
logistic regression analysis was performed to identify the influ-
ence of selected factors on the variable “child’s alcohol drinking
per week” and thus established: the regression coefficient, value
of OR (Odds Ratio) and 95% confidence interval. To establish the
optimal logistic regression model, we used backward selection
method, where at first we included all independent variables into the
model. Consequently, we excluded the variables that did not have a
statistically significant effect on the dependent variable – “child’s
alcohol drinking per week”, and then we repeated the analysis.
The type of variables used for the model of logistic regression
was similar to the one used in the study of Marcinkova et al. “So-
cioeconomic predictors of smoking behaviour among school-aged
children in Slovakia”, nevertheless, there was a need for several
modifications, because of the specificity of the alcohol abuse (8).
The sample consisted of 2,494 respondents. In terms of gender
representation there were more boys (52%) than girls (48%). The
median age of respondents was 13 years (I.Q=12, III.Q=14).
Minimum age was 10 years and maximum 15 years.
In the study group 78% of all respondents (95% CI=76−80)
drank alcohol infrequently (less than once a week) or did not drink
alcohol at all, and 22% of respondents (95% CI=20–24) drank
alcohol at least once a week.
There was no statistically significant difference in alcohol
drinking per week between boys and girls (Table 1).
In our study group, we also examined the experiences of re-
spondents with the accessibility of selected alcoholic beverages.
Their perceptions of the accessibility differed by gender. More
boys than girls considered alcoholic beverages such as beer, wine
and spirit quite easily accessible. The differences were confirmed
as statistically significant (Table 2).
The next step of data analysis was to perform the model of
multivariate logistic regression analysis using the independent
continuous variable age of respondents and categorical: gender of
respondents, mother’s alcohol drinking, father’s alcohol drinking,
sibling’s alcohol drinking, parental rules, parental control, and men-
tal support from parents (if their children have problems) to identify
their effect on the dependent variable – “child’s alcohol drinking
per week” (respondents who did not drink alcohol during the week
= 0, respondents who drank alcohol at least once a week = 1).
We found out that mother’s alcohol drinking and a lack of the
psychological support from parents did not have a statistically
significant influence on the child’s alcohol drinking per week.
We did not include the above mentioned non-significant variables
into the final regression model and we repeated the analysis. The
results are shown in Table 3.
The United Nations Office on Drugs and Crime (UNODC)
reported that the use of alcohol, tobacco and other drugs among
young people is increasing in most countries and several stud-
ies focus on the prevalence and causes of the substance use (9).
Several authors indicate that the differences between boys and
girls as regards alcohol drinking are continuously diminishing
(10–12) and show an alarming number of alcohol intoxication in
children (11, 13–15). This fact can be confirmed by the results of
our study as well, because there was no statistically significant
difference between boys and girls in frequency of alcohol drinking
per week. According to the international study “Health Behaviour
in School-aged Children (HBSC)” carried out in 2005–2006, the
prevalence of alcohol consumption in the countries involved in
this study varied. Among 11 years old respondents who drank
Genderabs.% 95% CI p value
At least 1 time
a week *
*Volume of wine glass was 0.2 l, beer glass 0.5 l and spirits 5 cl.
Table 1. Comparing the experiences with alcohol drinking per
week between boys and girls in the sample (n=2,494), 2010
alcohol at least once a week dominated boys over girls, but among
13 years old respondents in Spain dominated girls (7%) over
boys (6%). Similarly, among 15 years old respondents in Greece
dominated girls (13%) over boys (11%) (16). It should be noted
that compared to other countries in the HBSC study, 11 years old
respondents from Slovakia exceeded the average of alcohol drink-
ing at least once a week (17). In our study group at least 22% of
boys (95% CI=20–25) and 21% of girls (95% CI=19–24) drank
alcohol once a week.
The Ministry of Health in Australia in its publication “Teenag-
ers and Alcohol: A Guide for Parents” focused on the prevention
of alcoholism in children. The publication points out that the
discussion in families about the effects of alcohol consumption on
health should begin before children reach the age of ten − eleven
years. Children are more susceptible to this information in the
early age, since they need to know what parents expect (18).
However, in Slovak families frequency of this discussion could
be influenced by the fact that there is a strong tradition of local
drinking of alcoholic beverages, which include mainly spirits
and wine (19). The relatively easy accessibility of wine was also
mentioned by respondents in our study group, but as for girls it
was confirmed that spirits are quite difficult to access. Overall,
our group experienced relatively easy accessibility of beer.
The authors of several studies indicate that the older children
are, the higher chance there is for them to drink alcohol (13, 20).
Quite easy available
Table 2. Comparing the experiences with the availability of selected alcoholic beverages between boys and girls in the sample
Age of respondents
Father’s alcohol drinking
Sibling’s alcohol drinking
Table 3. Results of the repeated multivariate logistic regression analysis selected independent variables on child’s alcohol
drinking per week
Specifically, in our study group the chance increased 1.45 times
(95% CI=1.31–1.61). In the families where one of the parents
is drinking alcohol, the risk of alcohol drinking in children also
increases (20–22). Wong et al. stated that in children younger
than 14 years who had a parent addicted to alcohol the risk of
alcohol abuse increased compared to the control group (23). In
our study group, if the father drank alcohol every day, the chance
to drink alcohol weekly increased in children 2.23 times (95%
CI=1.19–4.18). Several authors indicate that a statistically signifi-
cantly higher number of children drank alcohol if not controlled
by their parents and if their parents were not taking care in what
activities they engaged in during their leisure time when compared
with the control group (23–25). In our respondents, these aspects
of parental control were confirmed to be very important as well,
otherwise the chance to drink alcohol increased 2.5 times (95%
Authors of several studies have also identified alcohol drinking
among peers or friends as another very important factor in the
context of alcohol drinking among children (26, 27). The results
of another study point to the fact that if siblings drank alcohol,
there was a significantly increased chance of respondent’s alcohol
abuse (24). In our study group, if respondents had siblings who
drank alcohol every day, there was a chance of their alcohol abuse
4.37 times higher (95% CI=1.78–10.69). Ando et al. also found
that girls are more sensitive to this factor than boys (27).
However, there are some possible limits to our study. One
of them may be due to the comparison of our findings with the
results of other studies, as these studies might examine different
frequency of alcohol use among respondents. Because of the
questionnaire method of data collection, there might be possible
bias due to falsely answered questions. Some respondents might
feel ashamed to answer that they have been drinking alcohol,
even despite the questionnaires being anonymous and completed
without teacher supervision.
The results of our study point to the fact that it is necessary
to focus on the prevention of alcohol drinking among youth.
Given the relatively high number of respondents who reported
experiences with the relatively easy accessibility of alcoholic
beverages, we recommend greater controls of the sale of alcoholic
beverages to persons under 18 years of age. The next step could
be collaboration with school psychologists on distribution of the
results of our study and also the use of results for developing pre-
ventive programmes for the schools. We are also going to extend
this type of survey to high schools and compare the results with
other foreign studies. Another possibility to continue our research
could be exploring associations between alcohol drinking and
marihuana use at high schools according to the study of Csémy,
Sovinová and Prochádzka “Alcohol consumption and marihuana
use in young adult Czechs” (28).
We would like to thank school authorities, teachers and primary school
children for their collaboration. The authors would like to acknowledge
Dr. Monica O’Mullane, PhD., for English-language proofing of the
Conflict of Interests
The project was funded by the Ministry of Education of Slovakia and the
General Secretariat of the Committee of Ministers for Drug Dependen-
cies and Drug Control. Project implementation is one of the activities
supporting the fight against drugs and drug addiction in accordance with
the national drug strategy. The project is registered under the name:
“Cross-sectional study of attitudes, habits and awareness about drugs
among primary school children aged 8 to 15 years in Slovakia in the
school year 2009/10”.
1. Blum RW, Nelson-Mmari K. The health of young people in a global
context. J Adolesc Health. 2004 Nov;35(5):402-18.
2. World Health Organization. Media centre. Young people: health risks and
solutions [Internet]. Geneva: WHO; 2011 [cited 2012 Aug 20]. Available
3. Koleničová J. The need for intensive drug prevention focused on the
school environment. In: Current problems of drug addiction in Slovakia
and other EU countries: proceedings; 2010 Apr 27; Bratislava, Slovakia.
Bratislava: University of Economics in Bratislava; 2010. p. 32-6. (In
4. Bieliková M, Pétiová M. Drugs and youth lifestyle in the Slovac Republic.
Bratislava: The Institute of Information and Prognoses of Education;
2003. (In Slovak.)
5. Nociar A. Final report from the TAD for primary school children, sec-
ondary school students and their teachers in 2010 [Internet]. Bratislava:
Research Institute of Child Psychology and Patopsychology; 2010 [cited
2012 Jul 14]. Available from: http://www.infodrogy.sk/indexAction.cfm
?module=Library&action=GetFile&DocumentID=845. (In Slovak.)
6. Nociar A. Surveys on drugs, alcohol and tobacco among youth in Slovakia.
Bratislava: Veda; 2004. (In Slovak.)
7. Warren CW, Jones NR, Peruga A, Chauvin J, Baptiste JP, Costa de Silva
V, et al.; Centers for Disease Control and Prevention (CDC). Global
youth tobacco surveillance, 2000-2007. MMWR Surveill Summ. 2008
8. Marcinkova D, Majdan M, Gergelova P, Rusnak M, Pekarcikova J, Baska
T. Socioeconomic predictors of smoking behaviour among school-aged
children, in the Slovakia. Bratisl Lek Listy. 2009;110(6):345-9.
9. United Nations Office on Drugs and Crime. Conducting school surveys
on drug abuse: Global Assessment Programme on Drug Abuse. Toolkit
module 3 [Internet]. New York: United Nations; 2003 [cited 2011 Mar
6]. Available from: http://www.unodc.org/pdf/iran/links/UNODC/
10. Goodkind S, Wallace JM, Shook JJ, Bachman J, O'Malley P. Are girls
really becoming more delinquent? Testing the gender convergence hy-
pothesis by race and ethnicity, 1976-2005. Child Youth Serv Rev. 2009
11. Bitunjac K, Saraga M. Alcohol intoxication in pediatric age: ten-year
retrospective study. Croat Med J. 2009 Apr;50(2):151-6.
12. Bezinović P, Malatestinić D. Perceived exposure to substance use and
risk-taking behavior in early adolescence: cross-sectional study. Croat
Med J. 2009 Apr;50(2):157-64.
13. Toumbourou JW, Hemphill SA, McMorris BJ, Catalano RF, Patton GC.
Alcohol use and related harms in school students in the USA and Australia.
Health Promot Int. 2009 Dec;24(4):373-82.
14. Weinberg L, Wyatt JP. Children presenting to hospital with acute alcohol
intoxication. Emerg Med J. 2006 Oct;23(10):774-6.
15. Woolfenden S, Dossetor D, Williams K. Children and adolescents with
acute alcohol intoxication/self-poisoning presenting to the emergency
department. Arch Pediatr Adolesc Med. 2002 Apr;156(4):345-8.
16. Currie C, Gabhainn SN, Godeau E, Roberts C, Smith R, Currie D, et al.,
editors. Inequalities in young people’s health: HBSC international report
from the 2005/2006 survey. Health policy for children and adolescents,
no. 5 [Internet]. Copenhagen: WHO Regional Office for Europe; 2008
[cited 2012 Aug 19]. Available from: http://www.euro.who.int/__data/
17. Baška T, Kolarčík P. Risky behaviour in school children: smoking, use
of alcohol, marijuana, physical violence. In: Madarasová Gecková A,
Katreniaková, Z, Kollárová J, Veselská Z, editors. Social determinants
of health of schoolchildren: national report on health and health-related
behavior of 11 -, 13 - and 15-year old school children, based on a survey
conducted in 2005/2006 in the framework of the international project
“Health Behaviour in School Aged Children” (HBSC) [Internet]. Košice:
Equilibria; 2009 [cited 2012 Jun 21]. p.53-62. Available from: http://
18. Australian Government, Department of Health and Ageing. Teenagers
and alcohol: a guide for parents [Internet]. Commonwealth of Australia;
2006 [cited 2011 Sep 18]. Available from: http://www.alcohol.gov.au/
19. Ochaba R, Bielik I. Legal aspects of alcohol control in public health. Lek
Obz. 2010; 59(3). (In Slovak.)
20. Donovan JE, Molina BSG. Children's introduction to alcohol use: sips
and tastes. Alcohol Clin Exp Res. 2008 Jan;32(1):108-19.
21. Ohannessian CM. Does technology use moderate the relationship between
parental alcoholism and adolescent alcohol and cigarette use? Addict
Behav. 2009 Jun-Jul;34(6-7):606-9.
22. Hussong AM, Wirth RJ, Edwards MC, Curran PJ, Chassin LA, Zucker
RA. Externalizing symptoms among children of alcoholic parents: Entry
points for an antisocial pathway to alcoholism. J Abnorm Psychol. 2007
23. Wong MM, Nigg JT, Zucker RA, Puttler LI, Fitzgerald HE, Jester JM,
et al. Behavioral control and resiliency in the onset of alcohol and illicit
drug use: a prospective study from preschool to adolescence. Child Dev.
206 Download full-text
24. Moore GF, Rothwell H, Segrott J. An exploratory study of the relationship
between parental attitudes and behaviour and young people's consumption
of alcohol. Subst Abuse Treat Prev Policy. 2010 Apr 22;5:6.
25. Lopez B, Wang W, Schwartz SJ, Prado G, Huang S, Hendricks Brown C,
et al. School, family, and peer factors and their association with substance
use in Hispanic adolescents. J Prim Prev. 2009 Nov;30(6):622-41.
26. Parsai M, Voisine S, Marsiglia FF, Kulis S, Nieri T. The protective and
risk effects of parents and peers on substance use, attitudes and behaviors
of Mexican and Mexican American female and male adolescents. Youth
27. Ando M, Asakura T, Ando S, Simons-Morton BG. Psychosocial factors
associated with smoking and drinking among Japanese early adolescent
boys and girls: Cross-sectional study. Biopsychosoc Med. 2007 Jul 4;1:13.
28. Csémy L, Sovinová H, Procházka B. Alcohol consumption and marijuana
use in young adult Czechs. Cent Eur J Public Health. 2012 Dec;20(4):244-
Received April 11, 2013
Accepted in revised form October 14, 2013
WASHINGTON, DC – 14 November 2013. The world should
aim to have vaccines which reduce malaria cases by 75%, and are
capable of eliminating malaria, licensed by 2030, according to the
updated 2013 Malaria Vaccine Technology Roadmap, launched
today. This new target comes in addition to the original 2006
Roadmap’s goal of having a licensed vaccine against Plasmo-
dium falciparum malaria, the most deadly form of the disease,
for children under 5 years of age in sub-Saharan Africa by 2015.
“Safe, effective, affordable vaccines could play a critical
role in defeating malaria,” said Dr Robert D. Newman, Director
of WHO’s Global Malaria Programme. “Despite all the recent
progress countries have made, and despite important innovations
in diagnostics, drugs and vector control, the global burden of
malaria remains unacceptably high.”
The most recent figures by the World Health Organization
indicate that malaria causes an estimated 660,000 deaths each
year from 219 million cases of illness. Scale-up of WHO recom-
mended malaria control measures has been associated with 26%
reduction in the global malaria death rate over the last decade.
Effective malaria vaccines could be an important complement to
existing measures, if they can be successfully developed.
Final results from Phase III trials of the most advanced vaccine
candidate, RTS,S/AS01, will be available by 2015. Depending
on the final trial results, and depending on the outcome of the
regulatory review by the European Medicines Agency, a WHO
recommendation for use and subsequent prequalification of this
first vaccine could occur in late 2015.
The new roadmap, launched today at the annual conference of
the American Society of Tropical Medicine & Hygiene in Wash-
ington DC and also announced in a letter published in The Lancet,
aims to identify where additional funding and activities will be
particularly key in developing second generation malaria vaccines
both for protection against malaria disease and for malaria elimi-
nation. These include next-generation vaccines that target both
Plasmodium falciparum and Plasmodium vivax species of malaria.
“The new vaccines should show at least 75% efficacy against
clinical malaria, be suitable for use in all malaria-endemic ar-
eas, and be licensed by 2030,” says Dr Jean-Marie Okwo Bele,
Director of WHO’s Department of Immunization, Vaccines and
Biologicals. “The roadmap also sets a target for malaria vaccines
that reduce transmission of the parasite.”
NEW MALARIA VACCINES ROADMAP TARGETS NEXT
GENERATION PRODUCTS BY 2030
PARTNERS AGREE APPROACH FOR DEVELOPING VACCINES CAPABLE OF REDUCING
MALARIA CASES BY 75%, AND TO ENABLE MALARIA ELIMINATION
The 2013 Malaria Vaccine Technology Roadmap cites several
reasons for the update, among them changing malaria epidemiol-
ogy associated with the successful scale-up of malaria control
measures in the last decade, a renewed focus on malaria elimina-
tion and eradication in addition to the ongoing need to sustain
malaria control activities, and new technological innovations since
2006 including promising early work on so-called transmission-
blocking malaria vaccines.
WHO lists 27 malaria vaccine candidates currently in clinical
trials, with most in early stages of testing; RTS,S/AS01 is the only
one currently in the late-stage development.
The Roadmap’s vision centres on developing safe and effec-
tive vaccines against Plasmodium falciparum and Plasmodium
vivax that prevent disease and death and prevent transmission to
enable malaria eradication, and is built around two strategic goals:
• Development of malaria vaccines with protective efficacy of at
least 75% against clinical malaria suitable for administration
to appropriate at-risk groups in malaria-endemic areas.
• Development of malaria vaccines that reduce transmission
of the parasite and thereby substantially reduce the incidence
of human malaria infection. This will enable elimination in
multiple settings. Vaccines to reduce transmission should be
suitable for administration in mass campaigns.
The Malaria Vaccine Technology Roadmap is the result of a
consultative process led by WHO, which brought together the
global community of malaria vaccine researchers and product
developers, and is supported by an informally-organized group
of malaria vaccine funders. The Malaria Vaccine Funders Group
comprises the Bill & Melinda Gates Foundation, the European &
Developing Countries Clinical Trials Partnership, the European
Vaccine Initiative, the European Commission, the PATH Malaria
Vaccine Initiative, the US Agency for International Development,
the US National Institute of Allergy and Infectious Diseases, the
Wellcome Trust, and WHO.
World Health Organization. Media centre. New malaria vac-
cines roadmap targets next generation products by 2030 [Inter-
net]. Geneva: WHO; 2013 [cited 2013 Dec 9]. Available from: