Content uploaded by Sangeeta Kaur Sran
Author content
All content in this area was uploaded by Sangeeta Kaur Sran on May 15, 2018
Content may be subject to copyright.
__________
*Corresponding author. Tel.: +6019-488114; Emails: sangeeta.singh@monash.edu
E-mail: sangeetakaur.sran@gmail.com
© 2018 The Authors
Qualitative Research Conference (QRC) 2018
10-12 July 2018, Melaka, Malaysia
Ecological influences on youth alcohol consumption
patterns: scoping review on studies within the timeline
of 2000-2015
Sangeeta Kaur Singh*a&b, Gaanesh Subramaniam a, Daniel Reidpathb, Pascale Alloteyb
a. a Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia. T: +603
5514 6000/E: sangeeta.singh@monash.edu
b. Perdana University-Royal College of Surgeons in Ireland School of Medicine, MAEPS Building, MARDI Complex, Jalan
MAEPS Perdana, 43400 Serdang, Selangor, Malaysia, Tel:+603 89418646 ext 182/E: sangeetakaur@perdanauniveritsy.edu.my
1. ABSTRACT
Alcohol-related harms among young adults who consume alcohol at a riskier level do encounter
challenges with biological, environmental, psychological and social factors that affect them and the
society at large. The aim of this study is to conduct a scoping review on ecological factors; especially
the intrapersonal and interpersonal ecological influences on youth alcoholism.
This scoping review covered a total of 26 studies spanning four themes: studies on ethnic, gender,
family and peer influences. The review comprises of 13 cohorts and 13 cross-sectional studies.
Eighteen out of 26 studies, showed significant family and peer influences that were closely related to
riskier consumption patterns amongst youth. Whereby, sixteen studies indicated that youth
consumption patterns are closely related to their ethnic associations. Studies on gender differences
revealed that riskier alcohol consumption and associated risk behaviors are more prominent among
female within the age range of 18-25-year-olds.
An integrated prevention package that addresses the risk-taking behaviors which are directly
associated with health factors among youth is required. Stokols guideline on Social Ecology Model for
Health Promotion; which addresses human-environment interactions that involve individual, families
and cultural group's prevention and intervention may be a suited approach.
Proceedings of the Qualitative Research Conference (QRC) 2018
10-12 July 2018, Melaka, Malaysia
2
2. INTRODUCTION
In 2011, the World Health Organization has estimated that there were 2 billion people worldwide
consuming alcohol beverage and 76.3 million had an alcohol use disorder (World Health
Organization, 2011). Alcohol-related harms among young adults who consume alcohol at a riskier
level do encounter challenges with biological, environmental, psychological and social factors that
affect them and the society at large (DeWit, Adlaf, Offord, & Ogborne, 2000);(Wechsler & Nelson,
2015);(Hughes et al., 2011). These challenges may be loftier at a youth level; issues such as alcohol-
related harms to an individual, family, and community at large. Hence, as explained by Lang and
Rayner the health behaviours of a community at large impacts everyone collectively (Lang & Rayner,
2012).
Evidence has shown that child usually imitates parents behaviours (Gochman, 2013) and this is no
different when the use of substance is observed in a household (Simons, Sutton, Simons, Gibbons, &
Murry, 2016);(Hadley et al., 2016);(Hayakawa, Giovanelli, Englund, & Reynolds, 2016). It is a usual
inference that a child is first exposed to alcohol consumption through family norms or socialization
practices and behaviours (Donovan & Molina, 2011). The ecological aspects of parenting techniques
(Barnes, Welte, & Hoffman, 2002), being in a single parent household (Gabel, 1992), parental
monitoring and family closeness (Moore, Rothwell, & Segrott, 2010), all had correlations with the
levels of children’s drinking behaviours. In addition, families that experience violence, conflicts and
liberal attitudes towards substance use, alcohol, and petty crime may also expose children to such
risky behaviours that may reflect as cultural and societal norms. In two studies conducted among high
school students in Malaysia and Taiwan, there was a significant association between young
adolescent consumption patterns against the patterns observed in their households (Wan Rozita,
Hanjeet Kaur, & Lim, 2005);(Yeh, 2006).
Other than household practices, young adolescents with parental detachment issues tend to form an
attachment to their peers (Catalano & Hawkins, 1996). A study done in Lebanon showed that peers
opinion and behaviours seem to be a major contributor towards harmful alcohol consumption
practices among youth (Barbour, et al, 2013). Similarly, a review on gender differences and factors
influencing alcohol use, also found that peer deviant behaviours are reinforcer on riskier alcohol use
especially among young male consumers (Schulte, Ramo, & Brown, 2009).
Studies throughout the world have shown that gender differences create a unique intricacy among
those who consume alcohol at a riskier level; evidence indicates that men are more inclined to have a
higher risk of harmful alcohol consumption practices compared to their opposite sex (Helzer et al.,
1990);(Hupkens, Knibbe, & Drop, 1993);(Wilsnack, Vogeltanz, Wilsnack, & Harris, 2000). Such risky
alcohol consumption patterns are mainly noted among binge consumers even among men in
abstinent countries or where low alcohol prevalence is observed within general population
(Assanangkornchai, Sam-Angsri, Rerngpongpan, & Lertnakorn, 2010);(Mutalip, Kamarudin,
Manickam, Hamid, & Saari, 2014). However, it is important to note that female alcohol consumption
patterns have also increased over the years (Mustonen, Metso, Paakkanen, Simpura, & Kaivonurmi,
1999); (Bloomfield, Gmel, Neve, & Mustonen, 2001);(Bergmark, 2004). Therefore, a better
understanding of how gender drinking patterns are evolving over time is equally pertinent.
As described above, alcohol consumption patterns do differ in different segments of the population
and these differences are driven by culture, ethnic or gender groups which may elevate with certain
environmental or social factors. Several studies on ecological theories revolving around alcohol use
have discussed and correlated these factors (Vantamay, 2009);(Bogg & Finn, 2009);(Gruenewald,
Remer, & LaScala, 2014) to human ecology; that evolve over time (Lang & Rayner, 2012).
The aim of this review is to collate evidence on ecological influences and its impact on youth alcohol
consumption patterns. The ecological influences that will be assessed here are a) intrapersonal
influences, such as gender and ethnic group association; along with, b) interpersonal influences, that
interchanges around family and friend’s alcohol consumption patterns. This review also aims to
address the research gaps in the areas reviewed.
Proceedings of the Qualitative Research Conference (QRC) 2018
10-12 July 2018, Melaka, Malaysia
3
3. METHODS
This study used computer-assisted searches to collate relevant articles. One large database
(EBSCOhost integrated database) was searched. EBSCOhost integrated database includes many
relevant databases like Access Medicine, BMJ Journals, Medline Complete, Google Scholar, Pub
Med and Science Direct. terms used were i) alcohol* AND use and abuse* AND youth*, ii) ecological
influences* AND family* AND peer*, iii) gender* AND differences* AND drinking patterns*, iv) ethnicity
* AND differences* AND alcohol. Search terms were slightly altered in order to exploit the database
effectively and the process is described in Figure 1, listed below. The searches were limited to English
Language articles from 2000 to 2015. Unpublished dissertations were not included. Duplicated
findings were removed, and remaining articles were reviewed to see if these studies meet the specific
criteria set by aims of this review:
Were there gender differences in alcohol consumption patterns and its consequences?
How did ethnic groups association differ in riskier alcohol consumption patterns among young
consumers?
What is the impact of interpersonal influences on youth riskier alcohol consumption?
Proceedings of the Qualitative Research Conference (QRC) 2018
10-12 July 2018, Melaka, Malaysia
4
Articles initially
identified through
database searches
(n=574)
Articles from year
2000-2016
(n=519)
Non-English
papers excluded
Articles excluded
via title scan based
on the broad
relevance of topic
area
Abstract reviewed
(n=92)
Articles excluded if
major findings not
related to ethnicity,
family, gender and
peer factors
Articles included in
scoping review
(n=26)
Figure 1: Flowchart explaining search strategy of scoping review
This scoping review is based on the framework proposed by Arksey & O’Malley, 2005; four themes
emerged from 26 studies: 8 studies on family influences, 5 on peer influences, 8 on gender and 5 on
ethnic differences are analyzed and discussed. Majority of the studies were based in the United
States of America, with other studies from Australia, Cambodia, Finland, Italy, Lebanon, Malaysia,
New Zealand, Taiwan, and Switzerland. The studies included were mainly cohort (n=13) and cross-
sectional (n=13) studies. Twenty-six studies reviewed here, are assessed for quality through a
consultative process to avoid the risk of bias assessment, with the application of Newcastle-Ottawa
Scale [NOS]. The scores from this scale are listed in table 1, 2, 3 and 4.
Proceedings of the Qualitative Research Conference (QRC) 2018
10-12 July 2018, Melaka, Malaysia
5
4. EVIDENCE FROM THE STUDIES REVIEWED
Gender differences
Eight studies comprising of five cross-sectional population surveys [including GENACIS project which
is done simultaneously in 35 countries] and three longitudinal studies were reviewed for gender-
related differences. The age limitation for youth was not applied in this section on gender
consumptions analysis; this is to ensure a comprehensive understanding of the differences between
genders in consumption patterns regardless of age. Hence, participants within the age range of 10-70
years old were included. Most studies reported results on gender differences in alcohol consumption,
exposure, and behaviour. Majority of the studies were conducted in the United States and Australia.
Studies from Cambodia, Finland, Hungary, and Italy were also included.
Intrapersonal Influences
As summarised in Table 1; eight of the studies reviewed here, indicated that there are significant
gender differences among women and male consumers. The difference varied from positive to
negative factors that are more prominent in male consumers than their counterparts. It is important to
note that women may encounter riskier consumption patterns in early adulthood [ages 18-21] or later
between the ages range of 35-60 years old. Therefore, it is imperative to ensure gender-specific
criteria are amalgamated when interventions or research studies are being explored.
For instance; York, in 2003 reported that 46% out of 1,232 American women were consuming alcohol
on a daily basis. Thirteen percent of these women reported a daily consumption of four or more
drinks- this, variations in daily consumption ranged from 1 to 30 for men and 1 to 16 for women. This
study finding emphasized that age by gender variation was not significantly different over time and
frequency of consumption amongst pathological consumers were almost similar among men and
women (York, Welte, & Hirsch, 2003).
There is a varied reason as to why and how alcohol consumption patterns differ among men and
women. In a study done on 102 social drinkers- alcohol consumption was associated with increased
aggression among men (Giancola et al., 2002). Whereby, in a study in Finland; revealed that women
associated alcohol consumption patterns to positive outcomes. For example; the women in this study
claimed that alcohol consumption made them feel optimistic about life and they felt better even when
they had to deal with interpersonal issues at home or at work-places. For the men in this study; they
associated alcohol consumption with the socialization factor that built confidence in alluring women.
Hence, men perceive hedonistic benefits and women perceived more functional benefits from alcohol
consumption (Mustonen et al, 2000).
However, when young women consume alcohol at a riskier level they may experience negative
outcomes. A longitudinal study of national representative adolescent data used by Chen and
Jacobson in 2012; indicated that greater gender differences in rates of linear change are noted,
especially on alcohol use. Basically, this refers to the fact that females tend to show higher levels of
substance use in early years compared to their counterparts (Chen & Yin, 2008). Such consumption
patterns are concerning because, when females do consume heavily, they are more vulnerable to
alcohol use disorders. These, forms of disorders appear to be severe in females compared to males
(Nolen-Hoeksema, 2004). In addition to that, other associated riskier behaviours are also closely
related to riskier alcohol consumption patterns. For instance, evidence from Cambodian study among
300 youths aged between 10-24 years residing in rural settings – revealed that majority [64%] of
female consumers reported vulnerability towards risky sexual behaviours, compared to their male
counterparts (Lopez, Mukaire, & Mataya, 2015). Such vulnerabilities among female consumers are
more likely to go unnoticed and undiagnosed in healthcare settings by their physicians (Brienza &
Stein, 2002). This is concerning, especially when evidence from Cambodia indicated that females who
do seek health interventions, they may do so at a non-medical facility (Lopez et al., 2015).
Therefore, adequate and specific strategies are required to address riskier consumption patterns
among females, especially when such consumption patterns prolong to later years. For instance, a
study in Italy on 1059 daily consumers, revealed that heavy consumption patterns among females
continued until later years (Guerrini, Gentili, & Guazzelli, 2006). Similarly, an Australian study of
Proceedings of the Qualitative Research Conference (QRC) 2018
10-12 July 2018, Melaka, Malaysia
6
14,941 females, indicated that risky consumption and associated problem behaviours continue to
escalate among females aged 35 to 65-year-olds (Livingston & Room, 2009).
Interpersonal Influences
Gender and associated alcohol consumption patterns also impact a family as a whole. For example,
Kelly in 2012 explored the impact of family emotional engagement on adolescent alcohol use and in
her findings, she revealed that female emotional closeness to mothers was associated with less
frequent alcohol use. This effect appeared to operate by reducing exposure to high-risk peer
networks. However, parental disapproval of alcohol use was protective for both genders, but this
effect was larger for males than females (Kelly et al., 2011).
A Hungarian study in 2015, indicated that parental socioeconomic status such as mother’s education
was inversely related to smoking and alcohol consumption among young adults. Whereby, female
with father who had high education displayed higher risk behaviours; such association is closely
related to the fact that highly educated fathers may have higher permissive attitudes. Once again,
emphasizing the need that both parental education and active involvement in youth’s life cycle, will
promote better coping mechanism on how to manage substance use patterns among youth (Piko,
Varga, & Wills, 2015).
Table 1: Ecological influences from gender perspective reviewed against assessment scale
Studies
Sample size and method
*
*
*
Findings relevant to this scoping review
NOS
/10
1. Developmental
Trajectories of
Substance Use from
Early Adolescence to
Young Adulthood:
Gender and
Racial/Ethnic
Differences. (P. Chen &
Jacobson, 2012)
Longitudinal Study of
Adolescent Health;
examined gender and
racial/ethnic. A sample
size of 20,160
representatives of
national data In US.
Mean age at 21.2 (for
those age 12 to 25)
Alcohol use exhibited the highest rates.
Substance use increased from age 12,
reached a stationary point (i.e., the
highest level) at about age 25, and then
declined.
Females exhibited higher levels of
substance use than males during early
adolescence.
7
2. Characteristics of youth
sexual and reproductive
health and risky
behaviours in 2 rural
provinces of Cambodia.
(Lopez et al., 2015)
Multi-staged sampling
method, 30 villages- 300
rural youths ages within
10-24.
The frequency of alcohol use between 1–5
times was evident in 90% of youths.
More boys used alcohol than girls (74.2
% vs. 57.7 %)
77% of female reported risky sexual
behaviours when alcohol consumption
is observed.
More females 64% reported that they
practice risky behaviours than males.
7
3. A Study of Motives for
Tobacco and Alcohol
Use Among High
School Students in
Hungary. (Piko et al.,
2015)
500 students (age
range = 14–20 years;
M = 16.4, SD = 1.31;
34 % males; 99.4 %
response rate)
The social norm is a dominant motive for
youth and mostly they consume in social
situations
Mother’s education was inversely
related to both smoking and drinking
Level of father education was positively
related to drinking among girls.
6
4. Alcohol consumption
and heavy drinking: a
survey in three Italian
villages. (Guerrini et al.,
2006)
Information on alcohol-
drinking patterns was
collected from 2972
individuals using a
questionnaire that
included a masked form
of the CAGE rating
scale.
Heavy drinking was significantly higher in
females compared to males, but daily
drinking was higher in males compared to
females.
Out of 1059 consumers, 25% female were
daily consumers
6
Proceedings of the Qualitative Research Conference (QRC) 2018
10-12 July 2018, Melaka, Malaysia
7
Results focused on:*Ethnic group association and ** Family and peer influences.
In conclusion, Table 1 findings above resonates the fact that normative influences that revolve around
riskier consumption patterns do contribute to intense alcohol use among youths. These forms of
vulnerabilities were also closely tied to ethnic group composition.
Ethnic group differences
In this section, five studies were analyzed. Two of these, are cross-sectional population surveys, and
three are longitudinal studies that reviewed ethnic-related differences. The age range for youths was
not considered in this section to ensure appreciation of ethnicity and its associated risk is
5. Variations by age and
sex in alcohol-related
problematic behaviour
per drinking volume and
heavier drinking
occasion. (Livingston &
Room, 2009)
Mixed methods to collect
data from almost 29,445
Australians aged 12 or
older.
Both annual volume and risky drinking
occasions peak in the early twenties or late
teens.
Total consumption and risky drinking
occasion peak at slightly younger ages for
females (18–19)
There is a possibility that females are
displaying high problematic behaviour at
specific levels of drinking (eg 8 or more
drinks)
8
6. Gender differences in
the impact of families on
alcohol use: a lagged
longitudinal study of
early adolescents. (Kelly
et al., 2011)
A total of 855 Australian
students
(modal age 10–11 years
at baseline) participating
in the International
Youth Development
Study (Victoria,
Australia).
For girls, the emotional closeness to
mothers led to lower exposure to high-risk
peer network and less frequent alcohol
use
Parent disapproval of alcohol use was
protective for both genders, but this effect
was larger for boys than girls.
8
7. Gender comparison of
alcohol exposure on
drinking occasions.
(York et al., 2003)
A representative sample
(N = 2,627) of the U.S.
adult population was
surveyed using
computer-assisted
telephone interviewing.
Of the 1,833 current drinkers (73.4% men
& 67.2% women), women reported
consuming a mean of 2.2 standard drinks
(1 drink = 12 g ethanol) on typical drinking
occasions (days); men reported
consuming a mean of 3.2.
The duration of the drinking episode was
similar for women (122 minutes) and men
(126 minutes).
The hourly rate of drink consumption was
thus lower for women (approximately 1.1
drinks/hour) than for men (approximately
1.6 drinks/hour).
9
8. Relationships of
drinking behaviour,
gender and age with
reported negative and
positive experiences
related to drinking.
(Mustonen & others,
2000)
Interviews were
performed with a
representative sample of
the Finnish population
between 15 and 69
years of age.
For women, drinking helped them to sort
out interpersonal problems at home or in
the workplace, to feel more optimistic
about life, and to express their feelings.
(Functional benefits)
Men more commonly reported that
drinking had helped them to be funnier
and wittier and to get closer to the
opposite sex. (Hedonistic benefits)
7
Proceedings of the Qualitative Research Conference (QRC) 2018
10-12 July 2018, Melaka, Malaysia
8
encapsulated. Hence, studies with age variations of 13 to 70 years were included. The studies
reviewed are from New Zealand, Malaysia and the United States of America.
Ethnic group differences are prominent within a multi-racial country such as Malaysia. A study
conducted in Kuala Lumpur, involving 8532 students from secondary schools, found that the Chinese
students were 1.55 times more likely to consume alcohol compared to other ethnic groups (Wan
Rozita et al., 2005). The National Health and Morbidity Survey 2011 in Malaysia also found that
current alcohol use is most prevalent among the Chinese. However, riskier alcohol consumptions
patterns were noted among local natives from Sabah and Sarawak. Similar risky consumption
patterns were also noted amongst the Indians ethnic group with an odds ratio of 1.7 higher than
Chinese. It is relevant to note that the national prevalence for the current consumer is at, 24% (95%
CI: 21.0, 26.4) and risky drinking patterns are evident. Such consumption patterns are mainly noted
among 18-39 years olds (Mutalip et al., 2014).
However, such ethnic differences could also be a beneficial factor for young adults. In a study on 854
young Asian American; revealed that Asian language use was protective against alcohol misuse and
alcohol dependence. The study concluded that cultural and socioeconomic factors of problematic
consumption could differ for foreign-born Asian American (Cook, Bond, Karriker-Jaffe, & Zemore,
2013).
On the contrary, negative factors are also visible among different ethnic groups. A US study revealed
that Whites were younger than Blacks and Hispanics of the same sex at drinking onset and
progressed to alcohol dependence at a faster rate. This study emphasized the fact that there a
significant association in the course of transition that is noted in alcohol initiation to alcohol
dependence by race or ethnicity (Alvanzo et al., 2011).
Some of these ethnic differences are associated with the ethnic group association rather than the
cultural identity. For instance, a New Zealand study examined the role of Maori ethnic and cultural
identity in alcohol use and misuse. The study concluded that although Maories were found to be
associated with modestly increased risk of alcohol use and abuse, there was little evidence to suggest
that the rates of alcohol use differed in regards to their cultural identity (Marie, Fergusson, & Boden,
2012).
As noted in Table 2; the studies reviewed here, indicate that there is a significant impact of
intrapersonal influences on youth consumptions patterns and their ethnic associations. However,
there is a need to apply caution to the above-mentioned findings; because other than ecological
issues such as family - peer influences; gender and social economic factors are equal contributors to
youth alcohol use. Hence, the riskier consumption pattern factors are still undetermined and some of
these associated factors are discussed below.
Table 2: Ecological influences that differ between ethnic groups
Studies
Sample size and method
*
*
*
Findings relevant to this scoping
review
NOS
/10
1. Factors related to
alcohol drinking
among the
adolescents in
Federal Territory,
Kuala Lumpur. (Wan
Rozita et al., 2005)
The two-stage stratified sampling
design was used to recruit 8532
eligible students from the selected
secondary schools in Kuala Lumpur.
Significant factors were identified
related to alcohol consumption,
namely Chinese ethnic group (1.55).
6
2. Alcohol consumption
and risky drinking
patterns in Malaysia:
findings from NHMS
2011. (Mutalip et al.,
2014)
The paper analysed data from the
National Health and Morbidity
Survey 2011. It was a cross-
sectional population-based with two
stages stratified random sampling
design. A validated Alcohol Use
Disorder Identification Test Malay
questionnaire was used to assess
the alcohol consumption and its
alcohol-related harms.
Ethnicity was significantly associated
with risky drinking where Bumiputera
Sabah and Sarawak had the highest
odds of 2.7 followed by another
ethnicity with the odds of 2.1 higher
than Chinese relatively. Indian had
odds of 1.7 higher than Chinese.
7
Proceedings of the Qualitative Research Conference (QRC) 2018
10-12 July 2018, Melaka, Malaysia
9
Studies
Sample size and method
*
*
*
Findings relevant to this scoping
review
NOS
/10
3. Who’s At Risk? Ethnic
Drinking Cultures,
Foreign Nativity, and
Problem Drinking
Among Asian
American Young
Adults. (Cook et al.,
2013)
This study was a nationally
representative sample of 854 Asian
American young adults extracted
from the Wave 4 National
Longitudinal Study of Adolescent
Health data.
Asian language use was
protective against alcohol-misuse
symptoms and alcohol-
dependence symptoms for the
foreign-born.
Asian Indians consumed the
smallest volume of alcohol,
followed by the Vietnamese and
Chinese/Taiwanese. Koreans
were estimated to consume the
largest volume of alcohol among
all Asian people, followed by the
Japanese.
9
4. Race/ethnicity and
sex differences in the
progression from
drinking initiation to
the development of
alcohol dependence.
(Alvanzo et al., 2011)
This study uses data from Wave I of
the National Epidemiologic Survey
on Alcohol and Related Conditions
(NESARC) to compare a nationally
representative sample of White,
Black and Hispanic adults 18–44
years of age (n = 21,106).
Drinking onset is earlier in Whites
compared to Blacks and
Hispanics.
White tends to progress to alcohol
dependence at a faster rate than
Blacks and Hispanics.
8
5. The Links between
Ethnicity, Cultural
Identity and Alcohol
Use, Misuse and
Dependence in a New
Zealand birth cohort.
(Marie et al., 2012)
Data were gathered as part of a
longitudinal study of a New Zealand
birth cohort of 1000 young people.
(The Christchurch Health and
Development Study).
Māori ethnic group association
lead to higher alcohol-attributed
deaths (1.47-1.63) compared to
non-Maori people.
Higher consumption patterns were
dominant among youth aged 18-
21 years old.
9
Results focused on: * Ethnic group association and ** Family and peer influences.
Table 2 findings conclude the fact that ethnic group association may be a greater affluence that is
closely linked to riskier consumption patterns among youth.
Interpersonal influences
A total of thirteen studies were reviewed on ecological factors [with a specific focus on family and peer
influences], that were directly and indirectly associated with youth alcoholism. The majority [6 out of
13], studies utilized a longitudinal approach. Other study methodologies include cross-sectional
population surveys and Structural Equation Models (SEM). The sample age for participants were
adolescent children aged between 6-26 years old, with the majority of studies focusing on students in
schools and universities. Majority of the studies were conducted in the United States of America, with
four other studies conducted in Switzerland, Taiwan, and Lebanon.
Family influence
There have been questions about the impact of parental alcohol-related messages and parenting
style on alcoholism in adolescents. Zero tolerance communications by parents appeared to be most
protective against alcohol use and consequences. Harm minimization messages were noted to be
least effective communitarian strategies. Messaging on minimization of harms or abstinence were less
effective especially among young adults (Abar, Morgan, Small, & Maggs, 2012). Parenting style like
monitoring and disapproval of heavy consumption were negatively associated with heavy episodic
drinking. Where else, higher levels of perceived monitoring and disapproval were associated with
lower levels of heavy episodic drinking. Perceived parental permissiveness was significantly and
Proceedings of the Qualitative Research Conference (QRC) 2018
10-12 July 2018, Melaka, Malaysia
10
positively associated with heavy episodic drinking (Wood, Read, Mitchell, & Brand, 2004). Contrary to
this, another study explored similarities between youth in different countries with different alcohol
policies and they concluded that adult-supervised settings for alcohol use resulted in higher levels of
harmful alcohol consequences (McMorris, Catalano, Kim, Toumbourou, & Hemphill, 2011). This
contradicts with predictions derived from the harm-minimization policy.
An interesting study took parental monitoring a step further by examining the potential gender-specific
parental influences on consumption control and alcohol-related problems in 581 university students.
The study showed that daughters, perceptions of a permissive father were indirectly linked to more
alcohol-related problems; while for sons, perceptions of mother and authoritativeness were directly
linked to fewer alcohol-related problems (Patock-Peckham, King, Morgan-Lopez, Ulloa, & Filson
Moses, 2011).
In addition to parental assent and monitoring approach; parental consumption patterns do have a
direct impact on youth drinking patterns as well. For example; paternal alcoholism and paternal
absence were associated with the development of behavioural problems amongst youth. These
behaviours were explored in a study and the results revealed that a propensity for physical aggression
and low anxiety best-distinguished son of male alcoholics [SOMAs] from non-SOMAs at ages 6 and
12 years old (Carbonneau et al., 1998). Yeh, conducted a survey on 779 high school students in
Taiwan and found that the probability of developing adolescent drinking problem was fourfold greater
in students whose fathers had heavy consumption episodes, with males having a probability of 2.22 -
2.71 fold greater than in female adolescents (YEH, 2006).
Summarization of the results found in the eight of the studies evaluated under family influences shown
in Table 3; indicates that it is crucial for parents to have effective and engaging communication on
risks associated with alcohol use. Such communication enforcement needs to be tailored to ongoing
efforts to build a healthy relationship with a child who is transitioning from adolescent to young
adulthood. The transformation from child ecology to young adult life cycle comes with many
challenges involving risk-taking practices that could impact alcohol consumption behaviours.
Table 3: Ecological influences, reviewed against assessment scale I – Family influences
Studies
Sample size and method
*
*
*
Findings relevant to this scoping
review
NOS
/10
1. Investigating Associations
Between Perceived Parental
Alcohol-Related Messages
and College Student
Drinking.(Abar et al., 2012)
A longitudinal study of 585
participants who are less than
21 years completed web-based
surveys.
Zero tolerance messages seemed
to be more protective compared to
harm reduction based messages.
Harm reduction messages were
associated with riskier alcohol use
in college.
9
2. Influence of Family Factors
and Supervised Alcohol Use
on Adolescent Alcohol Use
and Harms: Similarities
Between Youth in Different
Alcohol Policy Contexts.
(McMorris et al., 2011)
Representative samples
seventh-grade students (N =
1,945) were recruited from
schools in US and Australia.
Students completed
comprehensive annually from
2002(seventh grade) to 2004
(ninth grade).
Adult supervision resulted in
higher levels of harmful alcohol
consequences contrary to
predictions derived from the harm-
minimization policy.
8
3. Factors associated with
alcohol consumption,
problem drinking, and
related consequences
among high school students
in Taiwan.(YEH, 2006)
A total of N=779 10th-grade
students from four randomly
selected high schools in eastern
Taiwan were included in the
self-reported survey.
Parents (fathers) and peer groups
influenced alcohol consumption.
The probability of developing
adolescent problem drinking was
fourfold greater in students whose
fathers had habits of drinking.
6
4. Do Parents Still Matter?
Parent and Peer Influences
on Alcohol Involvement
N=556 participants (late
adolescents) completed a mail
survey.
Parental monitoring and parental
disapproval led to lower levels of
heavy episodic drinking.
8
Proceedings of the Qualitative Research Conference (QRC) 2018
10-12 July 2018, Melaka, Malaysia
11
Studies
Sample size and method
*
*
*
Findings relevant to this scoping
review
NOS
/10
Among Recent High School
Graduates. (Wood et al.,
2004)
5. Gender-Specific Mediational
Links Between Parenting
Styles, Parental Monitoring,
Impulsiveness, Drinking
Control, and Alcohol-Related
Problems. (Patock-Peckham
et al., 2011)
A multiple-group, SEM model
with (316 women, 265 men)
university students was
examined.
For daughters, perceptions of a
permissive father were indirectly
linked to more alcohol-related
problems, while for sons;
perceptions of mother and
authoritativeness were directly
linked to fewer alcohol-related
problems.
7
6. Sibling Influence on Alcohol
Use in a Young Adult, High-
Risk Sample.(Trim, Leuthe,
& Chassin, 2006)
Data from sibling pairs (n = 169
pairs) in an ongoing longitudinal
study of children of alcoholics
and matched controls were
collected at two-time points 5
years apart.
Older sibling influence on younger
sibling alcoholism was significant
only among sibling pairs who were
of the same gender, closer in age,
and from higher conflict families
9
7. My older sibling was drunk –
Younger siblings’
drunkenness in relation to
parental monitoring and the
parent-adolescent
relationship. (Gossrau-
Breen, Kuntsche, & Gmel,
2010b)
Regression models were
conducted based on a national
representative sample of 3725,
8th to 10th graders in
Switzerland (mean age 15.0,
SD ¼ .93) who indicated having
older siblings
Parental monitoring is important in
preventing risky drinking in
younger children even if older
children engage in riskier
consumption patterns. However, a
satisfying relationship with parents
does not seem to be sufficient to
counterbalance older siblings’
influence.
8
8. The Earlier the More?
Differences in the Links
between Age at First Drink
and Adolescent Alcohol Use
and Related Problems
According to Quality of
Parent-Child Relationships.
(Kuntsche, van der Vorst, &
Engels, 2009a)
Structural equation models were
estimated based on a three-
wave, 2-year prospective study
of 364 adolescents.
Adolescents those who had a late
alcoholic first drink and a high-
quality relationship with their
parents were found to have lower
levels of alcohol use
9
Results focused on:* Ethnic group association and ** Family and peer influences.
Table 3, concludes the fact that family influences are dominant factors to take into considerations and
there is a need to engage parents to avoid harmful alcohol use throughout the lifecycle of an offspring.
Peer influence
An example of peer influence evidence on youth alcoholism is seen when Duncan and colleagues
studied 405 randomly recruited youth from three age cohorts (9,11,13 years) and assessed them
annually for 4 years. The study showed that more peer deviance and peer encouragement of alcohol
use was related to an increase in alcohol use rates from ages 9 to 16 (Duncan, Duncan, & Strycker,
2006). These, forms of peer influence continued to remain significant for some adolescent who
transitioned into young adults. For instance, from 75% [N=1036] of youths within the age range of 17-
22-year-olds - from different universities in Lebanon; claimed that they usually consume alcohol with
their friends. Hence, indicating that their consumption patterns revolved around peer’s opinion and
behaviour (Barbour et al., 2013).
In addition to peer pressure, social anxiety is also an important factor for consideration in youth
alcohol use. For socially anxious youth, high levels of perceived peer use in relation to high levels of
Proceedings of the Qualitative Research Conference (QRC) 2018
10-12 July 2018, Melaka, Malaysia
12
affiliation need to result in greater alcohol use in average and more frequent episodic drinking.
Specific to heavy episodic drinking, the interaction between social anxiety and perceived peer drinking
seemed to affect girls and boys differentially. Thus, it was inferred that alcohol-related risk associated
with social anxiety might be gender specific (Anderson, Tomlinson, Robinson, & Brown, 2011).
Some studies highlighted protective factors that may co-exist with peer pressure such as school
bonding. In a study of 2582 American Indian and Alaskan Native student; school bonding was
associated with lower likelihood of lifetime alcohol use for adolescents younger than age 16, and a
lower level use among users for all adolescents. Thus, school bonding is seen as a buffer against
peer alcohol use among adolescents younger than 16 years old (Dickens, Dieterich, Henry, &
Beauvais, 2012).
There is a certain moderating variable effect of peer’s use of alcohol on youth alcoholism, namely
perceived harm of alcohol use and risk-taking. The effect of increased exposure to alcohol using
friends is stronger when the youth is less likely to perceive the harmful effects of alcohol use, or when
a youth indicates increased interest in risk-taking behaviours. Hence, although a friend’s use of
alcohol is a major predictor of a youth‘s own alcohol use; some are more likely than others to be
influenced by a friend’s behaviour depending on the perception of harm and predisposition to risk-
taking (Henry, Slater, & Oetting, 2005).
The evidence in this section shown in Table 4; stipulates that alcohol use and misuse are associated
with several domains of influence in youth interpersonal ecology. Some predictors of alcohol misuse
are closely related to peer opinion and behaviours. These forms of predictors are linked to personal
factors like social anxiety, perceived harms of alcohol use and risk-taking behaviour. Therefore,
enforcing the need for prevention efforts which encapsulate adolescence, who may be exposed to
such risk-taking behaviours from an early age is essential. In addition, there is an equal emphasis to
also monitor peer involvements that are equally at risk of alcohol misuse.
Table 4: Ecological influences II, reviewed against assessment scale II –Peer influence
Studies
Sample size and method
*
*
*
Findings relevant to this scoping
review
NOS
/10
1. Alcohol Use from Ages 9 –
16: A Cohort-Sequential
Latent Growth Model.
(Duncan et al., 2006)
The sample comprised 405
randomly recruited youth
from three age cohorts (9,
11, and 13 years), assessed
annually for 4 years.
The greater the peer deviance and
friend’s encouragement of alcohol
use, the greater the increase in
alcohol use rates from ages 9 to 16
years.
10
2. Do personal beliefs and
peers affect the practice of
alcohol consumption in
university students in
Lebanon?. (Barbour et al.,
2013)
A total of 1500
questionnaire were
distributed to students from
all universities in Lebanon.
Risk factors for harmful drinking
were:
friends’ agreeing with alcohol
consumption (crude OR = 6.22),
a higher proportion of friends who
drank regularly (OR = 17.3) and
higher frequency of drinking
alcohol with friends (OR = 80.1).
7
3. Friends or Foes: Social
Anxiety, Peer Affiliation, and
Drinking in Middle School.
(Anderson et al., 2011)
1,500 early adolescents
from southern California
completed the Social
Anxiety Scale for Children-
Revised as well as
measures of perceived peer
drinking and self-reported
lifetime and current drinking.
Youth who are socially anxious had
higher levels of perceived peer use
which led to greater alcohol use on
average and more frequent episodic
drinking. For heavy episodic
drinking, the interaction of social
anxiety and perceived peer drinking
seemed to affect girls and boys
differentially.
8
4. School Bonding As a
Moderator of the Effect of
Peer Influences on Alcohol
Use Among American
Indian Adolescents.
(Dickens et al., 2012)
Survey data were collected
from middle and high school
students during the 2009–
2010 and 2010–2011 school
years from 37 school
districts in the United States.
The sample consisted of
2,582 students
Peer alcohol use was seen as a risk
factor for
lifetime alcohol use and
level of alcohol use among users.
School bonding led lower
likelihood of lifetime alcohol use
for adolescents younger than age
16 and a lower level of use among
7
Proceedings of the Qualitative Research Conference (QRC) 2018
10-12 July 2018, Melaka, Malaysia
13
Studies
Sample size and method
*
*
*
Findings relevant to this scoping
review
NOS
/10
users for all adolescents.
5. Alcohol Use in Early
Adolescence: The Effect of
Changes in Risk Taking,
Perceived Harm, and
Friends’ Alcohol Use.
(Henry et al., 2005)
1,065 students were in sixth
or seventh grade at the
initial survey and provided
survey data on three
additional occasions over a
period of 2 years.
Increased exposure to alcohol-using
friends happens when an adolescent
is less likely to perceive harmful
effects of alcohol use and when they
are prone to risk taking behaviour.
9
Results focused on: * Ethnic group association and ** Family and peer influences.
5. DISCUSSION
The aim of this review is to gather available evidence on ecological influences such as family, peer,
gender, and ethnicity; which, clearly indicates the complexity that revolves around youth riskier
alcohol consumption patterns. However, the evidence gathered from twenty-six studies in Table 1,2,3
and 4 emphasised the fact that interpersonal influences – especially positive parental factors, could
act as protective buffers in addressing youth alcoholism (Abar et al., 2012);(Wood et al.,
2004);(Gossrau-Breen, Kuntsche, & Gmel, 2010a);(Kuntsche, van der Vorst, & Engels,
2009b);(Patock-Peckham et al., 2011);(McMorris et al., 2011). Thus, addressing family-based
strategies that improve positive parental involvement in their offspring lives could address riskier
alcohol consumption patterns among youth. For instance, prevention strategies packages for parents
that encompasses of intrapersonal to interpersonal influences could enhance coping skills that
address riskier consumption patterns among young children who transition into young adults (Lopez
et al., 2015);(Piko et al., 2015);(Livingston & Room, 2009);(Kelly et al., 2011);(Mustonen et al,
2000);(Wan Rozita et al., 2005);(Abar et al., 2012);(McMorris et al., 2011);(YEH, 2006);(Wood et al.,
2004);(Kuntsche et al., 2009b). These family-based intervention model that comprises of distal and
proximal factors needs to be packaged in the interactive and integrated package. Such package,
could elaborate zero tolerance messages, with added mechanism on improving parental monitoring
and positive relationship that have proven to the best approach to minimise riskier consumption
patterns among youths (Abar et al., 2012);(Wood et al., 2004);(Kuntsche, van der Vorst, & Engels,
2009a);(Velleman, Templeton, & Copello, 2005). Some of the elements of an interactive intervention
package that takes into consideration the transitions that occur in child’s life to young adulthood; is
described in Figure 2.
In addition, to the above mentioned interactive package; there is also a need to include associated
factors that correlated to intra and interpersonal influences. For instance, ethnic group association,
gender, and peer influences could all be contributing factors to riskier consumption patterns (Patock-
Peckham et al., 2011);(Duncan et al., 2006). Thus, emphasising the need on continuous research to
address the riskier alcohol patterns which may be evident among families from a certain ethnic group
(Mutalip et al., 2014);(Cook et al., 2013);(Alvanzo et al., 2011);(Marie et al., 2012);(Chen & Jacobson,
2012);(Lopez et al., 2015);(Livingston & Room, 2009);(Kelly et al., 2011);(Mustonen et al, 2000).
These forms of influences could also be closely linked to the genetic makeup of youth from specific
kinship (Kendler, Myers, Dick, & Prescott, 2010), social or cultural factors (Marie et al., 2012).
Therefore, Stokols guideline on Social Ecology Model for Health Promotion; which addresses human-
environment interactions that involves individual, families and cultural groups prevention and
Proceedings of the Qualitative Research Conference (QRC) 2018
10-12 July 2018, Melaka, Malaysia
14
intervention may be a suited approach (Stokols, 1996);(McLeroy, Bibeau, Steckler, & Glanz,
1988);(YEH, 2006);(Gossrau-Breen et al., 2010). The following figure 2, demonstrates the need for
positive reinforcement messaging from parents that are mapped against growth chart of their
offspring.
Family Influences on youth alcohol use:
“Parents promote abstinence messages”
Adolescence
<18
Youth
18-25
Male
Female
Male
Female
Parents promote abstinence
messages
Parents promote abstinence with information on
benefits and risk associated with alcohol usage
Parents consume alcohol responsibly in front of children
(Male not more than 4 drinks at a siting and female not more than 2 at a sitting; over a
period of two to four hours)
Parents to build a strong relationship
with constant probing to assess
knowledge on possible risk factors
resulting from substance use
Fathers or Male family
members
Mothers or female
family members
to also address knowledge on potential risk
associated with harmful consumption and
another risk (ex; sexual, violence & drunk
driving/riding)
Figure 2: Positive reinforcement messaging cater for parent interactions with their offspring.
6. RESEARCH GAPS
As highlighted above, there is a need to build on evidence to ensure interactive intervention packages
are catered and directed at the right audience at a specific timeframe.
The packaging of interactive messaging that focuses on family-based interventions; parents
address the protective factors, risk factors and resilience via communication. Parent to build a
positive relationship with a child through adolescence and youth. However, such messaging
needs to also be mapped against the current gaps identified in relations to gender-specific
parental influence.
Addressing interpersonal influences, which are interwoven with peer’s influence on alcohol
consumption should be explored. This might help in tailoring intervention to a certain group of
youth who possess specific personal factors which separates them from the high-risk groups.
Research is also required on the convergence of men’s and women’s consumption patterns.
Evidence highlighted above have indicated that there is an increasing trend of alcohol
consumption among females that revolves around evolution in women’s lives (Holmila &
Raitasalo, 2005). It is crucial to highlight the fact that there is limited research on addressing
alcohol consumption patterns within females especially in South East Asia. This form of
evidence is crucial since there is an increase in average volume of drinking among women
residing in this region (Das, Balakrishnan, & Vasudevan, 2006).
Proceedings of the Qualitative Research Conference (QRC) 2018
10-12 July 2018, Melaka, Malaysia
15
Finally, the relationship of ethnicity and consumption patterns is critical in addressing its risk
and protective factors. These forms of tailored information could inform prevention and
intervention activities.
7. CONCLUSION
In relation to the ecological factors that influence youth alcoholism, this review found that intra and
interpersonal influences were so inextricably linked to one another. Hence, a multidimensional
approach through a primary prevention package needs to be developed for parents so that they could
strategically address riskier alcohol consumption patterns among youths.
In addition, studies on gender highlighted the differences in drinking patterns between genders and
consumption consequences. The incidence of heavy and problematic consumption seemed to have
significant gender differences that are important to consider when planning effective prevention
programmes. The gender-specific parental influences should also be taken into account when
planning an intervention.
Finally, this review also revealed that ethnicity and cultural identification are relevant factors to be
considered in studies on riskier alcohol use. Hence, more studies relating to risk and protective factors
of specific ethnic groups in particular locale are warranted. This ensures the fact that ethnic group
associations are integrated into prevention and intervention initiatives.
8. LIMITATIONS
Unlike previous reviews which focused on broader aspects, this review has specifically discussed the
intra and interpersonal ecological influences of riskier alcohol consumption among youth. However,
the 26 studies in this scoping review have been cross-sectional and longitudinal studies from specific
countries only; thus, this limits our understanding of temporal patterns of alcohol consumption among
individuals in varied age range. Furthermore, the author intended to encapsulate some Asian
population studies to ensure regional differences- but, only five studies were included that were
aligned with aims of the review.
9. DISCLAIMERS
The following is author’s statement; hence views expressed in the submitted article are the teams and
not an official position of the institution or funder.
10. SOURCE OF SUPPORT
No funding support was rendered to this study.
11. CONFLICT OF INTEREST
The authors confirm there are no conflicts of interest pertaining to the article.
Proceedings of the Qualitative Research Conference (QRC) 2018
10-12 July 2018, Melaka, Malaysia
16
12. ACKNOWLEDGEMENTS
This work would not have been possible without the support of partial sponsorship from Jeffrey Cheah
School of Medicine and Health Sciences and protected academic time to pursue my PhD work at
Royal College of Surgeons in Ireland School of Medicine, Perdana University.
REFERENCES
1. Abar, C. C., Morgan, N. R., Small, M. L., & Maggs, J. L. (2012). Investigating associations between perceived parental alcohol-
related messages and college student drinking. Journal of Studies on Alcohol and Drugs, 73(1), 71–79.
2. Alvanzo, A. A., Storr, C. L., La Flair, L., Green, K. M., Wagner, F. A., & Crum, R. M. (2011). Race/ethnicity and sex
differences in progression from drinking initiation to the development of alcohol dependence. Drug and Alcohol Dependence,
118(2), 375–382.
3. Anderson, K. G., Tomlinson, K., Robinson, J. M., & Brown, S. A. (2011). Friends or Foes: Social Anxiety, Peer Affiliation, and
Drinking in Middle School*. Journal of Studies on Alcohol and Drugs, 72(1), 61–69.
4. Arksey, H., & O’Malley, L. (2005). Scoping studies: towards a methodological framework. International Journal of Social
Research Methodology, 8(1), 19–32.
5. Assanangkornchai, S., Sam-Angsri, N., Rerngpongpan, S., & Lertnakorn, A. (2010). Patterns of alcohol consumption in the Thai
population: results of the National Household Survey of 2007. Alcohol and Alcoholism, 45(3), 278–285.
6. Barbour, B., Salameh, P., & others. (2013). Do personal beliefs and peers affect the practice of alcohol consumption in university
students in Lebanon? Retrieved from http://apps.who.int/iris/handle/10665/118392
7. Barnes, G. M., Welte, J. W., & Hoffman, J. H. (2002). Relationship of alcohol use to delinquency and illicit drug use in
adolescents: Gender, age, and racial/ethnic differences. Journal of Drug Issues, 32(1), 153–178.
8. Bergmark, K. H. (2004). Gender roles, family, and drinking: women at the crossroad of drinking cultures. Journal of Family
History, 29(3), 293–307.
9. Bloomfield, K., Gmel, G., Neve, R., & Mustonen, H. (2001). Investigating gender convergence in alcohol consumption in
Finland, Germany, The Netherlands, and Switzerland: a repeated survey analysis. Substance Abuse, 22(1), 39–53.
10. Bogg, T., & Finn, P. R. (2009). An Ecologically Based Model of Alcohol-Consumption Decision Making: Evidence for the
Discriminative and Predictive Role of Contextual Reward and Punishment Information. Journal of Studies on Alcohol and
Drugs, 70(3), 446–457.
11. Brienza, R. S., & Stein, M. D. (2002). Alcohol Use Disorders in Primary Care. Journal of General Internal Medicine, 17(5),
387–397. https://doi.org/10.1046/j.1525-1497.2002.10617.x
12. Carbonneau, R., Tremblay, R. E., Vitaro, F., Dobkin, P. L., Saucier, J.-F., & Pihl, R. O. (1998). Paternal alcoholism, paternal
absence and the development of problem behaviors in boys from age six to twelve years. Journal of Studies on Alcohol, 59(4),
387–398.
13. Catalano, R. F., & Hawkins, J. D. (1996). A Theory of Antisocial Behavior. Delinquency and Crime: Current Theories (1996),
149. Retrieved from
https://books.google.com/books?hl=en&lr=&id=9y7YwwpBoaUC&oi=fnd&pg=PA149&dq=The+Social+Development+Model:
+A+Theory+of+Antisocial+Behavior&ots=uAAAFAQKwM&sig=Wj-zOxcy0kgPIZ4RIDZqyoHo8ak
14. Chen, C.-C., & Yin, S.-J. (2008). Alcohol abuse and related factors in Asia. International Review of Psychiatry (Abingdon,
England), 20(5), 425–433. https://doi.org/10.1080/09540260802344075
15. Chen, P., & Jacobson, K. C. (2012). Developmental Trajectories of Substance Use From Early Adolescence to Young
Adulthood: Gender and Racial/Ethnic Differences. Journal of Adolescent Health, 50(2), 154–163.
https://doi.org/10.1016/j.jadohealth.2011.05.013
16. Cook, W. K., Bond, J., Karriker-Jaffe, K. J., & Zemore, S. (2013). Who’s at risk? Ethnic drinking cultures, foreign nativity, and
problem drinking among Asian American young adults. Journal of Studies on Alcohol and Drugs, 74(4), 532–541.
17. Das, S. K., Balakrishnan, V., & Vasudevan, D. M. (2006). Alcohol: its health and social impact in India. Med Soc, 19(2), 94–99.
Proceedings of the Qualitative Research Conference (QRC) 2018
10-12 July 2018, Melaka, Malaysia
17
18. DeWit, D. J., Adlaf, E. M., Offord, D. R., & Ogborne, A. C. (2000). Age at First Alcohol Use: A Risk Factor for the
Development of Alcohol Disorders. American Journal of Psychiatry, 157(5), 745–750.
https://doi.org/10.1176/appi.ajp.157.5.745
19. Dickens, D. D., Dieterich, S. E., Henry, K. L., & Beauvais, F. (2012). School bonding as a moderator of the effect of peer
influences on alcohol use among American Indian adolescents. Journal of Studies on Alcohol and Drugs, 73(4), 597–603.
20. Donovan, J. E., & Molina, B. S. (2011). Childhood Risk Factors for Early-Onset Drinking*. Journal of Studies on Alcohol and
Drugs, 72(5), 741–751.
21. Duncan, S. C., Duncan, T. E., & Strycker, L. A. (2006). Alcohol use from ages 9 to 16: A cohort-sequential latent growth model.
Drug and Alcohol Dependence, 81(1), 71–81.
22. Gabel, S. (1992). Behavioral problems in sons of incarcerated or otherwise absent fathers: The issue of separation. Family
Process, 31(3), 303–314.
23. Giancola, P. R., Helton, E. L., Osborne, A. B., Terry, M. K., Fuss, A. M., & Westerfield, J. A. (2002). The effects of alcohol and
provocation on aggressive behavior in men and women. Journal of Studies on Alcohol. Retrieved from
http://psycnet.apa.org/psycinfo/2002-13004-008
24. Gochman, D. S. (2013). Handbook of Health Behavior Research III: Demography, Development, and Diversity. Springer Science
& Business Media.
25. Gossrau-Breen, D., Kuntsche, E., & Gmel, G. (2010a). My older sibling was drunk - younger siblings’ drunkenness in relation to
parental monitoring and the parent-adolescent relationship. Journal of Adolescence, 33(5), 643–652.
https://doi.org/10.1016/j.adolescence.2009.11.006
26. Gossrau-Breen, D., Kuntsche, E., & Gmel, G. (2010b). My older sibling was drunk–Younger siblings’ drunkenness in relation to
parental monitoring and the parent–adolescent relationship. Journal of Adolescence, 33(5), 643–652.
27. Gruenewald, P. J., Remer, L. G., & LaScala, E. A. (2014). Testing a social ecological model of alcohol use: the California 50-
city study. Addiction (Abingdon, England), 109(5), 736–745. https://doi.org/10.1111/add.12438
28. Guerrini, I., Gentili, C., & Guazzelli, M. (2006). Alcohol consumption and heavy drinking: a survey in three Italian villages.
Alcohol and Alcoholism, 41(3), 336–340.
29. Hadley, W., Brown, L. K., Barker, D., Warren, J., Weddington, P., Fortune, T., & Juzang, I. (2016). Work It Out Together:
Preliminary Efficacy of a Parent and Adolescent DVD and Workbook Intervention on Adolescent Sexual and Substance Use
Attitudes and Parenting Behaviors. AIDS and Behavior, 20(9), 1961–1972. https://doi.org/10.1007/s10461-016-1418-6
30. Hayakawa, M., Giovanelli, A., Englund, M. M., & Reynolds, A. J. (2016). Not Just Academics: Paths of Longitudinal Effects
From Parent Involvement to Substance Abuse in Emerging Adulthood. Journal of Adolescent Health, 58(4), 433–439.
https://doi.org/10.1016/j.jadohealth.2015.11.007
31. Helzer, J. E., Canino, G. J., Yeh, E.-K., Bland, R. C., Lee, C. K., Hwu, H.-G., & Newman, S. (1990). Alcoholism—North
America and Asia: A comparison of population surveys with the Diagnostic Interview Schedule. Archives of General Psychiatry,
47(4), 313–319.
32. Henry, K. L., Slater, M. D., & Oetting, E. R. (2005). Alcohol use in early adolescence: the effect of changes in risk taking,
perceived harm and friends’ alcohol use. Journal of Studies on Alcohol, 66(2), 275–283.
33. Holmila, M., & Raitasalo, K. (2005). Gender differences in drinking: why do they still exist? Addiction, 100(12), 1763–1769.
34. Hughes, K., Quigg, Z., Eckley, L., Bellis, M., Jones, L., Calafat, A., … van Hasselt, N. (2011). Environmental factors in drinking
venues and alcohol-related harm: the evidence base for European intervention. Addiction (Abingdon, England), 106 Suppl 1, 37–
46. https://doi.org/10.1111/j.1360-0443.2010.03316.x
35. HUPKENS, C. L., Knibbe, R. A., & Drop, M. J. (1993). Alcohol consumption in the European Community: uniformity and
diversity in drinking patterns. Addiction, 88(10), 1391–1404.
36. Kelly, A. B., O’Flaherty, M., Toumbourou, J. W., Connor, J. P., Hemphill, S. A., & Catalano, R. F. (2011). Gender differences in
the impact of families on alcohol use: A lagged longitudinal study of early adolescents. Addiction, 106(8), 1427–1436.
37. Kendler, K. S., Myers, J., Dick, D., & Prescott, C. A. (2010). The Relationship Between Genetic Influences on Alcohol
Dependence and on Patterns of Alcohol Consumption. Alcoholism: Clinical and Experimental Research, 34(6), 1058–1065.
https://doi.org/10.1111/j.1530-0277.2010.01181.x
38. Kuntsche, E., van der Vorst, H., & Engels, R. (2009a). The earlier the more? Differences in the links between age at first drink
and adolescent alcohol use and related problems according to the quality of parent-child relationships. Journal of Studies on
Alcohol and Drugs, 70(3), 346–354.
Proceedings of the Qualitative Research Conference (QRC) 2018
10-12 July 2018, Melaka, Malaysia
18
39. Kuntsche, E., van der Vorst, H., & Engels, R. (2009b). The earlier the more? Differences in the links between age at first drink
and adolescent alcohol use and related problems according to the quality of parent-child relationships. Journal of Studies on
Alcohol and Drugs, 70(3), 346–354.
40. Lang, T., & Rayner, G. (2012). Ecological public health: the 21st century’s big idea? An essay by Tim Lang and Geof Rayner.
BMJ, 345, e5466. https://doi.org/10.1136/bmj.e5466
41. Livingston, M., & Room, R. (2009). Variations by age and sex in alcohol-related problematic behaviour per drinking volume and
heavier drinking occasion. Drug and Alcohol Dependence, 101(3), 169–175.
42. Lopez, J. R., Mukaire, P. E., & Mataya, R. H. (2015). Characteristics of youth sexual and reproductive health and risky
behaviours in two rural provinces of Cambodia. Reproductive Health, 12(1), 83. https://doi.org/10.1186/s12978-015-0052-5
43. Marie, D., Fergusson, D. M., & Boden, J. M. (2012). The Links Between Ethnicity, Cultural Identity and Alcohol Use, Abuse
and Dependence in a New Zealand Birth Cohort. Alcohol and Alcoholism, 47(5), 591–596.
44. McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An Ecological Perspective on Health Promotion Programs. Health
Education Quarterly, 15(4), 351–377. https://doi.org/10.1177/109019818801500401
45. McMorris, B. J., Catalano, R. F., Kim, M. J., Toumbourou, J. W., & Hemphill, S. A. (2011). Influence of Family Factors and
Supervised Alcohol Use on Adolescent Alcohol Use and Harms: Similarities Between Youth in Different Alcohol Policy
Contexts*. Journal of Studies on Alcohol and Drugs, 72(3), 418–428.
46. Moore, G. F., Rothwell, H., & Segrott, J. (2010). An exploratory study of the relationship between parental attitudes and
behaviour and young people’s consumption of alcohol. Substance Abuse Treatment, Prevention, and Policy, 5(1), 1.
47. Mustonen, H., Metso, L., Paakkanen, P., Simpura, J., & Kaivonurmi, M. (1999). Finnish drinking habits in 1968, 1976, 1984,
1992 and 1996: Tables and publications based on Finnish Drinking Habit Surveys. Stakes. Retrieved from http://thl32-
kk.lib.helsinki.fi/handle/10024/77511
48. Mustonen, H., & others. (2000). Relationships of drinking behaviour, gender and age with reported negative and positive
experiences related to drinking. Addiction, 95(5), 727–736.
49. Mutalip, M. H. B. A., Kamarudin, R. B., Manickam, M., Hamid, H. A. B. A., & Saari, R. B. (2014). Alcohol consumption and
risky drinking patterns in Malaysia: findings from NHMS 2011. Alcohol and Alcoholism, 49(5), 593–599.
50. Patock-Peckham, J. A., King, K. M., Morgan-Lopez, A. A., Ulloa, E. C., & Filson Moses, J. M. (2011). Gender-Specific
Mediational Links Between Parenting Styles, Parental Monitoring, Impulsiveness, Drinking Control, and Alcohol-Related
Problems*. Journal of Studies on Alcohol and Drugs, 72(2), 247–258.
51. Piko, B. F., Varga, S., & Wills, T. A. (2015). A Study of Motives for Tobacco and Alcohol Use Among High School Students in
Hungary. Journal of Community Health, 40(4), 744–749. https://doi.org/10.1007/s10900-015-9993-4
52. Schulte, M. T., Ramo, D., & Brown, S. A. (2009). Gender Differences in Factors Influencing Alcohol Use and Drinking
Progression Among Adolescents. Clinical Psychology Review, 29(6), 535–547. https://doi.org/10.1016/j.cpr.2009.06.003
53. Simons, L. G., Sutton, T. E., Simons, R. L., Gibbons, F. X., & Murry, V. M. (2016). Mechanisms That Link Parenting Practices
to Adolescents’ Risky Sexual Behavior: A Test of Six Competing Theories. Journal of Youth and Adolescence, 45(2), 255–270.
https://doi.org/10.1007/s10964-015-0409-7
54. Trim, R. S., Leuthe, E., & Chassin, L. (2006). Sibling influence on alcohol use in a young adult, high-risk sample. Journal of
Studies on Alcohol, 67(3), 391–398.
55. Vantamay, S. (2009). Alcohol consumption among university students: applying a social ecological approcah for multi-level
preventions. Southeast Asian Journal on Tropical Medicine Public Health, 40(2). Retrieved from
http://www.tm.mahidol.ac.th/seameo/2009-40-2/20-4496.pdf
56. Velleman, R. D., Templeton, L. J., & Copello, A. G. (2005). The role of the family in preventing and intervening with substance
use and misuse: a comprehensive review of family interventions, with a focus on young people. Drug and Alcohol Review, 24(2),
93–109. https://doi.org/10.1080/09595230500167478
57. Wan Rozita, W. M., Hanjeet Kaur, A. N., & Lim, K.-I. (2005). Factors related to alcohol drinking among the adolescents in
federal territory, Kuala Lumpur. Prevalence, 771, 9–0.
58. Wechsler, H., & Nelson, T. F. (2015). What We Have Learned From the Harvard School of Public Health College Alcohol
Study: Focusing Attention on College Student Alcohol Consumption and the Environmental Conditions That Promote It. Journal
of Studies on Alcohol and Drugs. https://doi.org/10.15288/jsad.2008.69.481
59. Wilsnack, R. W., Vogeltanz, N. D., Wilsnack, S. C., & Harris, T. R. (2000). Gender differences in alcohol consumption and
adverse drinking consequences: cross-cultural patterns. Addiction, 95(2), 251–265.
Proceedings of the Qualitative Research Conference (QRC) 2018
10-12 July 2018, Melaka, Malaysia
19
60. Wood, M. D., Read, J. P., Mitchell, R. E., & Brand, N. H. (2004). Do parents still matter? Parent and peer influences on alcohol
involvement among recent high school graduates. Psychology of Addictive Behaviors, 18(1), 19.
61. World Health Organization (Ed.). (2011). Global status report on alcohol and health. Geneva, Switzerland: World Health
Organization.
62. YEH, M.-Y. (2006). Factors associated with alcohol consumption, problem drinking, and related consequences among high
school students in Taiwan. Psychiatry and Clinical Neurosciences, 60(1), 46–54.
63. York, J. L., Welte, J., & Hirsch, J. (2003). Gender comparison of alcohol exposure on drinking occasions. Journal of Studies on
Alcohol, 64(6), 790–801.
