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Alcohol Drinking Behavior Among High School Students In Low-Income

Urban Community Baguio City, Benguet Province, Philippines

Article · September 2008

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 Alcohol Drinking Behavior Among High School
Students In Low-Income Urban Community
Baguio City, Benguet Province, Philippines

Erwin Tano Furiscal *

Nonglak Pancharuniti **
Boonyong Keiwkarnka ***

Abstract
According to the World Health Organization, the burden of disease from alcohol
exceeds tobacco because harmful consequences lead to death and disability in the younger
years of life. There is widespread of alcohol consumption among 2 billion people worldwide
with 76.3 million diagnosed with alcohol abuse (World Health Organization, 2005).
A cross-sectional survey was conducted to assess the alcohol drinking behavior of
adolescents and its related factors among 280 3rd year and 4th year high school students in
one purposively selected high school in Baguio, Philippines during January, 2008. A high
proportion of respondents in this study (74.3%) were 15-16 years old. The data were
analyzed by using MINITAB. Chi-Square test was used for testing association between the
dependent variable and independent variables and criteria for statistical significance was set at
α = 0.05.
There were 30.8% of students as drinkers; 47.1% of drinkers were males and 18.2%
were females. There was a statistically significant association between alcohol drinking
behavior and being male (Chi-Square = 26.9; p-value = <0.001). 62.9% of the student
drinkers consumed > 1 bottle of alcohol per day. Attitude towards favorable to drinking, being
able to afford liquor and parental influence were also positively statistically significantly
associated with alcohol drinking behavior (Chi-Square = 9.82; p-value = 0.01), (Chi-Square
= 28.34; p-value = <0.001) and (Chi-Square = 30.62; p-value = <0.001) respectively.
It was concluded that family influence, attitude towards drinking and affordability of liquor
were the contributing factors to students' drinking behavior. It was recommended that
families, school and city officials should actively be involved in initiating activities against
alcohol drinking among adolescents.

Keywords
Alcohol drinking behavior Adolescent High School Students

* R.N., M.P.H.M., ASEAN Institute for Health Development, Mahidol University, Thailand
** D.D.S., M.P.H., Dr. P.H., ASEAN Institute for Health Development, Mahidol University, Thailand
*** Dr. P.H., ASEAN Institute for Health Development, Mahidol University, Thailand

⌫⌫ ⌫
 พฤติกรรมการดืม่ เครือ่ งดืม่ แอลกอฮอลล์ในกลุม่ นักเรียนมัธยมศึกษา
ทีอ่ าศัยในชุมชนรายได้นอ้ ย ในเมืองบาเกียว ประเทศฟิลปิ ปินส์
เออร์วนิ ทาโน ฟูรสิ คาล
นงลักษณ์ พันธจารุนธิ
บุญยง เกีย่ วการค้า

บทคัดย่อ
องค์การอนามัยโลกระบุว่า การดื่มสุราในกลุ่มผู้มีอายุน้อยสร้างความเสียหายและมีผลกระทบ
ร้ายแรงจนถึงแก่ชีวิต โดยพบว่าจำนวนผู้ดื่มเครื่องดื่มแอลกอฮอล์ทั่วโลกมีประมาณ 2 พันล้านคน
โดย 76.3 ล้านคนทีเ่ ป็นผูม้ พี ฤติกรรมการบริโภค(ดืม่ )เกินปกติ
ในการศึกษาแบบภาคตัดขวางถึงพฤติกรรมการดื่มเครื่องดื่มแอลกอฮอลล์และปัจจัยที่เกี่ยวข้อง
ในกลุม่ เด็กวัยรุน่ ระดับมัธยมศึกษาตอนปลายอายุ 15-16 ปีทส่ี ำรวจเมือ่ เดือน มกราคม 2551 จำนวน
280 คน ทีบ่ าเกียว ฟิลปิ ปินส์ มีผใู้ ห้ความร่วมมือในการศึกษาเป็นจำนวน 74.3% โดยการวิเคราะห์
ข้อมูลด้วยโปรแกรม MINI TAB สถิติที่ใช้คือ Chi-Square เพื่อหาความสัมพันธ์ระหว่างตัวแปร
โดยกำหนดนัยสำคัญทางสถิตทิ ่ี ค่า α = 0.05
จากการศึกษา พบว่า 30.8% ของนักเรียนมีพฤติกรรมการดื่มเครื่องดื่มแอลกอฮอล์ 47.1%
ของผูด้ ม่ื เป็นชาย และ 18.2% เป็นหญิง การเป็นชายมีแนวโน้มจะทำให้เป็นผูด้ ม่ื เครือ่ งดืม่ แอลกอฮอล์
(Chi-Square = 26.9; p-value = <0.001) โดย 62.9% ดืม่ มากกว่า 1 ขวด/วัน การมีทศั นคติยอมรับ
การดื่ม และความสามารถในการซื้อหาเครื่องดื่มและอิทธิพลจากพ่อแม่ที่ดื่มเครื่องดื่มแอลกอฮอล์
มีผลต่อการก่อให้เกิดพฤติกรรมการดื่มในกลุ่มศึกษา (Chi-Square = 9.82; p-value = 0.01),
(Chi-Square = 28.34; p-value = <0.001) และ (Chi-Square = 30.62; p-value = <0.001) ตามลำดับ
ดังนัน้ อิทธิพลจากครอบครัว ทัศนคติตอ่ การยอมรับการดืม่ ความสามารถซือ้ หาเครือ่ งดืม่ ได้ มีผล
โดยรวมต่อพฤติกรรมการดื่มเครื่องดื่มแอลกอฮอล์ในเด็กวัยรุ่นกลุ่มดังกล่าวนี้ จึงควรเสนอให้มีการ
ร่วมมือกันระหว่างครอบครัว โรงเรียน และการกำหนดกฎระเบียบของสังคม ในการยับยั้งการดื่ม
เครื่องดื่มแอลกอฮอล์ในกลุ่มวัยรุ่นดังกล่าวอย่างเข้มแข็งต่อไป

คำสำคัญ
พฤติกรรมการดืม่ เครือ่ งดืม่ แอลกอฮอลล์ วัยรุน่ นักเรียนมัธยมศึกษา

☺
Introduction
Adolescence is period in which many
young people begin to experiment with
smoking or drinking. The minimum legal
drinking age as provided by law is 21, how-
ever many young people under 21 years old
consume alcohol. Some abuse alcohol by
drinking frequently or by binge drinking
often defined as having five or more drinks in
a row (National Institute on Alcohol Abuse
and Alcoholism, 1997).
While drinking may be a singular pro-
blem behavior for some, research suggested
that for others it may be an expression of
general adolescent turmoil that includes other
problem behaviors and that these behaviors
are linked to unconventionality, impulsiveness,
and sensation seeking (Jessor, et al., 1977 -
Leigh, et al., 1993).
In Baguio City and in the Philippines, there
were limited data available on the issue of
alcohol drinking among adolescents. More
effort was still needed in order to address
the problem of alcohol drinking among
adolescents that was why this study was un-
dertaken.
Theoretical Framework
The Precede model was the basis of
the researcher's conceptual framework
because this theoretical model was based on
a theoretical foundation that addresses
comprehensive assessment and program
planning. The Precede model framework
used the components of predisposing, rein-
forcing, and enabling factors which was
suitable for use in describing and analyzing
the independent variables in this study. The
Epidemiological model was also adapted in
this study. This model's approach to health
problems was based on asking questions such
as what, when, where, why and how which
described the health problem in terms of
⌫⌫ ⌫
time, place and person. The researcher
deemed it appropriate to use some of the
salient attributes of this model in describing
and analyzing the dependent variable.
Methodology
Study design:
This was a cross-sectional descriptive
research study in which the data were col-
lected by self-administered questionnaire
from January 10 to February 8, 2008.
Study population :
The study population were adolescent
high school students living in low-income ur-
ban communities in Baguio City, Philippines.
The biggest public high school in Baguio was
purposively selected for this study, the Baguio
City National High School. The sample size
in this research study was 280 male and fe-
male high school students who were in the
3rd year and 4th year levels respectively.
Instrument:
Data was collected by self-adminis-
tered questionnaire as follows:
- Predisposing factors: Knowledge on
alcohol drinking was measured by 9 closed-
ended questions with one correct answer that
corresponded to 1 point. Total score for
knowledge were classified by using the
Benjamin Bloom scale; Attitude towards
alcohol drinking behavior was measured by
10 questions scored classified by using Likert
scale. There were 10 statements on attitude
towards alcohol drinking, which were scored
from 1 to 5 depending on the degree of agree-
ment or disagreement to the statement.
- Enabling factors referred to accessi-
bility of students to obtain liquor products
and affordability of the price to buy liquor
products. Accessibility and affordability were
categorized by multiple choices and then
recorded as dichotomous variables.
- Reinforcing factors referred to peer
influence, parental influence and neighbors'
influence on the students' drinking or non-
drinking. These were also categorized by
multiple choices and then recorded as
dichotomous variables.
dependent variable and independent
variables. For the pre-test, reliability of the
questionnaire was tested by using KR-20 and
Cronbach's alpha coefficient for knowledge
and attitude respectively. KR-20 was 0.60
for knowledge and Cronbach's alpha
coefficient was 0.68 for attitude.

Data collection: Results

The data was collected by using self-
administered questionnaire survey forms with
66 open-ended and closed questions. Two
year level coordinators (one 3rd year level
coordinator and one 4th year level coordina-
tor) were briefed by the researcher about the
purpose of the study and assisted the re-
searcher in the distribution and retrieval of
questionnaire survey forms.
Data analysis:
Data analysis was performed by using
MINITAB and the results were presented by
using frequency, percentage, minimum, maxi-
mum, median, mean, SD, and Chi-Square
test to find the association between the
General characteristics of students
As shown in table 1, a high proportion of
respondents in this study at 74.3% belonged
to the 15-16 years old age group. 56.8%
were females and 43.2% were males.
50.7% were in the 4th year high school level
while 49.3% were in the 3rd year high school
level as shown in table 1. Among students
who were < below 15 years old, 75.68%
were non-drinkers while only 24.32% were
drinkers. Students who were 15-16 years
old, 72.12 were non-drinkers while 27.88%
were drinkers. For students who were > 16
years old, 45.71% were non-drinkers and
54.29% were drinkers.

Table 1 General characteristic of students

Factors Drinker Non-drinker Total

n % n %

Age
< 15 years old 9 24.32 28 75.68 37
15-16 years old 58 27.88 150 72.12 208
> 16 years old 19 54.29 16 45.71 35
Gender
Male 57 47.11 64 52.89 121
Female 29 18.24 130 81.76 159

☺
 Level of knowledge on alcohol drinking
The level of knowledge on alcohol
drinking as shown in table 2 indicated that
almost 80% of students had good level of
knowledge, 20.4% had moderate knowledge
and 1.8% had poor knowledge. The mean
score of correct answers was 8.2 with a stan-
dard deviation of 1.2. Nine questions were
asked to evaluate the students' level of knowl-
edge about alcohol drinking. The range of
knowledge scores was from 0-9 and the
cut-off point for classification was based on
Benjamin Bloom scale. Students who got ?
80% of total score were classified as having
good knowledge, while those who got 60%
- 80% of the total score were classified as
moderate and those who got ? 60% of
total score were classified as having poor
knowledge level.

Table 2 Level of knowledge on alcohol drinking behavior among students

Level of knowledge Frequency Percentage

(based on 9 knowledge questions)

Good knowledge (> 80% of total score); 218 77.9

8-9 scores
Moderate knowledge score (60% - 80% of total score); 57 20.4
5-7 scores
Poor knowledge score (<60% of total score); 5 1.8
0-4 scores

Mean = 8.2; Median = 9.0; Mode = 8.3; S.D. = 1.2 Max = 9; Min = 0

Level of attitude towards alcohol drinking behavior

The level of attitude towards alcohol
drinking as shown in table 3 indicated that
only 27.9% of students
had good level of attitude towards alcohol
drinking while 46% had moderate level of
attitude towards alcohol drinking and
26.1% of students in this study had poor level
of attitude towards alcohol drinking. The
mean score of correct answers was 27.4 with
a standard deviation of 4.8. Ten statements
where given to evaluate the student's level
of attitude towards alcohol drinking. The
range of attitude scores was from 10-45 and
the cut-off point for classification was based
on Likert scale. Students who got > 80%
of total score were classified as having good
attitude, while those who got 60% - 80% of
the total score were classified as moderate
and those who got < 60% of total score were
classified as having poor level of knowledge.

⌫⌫ ⌫
Table 3 Level of attitude towards alcohol drinking behavior among students

Level of Attitude Frequency Percentage

(based on 10 attitude statements)

Good attitude score (>80 of total score), 78 27.9

37-45 scores
Moderate attitude score (60% - 80% of total score); 129 46.0
27-36 scores
Poor attitude score (< 60% of total score); 73 26.1
10-26 scores

Mean = 27.4; Median = 27; Mode= 27.3; SD = 4.8; Min. = 10; Max. = 45

Alcohol drinking behavior and its pat- tern

The alcohol drinking pattern of students tity of drink per day, 62.9% among student
as shown in table 4 indicated that 54.6% of drinkers admitted to consume > 1 bottle of
students in this study were non-drinkers while alcohol per day while 62.5% of students in
30.8% of students were drinkers. For quan- the study were non-drinkers.

Table 4 Alcohol drinking behavior and its pattern

Frequency Percentage

Drinking status
Yes, I drink 86 30.8
Yes, but I quit now 40 14.3
No, I don't drink 153 54.6
* (missing) 1 0.36
Quantity of drink per day
1 bottle 39 37.1
>1 bottle 66 62.9
* (missing, don't drink or quit) 175 62.5
Frequency of drinking per week
Once a week 65 58.6
> once a week 46 41.4
* (missing, don't drink, etc.) 169 60.4
Age of initiation to alcohol drinking
<15 years old 80 62.99
>15 years old 47 37.01
* (missing, don't drink, etc.) 153 54.64

☺
Table 4 Alcohol drinking behavior and its pattern (cont.)
Reason for continuing to drink alcohol
Friends make me drink
I see my parents drink
Make me feel matured enough
Relieves stress
It's my addicted habit now
Others (for good times, forget problems etc.)
* (missing, don't drink, etc.)
Associations between alcohol drinking behavior and independent variables
The significant associations between
alcohol drinking behavior and the indepen-
dent variables as shown in table 5 indicated
that in the socio-demographic factors, greater
age and male gender had statistically signifi-
cant associations with alcohol drinking (x2 =
10.631; p-value = 0.01) and (x2 = 26.908;
p-value = <0.0001) respectively. In the pre-
disposing factors, one variable associated
with alcohol drinking behavior was attitude
(x2 = 9.820; p-value = 0.01).
In the enabling factors, affordability
of liquor products also had statistically
significant association with alcohol drinking
behavior (x2 = 28.335; p-value = <0.0001).
With regard to reinforcing factors, parental
influence and sibling influence had statistically
significant associations with alcohol drinking
⌫⌫ ⌫
Frequency Percentage
33 26.40
2 1.60
11 8.80
34 27.20
8 6.40
37 29.60
155 55.36
behavior (x2 = 30.620; p-value = <0.0001)
and (with x2 = 19.037; p-value = <0.0001)
respectively. In alcohol drinking pattern three
variables associated with alcohol drinking
behavior were quantity of drink, frequency of
drinking and age of initiation (x2 = 80.743;
p-value = <0.0001), (x2 = 149.535; p-value
= <0.0001) and (x2 = 143.5; p-value =
<0.0001) respectively.
These statistically significant associations
reflected that the alcohol drinking behavior of
students could be attributed to family influ-
ence (parental and sibling influence), attitude
towards alcohol drinking and affordability of
liquor products. These factors indicated the
impact of family influence, level of attitude
towards alcohol drinking and the affordability
of liquor products.
Table 5 Associations of independent variables and dependent variable
Independent Variables
Socio-demographic factors
Age
Gender
Predisposing factors
Attitude
Enabling factors
Affordability of liquor products
Reinforcing factors
Parental influence
Sibling influence
Alcohol drinking pattern
Quantity of drink
Frequency of drinking
Age of initiation to alcohol drinking
Discussion
1.Alcohol drinking status of students
The prevalence of alcohol drinking among
high school students as revealed in this study
was 30.82% (i.e. those who are actively
engaged in drinking alcohol) with the other
14.34% of students who used to drink but
have stopped. This figure was less than
9.00% lower compared to the lifetime
prevalence rate at 39.00 % but even much
lower compared to the 75.40% current
prevalence rate of alcohol drinking among
Filipino youths which was done in 2001.
2. Age of initiation toal cohol drink-
ing
The average age range of initiation to
alcohol drinking among high school students
in this study is < 15-16 years old. The
youngest age of initiation to alcohol drinking
is at 8 years old while the oldest age is at 16.
In a similar previous study conducted by
Grant Union High School in Oregon, U.S.A.
☺
X2 p-value
10.6 0.005
26.9 <0.001
9.8 0.01
28.3 <0.001
30.6 <0.0001
19 <0.0001
80.7 <0.0001
149.5 <0.0001
143.5 <0.0001
in 2004, findings revealed that alcohol use is
common among students at the 12th grade
level, with many of them being initially ex-
posed to alcohol at an alarmingly young age,
although it was not mentioned exactly how
young was the age of initiation to alcohol
drinking in that particular study.
3. Reason/s why students continue
to engage in alcohol drinking
Among those students who were actively
engaged in alcohol drinking, 12.14% said that
drinking alcohol was a way to relieve stress
either at school and/or at home, while 11.79%
revealed that they engage in alcohol drinking
because their friends make them or encour-
age them to drink. On the other hand, about
3.93% of those who were actively engaged
in drinking said that drinking alcohol makes
them feel that they were matured enough to
engage in such activity while a mere 2.86%
revealed that alcohol drinking has now
become their addicted habit.
In previous references, it was mentioned
that while drinking may be a singular prob-
lem behavior for some, research suggests that
for others it may be an expression of general
adolescent turmoil that included other prob-
lem behaviors and that these behaviors were
linked to unconventionality, impulsiveness, and
sensation seeking.
Conclusion and Recommendation
A. Conclusion
The prevalence of alcohol drinking was
30.82% in this population and the average
age range of initiation to alcohol drinking
among high school students in this study is <
15-16 years old. Two main reasons why stu-
dents drank alcohol drinking were to relieve
stress and due to peer influence. The three
biggest contributing factors for alcohol drink-
ing behavior were family influence, intention
to drink and the affordability of alcoholic
products. It can be concluded that among
the three contributing factors, it is the family
which plays a key role in establishing and
modifying the student's behavior pattern
towards alcohol drinking. Peer influence or
peer pressure in this study can be viewed as
a barrier to change in the health behavior of
students.
⌫⌫ ⌫
B. Recommendations
- A healthy lifestyle program should
be developed both within the family circle if
possible and should also be integrated in the
school's curriculum;
- The school management should seri-
ously consider the current school policy, rules
and regulations about alcohol drinking;
- School authorities should involve their
students in anti-alcohol drinking campaign and
should sponsor healthy lifestyle programs;
- The City Health Office should build
networks among high school institutions in the
city to collaborate in formulating health
education policies and programs on the
effects of alcohol drinking;
- An in-depth study on how the print and
broadcast media make an impact on the
alcohol drinking behavior of adolescents
should be considered by succeeding
M.P.H.M. batches.
Acknowledgements
The author would like to thank
Dr.Jeffrey Roseman, M.D., M.P.H., Ph.D,
Prof. Emeritus, Epidemiologist, University
of Alabama at Birmingham, USA., and
Dr. Teera Ramasoota, M.D., M.P.H., Dip.
in Dermal Pathology, Thailand, for their
comments to this article.
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