CHAPTER II

Review of Related Literature and Studies

This section comprises the various related articles and readings as well as related
studies and researches considered to support and strengthen the concepts of the study.

Related Literature

According to (Guo, Lan MDa,c; Deng, Jianxiong MDb; He, Yuan MSa; Deng,
Xueqing MSa; Huang, Jinghui MSb; Huang, Guoliang MSb; Gao, Xue MDa; Zhang,
Wei-Hong PhD, MDc,*; Lu, Ciyong PhD, MDa, 2016). Alcohol misuse among
adolescents is a common issue worldwide and is an emerging problem in China. This
study aimed to investigate the prevalence of alcohol drinking and alcohol-related
problems among Chinese adolescents and to explore their risk factors and connections. A
cross-sectional study using an anonymous questionnaire was conducted among junior and
senior high school students between 2010 and 2012. Data on self-reported alcohol use,
alcohol-related problems, school factors, family factors, and psychosocial factors were
collected. Descriptive analyses were made of the proportions of sociodemographics,
family, school, and psychosocial factors. Multilevel logistic regression models were
conducted to analyze the risk factors for alcohol drinking and alcohol-related problems of
the 105,752 students who ranged in age from 9 to 21 years, the prevalence of current
drinking among students was 7.3%, and 13.2% students reported having alcohol-related
problems. Male students were 1.78 (95% confidence interval [CI] = 1.69–1.87) times
more likely to be involved in current drinking and 1.86 (95% CI = 1.79–1.93) times more
likely to have alcohol-related problems. Higher grade level students were at a higher risk
of current drinking (adjusted odds ratio [AOR] = 1.09, 95% CI = 1.05–1.13) and having
alcohol-related problems (AOR = 1.43, 95% CI = 1.42–1.58). Older students were more
likely to report current drinking (AOR = 1.06, 95% CI = 1.04–1.17) and having alcohol-
related problems (AOR = 1.83, 95% CI = 1.82–1.85). Having poor classmate relations
(AOR = 1.28, 95% CI = 1.03–1.37), having poor relationships with teachers (AOR =
1.08, 95% CI = 1.00–1.16), and below average academic achievement (AOR = 1.50, 95%
CI = 1.41–1.59) were positively associated with current drinking. Moreover, students
with suicidal ideation were at a higher risk of current drinking (AOR = 1.70, 95% CI =
1.61–1.81) and having alcohol-related problems (AOR = 2.08, 95% CI = 1.98–2.16).
Having higher Center for Epidemiology Scale for Depression scores was positively
associated with current drinking (AOR = 1.09, 95% CI = 1.05–1.11) and having alcohol-
related problems (AOR = 1.08, 95% CI = 1.06–1.18). Alcohol drinking and alcohol-
related problems among Chinese adolescents are major public health problems, and
effective preventive programs will require full consideration of the individual, social, and
environmental factors that facilitate and prevent alcohol use. Adolescence is a period
filled with immense behavioral, psychological, and social changes and challenges. This
life stage is characterized by increased imitation and exploration along with a range of
risky behaviors, including substance use. Among adolescents, alcohol consumption is a
common behavior in modern society; however, this behavior has some related negative
traits that can inhibit an individual's growth and maturation. Previous studies have
demonstrated that adolescents might exhibit an idiosyncratic pattern of reactivity to
alcohol that might expose them to higher risk of use and that alcohol use in adolescence
might lead to alcohol abuse/dependence in adulthood. A prior study on substance uses
among adolescents in a southwestern province in China in 2001 estimated that the
prevalence of alcohol drinking was 1.6%, and a study in Finland reported that alcohol-
attributable mortality increased over the period 1998 to 2007. According to the
monitoring the future (MTF) reports in 2011, drinking is one of the leading causes of
morbidity and mortality during adolescence as well as later in life. Moreover, a global
study in 2010 reported that mental and substance use disorders accounted for 183.9
million disability-adjusted life years globally. Social inequalities are one of the most
important determinants of health and health-related behaviors. Previous reports from the
health behavior in school-aged children (HBSC) study in Europe have demonstrated that
social inequalities in age, gender, and socioeconomic status dimensions were related to
alcohol use and alcohol-related problems. Moreover, prior studies also showed that
young people living in low socioeconomic status households were less likely to have
adequate access to health resources and more likely to be exposed to psychosocial
problems. In addition, many studies have found that alcohol drinking and alcohol-related
problems were associated with mental disorders among adolescents. A previous study in
Europe demonstrated that depression was associated with alcohol problems among
European American students. A recent meta-analysis found a significant association
between alcohol use disorder and both suicidal ideation and suicide attempt. Regarding
the role of gender in the relationship between alcohol use and mental disorder, a previous
study in the United States found that the association between alcohol abuse and mental
illness was stronger among females than males. As discussed in a previous study, an
individual's alcohol use and his problems with alcohol begin and develop in a cultural
context, and social values can encourage or discourage young people's alcohol use.
Notably, China is a large country with a traditional alcohol culture, and it is a country that
differs dramatically from Western countries in its approach to social, political, and
economic policies. It is necessary to determine the sheer number of adolescents in China
who use alcohol and whether alcohol-related problems and their correlates occur among
Chinese adolescents in similar ways as they manifest among Western adolescents. With
the rapid economic development, sociocultural changes, and globalization, Chinese
adolescents are becoming more easily exposed to alcohol use and alcohol-related
problems. Therefore, we conducted this large-scale cross-sectional study to investigate
the prevalence of alcohol use and alcohol-related problems among Chinese adolescents
and to explore risk factors and connections to help develop prevention and intervention
programs to reduce adolescent alcohol use in China. All data were entered by 2
investigators independently using EpiData 3.1 (The EpiData Association, Odense,
Denmark, Europe), and statistical analyses were conducted using IBM SPSS 21.0 (IBM,
Armonk, NY) and SAS 9.2 (SAS Institute, Inc., Cary, NC). Descriptive analyses were
used to describe demographic characteristics and the prevalence of current drinking and
alcohol-related problems among the sampled adolescents. Considering that our study
used a multistage sampling, students were grouped into schools, and therefore might not
be independent, we performed 2-level analyses in which schools were treated as clusters
by the PROC GLIMMIX procedure used to compute the generalized linear mixed models
for alcohol drinking and alcohol-related problems among adolescents in SAS. All
covariates that were statistically significant in the univariate analysis and that had been
widely reported in the literature were further analyzed by multivariate analysis. Adjusted
odds ratios (AORs) were obtained with 95% confidence intervals (95% CIs). All
statistical tests were 2-sided in which a P value of less than 0.05 was considered
significant.

This chapter consists of a review of the literature related to alcohol drinking. The
discussion begins with situation of alcohol drinking in Vietnam, impacts of alcohol
drinking in Vietnam, and effects of alcohol consumption. This is followed by a
presentation of the Theory of Triadic Influence (TTI). The related literature on alcohol
drinking delineates some of the factors related to alcohol drinking behavior among
adolescents.

Vietnam is a developing country with a population of over 85 million in 2009.

According to the 2009 Vietnam Population and Housing Census, there was approximate
45% of the population of Vietnam was under 25 years old (Central Population, 2010).
During the previous decades, Vietnam was one of the poorest countries in Asia.
However, since 1986, Vietnam has undergone multiple economic and reforms with the
establishment of a more liberalized market system. Since that time, the increasing
development and industrialization in Vietnam, the socio-economy had subsequently
increased. Therefore, a shift of traditional lifestyle to a more westernized one is taking
place (HSPI, 2006). These changes have resulted in a reduction in the poverty rate from
60% to 20% over the past 15 years (World Bank, 2007). The economy and society in
Vietnam are changing rapidly because international joint ventures lead to the decreasing
of social, economic, and political isolation. Alcohol overuse results in serious
consequences for the community health and society in Vietnam. It was shown that
approximately 4.4% of the Vietnamese suffered from diseases and injuries related to
alcohol (MOH, 2006). At the Hospital of Mental Health, Vietnam, the proportion of
psychiatric treatment accounted for 5-6% alcoholic psychiatric patients. This percentage
had increased in five years, from 4.4% in 2001 to 7.03% in 2005. Alcohol poisoning has
also actually become a risk affecting the lives and health in Vietnamese drinkers. The
case fatality rate from alcohol poisoning in Vietnam was approximately 21.4%. There
were 9 drinkers in the North and 15 drinkers in the South of Vietnam who died due to
alcohol poisoning from 2000 to 2008. In Ho Chi Minh City, there were 10 drinkers died
between September 29 and October 20, 2008, from the poisoning of alcohol (Vietnam
Food Administration, 2009). In addition, the prevalence of the road traffic deaths
involving alcohol was 34% in Vietnam (WHO, 2011 b). Alcohol consumption among
adolescents and youths in some places such as karaoke & hugs, beer & hugs is the
immediate access to commercial sex workers and unsafe sexual behavior. Therefore, the
consumption of alcohol has been correlated with a higher prevalence for sexually
transmitted diseases including HIV/ AIDS as well as unwanted pregnancy in adolescents
and youths in Vietnam (Kaljee et al., 2005; Tho et al., 2007). Viet Nam has one of the
world’s highest abortion rates with an estimated rate of 83.3 per 1,000 women receiving
abortions including 300,000 abortions performed annually for women below 19 years
old. However, many abortions are performed in private clinics and are not reported to the
local government health department (Alan Guttmacher Institute, 1999). Moreover, the
harmful use of alcohol also results in theft, criminal damage, robbery, or selling illegal
drugs by Vietnamese adolescents (MOH, 2009). The prevalence of juvenile crime is
increasing in recent years. According to Ministry of Security Vietnam, there were 15,589
juvenile crimes in Vietnam by the year 2007 (Nguyen, 2008).

Related Studies

Alcoholism is, broadly, any drinking of alcohol that results in significant mental
or physical health problems. (Littrell J, 2014). Environment and genetics are two factors
in the risk of development of alcoholism, with about half the risk attributed to each.
(Washington, DC: American Psychiatric Association, 2013). Stress and associated
disorders, including anxiety, are key factors in the development of alcoholism as alcohol
consumption can temporarily reduce dysphoria. (Moonat S, Pandey SC, 2012).
 Prevention of alcoholism may be attempted by reducing the experience of stress
and anxiety in individuals. (Washington, DC: American Psychiatric Association, 2013 &
Moonat S, Pandey SC, 2012).

The World Health Organization has estimated that as of 2016, there were 380
million people with alcoholism worldwide (5.1% of the population over 15 years of age).
(World Health Organization,2018). As of 2015 in the United States, about 17 million
(7%) of adults and 0.7 million (2.8%) of those age 12 to 17 years of age are affected.
Alcoholism is most common among males and young adults. Geographically, it is least
common in Africa (1.1% of the population) and has the highest rates in Eastern Europe
(11%), (Washington, DC: American Psychiatric Association, 2013).

According to (Iranpour and Nakhaee, 2019) In the early decades of the 20th
century, discussions regarding alcohol were dominantly directed toward its therapeutic
uses, but authorities now state that any level of alcohol consumption poses negative
effects on health. Over recent months, increased attention has been devoted to disease
burdens attributable to alcohol use worldwide. As more and more studies are conducted
to illuminate the harmful effects of alcohol on different body systems, the mounting
evidence generated requires documentation and publication. The current review was
aimed at providing an overview of the recent literature on the adverse consequences of
alcohol consumption.

Alcohol is widely believed to be the only psychoactive substance with addictive

potential “that is not controlled at the international level by legally binding regulatory
frameworks” despite its profound implications for populations and public health. (World
Health Organization. Global status report on alcohol and health 2018). The adverse
effects of alcohol on health has been the subject of a rising number of studies in recent
years, (Rehm J., 2011) with such research asserting that even modest alcohol use
contributes to over 60 acute and chronic health conditions. (Global Burden of Disease
Study., 2016 & Lancet., 2018). Studies have also shown that alcohol consumption is
associated with more than 200 diseases, although its pathogenicity and lethality through
chronic illnesses depend on the amount and quality of alcohol consumed and the patterns
that underlie its intake. (Shield KD, Parry C, Rehm J., 2018).

Some scholars suggested that drinking small amounts of alcohol helps prevent
conditions such as diabetes, ischemic heart disease (IHD), dementia, and cognitive
decline, but none of the seminal review studies reported a “safest level” of alcohol
consumption. (Griswold MG, Fullman N, Hawley C, Arian N, Zimsen SRM, Tymeson
HD, 2018). Another major concern about alcohol intake is that its health implications
that occur through the mechanisms of other diseases, especially cancers, are likely to be
underreported. (Burton R, Sheron N., 2018). Such consumption, for instance, is
associated with 18% of suicides, 18% of interpersonal conflicts and violence, 27% of
road accidents, 13% of epilepsy cases, 48% of liver cirrhosis cases, 26% of oral cancer
cases, 20% of tuberculosis (TB) cases, 11% of colon cancer cases, 5% of breast cancer
cases, and 7% of hypertension (HTN) and heart disease cases worldwide, as indicated by
the World Health Organization (WHO). (WHO, 2018).

The latest WHO report showed that in 2016, about 43% of the population over the
age of 15 years (2.3 billion people) had consumed alcohol in the preceding 12 months.1
The report also indicated that the lowest and highest alcohol consumption rates (2.9% and
59.9%, respectively) were found among the populations belonging to the areas where the
Regional Office for the Eastern Mediterranean (EMRO) and the Regional Office for
Europe have jurisdiction, respectively. The total alcohol per capita consumption (APC) in
2016 was 6.4 liters, which does not reflect any change from the levels recorded in 2010.
However, a decline and an increase in this level were observed in the European region
and the Western Pacific and Southeast Asia, respectively. Nevertheless, the percentage of
“current drinkers” all over the world in 2016 was generally 4.6% lower than that in 2000,
mostly because of an increase in prevalence of former drinkers and much less due to
increases in the proportion of people with no alcohol use in their lifetime. (World Health
Organization. Global status report on alcohol and health, 2018). Interestingly, 25.5% of
the alcohol consumed globally is ingested illicitly or without proper supervision. The
alcohol consumed in this manner includes homemade alcoholic drinks, medical and
industrial alcohols that are misused as drinks, and other alcoholic beverages that are
produced and sold illegally. This type of alcohol consumption occurs in EMRO countries
and in the Region of the Americas (AMR) at rates of 70.2% and 1.1% out of the total,
which are respectively the highest and lowest rates worldwide.1 In 2016, the world’s
average rate of heavy episodic drinking (HED) (defined as drinking 60 g or more of pure
alcohol on at least a single occasion at least once per month) was 18.2%, and the highest
and lowest rates were observed in European and EMRO countries with 26.4% and 0.5%
of total consumption, respectively. HED is associated with alcohol poisoning and
increased respiratory rate, heart rate, body temperature, and the gag reflex, which may
lead to a coma and death. (WHO, 2018) till in 2016, alcohol use was the most important
risk factor for death in the age group of 15 to 49 years and the seventh leading risk factor
for all deaths and disability-adjusted life years (DALYs). In the age group, 5.3% of all
deaths in the world (2.8 million deaths), 12.2% of all deaths among men, and 3.8% of all
deaths among women, are related to alcohol consumption. (Griswold MG, Fullman N,
Hawley C, Arian N, Zimsen SRM, Tymeson HD, 2018). These statistics render alcohol
deadlier than afflictions such as diabetes, TB, and acquired immune deficiency syndrome
(AIDS). (WHO, 2018).

Although populations belonging to the lower socioeconomic class consume

alcohol to a smaller extent than the individuals of high economic standing, they exhibit
higher morbidity and mortality rates because of the adverse effects stemming from their
combination of alcohol consumption with other hazardous behaviors and conditions, such
as smoking, poor diet, and obesity; lower socioeconomic groups also have a greater
occurrence of HED. (Rosenberg G, Bauld L, Hooper L, Buykx P, Holmes J, Vohra J.,
2017).

To identify what the most harmful drug is in the world, British researchers
recently conducted multi-criteria decision analysis to rank medications in this respect.
(Nutt DJ, King LA, Phillips LD., 2010). They found that in the United Kingdom (UK),
the reputation of being the most dangerous substance in terms of overall harm to users
and others belonged to alcohol. In another study on substance abuse, a scale called
margin of exposure (MOE) [the ratio of the no observed adverse effect level (NOAEL) of
a substance to the normal dose of exposure] was used to rank control measures for
substance abuse and health risk assessment. The researchers revealed that, on a
population scale, alcohol was the only substance falling within the high-risk category. In
what follows, the latest developments in research on alcohol-related harms are discussed.
(Lachenmeier DW, Rehm J., 2015).

Since 1995, many studies have shown that consuming any amount of alcohol can
increase the risk of cancer. These works, however, did not specify a threshold for the
emergence of carcinogenetic effects from alcohol and suggested that the best way to
avoid carcinogenicity was to abstain from alcohol consumption. (Rehm J, Soerjomataram
I, Ferreira-Borges C, Shield KD., 2019). Alcohol-induced liver diseases (ALDs) are
currently the most common type of liver-related disorders in Europe. Patients suffering
from ALD experience increased life expectancy when they abstain from alcohol use, as
liver cirrhosis is directly related to alcohol consumption, even in modest amounts.
(Simpson RF, Hermon C, Liu B, Green J, Reeves GK, Beral V, et al., 2019). Research
showed that moderate to high amounts of alcohol not only directly increases the risk of
elevated albuminuria and the incidence of chronic kidney disease (CKD), but also causes
kidney damage indirectly by increasing blood pressure. (Pan CS, Ju TR, Lee CC, Chen
YP, Hsu CY, Hung DZ, et al., 2018). Statistics showed that countries with high alcohol
usage among their populations also exhibit high suicide rates. A positive correlation was
discovered between alcohol consumption and psychological disorders that adversely
affect mental health, causing depression, cognitive impairment, dysphoria (disinhibition),
irritability, and impaired judgment. (Pompili M, Serafini G, Innamorati M, Dominici G,
Ferracuti S, Kotzalidis GD, et al., 2010). Across the world, alcohol is a crucial risk factor
for intentionally inflicted and unintentionally acquired injuries. Previous studies focused
on the role of alcohol in interpersonal street violence (often among men), but recent
research has also investigated its implication in domestic violence, including sexual
violence. According to a 2016 WHO report, interpersonal violence induced by alcohol
consumption causes 90000 deaths every year. Intake of alcohol is known to reduce
inhibition and stimulate aggressive behaviors in men. (WHO, 2018).

A significant proportion of individuals afflicted with alcohol use disorders

(AUDs) are between the ages of 18 and 29, which is the age group to which most college
students belong. Studies revealed that alcohol consumption damages mental health,
unfavorably influences mental performance, and drives increased engagement in high-
risk behaviors. Alcohol consumption also causes students to progressively engage in
absenteeism, fall behind on schoolwork, perform poorly on exams, and overall, exhibit
declined academic performance. (El Ansari, Stock C, Mills C., 2013 & Patte KA, Qian
W, Leatherdale ST., 2017).

The findings of the latest scientific studies increasingly highlight the profound
and extensive implications of alcohol-related harms for individuals and larger
populations, casting doubt on previous hypotheses regarding alcohol potentially having
favorable effects on certain conditions and explicitly indicating that no level of alcohol
intake is safe. (Rosenberg G, Bauld L, Hooper L, Buykx P, Holmes J, Vohra J., 2017).

Synthesis

Alcohol abuse has devastated many lives and significantly harmed many patients
and families. The devastating consequences of inappropriate or excessive alcohol
consumption are widely known. These related literature and studies that we conduct are
basically important for the people to know how valuable it is to give awareness and
solution about alcohol addiction. Why is it important to give awareness about alcohol
addiction? We could have save many lives just by spreading awareness and also we could
have help innocent teenagers to prevent alcoholism.