Alcohol use among adolescents and young adults in Albania

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Suggested citation: Babameto A, Kraja B, Prifti S, Resuli B. Alcohol use among adolescents and young adults in Albania. Alban Med J 2016;3:21-6.

Alcohol use among adolescents and young adults in Albania

Adriana Babameto1, Bledar Kraja1, Skerdi Prifti1, Bashkim Resuli1

1 Service of Gastro-Hepatology, University Hospital Center “Mother Teresa”, Tirana, Albania.

Corresponding author: Prof. Asoc. Adriana Babameto 
Address: Dibra Street, No. 370, Tirana, Albania
Telephone: +355 692183269; E-mail: ababameto2000@yahoo.com

Abstract

Aim: Alcohol use during adolescence and young adulthood remains a prominent worldwide public health problem. The aim of this study was to provide an overview of the frequency and volume of alcohol consumption, drinking habits and beverage preferences among adolescents and young adults in Albania.
Methods: During the period 2007-2008, 583 adolescents (31 boys and 252 girls) and 755 young adults (402 boys and 353 girls) from different regions of Albania completed a standardized self-administered questionnaire concerning the overall frequency of drinking on a weekly basis during the last 12 months, the number of drinks per drinking day, drinking habits and beverage preferences. 
Results: The prevalence of alcohol consumption increased with age, from adolescents (63%) to young adults (77%). Daily drinking was also more common in young adults (11%) compared with adolescents (5%), p<0.001. Also, girls seem less likely than boys to drink frequently. The proportion of moderate drinkers, heavy drinkers and binge drinkers was higher in young adults than adolescents, respectively 28%, 9%, 34% and 20%, 4%, 28%. The most common type of alcohol beverage preferred by adolescents and young adults was beer, followed by spirits. 
Conclusion: Alcohol drinking among adolescents and young adults in Albania is widespread and worrisome. These findings should raise the awareness of health professionals and policymakers in Albania and other transitional countries.

Keywords: adolescents, alcohol consumption, drinking patterns, heavy drinkers, young adults.

Introduction
Alcohol consumption is a worldwide problem and a major risk factor for alcohol-related diseases, with a high morbidity and mortality (1,2). Epidemiological findings on adolescents and young adults alcohol use indicate not only the high rates of alcohol consumption among those age groups, but also the fact that many adolescents and young adults engage in drinking practice (e.g. binge drinking, daily drinking) associated with a considerable number of fatalities on roads or suicide, a broad social impact, such as violence, hooliganism, crime, sexual assaults, with a range of other risky behaviours including tobacco or illicit drugs and with disruption in significant contents (e.g. school, family, work) (3). On the other hand, studies conducted in various countries have demonstrated that both frequency of drinking alcoholic beverages and the amount of alcohol consumed per person or per occasion vary greatly among different countries and cultures, among different population groups within given country, and for each population over time. These differences are found not only for adult drinkers but also for adolescents and young adults (4). 
Alcohol has been consumed in Albania for centuries. Because of political and social restrictions after the Second World War, its use before 1990 has been limited for occasional and festive events. The number of regular and heavy drinkers was restricted almost entirely to the elderly and adults. Moreover, the use of alcohol by women has been nearly inexistent. Rapid political, economic, social and cultural transformation after 1990 has deeply changed habits of alcohol use and alcohol-related phenomena. This paper reports the results of an anonymous self-administered survey, undertaken among adolescents and young adults from different regions of Albania.
More specifically, the objective of this study is to provide factual information about of the overall frequency of alcohol consumption, volume of alcohol intake, drinking habits and beverages preferences among adolescents and young adults in Albania.

Methods

Study population 
The study population comprised a random sample of 583 adolescents (331 boys and 252 girls) and 755 young adults (402 boys and 353 girls) from different districts of Albania. The study was conducted during the period 2007-2008.

Examination procedure 
The participants filled in a standardized self-administered questionnaire concerning drinking habits. The survey questions addressed to the overall frequency of drinking on a weekly basis during the last 12 months, volume of pure alcohol consumption (i.e. the usual number of drinks per drinking day), on drinking habits and beverage preferences.

Alcohol intake 
In order to calculate the amount of alcohol in grams for each “drink”, participants were informed about the “drink size” and alcohol content of the drinks they had consumed. A standard “drink size” was defined as a volume of various alcohol beverages that contains approximately 12-13 gram of pure alcohol, i.e. 10 ounces of light beer (a bottle of beer = 340 ml), 4 ounces of regular wine (a glass of wine = 142 ml) and 1.5 ounces of strong drink (a shoot of raki = 43 ml).
Individuals were classified according to the prevalence of drinking behaviour, such as rates of abstinence or current drinking (once a week, 3-4 times a week or every day) and according to the volume of alcohol consumption, i.e. the number of drinks consumed in a single day (grams/ethanol per day). As abstainers were defined people who had never consumed more than 12 alcoholic drinks in one year, light drinkers those who consumed 1-13 alcoholic drinks per month, moderate drinkers persons who consumed 4-14 alcoholic drinks per week and heavy or harmful drinkers respondents who consumed five or more alcoholic drinks per day for men and four or more alcoholic drinks per day for women. Binge drinking was considered having five or more alcoholic drinks in one occasion during the past 30 days. 
Finally, participants were asked to indicate the drinking habits and the number of servings of beer, wine, spirits or mixed drinks they consumed on a drinking day. Those who obtained less than 50% of their alcohol consumption from one type of beverage were classified as having no specific preferences.

Results 
Table 1 shows the frequency of total alcohol consumption by two groups. The lowest proportion of abstainers was found in young adults (22.8% of responders). Nearly half of adolescents (47.9%) and more than half of young adults (51.0%) used to drink once a week. The proportion of responders who consumed alcoholic beverages 3-4 times a week was 10.8% among adolescents and 15.4% among the young adults. Daily drinking seemed also to be more common in young adults (10.8%) compared with adolescents (4.7%). The percentage of girls who consumed alcohol increased from adolescents (60.8%), to the young adults (73.6%). Girls were also less likely than boys to drink frequently. The majority of adolescents and young adults consuming alcohol 3-4 times a week were males (p<0.001). Likewise, adolescents who drank every day were almost exclusively of male gender.

Table 1. Classification of respondents according to the frequency (in percent) of drinkingtab-1

Table 2 shows a constant increase of moderate alcohol intake from adolescents (20.0%) to young adults (28.5%), p<0.001. Also, the percentage of heavy drinkers (more than 60g/day) was higher in young adults (9.3%). Even the proportion of heavy drinkers (more than 60g/day) was higher in young adults (9.3%) than adolescents (4.2%). Binge drinking was found among 28% of adolescents (70.8% boys and 29.2% girls) and in 34% of young adults (68.4% boys and 31.6% girls).

Table 2. Classification of respondents (in percent) according to the volume alcohol consumptiontab-2

Table 3 provides an overview of the overall frequency of habits and type of alcohol beverage preferences. The most common type of alcohol beverage preferred by adolescents and young adults was beer, followed by spirits and wine. There were no significant differences regarding the drink preferences between boys and girls. Girls were proportionally less likely to prefer wine or distilled spirits and more likely to drink beer. About a third of respondents did not report any specific preferences.

Table 3. Overall frequencies (in percent) of drinking habits and alcohol beverage preferencestab-3

Discussion
This survey focussed on the prevalence of current drinking, mean level of alcohol consumption, as well as drinking habits and types of alcohol beverages and is one of the first study on alcohol consumption among adolescents and young adults in Albania. 
Trend of alcohol consumption by adolescents and rates of alcohol-related problems had remained stable or had risen until 2003, particularly in some Eastern European countries, followed by a decreasing trend observed in the last years (5). Our findings indicate that 63.4% of teenagers use alcoholic beverages regularly and the percentage of 10.8% of the alcohol use with frequency of 3-4 times a week, lists Albania between in the middle of various countries in Europe (5). On the other hand, 28% of adolescents (68% boys and 32% girls) were engaged in binge drinking. Besides the known factors, related to the physiological, personality and life-style change, such as the tendency to emphasize independence, changing beliefs, habits and performance, influence of peers, risk taking, rebelliousness on actions outside the social rules, the alcohol use by adolescents in Albania was strongly influenced by profound social and cultural changes during the last two decades (6,7).
The worrisome problem of alcohol abuse by adolescents turn them into regular consumers and progressive heavier drinkers, with alcohol problems in their future (8,9). Individuals who begin drinking at the age of 15 years are four times more likely to become alcohol-dependent than those who do not use alcohol before the age of 15 years (10).
In our study, teenage boys had a higher prevalence of alcohol use than girls, especially concerning the category of 3-4 times a week and daily drinking (Table 1). Such models of differences between boys and girls are encountered in the majority of European countries, except Sweden, Finland and Norway (5). 
When adolescents start to drink, they generally tend to consume high quantities of alcohol, thus undermining the safety of themselves and others (11,12). Specifically, 20.0% of the teenagers interviewed (64.3% boys and 35.7% girls) were included in the group of moderate drinkers and 4.2% of them as heavy drinkers. 
The survey shows that drinking is common among young adults. Concretely, 51.0% of students interviewed used to drink alcohol once a week. A higher frequency of alcohol use, more than three times a week was found in 15.4% of students, less than those in developed countries of Europe, such as the Netherlands, Austria, Belgium or England (20%-25%), but higher than in Finland, Iceland, Norway or Sweden (13). The transitory period from adolescents to young adults is marked by frequent change and exploration and also of increased alcohol use and abuse (14). We consider that freedom from family ties and control, life in the dormitories, freedom from social control and the freedom to purchase alcohol, make students easier to embrace alcoholic beverages. The full-time college students are more likely to drink heavily and get drunk than those part-time or non-college peers (15). As in other post-communist countries, a major impact on Albanian students has the natural tendency of globalization, which leads to the trend of reducing differences between cultures through the use of alcohol. Comparative qualitative studies have shown some surprising similarities between youth drinking practices in Northern and Southern Europe (16). Binge drinking was found in 34% of the students (65% boys and 35% girls). Students are in fact able to consume much longer amounts of alcohol than adolescents before experiencing the negative consequences of drinking. This unusual tolerance may help to explain the high rate of binge drink among students.
Alcohol consumption in students is characterised by tendencies of the use of large quantities of it. Excessive youthful drinking, thus, may be seen as part of an overall tendency toward experimentations and risk-taking and not as an isolated and bizarre behaviour specific to a certain type of alcohol drink. The data of our study show that while 39.4% of students are included in the group of light drinkers, almost one third of them (28.5%) are considered moderate drinkers and 9.3% of them as heavy drinkers. Our data on the heavy drinkers are in fact lower than the 15.6% prevalence found in students of 35 different countries of Europe (15).
Preferences for specific types of alcohol drinks vary between different population groups. In our study, the most common type of alcohol beverage preferred by adolescents and young adults was beer, followed by spirits and wine (Table 3). In fact, distilled spirits, rather than wine, are the second most common beverage of choice (17). Finally, the study showed that adolescents and young adults consume alcohol in a variety of contexts, mostly outside at public places (bars, restaurants, parks, beaches), as well as homes of friends or acquaintances. 
In conclusion, our survey indicates that alcohol drinking among adolescents and young adults in Albania is both widespread and harmful. In addition to the high rates of alcohol use among these age-groups, our data indicate the particularly worrisome aspect concerning the high prevalence of moderate or heavy drinking and heavy episodic drinking. The information provided in this study should support the efforts and social policies regarding health and well-being of Albanian youth.

Acknowledgements
We would like to thank for their assistance the doctors that helped in data gathering from all over Albania: Nevila Tabaku, Hilmi Duhanxhi, Nehat Dumani, Vanedik Çallo, Vasil Kareco, Sotiraq Vangjeli, Albana Duni, Vigjilenca Demiraj.

Conflicts of interest: None declared.

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