# data[].attributes.headline
Have a look below at the type of websites and data that you could look for when you are researching your own topics.

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Have a look below at the type of websites and data that you could look for when you are researching your own topics.

# data[].attributes.headline
Have a look below at the type of websites and data that you could look for when you are researching your own topics.

# data[].attributes.subject
Have a look below at the type of websites and data that you could look for when you are researching your own topics.

# data[].attributes.headline
Below indicates ways that you might carry out some research of your own and present data......

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Below indicates ways that you might carry out some research of your own and present data......

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Statistics on Obesity, Physical Activity and Diet - England, 2018 [PAS] - NHS Digital

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We're the national information and technology partner to the health and social care system using digital technology to transform the NHS and social care

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Abstract

INTRODUCTION

Alcohol is a major global threat to public health ( Ofori-Adjei et al., 2007). The World Health Organization (WHO) reports that alcohol consumption is related to 3.2% of mortality worldwide ( Rehm et al., 2003), while in Europe alcohol accounted for 6.5% of deaths and 11.6% of disability adjusted life years in 2004 ( Rehm et al., 2009). Although the main burden of chronic alcohol-related disease is in adults, its foundations often lie in adolescence ( Bellis et al., 2009). The latest ESPAD survey of alcohol use among 14-15-year olds in 36 European countries found that 87% reported lifetime alcohol use, with 57% consuming alcohol on one or more occasion in the previous month ( Hibell et al., 2011). ESPAD found considerable variation in the levels of youth alcohol consumption between countries, with adolescents in the UK and Nordic countries drinking three times more than in Southern and Eastern Europe. Rates of youth alcohol use are lower in the USA than in Europe, with 70% of 18-year olds reporting lifetime alcohol use, and 33% in the preceding month ( Johnston et al., 2011). While the proportion of young people in England aged 11-15 years who reported that they have drunk alcohol decreased from 62 to 45% between 1988 and 2011, the mean amount consumed approximately doubled (from 6.4 to 10.4 units of alcohol per week) between 1994 and 2011 ( Fuller, 2012). In England there has been a rapid increase in regular alcohol consumption during school-aged years, with 1% of 11 years reporting weekly alcohol consumption compared with 28% of those aged 15 years of age ( Fuller, 2012). Adolescents in the UK are now among the heaviest drinkers in Europe ( Hibbell et al., 2009).

Alcohol consumption and related harm increase steeply from the ages of 12-20 years ( NHS Information Centre, 2008). In early adolescence alcohol use and alcohol use disorders (AUDs-alcohol abuse/harmful alcohol use and alcohol dependence) are relatively uncommon. But, alcohol has a disproportionately adverse effect on younger adolescents, for example, possibly predisposing them to damage the developing brain ( Zeigler et al., 2005), to develop alcohol dependence in later life ( Dawson et al., 2008; Hingson and Zha, 2009) and increasing risk of disability ( Sidorchuk et al., 2012). In middle adolescence (ages 15-17 years) binge drinking (single occasion consumption leading to intoxication) emerges. Binge drinking is associated with increased risk of unprotected/regretted sexual activity ( Windle and Windle, 2004; Hibbell et al., 2009, 2011), criminal and disorderly behaviour ( Department of Health, 2007; Hibbell et al., 2009), suicide and deliberate self-harm ( McCloud et al., 2004), injury ( Hibbell et al., 2009), drink driving or allowing oneself to be carried by a drink driver ( Bukstein and Kaminer, 1994), alcohol poisoning ( Rehm et al., 2003) and accidental death ( Thunstrom, 1988).

A review of national guidelines on consumption to limit alcohol-related harms ( Furtwaengler and de Visser, 2013) found a lack of consensus between countries. Several nations had no official guidance on levels of consumption; others had a wide variety of definitions of a 'standard drink' (ranging from 8 g ethanol to 14 g). Actual guidance provided ranged from 20 to 56 g/day for males and 10 to 42 g/day for females. There are no specific guidelines for alcohol consumption among young people. In 2009 the Chief Medical Officer (CMO) for England provided recommendations ( Donaldson, 2009) on alcohol consumption for young people based on an evidence review ( Newbury-Birch et al., 2009). The CMO advises that children should abstain before age 15 years and also suggests 15 to 17-year olds should not consume alcohol, but if they do drink, it should be no more than 3-4 units (24-32 g) and 2-3 units (16-24 g) per week in males and females, respectively, on an occasional basis.

Over the past 15 years the WHO, the US Surgeon General, the American Medical Association, and the American Academy of Paediatrics have called for practitioners to carry out screening and brief interventions (SBI) for adolescent drinkers ( Elster and Kuznets, 1994; Committee on Substance Abuse, 2001; World Health Organisation, 2006; NIAAA, 2007). The alcohol strategies in both England and Scotland identify adolescents as a key target group in which to reduce alcohol consumption and related harm ( Department of Health, 2007; Scottish Government, 2013). However, while there has been an increase in SBI activity in relation to adults presenting to health care providers, adolescents remain a neglected group.

BRIEF INTERVENTION FOR ADOLESCENTS

The term brief intervention (BI) encompasses a range of therapeutic processes from advice to extended counselling, and typically is delivered in short sessions on one or more occasions. A number of trials focusing upon young people (aged 12-21) have reported significant positive effects of BI on a range of alcohol consumption measures ( Monti et al., 1999, 2007; Bailey et al., 2004; Schaus et al., 2009; Bernstein et al., 2010; Walton et al., 2010). Walton et al. (2010) noted that BI reduced alcohol-related harms, and Bernstein et al. (2010) found significant reductions in alcohol consumption compared with 'information only' controls. Bailey et al. (2004) found that BI participants showed increased readiness to reduce alcohol consumption, an initial reduction in alcohol consumption, and an improvement in knowledge regarding alcohol and related problems compared with the control condition. Researchers from the USA have also reported reductions in blood alcohol concentration, number of drinks per week and risk-taking behaviour ( Schaus et al., 2009). Monti et al. (1999) concluded that BI subjects were less likely to drink and drive or experience alcohol-related injury than controls, although both treatment groups significantly reduced their alcohol consumption. A subsequent trial conducted by the same research group ( Monti et al., 2007) reported that alcohol consumption was also significantly decreased in both BI and control groups. Spirito et al. (2004) found a significant reduction in alcohol consumption at follow-up in both BI and control groups. However, adolescents who screened positive for alcohol problems at baseline reported more changes after BI than controls. Three trials reported null effects after BI ( Maio et al., 2005; Peterson et al., 2006; D'Amico et al., 2008). One trial that used an audio-taped programme with 12 to 17-year-old adolescents ( Boekeloo et al., 2004) reported an increase in alcohol use and binge drinking among BI subjects, although it should be noted that in this age group one would expect increase in uptake of drinking, so this does not necessarily represent an adverse effect, but rather potentially a lack of effect. There has been a lack of consensus regarding the most effective components of effective interventions. Therefore we conducted a brief review of reviews (and recent trials) to identify screening methods, types and settings for interventions applied to adolescent populations that are effective in reducing alcohol consumption and related harms.

METHOD

We conducted a review of reviews based upon publications from 2003 to 2013. A search of electronic databases (PubMed, Web of Science) was undertaken using the terms <alcohol>, <intervention> and <adolescent>. Search terms were expanded to include variations on these themes, and review papers were identified and summarized ( Carey et al., 2007; Deas, 2008; Lemstra et al., 2010; Wachtel and Staniford, 2010; Calabria et al., 2011; Jackson et al., 2011; Carney and Myers, 2012; Haug et al., 2012; Mitchell et al., 2013; Yuma-Guerrero et al., 2012; Champion et al., 2013; Newton et al., 2013; Pilowsky and Wu, 2013). We defined adolescent as aged 10-21 years. Any studies of alcohol screening and brief intervention for adolescents that were not included in any of the published systematic reviews were identified and included in this review ( Bernstein et al., 2010; Walton et al., 2010; Segatto et al., 2011; Gmel et al., 2012; Winters et al., 2012) (Table 1). Studies that focused upon primary prevention of alcohol use were excluded from this review.

HOW TO IDENTIFY ADOLESCENTS WHO DRINK

Various alcohol screening methods have been developed in the USA but have not been evaluated in the UK. Pilowsky and Wu (2013) reviewed screening instruments used in primary care settings, concluding that the CRAFFT had the most consistent data to support its use for older adolescents (15-18 years) in this setting; however, research comparing brief screening methods with more in-depth measures (such as the Time Line Follow Back) was limited. An earlier systematic review of alcohol screening and brief interventions in young people across a wider range of settings for both adolescents (age 10-17 years) and adults (aged over 18 years), conducted for the English National Institute for Health and Clinical Excellence (NICE) ( Jackson et al., 2009), reviewed 51 studies of alcohol screening. Questionnaires were found to perform better than blood markers or breath alcohol concentration in all age groups. In adolescents, the AUDIT questionnaire ( Saunders et al., 1993) was found to have greater sensitivity and specificity than other questionnaires (including CAGE, TWEAK, CRAFFT, RAPS4-QF, FAST, RUFT-Cut and POSIT). AUDIT sensitivities for adolescents range from 54 to 87% and specificities from 65 to 97% ( Clark and Moss, 2010): the majority of the findings were at the lower end of the range of sensitivity and specificity and are therefore suboptimal for effective screening. Electronic or computerized screening is becoming more widely used and has proved to be an effective and acceptable method of identifying 'at risk' adolescents ( Pilowsky and Wu, 2013).

Several shortcomings of existing alcohol screening methods for adolescents have been identified (Clark and Moss, 2010). Existing approaches do not sufficiently take account of age and developmental stage of adolescents. Any alcohol consumption may be of concern in younger adolescents, whereas identification of AUDs is more relevant in the older adolescent.

WHAT INTERVENTIONS ARE EFFECTIVE?

A number of reviews on effective interventions for adolescents identified as being in need of help or advice about their drinking have now been published; the most recent of these have focused upon the use of internet, computer and mobile phone technologies, collectively referred to as electronic brief interventions (e-BIs). These reviews present limited evidence that e-BI significantly reduces alcohol consumption compared with minimal or no intervention controls ( Champion et al., 2013; Mitchell et al., 2013; Newton et al., 2013). However some caution should be exercised when interpreting these findings as an earlier meta-analysis by Carey et al. (2012) that compared e-BI with more traditional face-to-face (F2F) delivery of interventions concluded that F2F is superior ( Carey et al., 2012).

BIs based on one or two sessions of motivational interviewing (MI) that lasted between 20 and 45 min have been studies in an adolescent population ( Monti et al., 1999, 2007; Peterson et al., 2006; D'Amico et al., 2008; Schaus et al., 2009). Delivery of these interventions was carried out by a range of trained professionals including physicians, nurse practitioners, psychologists, addiction clinicians and youth workers. One trial tested a more intensive programme of four MI sessions during a 1-month period ( Bailey et al., 2004). Two studies used information technology to deliver BI, one involving the use of an audio programme in primary care clinics ( Boekeloo et al., 2004) and the other an interactive computer programme in a minor injury unit ( Maio et al., 2005). The length of follow-up ranged from 2 to 12 months. Overall, the loss to final follow-up evaluations was low (0-20%), although D'Amico et al. (2008) reported that 34% of their study population were lost to follow-up. MI is more effective when delivered across a series of sessions, rather than as a one-off intervention; the 2012 review by Carney and Myers (2012) included nine studies of MI in adolescent populations, concluding that individual interventions across multiple sessions had the strongest effect.

There have been several reviews of more intensive psychosocial interventions for adolescent AUDs ( Williams and Chang, 2000; Deas and Thomas, 2001; Hser et al., 2001; Perepletchikova et al., 2008; Deas and Clark, 2009). Interventions have included behavioural and cognitive-behavioural therapies, motivational enhancement therapy (MET), contingency management and 12-step approaches (based on the principles of Alcoholics Anonymous). Family based interventions such as Multi Systemic Therapy and Multi Dimensional Family Therapy have been recommended by NICE for alcohol misusing adolescents with more complex needs ( NICE, 2011); however, these are beyond the scope of this review. Interpretation of this literature is complicated because most studies examine comorbid drug and AUDs rather than AUD alone, and a wide age range from 12 to 18 years, and sometimes up to 25 years. Of these psychosocial approaches, MET shows promise as a treatment intervention for AUD in adolescents ( Marlatt et al., 1998; Kaminer and Burleson, 1999; Dennis et al., 2004; McCambridge and Strang, 2004). MET has yet to be studied as a more intensive intervention in the context of a stepped care approach.

WHERE IS THE BEST PLACE TO DELIVER THESE INTERVENTIONS?

A systematic review of brief alcohol interventions in young people attending health settings identified eight randomized controlled trials between 1999 and 2008 ( Jackson et al., 2009). Seven were based in the USA ( Monti et al., 1999; Boekeloo et al., 2004; Spirito et al., 2004; Maio et al., 2005; Peterson et al., 2006; D'Amico et al., 2008), and one in Australia ( Bailey et al., 2004). Subsequently, a further trial based in a US student health centre was published in 2009 ( Schaus et al., 2009). Study population sizes range from 34 to 655, and ages ranged from 12 to 24 years. Three trials targeted socioeconomically disadvantaged groups where drug and alcohol misuse were more prevalent ( Bailey et al., 2004; Peterson et al., 2006; D'Amico et al., 2008). Four trials were based in ED in order to maximize the 'teachable moment' ( Williams et al., 2005) in which the connection between alcohol consumption and its adverse consequences can be more readily highlighted ( Monti et al., 1999, 2007; Spirito et al., 2004; Maio et al., 2005). Two studies recruited adolescents in a primary care setting during routine general check-ups ( Boekeloo et al., 2004; D'Amico et al, 2008) and one in a university health centre ( Schaus et al., 2009). The remaining trials targeted homeless youth ( Peterson et al., 2006) and those attending a youth centre that delivered health services ( Bailey et al., 2004). An earlier review of BIs in health settings ( Jackson et al., 2009) was based on eight Randomised Controlled Trials (RCTs) (mostly MI focused) conducted between 1999 and 2008, of which five reported positive effects upon consumption and related harms.

Opportunistic alcohol screening and brief intervention in emergency departments (ED) have shown efficacy in adolescents ( Monti et al., 1999, 2007; Spirito et al., 2004), with evidence of cost effectiveness in adults ( Barrett et al., 2006). One systematic review has explored BI delivered in ED settings ( Yuma-Guerrero et al., 2012). Of the seven RCTs identified, six of these employed a MI based intervention, and of these, half demonstrated significant reductions in alcohol consumption and consequences for the MI groups. Six of the seven studies reported positive treatment effects in all arms of the trials. To date no trials have been undertaken in paediatric ED settings; however, one programme of research is currently underway (SIPS Junior). The effectiveness of MI for this population had been previously reported by Wachtel and Staniford (2010) in a general review of effective interventions for adolescents ( Wachtel and Staniford, 2010).

Most studies of schools based interventions have focused upon primary prevention aimed at children prior to the onset of alcohol use, and are therefore beyond the scope of this review. Two published RCTs describe the effect of MI on children identified as current alcohol users; both report significant impact on alcohol use ( Winters and Leitten, 2007; Winters et al., 2012). Gmel et al. (2012) reported borderline significant effects for MI on reduced levels of consumption, concluding that the intervention was ineffective. These findings should be interpreted with caution, however, as a recent critical review ( Pape, 2009) reminds us to question the reliability of published reports of effectiveness in this setting. Calabria et al. (2011) reviewed interventions delivered outside of educational settings but were unable to identify any one approach that demonstrated superior impact.

DISCUSSION

With 12% of 11-15 year olds drinking weekly ( Fuller, 2012) and at least in the UK a fall in the age of onset of many alcohol-related harms such as alcohol liver disease ( NCEPOD, 2013) there is a need to develop public health measures to tackle adolescent drinking. Recent systematic reviews ( NICE, 2007, 2010) have not identified validated screening instruments that could be easily introduced across settings to accurately detect alcohol misuse use in younger adolescents (10-14 years old), who are more vulnerable to alcohol-related harms. In the absence of sensitive instruments to detect alcohol misuse in this age group, there is a risk of defining alcohol misuse in young people through the incidence of gross intoxication or hospital admissions due to alcohol poisoning, which might miss a proportion who could potentially benefit from alcohol intervention.

Greater accuracy in determining the level of need for alcohol misuse in adolescence will support the broader implementation of public health measures at a national and local level, as well as identify those individuals who may benefit from specific interventions. Screening methods that are sensitive to the developmental stage of the adolescent should be tested to maximize opportunities for intervention. Alcohol screening has been mostly studied in older adolescents and young adults of college age (18-24 years). Therefore the validity of alcohol screening methods in younger adolescents is unclear. Questionnaires such as the AUDIT may be too lengthy (10 items) to incorporate into busy settings pointing to the need for briefer tools for use in routine clinical practice.

Increasing engagement in screening particularly with younger adolescents might result from using computer screening and interviewing adolescents confidentially, separately from parents ( Ford et al., 1997; Gregor et al., 2003). Screening is perhaps the most important element of SBI-reactivity to assessment has an impact upon outcome and screening itself may be the briefest of BIs-and yet no single screening instrument has been identified that reliably determines a young person's risk status. It is likely that no single cut-off on any screening instrument will suit the broad age range encompassed by adolescence, and that lower thresholds for AUDs for younger age groups will be required. Research to develop to refine existing tools by establishing concordance with Time Line Follow Back data should be a priority.

Most of the published research on brief alcohol interventions for adolescents has been set in mainly acute medical and ED or educational settings. Other care interfaces (such as sexual health clinics, adolescent mental health services or Youth Offending Teams) should be considered as potential settings for both identification of AUDs and the delivery of BIs.

Based upon the reviews to date and the RCTs undertaken from 2010 onwards, MI/MET approaches appear to be associated with reductions in alcohol consumption and related harms, with health settings proving to be a promising location for such programmes. e-BIs (computer, web and phone based) offer both effective and cost effective delivery of interventions across settings that may prove to be more acceptable to the target population than more traditional (F2F) approaches, yet the most effective mechanism for e-BI is less apparent-the utilization of 'smart-phone' technology may add both function and credibility to interventions; however, their usefulness in this context remains untested, with several clinical trials currently underway.

This brief review of reviews and recent RCTs suggests that despite an increasing interest in applying screening and brief interventions to an adolescent population, there are no clear indications of which target population, setting, screening tool or intervention approach can be recommended. The relationship between age, alcohol consumption and harm is complex and further research is required in order to establish guidelines for consumption and thresholds of harm for different age groups.

Funding

Funding to pay the Open Access publication charges for this article was provided by Kings College London.

Conflict of interest statement

None declared.

REFERENCES

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Alcohol Screening and Brief Intervention for Adolescents: The How, What and Where of Reducing Alcohol Consumption and Related Harm Among Young People | Alcohol and Alcoholism | Oxford Academic

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Alcohol is a major global threat to public health ( Ofori-Adjei et al., 2007). The World Health Organization (WHO) reports that alcohol consumption is related to 3.2% of mortality worldwide ( Rehm et al., 2003), while in Europe alcohol accounted for 6.5% of deaths and 11.6% of disability adjusted life years in 2004 ( Rehm et al., 2009).

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Widespread media coverage has been given to news that "British teenagers are the third worst binge drinkers in Europe" (BBC News). The news is based on a report of a Europe-wide survey on alcohol and drug use by teenagers. Only teenagers in Denmark and the Isle of Man fared worse out of the 35 nations that were surveyed.

The complete report covers surveys, conducted in 32 European countries in 2007. Among the conclusions made by the UK investigators in the media (but not specifically mentioned in this report) is the advice on public health policies that might prevent harm. Many newspapers mention the effectiveness of alcohol education or mass media campaigns compared to taxation or minimum pricing strategies.

The overall conclusions of the lead investigator Professor Plant is that "alcohol education and mass media campaigns have a very poor track record in influencing drinking habits", whereas policies such as taxing alcohol to make it less affordable are far more effective and cost effective.

Where did the story come from?

The study was led by Björn Hibell, Ulf Guttormsson, Salme Ahlström, Olga Balakireva, Thoroddur Bjarnason, Anna Kokkevi and Ludwig Kraus from the European School Survey Project on Alcohol and Other Drugs (ESPAD). The report's production was funded by The Swedish National Institute of Public Health and the European Monitoring Centre for Drugs and Drug Addiction.

Professor Martin Plant and Dr Patrick Miller of the Alcohol and Health Research Unit at the University of the West of England, Bristol, were responsible for the survey conducted for the ESPAD study in the UK. This report is available online on the ESPAD website.

What kind of scientific study was this?

The European School Survey Project on Alcohol and Other Drugs (ESPAD) aims to collect and compare data on alcohol and drug use among 15 to 16-year-old students in European countries. The researchers have collected data four times so far. In 1995, a survey was conducted in 25 countries, while in 2007 the data collection was carried out in 35 countries.

This new report presents key results from the 2007 survey, as well as the trends found over time between the previous surveys.

During the spring of 2007, more than 100,000 students were surveyed from Armenia, Austria, Belgium, Bulgaria, Croatia, Cyprus, the Czech Republic, Denmark, Estonia, the Faroe Islands, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, the Isle of Man, Italy, Latvia, Lithuania, Malta, Monaco, the Netherlands, Norway, Poland, Portugal, Romania, Russian Federation, the Slovak Republic, Slovenia, Sweden, Switzerland, Ukraine and the UK. It involved giving a standardised questionnaire to students born in 1991; these students had an average (mean) age of 15.8 years at the time of data collection.

The researchers say that questionnaires were administered to a class-group, and the students answered the questionnaires anonymously, with teachers or research assistants acting as survey leaders. The six questions on alcohol included one that asked about typical daily consumption during the last 30 days of beer, cider, alcopops, wine or spirits. Answers could range from never to 10 or more drinks.

With two exceptions, the class samples are nationally representative: in Germany, the study was performed in only seven out of 16 federal states, while only the Flemish-speaking part of Belgium was surveyed. Overall, the researchers say that most sample sizes were close to 2,400 students per country (except for the small countries). They also say that any small differences between countries or over time should be interpreted with caution, offering a "rule of thumb" that differences of more than a few percentage points can quite confidently be considered significant.

For the UK part of the study, a target of 120 schools was set, covering two classes from each school. To obtain this number, 203 schools were approached. Out of 203 sampled schools, 104 (51%) did not participate. The most common reasons given for school refusal were that the school had taken part in other research projects, and that staff or students were already overloaded with these commitments. There were no discernible differences in the types of schools choosing to cooperating or not cooperating.

What were the results of the study?

At least two-thirds of the students in each of the countries surveyed had drunk alcohol at least once during their lifetimes.

Across all countries, an average of 90% of students had drunk alcohol at least once in their lifetime. Of these, 82% had drunk once in the past 12 months, and 61% had drunk alcohol in the past 30 days.

The researchers say that, overall, the prevalence of 'lifetime' and 'past 12 months' of drinking did not change from 1995 to 2007, whereas the 'past 30 days' figures increased until 2003 before they dropped a little in 2007, especially among boys.

The range of reported alcohol use among countries varied considerably. For example, the proportion of students reporting alcohol use in the past 30 days was 80% in Austria and Denmark, but only 31% in Iceland and 35% in Armenia.

In nearly all countries, boys drank more than girls. In a large majority of the countries, beer is the dominant beverage among boys, while spirits is the dominant beverage among girls in a little more than half of the countries.

On average, half of the students in these countries admitted to being "intoxicated at least once during their lifetime, to the point of staggering when walking, having slurred speech or throwing up". The researchers say that this had happened during the past 12 months for 39% of the students, and during the past 30 days for 18% of students. How frequently students got drunk varied between the sexes, with higher figures for boys in some countries and for girls in others.

A number of students reported problems during the past 12 months relating to their alcohol consumption. On average, 15% of them said they had experienced serious problems with parents, while 13% had "performed poorly at school or work", had "serious problems with friends" and "physical fights". Countries where many students reported problems relating to their alcohol consumption include Bulgaria, the UK, Latvia and the Isle of Man.

What interpretations did the researchers draw from these results?

Regarding drugs, smoking and alcohol trends, the researchers conclude that "in countries where many students report recent (past 30 days) alcohol use and intoxication, more students are likely to report experience of illicit drugs, inhalants and use of alcohol together with pills, and vice versa".

They say there is an upward trend for heavy episodic drinking throughout 1995-2007 (a 9% increase). This is mostly explained by the increasing prevalence of drinking among girls in a number of countries.

The overall impression is that the situation has improved in the long-term for substance use "apart from the heavy episodic drinking measure that display an increase throughout the period".

What does the NHS Knowledge Service make of this study?

The full report contains comprehensive data on the current situation and recent trends in the use of cigarettes, alcohol, illicit drugs and other substances in a cohort of 15 to 16-year-olds in most European counties. This provides useful information for planning services and public health approaches to tackling dangerous drinking.

The researchers make some comments regarding the reliability of this survey. They say that:

There was a low number of unanswered core questions (1.8%), and that the rates of inconsistent answers to questions about lifetime use, use in the past 12 months and use in the past 30 days were low (0-2%). This suggests that the questionnaires were completed accurately.

There were 405 questions to answer in the UK questionnaire, which is the highest of all countries. However, the researchers say that the time to answer the questionnaire was below average, and that the length of the questionnaire has probably not negatively influenced the validity of the answers.

Non-participation can be a problem for surveys, but in this case, even though more than half of the sampled schools in the UK and 60% of the classes did not participate for different reasons, it appears that the non-participating schools were randomly distributed. The researchers say that it can be assumed "that the sample is still representative of the UK student cohort".

Overall, this data provides a useful basis to decide future policy for reducing harm from alcohol and provides part of the evidence that will be needed by decision makers when considering the extent of the problem. Further evidence regarding the effectiveness of policies to reduce harm will be needed.

The lead investigator of this study in this country, Professor Plant, recommended that a minimum price of 50p per unit of alcohol should be introduced, and that it would save over 3,000 lives each year.

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travelling in the european economic area

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travelling outside the european economic area

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Widespread media coverage has been given to news that "British teenagers are the third worst binge drinkers in Europe" (BBC News). The news is based on a report of a Europe-wide survey on alcohol and drug use by teenagers. Only teenagers in Denmark and the Isle of Man fared worse out of the 35 nations that were surveyed.

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Task 1 look at this Prezi it will guide you step by step what you need to do.

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English Español 한국어 日本語 Deutsch Português Français Magyar Italiano

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1. Janet James , health promotion specialist nurse 1,

2. Peter Thomas , professor of health care statistics and epidemiology 3,

1. 1Bournemouth Diabetes and Endocrine Centre, Royal Bournemouth Hospital, Bournemouth, BH7 7DW

2. 2Bournemouth Diabetes and Endocrine Centre and Centre of Postgraduate Medical Research and Education, Bournemouth University

3. 3Centre of Postgraduate Medical Research and Education, Bournemouth University and Dorset Research and Development Support Unit, Poole Hospital

Correspondence to: J James janet.james{at}rbch.nhs.uk

Abstract

Objective To assess the long term effects of an obesity prevention programme in schools.

Design Longitudinal results after a cluster randomised controlled trial.

Setting Schools in southwest England.

Participants Of the original sample of 644 children aged 7-11, 511 children were tracked and measurements were obtained from 434 children three years after baseline.

Intervention The intervention was conducted over one school year, with four sessions of focused education promoting a healthy diet and discouraging the consumption of carbonated drinks.

Main outcome measures Anthropometric measures of height, weight, and waist circumference. Body mass index (BMI) converted to z scores (SD scores) and to centile values with growth reference curves. Waist circumference was also converted to z scores (SD scores).

Results At three years after baseline the age and sex specific BMI z scores (SD scores) had increased in the control group by 0.10 (SD 0.53) but decreased in the intervention group by −0.01 (SD 0.58), with a mean difference of 0.10 (95% confidence interval −0.00 to 0.21, P=0.06). The prevalence of overweight increased in both the intervention and control group at three years and the significant difference between the groups seen at 12 months was no longer evident. The BMI increased in the control group by 2.14 (SD 1.64) and the intervention group by 1.88 (SD 1.71), with mean difference of 0.26 (−0.07 to 0.58, P= 0.12). The waist circumference increased in both groups after three years with a mean difference of 0.09 (−0.06 to 0.26, P=0.25).

Conclusions These longitudinal results show that after a simple year long intervention the difference in prevalence of overweight in children seen at 12 months was not sustained at three years.

Introduction

Childhood overweight and obesity is an international problem, with 10% of school age children estimated to be overweight. 1 2 In the United Kingdom, obesity in children increased from 9.9% in 1995 to 13.7% in 2003. 3 Although the UK government has set an ambitious target of stopping this escalating trend by 2010, a recent publication forecasts that there could be further increases, with 19% of boys and 24% of girls aged under 10 predicted to be obese by 2010. 4

Numerous studies have been conducted with the aim of preventing obesity in children and young adults, many of which have been based in schools. 5 6 A recent revised Cochrane review 7 considered 22 studies, including 10 long term and 12 short term projects, most of which were school based and focused on multiple interventions, while some had more specific approaches. The review reported that in most cases the interventions did not significantly affect of the weight of the children. One reason for the disappointing results might have been that most of the projects were too short in duration to be effective.

One school based intervention described by the Cochrane review as a good quality randomised controlled trial was the Christchurch obesity prevention project in schools (CHOPPS), also sometimes referred to as the "ditch the fizz" project. This project was started in August 2001 and was completed over one school year. It was based in six junior schools in southern England and included children aged 7-11. The intervention focused on discouraging children from consuming carbonated drinks and involved one hour of additional health education during each of the four school terms. The intervention is described in more detail elsewhere. 8 The original project produced a modest reduction in the number of carbonated drinks consumed and a significant reduction in the number of children becoming overweight or obese. 8 Further anthropometric measures were taken two years after completion of the original project (three years after baseline) to assess any longitudinal effects.

Methods

Two years after completion of the original project one investigator (JJ) took additional longitudinal measurements. She had also completed the original measurements and conducted the education programme. Because of lack of funding we were unable to collect further drink diaries at this time.

Several different methods are used to assess overweight and obesity in children. We defined overweight and obesity using the 1990 British centile charts, in which children above the 91st centile are classified as overweight.

In the original project, the children in the three year groups attended junior schools in Christchurch, Dorset. Three years after baseline, the two older year groups had progressed to secondary schools and were tracked using school leaving lists. Most were attending three local secondary schools. From the original sample, 90 children had moved out of the area and 43 were attending secondary schools that were either outside of the project area or had fewer than six children from the original project attending. We traced 511 children from the original sample and carried out measurements on 434, 67% of the original sample (figure).

Outcome measures

One investigator (JJ) took anthropometric measures of height (without shoes) to the nearest 0.1 cm using the Portable Leister height measure (Seca, Marsden) and weight (in light clothing) measured to the nearest 0.1 kg on medical scales (Seca 770, Marsden). We converted body mass index (weight (kg)/(height (m) ²)) to z scores (SD scores) and to centile values using the 1990 growth reference disc (Child Growth Foundation). 9 The z score (SD score) accounts for the child's age and sex and represents the deviation compared with an average child of the same sex and age. Waist circumference was measured at the point of flexure as the child bends to one side, with 1 cm deducted to account for clothing. Waist circumference was converted to z scores (SD scores) with the 2001 McCarthy references for waist circumference. 10 Our primary outcome measures were the change in BMI z score and the prevalence of overweight.

Statistical methods

The sample size of 376 calculated for the original project was based on changes in consumption of carbonated drinks. This sample size had 90% power to detect mean differences in z score (SD score) for BMIs of 0.49, 0.42, 0.35, and 0.34 (assuming intracluster correlations of 0.1, 0.05, 0.01, and 0.001, respectively) between the intervention and control groups. As we were able to gather data on 434 children three years after baseline and using data from the 12 month follow-up we can refine this sample size calculation. In the original 12 month follow-up the intracluster correlation for the change in z score (SD score) over 12 months was −0.003 (assumed to be 0) and the SD was 0.44 in both groups combined. Thus at three years with a sample size of 434 and assuming an SD of 0.44 and an intracluster correlation coefficient of 0, the study had 90% power to detect differences of 0.14 between control and intervention groups.

The original design was a cluster randomised controlled trial, with class being the cluster. Data were aggregated for each cluster and the two sets of clusters compared by using the independent samples t test. Subsequently, because of the nature of the school environment and the progression of children to different schools, the clusters have not remained intact and some children were lost to follow-up. This resulted in some clusters having few children in them, and so reducing the validity of that method of analysis for the follow-up data. We therefore analysed the interval scaled data in this paper with MLwiN (version 2) using multilevel models to take into account variance within clusters. For binary data we implemented a logistic model using the same software. This has resulted in the 12 month analysis presented here not being identical to that in the original report. We used a 5% significance level.

Results

In the original project we collected baseline anthropometric measures from 644 children (321 girls). Of these, 434 children (209 girls) were re-measured three years later. There was no significant difference in the baseline z scores between children in the control and intervention groups who were present or missing at the final measurements. The average age was 8.6 (range 7.0-10.9) at the start of the project and 11.6 (10.0-13.9) at the three year follow-up.

Table 1 shows the BMIs, centile z scores (SD scores), and waist circumference z scores (SD scores) at baseline, 12 months, and three year follow-up. We also analysed data for each measure of change from baseline using baseline values, sex, and secondary school as covariates or cofactors. This made no material difference to the significance levels or mean changes between control and intervention group.

Table 2 shows the change in prevalence of overweight and obesity according to the 1990 British centile charts, with children above the 91st centile classed as overweight. As previously reported, at 12 months there was a significant difference between the control and intervention groups but three years after baseline the difference was smaller and no longer significant.

Discussion

A simple 12 month school based intervention focused on reducing consumption of carbonated drinks resulted in significant differences in the proportion of overweight children in the control and intervention groups. 8 Two years after the completion of the study, however, the difference was no longer significant, and the number of overweight children had increased in both groups, although the prevalence was still higher in the control group. In the three year follow-up, the only difference approaching significance was for the change in centile z score (SD score). Given the lack of a trend at 12 months this may well be a chance finding. The study had sufficient power to detect a difference of 0.14 or more, but the observed difference was only 0.10. The study was originally powered to detect differences in consumption of carbonated drinks, and so we cannot rule out a type II error.

The original project was different from many other school based interventions in that the intervention was specific and promoted a healthy diet based on the balance of good health. It focused specifically on discouraging the consumption of carbonated drinks. Several recent studies have further confirmed the association between these drinks and obesity, 11 12 13 14 15 as has a systematic review and meta-analysis of 88 studies. 16 The role of these drinks as a causative agent of obesity is also recognised by the World Health Organization. 17 One reason suggested for this association may relate to the high glycaemic index and that they provide "empty" calories. 18 The physiological effect on satiety from energy ingested in liquid form is thought to be different from that from solid foods and this may in part be due to faster transit times and reduced gastric distension. 19 Therefore the additional energy from these drinks may not be detected as easily by the body and individuals may not compensate for this additional energy by consuming less later. 19

Limitations

A proportion of children were lost to follow-up; although 67% of the original cohort were measured at three years. Because of the natural progression of children at school, the original clusters did not remain intact and therefore we had to use a different method of analysis from the original study.

Unfortunately because of financial and time limitations we were not able to measure any further changes in consumption of carbonated drinks, or the socioeconomic status and pubertal status of these children.

We thank the headmasters, teachers, parents, and children at the participating schools. We also thank David Phillips for discussion and advice and Julia Knott for assistance with data entry.

Contributors: JJ and DK developed the original idea. JJ delivered the education programme, carried out the anthropometric measurements, and analysed the data. All authors contributed to writing the manuscript. PT provided statistical and methodological advice. DK directed the project and is guarantor.

Funding: Internal resources within Bournemouth Diabetes and Endocrine Centre. JJ received a research scholarship from the Florence Nightingale Foundation (Band Trust Scholarship).

Competing interests: DK had a child attending one the schools involved in the original project.

Ethical approval: Dorset research and ethics committee approved the study.

Provenance and peer review: Not commissioned; externally peer reviewed.

The original project provided hope that a simple intervention could be beneficial in preventing obesity, but our new results show no effect two years after the end of the intervention. Evidence suggests that it would be beneficial for the whole population to decrease consumption of soft drinks, as these drinks have a high energy intake with little nutritional benefit. 16 The recent UK obesity guidelines from the National Institute for Health and Clinical Excellence (NICE) highlight the important role that schools can play in promoting healthy lifestyles. 20 Obesity is a complex condition, and another report suggests that specific interventions may ignore different interlinking influences. 21 It remains unclear whether specific interventions or those that focus on all aspects of the diet and physical activity are the most successful. Perhaps the true impact of any school based intervention can effectively be evaluated only if the interventions are continuous.

Footnotes

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Preventing childhood obesity: two year follow-up results from the Christchurch obesity prevention programme in schools (CHOPPS)

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Janet James , health promotion specialist nurse 1, Peter Thomas , professor of health care statistics and epidemiology 3, 1Bournemouth Diabetes and Endocrine Centre, Royal Bournemouth Hospital, Bournemouth, BH7 7DW 2Bournemouth Diabetes and Endocrine Centre and Centre of Postgraduate Medical Research and Education, Bournemouth University 3Centre of Postgraduate Medical Research and Education, Bournemouth University and Dorset Research and Development Support Unit, Poole Hospital Correspondence to: J James janet.james{at}rbch.nhs.uk Objective To assess the long term effects of an obesity prevention programme in schools.

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1. a Centre for Social Marketing, University of Strathclyde Stenhouse Building, Glasgow G4 0RQ

2. b Department of Marketing, University of Strathclyde Stenhouse Building, Glasgow G4 0RQ

3. c Health Education Board for Scotland Woodburn House Edinburgh EH10 4SG

Correspondence to: Professor Hastings

Accepted 29 November 1996

Abstract

Objective: To examine the appeal of "designer drinks" to young people.

Design: Qualitative and quantitative research comprising group discussions and questionnaire led interviews with young people accompanied by a self completion questionnaire.

Settings: Argyll and Clyde Health Board area west Scotland.

Subjects: Eight groups aged 12-17 years; 824 aged 12-17 recruited by multistage cluster probability sample from the community health index.

Results: Young people were familiar with designer drinks especially MD 20/20 and leading brands of strong white cider. Attitudes towards these drinks varied quite distinctly with age clearly reflecting their attitudes towards and motivations for drinking in general. The brand imagery of designer drinks-in contrast with that of more mainstream drinks-matched many 14 and 15 year olds' perceptions and expectations of drinking. Popularity of designer drinks peaked between the ages of 13 and 16 while more conventional drinks showed a consistent increase in popularity with age. Consumption of designer drinks tended to be in less controlled circumstances and was associated with heavier alcohol intake and greater drunkenness.

Conclusions: Designer drinks are a cause for concern. They appeal to young people often more so than conventional drinks and are particularly attractive to 14-16 year olds. Consumption of designer drinks is also associated with drinking in less controlled environments heavier drinking and greater drunkenness. There is a need for policy debate to assess the desirability of these drinks and the extent to which further controls on their marketing are required.

Key messages

There has been concern that designer drinks might have a particular appeal for teenagers and be legitimising under age drinking

Young people aged 14 and 15 years want drinks to be relatively strong inexpensive and pleasant tasting

Designer drinks are seen by 14 and 15 year olds to have these qualities and as a result are particularly appealing

By contrast for 16 and 17 year olds many designer drinks signal under age drinking and immaturity

Consumption of designer drinks is associated with heavier alcohol consumption drinking in less controlled environments and greater drunkenness

Introduction

In recent years a new range of fortified wines such as MD 20/20 or "Mad Dog" and strong white ciders such as White Lightning and Ice Dragon has emerged: so called "designer drinks." The fortified wines have sweet fruity flavours (for example cherry banana and strawberry) a concentration of alcohol by volume of between 13% and 21% and in 1994 sales of at least £40m. 1 The white ciders are according to industry sources filtered to remove colour and some flavours to make them more appealing to younger consumers 2 3 and usually have an alcohol by volume of between 8% and 9%. The appeal of these drinks to people under the age of 18 has been the focus of mounting public concern. 4 5

We reviewed the literature on young people's drinking to assess the main health concerns that have been expressed and the impact that designer drinks are claimed to have on these. We also describe the first major primary research that has been done to test these claims.

Adolescent drinking behaviour

Drinking alcohol in adolescence is a normative behaviour. Most people have their first taste of alcohol around the age of 10 (although Casswell et al report it to be at age 7 6) and are introduced to it by their parents usually to celebrate a special occasion. 7 8 9 By 16 about 90% have tasted alcohol. 10 11 12 13 Alcohol is thought to be important in adolescent development and socialisation as it helps young people to integrate with their peers and to negotiate their passage into the adult world. 14 15

Although most adolescents drink moderately and sensibly 9 16 17 many however have experience of intoxication 10 and a considerable minority drink heavily. Adolescent intoxication is associated (although not necessarily causally linked) with the occurrence of accidents certain crimes and risky behaviour including unsafe sexual encounters. 18 19 20 Heavy drinking while not a predictor of alcohol problems in later life 12 is associated with the use of illicit substances 9 21 and poor performance at school. 22

Under age drinking has not increased in recent years 23 24 but the quantity of alcohol being consumed on a typical drinking occasion is increasing. 25 In addition NHS information and statistics data (table 1) show a significant increase in the number of discharges for "non-dependent abuse of alcohol" among 11 to 17 year olds between 1990 and 1995 suggesting an increase in the occurrence of intoxication in young people. It is also clear that the amount of alcohol consumed and the frequency of drinking by teenagers increases with age 26 as does the tendency for drinking to move out of the parental home and into more public places where it is often done in the company of friends. 10 27 Furthermore these phenomena are correlated. 28

The impact of designer drinks on this picture is uncertain but concern has been expressed that they may be reinforcing the tendency to drink more on single occasions 25 with concomitant increases in the risks associated with intoxication. There is also concern that these drinks might have a particular appeal for teenagers 4 5 29 and that the marketing of them is legitimising an illicit activity.

Subjects and methods

We examined whether or not designer drinks appeal to young people; the nature of any such appeal and how it correlates with age; and whether or not the consumption of designer drinks is associated with greater alcohol intake per drinking session or greater loss of control or both.

We conducted both qualitative and quantitative research. The qualitative research comprised focus group discussions. This procedure entails bringing together six to eight respondents who are carefully selected in social demographic terms in an informal setting under the direction of a skilled moderator to discuss the subject of interest in depth. The method has been more fully described in a previous article published in this journal. 30 The quantitative research used conventional methods based on questionnaires to collect statistically reliable data from a large representative sample of the population.

Qualitative research

Fifty six children and young adults were interviewed in eight groups. These varied in terms of age (12-13; 14-15; 16-17 years) sex social class (A B C1 and C2 D E) and drinking behaviour (tried/not tried drinking) (table 2). Subjects were recruited door to door by professional interviewers and invited to attend discussions about their spare time activities at a prearranged venue. Respondents were paid a standard fee for attending and fieldwork took place in the west of Scotland during the summer of 1995. Each discussion lasted about two hours during which respondents were shown a wide range of alcohol products and related promotional material. They were encouraged to talk openly and informally about their drinking and their thoughts about the different products. Projective questioning procedures were used to tap emotional responses. All the discussions were tape recorded and then transcribed.

Quantitative research

A multistage cluster probability sample of 12-17 year olds was drawn from the community health index (a listing of names and addresses of people registered with a general practitioner within the health board area) for Argyll and Clyde Health Board. The initial sample frame comprised a list of all postcode sectors but those covering the most rural parts (that is islands and sectors with fewer than 500 households) were excluded for reasons of cost. A random sample of 30 postcode sectors was then drawn stratified by district and Carstairs score 31 (a measure of affluence or deprivation within an area) across the board. Within each of the 30 postcode sectors 40 people aged 12-17 years inclusive were selected from the index by using a random procedure stratified by age and sex.

A total sample of 824 respondents was achieved equivalent to a response rate of 78% after allowance for ineligible contacts. The achieved sample under-represented males and similarly under-represented 16 and 17 year olds and was therefore reweighted with census data.

The qualitative research informed the development of a two part questionnaire that then underwent detailed piloting. The first part of the questionnaire was completed in a face to face interview; the second seeking more sensitive information was completed by the respondent in confidence.

Results

Qualitative research

Most of the young people were familiar with designer drinks especially MD 20/20 and the leading brands of strong white cider. Their attitudes towards them varied quite distinctly with age clearly reflecting their attitudes towards and motivations for drinking in general.

"You can't remember what you did...but you can laugh at it."

"Everyone tells you what you've done and it's a class night."

(Girls; 14 to 15; C2 D E; drinkers; Paisley)

"I'd go out for 'a pint'...just a pint and I wouldn't get drunk off it. But I still go out and get leathered sometimes."

"If you down Mad Dog (MD 20/20) dead quick you get steaming then you throw up but if you're in pubs you can take your time. You drink to socialise as well."

(Boys; 16 to 17; A B C1; drinkers; Port Glasgow)

Children aged 12 and 13 years used alcohol to experience the adult world and to satisfy their curiosity. It also enabled many of them to socialise and to say that they had tried drinking. Those aged 14 and 15 were testing out their own limits and having fun. They enjoyed losing control every once in a while. For them drinking to get drunk was important as was sharing the experience with others. Those aged 16 and 17 were anxious to show their maturity and experience with alcohol drinking more like adults.

The drinks consumed matched these attitudes and motivations: 12 and 13 year olds experimented with any available drinks; 14 and 15 year olds consumed a wider range of drinks and wanted these to be relatively strong inexpensive and pleasant tasting (typically sweet)-all characteristics of designer drinks. On an emotional level they enjoyed drinking for fun getting drunk and losing control-again values offered by designer drinks. The characteristics and brand imagery of designer drinks in contrast with those of more mainstream products were thought to meet these requirements admirably.

"Because it's called Mad Dog (MD 20/20) you think you'll go mad."

(Boy; 14 to 15; C2 D E; drinkers; Paisley)

"It (TNT-a brand of white cider) makes you think about blowing your mind."

(Girl; 14 to 15; C2 D E; drinker; Paisley)

"It's (TNT) a pure novelty...that's blatantly made to get (the) young. Nobody over 18 would ever dream of drinking that kind of thing."

"You'd look stupid if you went to a nightclub and sat with a bottle of Mad Dog (MD 20/20) 'cos everybody is sitting drinking pints and stuff."

(Boys; 16 to 17; A B C1; drinkers; Port Glasgow)

Young adults aged 16 and 17 years had started to establish tastes for more "mature" drinks including a wider range of spirits and bottled beers. They went to pubs and clubs were keen to establish relationships with the opposite sex and wanted to appear adult and sophisticated. For them many designer drinks signalled immaturity and the under age drinker and were rejected as a result.

Quantitative research

The quantitative research showed that over two thirds (577/824; 70%) of 12-17 year olds drank alcohol and that of these more than half (295/577; 51%) had tried MD 20/20 and more than two fifths (244/577; 42%) had tried one of four brands of strong cider. As with the qualitative findings however there were considerable variations with age.

The frequency of drinking amount consumed and the extent of drunkenness increased with age (table 3). For example while only 2% of 12 year olds drank every week 4% of 12 year old drinkers had consumed 15 units or more on their last drinking occasion and 19% of those who had drunk in the previous 6 months claimed to have been really drunk. The equivalent figures for 17 year olds were 57% 26% and 69% respectively. The drinking environment also varied with age with 14-15 year olds drinking mainly in the open air (table 4).

Turning specifically to designer drinks we looked in detail at how the subjects perceived the market leader MD 20/20. The 577 young drinkers perceived it to have several appealing attributes including a sweet taste (482) pleasant taste (336) affordability (247) and being well known (410). It was also thought to be popular with people of their age (384); unpopular with people of their parents' age (420); a drink for the inexperienced drinker (261) and easy to drink outside (304). It scored better on many of these attributes than conventional beer (for example Budweiser; table 5).

When we gave the subjects a hypothetical choice of drinks (table 6) including a range of soft energy and alcoholic drinks the appeal of MD 20/20 was strongest among 13-15 year old drinkers but declined among 16-17 year olds. In contrast beer consistently increased in popularity with age.

Turning to actual consumption beer and spirits seemed to be the main drinks consumed although designer drinks were also popular with all 12-17 year olds. The popularity of designer drinks however peaked between the ages of 13 and 16. In contrast more conventional drinks such as spirits showed a consistent increase in popularity with age (table 7). For example strong white ciders were more popular among 13-14 year olds than other age groups with almost a quarter having consumed these drinks but much weaker conventional ciders such as Strongbow or Woodpecker (alcohol by volume 4.5-4%) showed no variation in consumption by age. Similarly the appeal of the recent arrival MD 20/20 decreased after age 16 but the appeal of the more traditional Buckfast did not.

Designer drinks tended to be consumed in less controlled circumstances. For example while just over a quarter (27%) of all drinkers had had their last drink in the open air this figure increased to over half (53%) for those who had drunk strong white cider and 65% for those who had drunk fortified wines (table 8).

Finally the survey showed that an interest in designer drinks was associated with heavier alcohol consumption and greater loss of control. Strong cider and fortified or tonic wines accounted for the highest alcohol consumption with an average intake on one drinking occasion of 6.8 units and 6.0 units respectively from these drinks alone. By contrast the lowest average intake was observed for conventional wines with a mean consumption of 2.1 units. Similarly those who had drunk strong cider and fortified wines on their last occasion of drinking reported greater sociability greater loss of control and greater aggressiveness or antisocial behaviour from their general drinking than drinkers who had not consumed such drinks.

Discussion

This research provides the first systematic evidence that designer drinks-a new range of fortified fruit wines and strong white ciders-are a cause for concern. They do seem to have both tangible and emotional qualities that make them appealing to young people often more so than conventional drinks. They are also being consumed by many youngsters. Furthermore this appeal and the level of consumption seems to peak before adulthood suggesting that these drinks are particularly attractive to 14-16 year olds. It is also clear that their consumption is associated with drinking in a less controlled environment heavier drinking and greater drunkenness.

There is a need for a thorough policy debate particularly concerning the extent to which these products should be freely marketed and whether further controls are required.

Acknowledgments

We thank Argyll and Clyde Health Board for providing access to the community health index and the interviewers and young people for collecting and providing the data. Particular thanks also go to Susan Anderson of the Centre for Social Marketing who coordinated the field force.

Funding: Health Education Board for Scotland.

Conflict of interest: None.

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Young people, alcohol, and designer drinks: quantitative and qualitative study

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a Centre for Social Marketing, University of Strathclyde Stenhouse Building, Glasgow G4 0RQ b Department of Marketing, University of Strathclyde Stenhouse Building, Glasgow G4 0RQ c Health Education Board for Scotland Woodburn House Edinburgh EH10 4SG Correspondence to: Professor Hastings Accepted 29 November 1996 Objective: To examine the appeal of "designer drinks" to young people.

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How to Develop a Questionnaire for Research

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A questionnaire is a technique for collecting data in which a respondent provides answers to a series of questions.http://www.quickmba.com/marketing/research/qdesign/ To develop a questionnaire that will collect the data you want takes...

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Ways to represent data | Data and statistics | 6th grade | Khan Academy

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Select a topic that you are interested in and think you can research.

I have given you a couple of examples: Childhood Obesity/ Teenage Binge Drinking and provided some websites etc. to show what you might look for.

Or you could research something in connection with the next course you progress on to, for example: Catering- different types of foods/  Art & Design- an artist you like/ Sport- the benefits of exercise or any other vocational area you are interested in.

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Look at this document and produce your own research plan. (Email your plan to me to approve your research project)

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Start to research and gather all your information- make notes in your own words.....
(DO NOT COPY & PASTE)

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Finally write your research assignment, make sure you provide a reference indicating where you have gathered your information from.

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How should I cite references in my assignments?

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Make sure you reference your work- there is a video in the column that you can watch.