Chapter 1 The Problem and Review of Related Literature and Studies

Introduction Alcoholism is one of the most abused substances in the Philippines because it is also considered as the most legal substance. No wonder that most alcoholic drinkers start as young as 13 years old. According to international statistics, people who begin drinking by age 15 are five times more likely to abuse or become dependent on alcohol than those who begin drinking after age 20. (U.S. Department of Health and Human Services) While according to the National Institute of Health, children who begin drinking before the age of fifteen are four times as likely to become alcoholics as teens who abstain from drinking. How do they come to drink as early as that? What does the reason behind drinking alcohol? There are several factors that may influence the drinking habits of the teens nowadays. One of the most popular is peer pressure which is also considered to be the leading cause of teenage drinking. (starbreezes.com) Getting drunk with friends used to be seen as a teenage rite of passage and a way to find out about the side effects of alcohol first-hand. But, according to official figures, todays teenagers are more likely to make binge drinking a regular part of their social life. (drinkaware.co.uk/ 2009) The guidance also emphasises the importance of parents influence on their childrens drinking. Attitudes to alcohol can often be passed down from parent to child because children see their parents as role models. (drinkaware.co.uk/ 2009) Children who

2 are taught moderation by their parents are less likely to abuse alcohol or have drinking problems. (Prof. Hanson, Ph. D.) Children of alcoholics are more likely to start drinking during adolescence than children of non-alcoholic; other children that have been informed about alcohol and warned of the dangers by their parents are less likely to drink; teenagers that have a good relationship with their parents are less likely to drink. (starbreezes.com) The influence of media and advertising also contributes to the alcohol consumption of the teenagers. One study conclude that alcohol advertising and promotion increases the likelihood that adolescents will start to use alcohol, and to drink more if they are already using alcohol. (Anderson, de Bruijn, Angus, Gordon, Hastings/ 2008) Some teens turn to alcohol as a way to cope with things like stress, anxiety, depression and life changes. They are also prone to commit suicide. (starbreezes.com) According to U.S. Department of Health and Human Services, they are risk to illicit drug use and tobacco use. This is supported by starbreezes.com because it said that teenagers often experiment when they are drank. Speaking of experimentation, drinking alcohol can make teenagers forget all about safe sex. Statistics show that after drinking, 11% of young people engaged in unprotected sex in 2007. 11% again claimed to regret that sexual encounter. (drinkaware.co.uk/ 2009) Teenagers are also more likely to be sexually active and less likely to practice safe sex. Thats why, two thirds of all cases of date rape and sexual assault comes from teenagers who are drank. (starbreezes.com)

3 Teenagers that drink are more likely to have behavioral problems than nondrinkers. These behavioral problems include aggression, criminal activity and running away from home. (starbreezes.com) A Home Office survey found that one in five (18%) 12-13 year olds and over a quarter (28%) of 14-15 year olds caused damage while drinking, while one in 10 15-16 year olds said that drinking had led them to get in trouble with the police. (drinkaware.co.uk/ 2009) Other than that, drinking alcohol can cause learning problems or lead to adult alcoholism. According to U.S. Department of Health and Human Services, a young person's brain and body are still growing so those who drink also are more likely to get poor grades in school and experienced academic failure than can lead to drop out.

Significance of the Study As what U.S. Department of Health and Human Services said, kids who drink are more likely to get poor grades in school and are at higher risk for being a crime victim those problems encouraged the researchers to conduct the study. Thus, this study expects to benefit the following: Respondents. The study will help the respondents become aware of the effect of drinking alcohol to health and as well as to the students academic performance in school. Educators. The study will help the teachers to guide their students in terms of its academic performances and be able to act on it.

4 Nursing Students. The study will enhance the knowledge and awareness of the nursing students regarding alcoholic drinking. Parents. The study will provide guidance to the parents about the alcoholic drinking status of their children with its associated health risk behaviors and awareness on the academic performances if it needs any improvement. Community. The study will impart knowledge and awareness to community people on the possible cause of prevalence of health risk behavior which may or may not be associated with drinking alcohol. Future Researchers. The will serve as a baseline data which will help them in the future researches.

Review of Literature and Studies This part of the study contains the past literatures and studies that will help the researchers and the readers to have background knowledge all about Underage drinking. This will serve as a baseline regarding the variables that is presented in the whole study.

Underage Drinking Refers to any use of alcohol by persons under the legal drinking age of 21. The harmful use of alcohol kills 2.5 million people, including 320,000 young people between 15 and 29 years of age. It is the third leading risk factor for poor health globally and

5 harmful use of alcohol was responsible for almost 4% of all deaths in the world, according to the estimates for 2004. (World Health Organization) In the Philippines, Filipino youths start drinking alcohol at the age of 16 or 17 while in some cases, children as young as 12 years old are already drinking alcoholic beverages. Drinking is more acceptable among girls than smoking. Nevertheless, it is still the case that is considered more appropriate for men than women to drink. Parents are more lax with boys, giving them more freedom to drink alcohol than their sisters. The teenagers said their family, friends, and the mass media have influenced them to experiment with drinking alcohol. Underscoring the critical role that the family plays in youth behaviors, young people seem to take their cue from their own parents attitudes and behaviors. Thus, a boy who grows up with an alcoholic father is more likely to become one himself.

HAMS: Harm reduction for Alcohol The NIAAA defines heavy drinking as 5 or more standard drinks in a day for a man and 4 or more standard drinks in a day for a woman. SAMHSA defines heavy drinking as drinking 5 or more standard drinks on the same occasion on each of 5 or more days in the past 30 days. The CDC defines heavy drinking for a man as exceeding 2 standard drinks per day for a man and one per day for a woman. (HAMS)

6 What is Moderate Drinking? Defining Drinks and Drinking Levels In the English language, moderate can be used as both a qualitative and a quantitative term, but it generally carries strong qualitative connotations. For example, Websters Dictionary (1966) defines moderate as characterized by an avoidance of extremes of behavior; observing reasonable limits, showing discretion and self-control. Dawson and colleagues (1995) proposed the following definitions, where one drink is equivalent to 0.5 fl. Oz. alcohol: o Abstainer: drinks less than 0.01 fl. Oz. alcohol per day (i.e., fewer than 12 drinks in the past year) o Light drinker: drinks 0.01 to 0.21 fl. Oz. alcohol per day (i.e., 1 to 13 drinks per month) o Moderate drinker: drinks 0.22 to 1.00 fl. Oz. alcohol per day (i.e., 4 to 14 drinks per week) o Heavy drinker: drinks more than 1.00 fl. Oz. alcohol per day (i.e., more than 2 drinks per day) In the United States, such guidelines are included in the publication Nutrition and Your Health: Dietary Guidelines for Americans, a document produced jointly by DHHS and USDA. The Dietary Guidelines, which are updated every 5 years, are designed to inform the American public about food choices that promote health and prevent disease. With respect to alcohol consumption, the most recent edition states, If you drink alcoholic beverages, do so in moderation. (DHHS and USDA/1995) Moderation is defined as no more than one drink per day for women and no more than two drinks per

7 day for men. A drink is considered to be 12 oz. regular beer, 5 oz. wine, or 1.5 oz. 80proof distilled spirits. Those drinking levels are considered a ceiling", not a floor- that is, one can drink less than those levels and still consider oneself a moderate drinker. (Dufour, MD, MPH)

Why do young people drink? Young people are at the stage in their lives where they are carelessly free. Most young people are bachelors and bachelorettes, whose ultimate desire at such a young age is to enjoy, have fun and do whatever they are capable of. In almost places and countries, young people are getting to the stage of full maturity. It is in the young adult stage where continuous exploration of self is sought and on-going search of self is still going on. Young people also tend to make most of their youthfulness that they delve into almost all sorts of activities, mostly those that involve some adrenaline. In todays modern era, it is not new for most young people to drink, smoke and party until the break of dawn. Independently socializing among friends, young people always opt to enjoy this stage of life. Along with the common practice of partying and smoking is the habit of drinking. Most parties held among young people cannot exist without the presence of alcoholic drinks and beverages, of all sorts, flavors, and mixtures. Apart from being one element of socializing tools, young people opt to drink of various reasons. At some point, young people drink because they want to create an atmosphere conducive for partying as well as socializing and getting to know other people through a couple of drinks, here and there. Another reason why young people drink is because of

8 the fact that drinking makes them assume that they are older and is able to feel that they are well in control of themselves. More so, drinking makes young people feel relaxed and at ease, especially when mingling with other people. (Plaza/ 2011)

Does Peer Pressure Influence Underage Drinking? D.A.R.E., Think First, Healthy Choices, Planned Parenthood, and overly manipulative anti-drug/alcohol commercials all proclaim that saying no, or walking away is the best and only way to navigate illegal substances. Teens, according to adults, are pressured by their peers and, in many circumstances, this proves to be true. However, thanks to those adults who so wisely guide us in the right direction, peer pressure, in regards to drinking, serves not to be a problem for the majority of Miramonte students. Society prohibits underage drinking, and because of that, teens want it. Teen drinking is hardly a problem in counties where drinking isnt taboo, as it is in our puritanical culture. The problem then lies in alcohol itself and accessibility, not the environment or desire for social acceptance. (Allen/ 2009)

How Peer Pressure Can Affect your Personal Health Peers are people that a child, adolescent or adult identifies with. A peer can influence, persuade and coerce you to do certain things or act a certain way in order to be accepted. Even though often perceived as negative, peer pressure can also affect a person in a positive manner. Your personal health can improve or decline depending on how you handle peer pressure. The pressure to drink alcohol can affect people of all ages. Teens

9 may be pressured into drinking by their alcohol-drinking peers and adults may feel pressure to drink during after-work social alcohol at a young age may affect brain and organ development and drinking can cause liver damage and liver failure in people of all ages. (eHow.com)

Peer Pressure, Parental Tolerance Contributes to Underage Drinking The study found that peer pressure to drink alcohol, along with an attitude of indifference and poor role modelling by adults is some of the top factors that area teens link to underage drinking. Other top survey results included a kids will be kids attitude adopted by adults, easy availability of alcohol, and greater acceptance of alcohol use than other drugs, and adults or older friends providing alcohol to teens. Coalition board members and BHS students Sarah Ewing and Brittany Younkman said these results confirmed their expectations. I expected most of the results, said Sarah, who also attends OHPCC. To see that peer pressure is influencing kids isnt surprising. (Loehr/ 2009)

Synthesis The following are the past studies that either have differences or similarities with this study. 1. Binge Drinking and Associated Health Risk Behaviors Among High School Students (Miller, Naimi, Brewer, and Jones/ 2007) focused more specifically on the

10 characteristics of underage binge drinkers and their associated health risk behaviors. Compared to this study, the researchers add another variable to be evaluated which is the academic performances of the respondents. 2. Drinking And Academic Performance in High School (DeSimone and Wolaver/ 2005) focused on the academic performance of the high school students associated with alcoholic drinking. Paralleled to this study, both has the same focus in terms of academic performances yet this study include another variable which is the

prevalence of health risk behaviors. Both also has the same respondents yet different place.

Conceptual Framework The independent variables are composed of the profile of the respondents which includes age, gender and year level, the influencing factors comprising peer, family, and media and the drinking status which are classified as heavy, moderate, and light drinkers. The independent variables may affect the early alcohol drinking of the respondents. The profile will serve as the baseline to be considered if the respondents belong to underage drinking which should be 13-17 years old. The influencing factors may contribute to the underage drinking behavior of the respondents while the drinking status will describe the type of drinkers the respondents belong.

11 The dependent variables are the academic performance and the health risk behaviors which will be the testing variables in the study wherein the underage drinking of the respondents may or may not influence the two.

Theoretical framework This will comprise all the relevant theories which may serve as basis in the conduct of the study. This will also provide the materials to be use in the study and in analysis of the study. According to Erik Eriksons stages of psychosocial development explain eight stages through which a healthily developing human should pass from infancy to late adulthood. In each stage the person confronts, and hopefully masters, new challenges. Each stages builds on the successful completion of earlier stages. The challenges of stages not successfully completed may be expected to reappear as problems in the future. In relation to the study, the respondents fall into the stage of Identity vs. Role confusion, ages 13-21 yet the respondents are 13-17 years old only. Identity is a special sort of synthesis of earlier stages and a special sort of anticipation of later ones. Youth is a time of radical change- the great body changes accompanying puberty, the ability of the mind to search ones own intentions of others, the suddenly sharpened awareness of the roles society has offered for later life. Adolescents are confronted by the need to re-establish [boundaries] for themselves and to do this in the face of an often potentially hostile world. This is often challenging since commitments are being asked for before particular

12 identity roles have formed. At this point, one is in a state of identity confusion, but society normally makes allowances for youth to find themselves. The problem of adolescence is one of role confusion. They think they dont have the sense of belongingness. Thats probably the reason why peer pressure is the most influential factor in this stage. To cope with what they called sense of belongingness, they try to adopt the behavior of their friends even its good or bad. According to Richard Evan's social inoculation theory extends McGuire's, and addresses social influences, beliefs, and attitudes that create pressure on a young person to use alcohol and other drugs. Such pressures include peer pressure or joining a group that exerts pressure on new, younger group members. Programs based on social inoculation theory teach students to resist social pressures. The popular "Just Say No" program is based on social inoculation theory. Students first are taught about the pressures that they can expect from peers to use alcohol and other drugs and then they are taught various ways to get out of uncomfortable peer pressure situations. In addition to instructing students to say "no," the "Just Say No" groups teach alternative responses, such as "I'm not interested." Many programs based on the social inoculation theory use modelling, as suggested by Bandura, to teach peer resistance skills. Others encourage public commitments from students as an added incentive to resist negative peer pressure. Social reinforcement often includes the entire group. Although results often are mixed in prevention evaluation, one point seems clear. Peer pressure is one of the most significant factors in alcohol use and abuse, and successful prevention strategies will address this fact. For instance, the most important correlate of beer drinking is peer influence,

13 followed by exposure to advertisements for beer. Peer influence has been found to have a significant impact on consumption levels and alcohol use behavior.

Statement of the Problem The major problem of this study is to determine the relationship of underage drinking to the prevalence of health risk behaviors and academic performance of high school students. It is supported with the following questions: 1. What is the profile of the respondents in terms of: Age Gender Year Level

2. How may the alcoholic drinking status of the respondents be described? 3. How does the following factors affect the current drinking status of the respondents: Peer Family Media

4. How may the following health risk behaviors be present among the respondents: Sexual behavior Tobacco use

14 Interpersonal violence Suicide Other drug use

5. How may the academic performance of the respondents in the following subjects be described in term of the GWA? English Mathematics Science

6. Is there a relationship between the drinking status of high school students when grouped according to: Academic performance Prevalence of health risk behaviors

Hypothesis of the Study Null Hypothesis. There is no significant relationship between underage drinking to the academic performance of the respondents. There is no significant relationship between underage drinking to the prevalence of health risk behaviors of the respondents.

Research Hypothesis. There is a significant relationship between underage drinking to the academic performance of the respondents. There is a significant

15 relationship between underage drinking to the prevalence of health risk behaviors of the respondents.

Operational Definition of Terms This part of the research may help the reader understand some key points and definition that used for the entire study.

Respondents. It refers to the high school students of Marcelo H. del Pilar National High School per year level, both male and female, aging 13-17 years old. Marcelo H. del Pilar National High School. It refers to the setting of the study. Peer. It refers to the factor that may affect the respondents alcoholic drinking behavior. Family. It refers to the factor that may influence the respondents drinking of alcohol. Media. It refers to the factor that may contribute to early alcoholic drinking of the respondents.

Scope and Delimitation The study focuses on the alcohol drinking status of the respondents in Marcelo H. del Pilar National High School (S.Y. 2012- 2013) ages 13-17 yrs. old that may or may

16 not affect the academic performance of the students in the subjects of English, Mathematics and Science and also to the prevalence of health risk behaviors including sexual behavior, tobacco use, interpersonal violence, suicide and other drug use. The study will be conducted for 2 months this year 2012. The datas will be gathered using questionnaires which serve as the main tool to determine the current drinking status of the respondents and other relevant information.

17 Chapter 2 Methodology This discusses the research locale, research design, population sampling or respondents of the study, research instrument, and the statistical treatment of data.

Research Design Research design is concerned with training a research question into a testing project. It has been considered a blueprint for research dealing with at least four problems: what questions to study, what data are relevant, what data to collect and how to analyze the results. The researchers made use of exploratory design defined as a type of research conducted for a problem that has not been clearly defined. Exploratory research helps determine the best research design, data collection method and selection of subjects. It is not typically generalizable to the population at large. It is flexible and can address research question of all types (what, why, how). Like this study, the researchers used exploratory research design in order to know if alcoholic drinking of students ages 13 to 17 has effect on the academic performance of the respondents and its health risk behaviors.

18 Research Locale The research will be conducted at Marcelo H. del Pilar National High School. The target respondents are composed of 50 students, male and female from first year to fourth year estimatedly. The total population is not yet gathered.

Population Sampling or Respondents of the Study Slovins Formula: n= N 1+N (a)2 The estimated target population is 200 students, 50 students per year level from first year to fourth year. In line with this, the respondents will be selected under the method of clustering wherein the study focuses on those who are drinkers only.

Data Gathering Procedure Data gathering was started by making a letter of permission to conduct a research about underage drinking. The researchers will be looking for 50 high school students per year level from first year to fourth year. Questionnaire will be used to facilitate data gathering. The researchers will explain the purpose of the study and procedure in answering questionnaires to the respondents. The questionnaire of respondents that will be classified as drinkers will be used for the study.

19 Researchers will making sure that all data and information that will be needed will be collected to cover all aspects of the problem. It was then analyze and tallied for the computations needed.

Research Instruments The researchers will use questionnaires to gather the data for the study.

Validation of the Instruments To validate the instrument constructed by the researchers, it was consulted to the researchers adviser, Ms. Joice Martin, RN.

20 Statistical Treatment of Data The data will be gathered, tabulated and prepared for the analysis using the following statistical expressions:

1. Frequency & Percentage Distribution will be used to determine the number of respondents falling under a particular category in relation to the total number of the respondents. Formula: % = (f x 100) N Where: % = percentage f = frequency N = total number of the respondent 2. Weighted Mean will be used to determine the mean status of the respondents in terms of the drinking status and academic performance of the respondents before and after the study. Formula: M= N Or X = fx N fw1 + fw2 + fw3 + fw4 + fw5 + fw6 + fw7.

Where:

M = mean fw = frequency multiply by weights N = total number of the respondents

21 3. Chi-square will be utilized to determine alcohol drinking behavior of the respondents to the prevalence of health-risk behaviors and academic performance. Formula:

= computed chi-square E = expected frequency O = observed frequency

22 References

www.ehow.com (). How Peer Pressure Can Affect your Personal Health. http://www.ehow.com/info_8670277_peer-can-affect-personal-health.html www.examiner.org (). Peer Pressure, Parental Tolerance Contributes to Underage Drinking. http://www.examiner.org/index.php?option=com_content&view=article&id=4617 :peer-pressure-parental-tolerance-contribute-to-underagedrinking&catid=34:local-news&Itemid=55 www.mhsmirador.com (). Does Peer Pressure Influence Underage Drinking? http://www.mhsmirador.com/opinion/2009/12/17/does-peer-pressure-influenceunderage-drinking-con/ www.pubs.niaaa.nih.gov (). What is Moderate Drinking? Defining Drinks and Drinking Levels. http://pubs.niaaa.nih.gov/publications/arh23-1/05-14.pdf Jacqueline W. Miller, Timothy S. Naimi, Robert D. Brewer, and Sherry Everett Jones (2007). Binge Drinking and Associated Health Risk Behaviors Among High School Students. http://pediatrics.aapublications.org/content/119/1/76.full.html www.knowswhy.com (2011) Why do young people drink? http://www.knowswhy.com/why-do-young-people-drink/

23 Anderson, de Bruijn, Angus, Gordon, Hastings (2008) Impact of Alcoholic Advertising and Media Exposure onAdolescent Alcohol Use: A Systematic Review of Longitudinal Studies http://alcalc.oxfordjournals.org/content/44/3/229.abstract

24 Appendix A Approval Letter

25 Appendix B Validation Letter

26 Appendix C Questionnaire

27 Joanna G. Cordova #211 Luwasan St. Guyong Sta. Maria, Bulacan 0926-319-0645 joannacordova25@yahoo.com

Educational Background: Elementary

Sta. Maria Ecumenical School Dr. T. Santiago St., Poblacion, Sta. Maria, Bulacan (1998-2005) Sta. Maria Ecumenical School Dr. T. Santiago St., Poblacion, Sta. Maria, Bulacan (2005-2009) Bulacan State University BS College of Nursing City of Malolos, Bulacan (2009 to present)

High School

College

Seminars Attended: Tabako Yoko: Anti-smoking and Public Health Advocacy Mariveles People Park, Mariveles, Bataan February 22, 2012 Membership to Organizations: Knightingale Society Member 2009 to present

28 Jhennie Shane I. Ilawan 1722 Mapayapa St. Sta.Cruz Village Sta.Maria, Bulacan 0916-924-6914 heartrules56_13@yahoo.com

Educational Background: Elementary

Sacred Heart Academy Poblacion, Sta. Maria, Bulacan (1998-2005) Sacred Heart Academy Poblacion, Sta. Maria, Bulacan (2005-2009) Bulacan State University BS College of Nursing City of Malolos, Bulacan (2009 to present)

High School

College

Seminars Attended: SakuNars: Heroes in the Midst of Danger Understanding Concepts on Emergency Nursing Management Bulacan State University-Hostel February 2, 2010 RN: Rich Na!- Achieving Prosperity through Nursing Entrepreneurship Bulacan State University- Hostel February 15, 2010 Tabako Yoko: Anti-smoking and Public Health Advocacy Mariveles People Park, Mariveles, Bataan February 22, 2012 Membership to Organizations: Knightingale Society Member 2009 to present

29 Zenaida R. Ligutan #10 Dr. Amparo St. Poblacion, Pandi, Bulacan 0916-151-4252 ligutanzenaida@yahoo.com

Educational Background: Elementary

Cong. Erasmo R. Cruz Memorial Central School Wakas, Bocaue, Bulacan (1998-2004) Best in Character Mamerto C. Bernardo Memorial Central School Poblacion, Pandi, Bulacan (2004-2005)

High School

Bunsuran National High School Bunsuran 1st, Pandi, Bulacan (2005-2009) Honor Student Bulacan State University BS College of Nursing City of Malolos, Bulacan (2009 to present)

College

Seminars Attended: SakuNars: Heroes in the Midst of Danger Understanding Concepts on Emergency Nursing Management Bulacan State University-Hostel February 2, 2010 Beyond Vital Signs Nursing Entrepreneurship Bulacan State University-Hostel February 22, 2010 Membership to Organizations: Knightingale Society Member 2009 to present

30 Eunice G. Olivarez 250 Frances, Calumpit, Bulacan 0905-942-1592 niz.8teen@yahoo.com

Educational Background: Elementary

F. Mendoza Memorial Elementary School Poblacion, Calumpit, Bulacan (1998-2005) Colegio de Calumpit (Formerly Calumpit Institute) Mc Arthur, Calumpit, Bulacan (2005-2009) Bulacan State University BS College of Nursing City of Malolos, Bulacan (2009 to present)

High School

College

Seminars Attended: Tabako Yoko: Anti-smoking and Public Health Advocacy Mariveles People Park, Mariveles, Bataan February 22, 2012 Membership to Organizations: Knightingale Society Member 2009 to present

31 Dhariel I. Rayo #0457 Porciuncula St. Cay Pombo Sta. Maria Bulacan 0906-848-1189 prince_yuki1029@yahoo.com

Educational Background: Elementary

Sta. Maria Elementary School Poblacion, Sta. Maria, Bulacan (1997-2005) Sacred Heart Academy Poblacion, Sta. Maria, Bulacan (2005-2009) Bulacan State University BS College of Nursing City of Malolos, Bulacan (2009 to present)

High School

College

Seminars Attended: SakuNars: Heroes in the Midst of Danger Understanding Concepts on Emergency Nursing Management Bulacan State University- Hostel February 2, 2010 RN: Rich Na!- Achieving Prosperity through Nursing Entrepreneurship Bulacan State University- Hostel February 15, 2010 Membership to Organizations: