Alcohol drinking pattern, socio-demographic risk factors, sleep problems, mental and perceived health in Hong Kong adolescents

Abstract

Although the associations of alcohol use disorder with sleep problems and mental health is well documented, the association of more moderate drinking with these consequences is less studied in adolescents. Little is known about the association between alcohol drinking and self-rated health in adolescents.

This thesis aims to investigate: (1) the prevalence and pattern of alcohol drinking, (2) the socio-demographic risk factors of current and binge drinking, and (3) the association of alcohol drinking with sleep problems, mental health problems, and self-rated health among an under-studied population of Chinese adolescents in Hong Kong.

This thesis is based on two cross-sectional surveys in adolescents. In a school-based alcohol survey in 2012-13, 23096 Secondary 1 (US grade 7) to7 students (mean age 14.7, SD 1.8; 52.1% boys) from 44 randomly selected secondary schools completed an anonymous questionnaire. Students reported the frequency, quantity, main alcohol type consumed, and other characteristics of drinking. Mental health was assessed using the Strengths and Difficulties Questionnaire (SDQ) consisting of 5 subscales (emotional symptoms, conduct problems, hyperactivity, peer relationship problems and prosocial activity) and the total difficulties score was the sum of the first 4 subscales. Adjusted odds ratio (AOR) and corresponding 95% confidence interval (CI) computed by multilevel regression was used to describe the associations of alcohol drinking with mental health problems and poor self-rated health (poor/very poor vs good/very good/excellent), adjusting for potential confounders. In the 2006-2007 Hong Kong Student Obesity Surveillance project, 33692 Secondary 1-7 students completed an anonymous questionnaire on lifestyles and health. Logistic regression was used to assess the association of less-than-weekly or weekly drinking (vs. nondrinking) with difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), early morning awakening (EMA), insomnia, difficulty breathing during sleep (DBS), and snoring. Multiple imputation were used to impute missing data. Over half (54.1%) the students were ever drinkers, including experimental drinkers (tried once or several times only: 37.5%), present drinkers regardless of frequency (13.6%), and former drinkers (2.9%). Current (past 30 days) drinking prevalence was 21.1%. Binge drinking in the past 30 days was 7.5% among all students, but 32.2% among current drinkers. Among current drinkers, beer was most commonly consumed (43.0%). Drinking most commonly occurred at home, during celebrations, and with friends. Generally, higher family affluence was associated with current drinking, binge drinking, and wine drinking. Less-than-weekly and weekly drinkers or binge drinkers were more likely to have an abnormal total difficulties score and report sleep problems including snoring, DBS, and insomnia. Alcohol drinking was more strongly associated with emotional symptoms and hyperactivity in girls than in boy, and was positively associated with poor SRH in girls only. Current drinking prevalence was 21.1% among Hong Kong adolescents. Generally, those who were older and had higher socioeconomic status were more likely to be current and binge drinkers. Drinking regardless of frequency, and binge drinking were associated with higher risk of mental health problems and sleep problems. Further prospective studies are warranted to ascertain these associations.