Understanding conversations about alcohol between parents and their 15-17 year olds: a qualitative study.

BACKGROUND: There is an increasing awareness that parents can play an important role in shaping their children's attitudes towards alcohol and use of alcohol. However, there has been little research exploring the conversations parents have with their children about alcohol. The present study aims to address this gap by exploring conversations between parents and their 15-17 year old children. METHODS: Using a cross-sectional qualitative design, recruitment took place over two phases to allow a purposive maximum variation sample of parents and young people. Sixty-four participants (n = 48 parents; n = 16 young people aged 15-17 years) took part in semi-structured interviews. The sample was diverse and included participants from throughout the United Kingdom. Thematic analysis was used to analyse the data separately for all parents and 16 matched parent-child pairs. RESULTS: The parents' findings were summarised within the following thematic areas: 1) style of conversation; 2) triggers to conversations; 3) topics conveyed during conversations; and 4) supervision of child's alcohol consumption. Most parents were comfortable talking to their children about alcohol. It was considered that open and honest conversations helped demystify alcohol for young people. Most conversations that parents had with their children were brief and informal and a wide range of triggers to these conversations were reported. There was some indication that as children got older conversations became more frequent and more focused on safety. Overall, the matched parent-child interviews were very consistent regarding levels of child drinking, conversation starters, and topics discussed. However, in some cases parents underestimated their child's need and desire for further conversations about alcohol. CONCLUSIONS: Most parents felt comfortable having conversations with their older children about alcohol. However, parents also wanted more support with having these conversations, particularly about how to start a conversation and what to talk about. This study provides several recommendations to help parents have an open conversation about alcohol with their children. For example, brief, informal chats seem to be the most appropriate way of speaking to children about alcohol compared to a more formal, "sit-down" style of conversation.

Listening for commissioning: A participatory study exploring young people's experiences, views and preferences of school-based sexual health and school nursing.

AIMS AND OBJECTIVES: To explore the experiences, views and preferences of young people aged 11-19 years regarding school-based sexual health and school nursing to inform commissioning and delivery for one local authority area in England during 2015. BACKGROUND: Promoting sexual health for young people remains a challenging, even controversial, but important public health issue. Concerns regarding accessibility, acceptability and efficacy in school-based sexual health and school nursing are evident in the literature. Additionally, a complex public health policy context now governs the funding, provision and delivery of sexual health and school nursing, which potentially presents further challenges. DESIGN: A qualitative, participatory design was used to explore sexual health and school nursing. Data were generated from 15 focus groups (n = 74), with young people aged 11-19 years, in educational-based settings in one local authority area in England. RESULTS: The resultant themes of visibility in relation to sexual health education and school nursing revealed both the complex tensions in designing and delivering acceptable and appropriate sexual health services for young people and the significance of participatory approaches. CONCLUSION: Our study shows the importance of participatory approaches in working with young people to clearly identify what they want and need in relation to sexual health. The findings also confirm the ways in which school-based sexual health remains challenging but requires a theoretical and conceptual shift. This we argue must be underpinned by participatory approaches. RELEVANCE TO CLINICAL PRACTICE: School nurses have always had a significant role to play in promoting positive sexual health for young people and they are exceptionally well placed to challenge the risk-based cultures that frequently dominate school-based sexual health. A shift of debates and practices towards the promotion of positive sexual health cultures though previously argued for now requires the active engagement and involvement of young people.

Parent-child conversations associated with alcohol-related risk behaviours in young people (13-17 years) in the UK: a cross-sectional study.

OBJECTIVE: To investigate different types of parent-child conversations associated with young people's (13-17 years) alcohol-related risk behaviours. DESIGN: Secondary analysis of the 2016 Drinkaware Monitor Survey. This survey employed a cross-sectional design and collected data using self-completion questionnaires. SETTING: UK-wide. PARTICIPANTS: 561 parent-child pairs were included in the analysis. The nationally representative quota sample was weighted by reference to the UK population. METHODOLOGY: Data were analysed using purposeful selection modelling (adjusted OR (AOR), 95% CIs). RISK BEHAVIOURS: 'Whether have ever drank' and 'whether vomited as a result of alcohol'. RESULTS: 50% (277/553) of young people reported drinking a whole alcoholic drink, and 22% (60/277) of these experienced vomiting as a result. After adjusting for age and gender, the likelihood of ever having drank alcohol was significantly increased among the following young people: those whose parents believed they knew a little about how much they drink (AOR 1.80, 95% CI 1.04 to 3.13) or that some/most/all friends drink (AOR 3.82, 95% CI 2.40 to 6.08); those given gentle reminders about taking care when drinking alcohol (AOR 1.82, 95% CI 1.15 to 2.88), practical advice (AOR 2.09, 95% CI 1.20 to 3.64) or designated time, led by the parent, to instil care around alcohol through a formal sit-down (AOR 1.79, 95% CI 1.07 to 2.99). The likelihood was reduced for parents aged 40-49 years (AOR 0.52, 95% CI 0.31 to 0.89) and conversations providing information (AOR 0.53, 95% CI 0.29 to 0.98). Vomiting was significantly associated with some/most/all friends drinking alcohol (AOR 3.65, 95% CI 1.08 to 12.30), parent's beliefs about child's frequency of drinking alcohol (AOR 1.26, 95% CI 1.02 to 1.54), parental harmful/dependency drinking (AOR 3.75, 95% CI 1.13 to 12.50) and having a formal sit-down conversation (AOR 2.15, 95% CI 0.99 to 4.66). CONCLUSIONS: We found evidence of mostly negative associations between young people's risk behaviours and different types of parent-child conversations. Conversations providing information were linked to a reduced tendency to have ever drunk alcohol. All other types of conversations were negatively associated with risk behaviours. Psychological reactance and conversation quality possibly explain these findings.

Pathways for practice and policy to reduce adolescent alcohol abuse: interpretations from a qualitative study.

This paper highlights pathways for practice and policy to reduce alcohol abuse among adolescents aged 14-17 years. These pathways have been generated following a qualitative study in England that explored adolescents' motivations for binge drinking and the associated outcomes. There are three distinct pathways under consideration. Firstly, the research clearly evidences the close link between binge drinking and an array of risky outcomes, thus supporting policies that tackle generic risk taking (such as Youth Development Programmes). Secondly, given the widely reported positive motivations for binge drinking, adopting a harm-minimisation approach may be more appropriate than promoting abstinence. This harm-minimisation approach can build on strategies reported by adolescents (such as drinking in groups) and consider safer, more supervised venues for adolescent drinking. Thirdly, this study highlights key risk groups, which would arguably be in greater need of harm-minimisation strategies. These were adolescents who drank primarily for the 'buzz', and also those younger age groups (particularly 14 and 15-year-olds) whose drinking was mostly confined to unsupervised, often outdoor locations. This was in contrast to slightly older age groups who, although illegally, were often able to access licensed premises which exerted more control over their drinking. The paper closes by referencing some of the wider policy issues, which must be taken into consideration when attempting to change the culture of binge drinking in England. These include issues surrounding the advertising and marketing of alcohol, the provision of alcohol education in schools and the promotion of alternative, safer activities for adolescents.

Fourteen to 17-year-olds' experience of 'risky' drinking--a cross-sectional survey undertaken in south-east England.

In the UK, young people's alcohol consumption is considered an important social and health problem, and is the focus of government strategy and intervention. There is widespread concern that many young people are drinking in a 'risky' way. That is, they are often drinking large amounts of alcohol in a single session, in unsupervised locations. This small-scale, quantitative study used a shortened adaptation of the Adolescent Alcohol Expectancy Questionnaire (AEQ) to examine 14-17-year-olds' experience of 'risky' drinking. The results suggest that a major transition towards first ever drunkenness occurs between the ages of 14 and 15. Young people of this age are more likely to be getting very drunk in unsupervised, and potentially more harmful, locations. It is suggested that using this questionnaire could offer the potential to obtain a rapid and reliable indication of young people's propensity towards possible alcohol-related harm.

Sexual health knowledge, attitudes and behaviours: variations among a religiously diverse sample of young people in London, UK.

OBJECTIVE: To report young people's variations in sexual health knowledge, attitudes and behaviours by religious affiliation. DESIGN: A cross-sectional, questionnaire-based survey administered in 16 Secondary/High schools in London, UK. The sample consisted of 3007 students in school Years 11-13 (aged 15-18), present in school on the day of questionnaire administration. Excluding those who described themselves as 'Other religious', 15.9% (n=418) described themselves as having no religious affiliation, 36.3% (n=957) were Christian, 25.8% (n=679) were Muslim and 22.1% were Hindu (n=582). The religious affiliation varied within and across different ethnic groups. METHOD: Self-administered questionnaire completed under 'exam' conditions, either in tutor groups or a school hall. The 30-minute questionnaires were distributed and collected by a team of ethnically and religiously diverse fieldworkers. RESULTS: Religious students, as opposed to those reporting no religious affiliation, generally reported poorer sexual health knowledge, and were more conservative in their attitudes to sex. Among males and females, those with no religious affiliation and Christian students reported the highest prevalence of sexual intercourse by some margin (around 20 percentage points) over the Hindus and Muslims. Christian males most frequently reported sexual intercourse at 49.7%, and Muslim females the least at 9.0%. Among those reporting sexual intercourse, risk behaviours among all religious and non-religious students were evident. Over one-third of Muslim females who had sexual intercourse did not use contraception on their first occasion compared to 10% of those with no religious affiliation, 12% of Christians and 20% of Hindus. Christian and Muslim females reported the highest prevalence of ever not using contraception at 55%, and non-use of contraception with two or more sexual intercourse partners at 14%. CONCLUSION: The findings demonstrate diverse sexual health knowledge, sexual attitudes and sexual behaviours among young people with different religious affiliations. These variations demonstrate the importance of tailoring health education and promotion interventions to meet the specific needs of young people from a variety of different religions. The challenge ahead is to find ways to work with these young people to broach such sensitive issues.

Girls and young women's participation in physical activity: psychological and social influences.

The importance of increasing young women's level of physical activity is recognized as a priority within the United Kingdom and other Westernized nations. This study, conducted in two distinct geographical locations in the United Kingdom, explores the leading influences upon levels of physical activity participation among 75 young women aged 15-19. Through in-depth interviews, this study explores the influence of psychological and social influences, by examining contrasting accounts from those young women who 'always' and 'never' participate in sport or physical activity. The main differences lie with the always participates, relative to the never participates, reporting more positive images of 'sport', positive perceptions of their own ability, low self-consciousness, firm motivations and personal choice to engage in activities and the supporting influence of their friends and family. The study also notes the detrimental impact of life transitions such as moving from college to full-time employment. Further case study analyses reveal the friendship group as the primary influence over all other factors considered. The research concludes by summarizing the influences on physical activity participation that are pertinent to this age group, highlights theoretical implications, suggests possible intervention strategies and reports areas of further investigation that are required.

Experience of sexual intercourse and reported risk behaviour among an ethnically diverse sample of young people.

BACKGROUND: Certain Black and Minority Ethnic (BME) groups have been identified as bearing a disproportionate burden of sexual ill health in the UK. There still exists a significant gap in the evidence-base concerning the sexual behaviours of BME youth. METHODS: We conducted a cross-sectional survey of 16 secondary schools in London, where the proportion of BME students exceeded two-thirds of the intake. The aim was to identify the factors associated with sexual intercourse and sexual risk behaviours. RESULTS: 2801 students aged 15 to 18 completed questionnaires. Compared with White British males, Black males were significantly more likely to report sexual intercourse (OR 3.04, 95% CI 1.92-4.81). Compared with White British females, Asian females were significantly less likely to report sexual intercourse (OR 0.43, 95% CI 0.27-0.69). Both sexes reporting school as their main source of information, as opposed to their family, had a lower likelihood of intercourse (males OR 0.33, 95% CI 0.21-0.53, females OR 0.39, 95% CI 0.25-0.62). Compared with White British males, contraceptive use at first ever intercourse was significantly less likely among Black males (OR 0.35, 95% CI 0.16-0.98) and males of Mixed ethnicity (OR 0.24, 95% CI 0.06-0.92). Among females, higher sexual health knowledge was associated with contraceptive use (OR 4.69, 95% CI 1.76-12.49). Males reporting higher sexual health knowledge were more likely to be 'sexually competent' at first ever intercourse (OR 2.28, 95% CI 1.10-4.69). CONCLUSIONS: Given the importance of sexual health knowledge, ensuring this is improved among all ethnic groups, especially the Black and Mixed male groups, is a key message to arise from this study. Delivering this information in a 'culturally competent' manner is an important goal.

Accessing research participants in schools: a case study of a UK adolescent sexual health survey.

While methods and results of school-based studies have been reported widely in the literature, little published information exists on the practical aspects of recruiting schools and students into a study. This paper reflects on the experiences of a UK-based sexual health survey among 3007 students aged 15-18 years. The survey explored beliefs, attitudes and behaviours in relation to sexual health. This case study highlights significant aspects of planning and conducting successful large-scale research in schools, focusing on the process of conducting the research rather than outcomes. As such, the paper will benefit those intending to sample a school-based population. The key features of effective and feasible research in schools are outlined in four areas: (i) adopting suitable research tools, (ii) selecting and contacting schools, (iii) selecting students within schools and (iv) the importance of fieldworkers. On-site and post-data collection feedback from teachers are incorporated into the discussion of good practice in partnership working with schools and students in research. We conclude by discussing fieldwork experiences and outlining key recommendations for researchers across disciplines engaging in school-based studies.

A qualitative study of the relationship between alcohol consumption and risky sex in adolescents.

This study examined how alcohol consumption over a single session can affect the likelihood of risky sex in adolescents. Risky sexual behavior, as defined in this study, included sexual intercourse without the use of contraception or aNY sexual behavior that was subsequently regretted. In-depth interviews were conducted with 64 adolescents (aged 14-17 years). Data were analyzed following the principles of Interpretative Phenomenological Analysis. The impact of alcohol consumption upon risky sexual behavior was found to operate through a "continuum of influence." The 5 effects or explanations within this continuum, possibly determined through the level of inebriation, are summarized as follows: (1) alcohol affecting young people's assessment of a person's sexual attractiveness; (2) alcohol used as an "excuse" for socially unacceptable behavior; (3) increased confidence and lowering of inhibitions; (4) impaired judgment in accurately recognizing and controlling a potentially risky situation; and (5) complete loss of control, memory loss, and "black-out." These explanations were ordered with increasing significance. That is, impaired judgment (Explanation 4) and complete loss of control (Explanation 5) arguably represented the most significant effects of drinking alcohol upon risky sexual behavior. For those participants who reported both risky and non-risky sexual behavior, risky events were more likely to occur when alcohol consumption had increased and when the impaired judgment and complete loss of control explanations were applicable. The implications of understanding this complex relationship are outlined, and they will be of interest to academics, practitioners, and policy-makers in the alcohol and sex fields.

The measurement of puberty: a review.

This paper has two main objectives. Firstly, to review the feasibility and validity of the various methods that have been used to measure puberty. With an appreciation of these measurement issues, the second objective is to summarize the evidence-base as to whether the age at menarche and the age at onset of puberty has decreased in recent years. In consideration of these methodologies, all of which report different levels of reliability and validity, it is only possible at present to draw inferences about possible changes in pubertal age and onset. Moreover, the wide variations in sample size, selection of participants (usually non-random), and study design reported in the reviewed studies have compounded this situation further. The paper closes by providing a summary of the findings which will be of relevance to those intending to critically review the current evidence surrounding age of puberty, as well as those set on carrying out future research into this area.