Daily Tobacco Consumption and Binge Drinking in Roma Adolescents in Three Spanish Areas

3 Revista de cercetare [i interven]ie social\ ISSN: 1583-3410 (print), ISSN: 1584-5397 (electronic) Selected by coverage in Social Sciences Citation Index, ISI databases DAILY TOBACCO CONSUMPTION AND BINGE DRINKING IN ROMA ADOLESCENTS IN THREE SPANISH AREAS Carmen MENESES FALCÓN, Eugenia GIL GARCÍA, Arantxa RODRÍGUEZ BERRIO Revista de cercetare [i interven]ie social\, 2014, vol. 44, pp. 132-146 The online version of this article can be found at: www.rcis.ro, www.doaj.org and www.scopus.com Published by: Expert Projects Publishing House On behalf of: „Alexandru Ioan Cuza” University, Department of Sociology and Social Work and Holt Romania Foundation REVISTA DE CERCETARE SI INTERVENTIE SOCIALA is indexed by ISI Thomson Reuters - Social Sciences Citation Index (Sociology and Social Work Domains) Working together www.rcis.ro expert project s publishin g 132 REVISTA DE CERCETARE SI INTERVENTIE SOCIALA - VOLUME 44/2014 Daily Tobacco Consumption and Binge Drinking in Roma Adolescents in Three Spanish Areas Carmen MENESES FALCÓN1, Eugenia GIL GARCÍA2, Arantxa RODRÍGUEZ BERRIO3 Abstracts The objective of the study is to explore tobacco and alcohol consumption amongst Roma adolescents, indicating any differences according to gender and geographical area (Andalusia, Madrid and the Basque Country). It was made a transversal study via a school survey comprising 569 Roma adolescents, registered in Secondary Education and ranging from 12 to 18 years of age. The data was collected between January and June 2011. The variables were: socio-demographic, religious beliefs, practice of sports, tobacco and alcohol consumption, and consumption context (peers, partner, and parents). The main results were that 16.2% of Roma adolescents smoked daily and drunk five or more alcoholic drinks (binge drinking) on the last occasion. Smoking on a daily basis was associated to being a boy, a parent that smokes, a partner that smokes and friends that smoke. Being a boy, getting drunk and having been to a botellón (social drinking in the street) increase the likelihood of binge drinking. Sports and religious factors were not associated to daily smoking or binge drinking. Therefore the Roma adolescent boys are at greater risk than girls of smoking daily and binge drinking, there being gender differences in intensive tobacco and alcohol consumption, but not in the general use of these substances. A smoking parent is associated to a greater risk of Roma boys smoking, and going to a botellón or getting drunk is associated to a greater risk of binge drinking. It is necessary to bear in mind the ethnic variable in educative socio-sanitary interventions. Keywords: Roma; ethnicity; adolescents; alcohol; tobacco; Spain. 1 Universidad Pontificia Comillas, Department of Sociology and Social Work, Madrid, SPAIN. Email: [email protected] (corresponding author) 2 Universidad de Sevilla, Department of Nursing, Seville, SPAIN. E-mail: [email protected] 3 Universidad de Deusto, Department of Social Work and Sociology, Bilbao, SPAIN. E-mail: [email protected] Working together www.rcis.ro 133 Introduction It is thought that the population pertaining to the Roma ethnic minority in Spain is close to 600,000 people (Fundación Secretariado Gitano, 2007), around 1.3% of the total Spanish population, distributed very heterogeneously in the Spanish territory. Amongst them we can identify two different collectives: those who have been settled in Spain for a long time, or in other words, their origin goes back to the first migratory movements that date from the 16th century, and are therefore indigenous Roma (Gamella, 1999), and those coming from recent migratory movements from Eastern Europe. In general, it is an ethnic group with living and health conditions that are different to the majority population with which it coexists, with unequal access to health services and sanitary assistance (Fundación Secretariado Gitano, 2009). There are few investigations concerning the health conditions of the Roma population in the European context. The data indicates that it is a population that lives in precarious living conditions, that has unhealthy alimentary habits and that underutilizes the primary assistance services (Hajioff & McKee 2000, Cabedo 2000, Zeman et al. 2003, Ferrer, 2003). Too frequently, their homes lack sewer systems and running water and they are located in impoverished areas. They have poorly balanced diets and exercise rarely compared to the majority population. They have a greater alcohol and tobacco consumption and a lower use of contraception methods. A lack in preventive activities related to accessing health services can also be noted. This all favors a greater infant mortality rate and a decrease in life expectancy which is 10 years less than that of the society with which they coexist (Hajioff & McKee, 2000). Many authors consider this group to be culturally different to the rest of the population. This group is characterized as being younger, having a lower level of education and high levels of school failure and unemployment, a high fertility and birth rate and a greater gender gap than that of the majority group (Calvo, 1990; San Roman, 1997; Gamella, 2000; Ferrer 2003). Despite the population being eminently young, there are few studies concerning Roma youths and adolescents. Numerous investigations show that, amongst the general population, adolescence is the time when the consumption of drugs, especially alcohol and tobacco is commonplace (Díez, 1998; Ariza, 2003; Observatorio Español de Drogodpendencias, 2009). However, we do not know how the consumption of psychoactive substances is distributed amongst Roma adolescents since the investigations carried out do not consider the cultural differentiation, and this is despite the acculturation and intercultural processes indicating that drug consumption and the circumstances associated to it vary according to ethnic groups (Blum et al. 2000, Best et al. 2001, Meneses et al, 2009). It has been considered that Roma adolescents smoke more than their non Roma counterparts REALITIES IN A KALEIDOSCOPE 134 REVISTA DE CERCETARE SI INTERVENTIE SOCIALA - VOLUME 44/2014 (Gerevich et al. 2010) and that this could be explained by the values associated to tobacco consumption amongst males (Petek et al. 2006). On the other hand, it has been shown that religious beliefs can be a protective factor in drug consumption (Engs & Mullen 1999), as are sports activities (Werch et al. 2003, Delisle et al. 2010). However, we do not know if these factors could offer protection or not to this ethnic group, who has a large religious affiliation to the evangelical church (Gamella, 1999). According to the latest School Population Survey (OED 2009), 38.1% have smoked during the last year, 72.9% have drunk alcohol; 30.5% have smoked hashish and 47% have gotten drunk in the last year. Is this data applicable to Roma youths and adolescents? Does ethnic identification influence in intensive drug consumption? Is it necessary to bear cultural differences in mind when designing prevention programmes against drug consumption? These and other questions have guided our objectives in this investigation. The objective of this study is to explore those factors associated to daily tobacco consumption and binge drinking amongst Roma adolescent boys and girls, which will enable the formulation of preventive interventions adapted to their culture. Methods Study design Transversal study via school survey carried out between the January and July 2011 on students of Compulsory Secondary Education in Andalusia, Madrid and the Basque Country. The survey was authorized by the selected education centers. Participants and data collection Initially the idea was to use simple random sampling as a model. Based on the Mapa de viviendas de la Comunidad gitana (Map of Roma Community homes) in Spain in 2007 (Fundación Secretariado Gitano 2007), we estimate that there are about 48,000 Roma children registered in ESO (Compulsory Secondary Education) throughout Spain, with about 22080 in Andalusia, 4800 in Madrid and 1056 in the Basque Country, given the population in each Autonomous Community. Considering a sample size of 500 Roma adolescents, estimating the sample sizes for p=q=0.5 we would get a sampling error of 4.4% with a 95% confidence interval. If we were to carry out a sample proportional to the size of each community, calculated proportionally, the corresponding quotas in each community would be: in Andalusia n=395, in Madrid n=86 and in the Basque Country n=19. This size was used as a minimum reference for obtaining the sample, although the 135 sample obtained was from 580 Roma adolescents distributed in the following way: 319 in Andalusia, 164 in Madrid and 97 in the Basque Country, which globally in the three communities reduces the sampling error to 4%, with a 95% confidence interval. The final sample comprised 569 Roma adolescents, since 11 questionnaires were discarded for not fulfilling the criteria established. The type of sample carried out in the end was intentional, as it was not possible to find a census which could be used to perform the random selection. We found those education centers with a greater concentration of Roma adolescents with the help of the Fundación Secretariado Gitano. To collect the greatest number of questionnaires we contacted the directors and education advisors in the centers of each geographical area and they confirmed the high percentage of registered students. The questionnaire was completed by all students in the selected classes and later the team selected those students who self-identified themselves as Roma for the sample, that is to say, the students themselves placed themselves in one of the ethnic groups offered to them (Asian, Black, Mixed, White, Roma, Other). The instrument for collecting the information was a confidential questionnaire filled out individually which was validated in a previous investigation. However, some modifications were made to it and before using it two discussion groups were held with adolescents and a pretest trial was performed in an education center that was not included in the sample and which served to assess these modifications. Education centers informed parents of the investigation and were entrusted with gathering permission forms. The data was collected in the classes by the researchers themselves, helped by the survey takers. Filling out of the questionnaire was supposed to take 40 to 45 minutes, but many Roma adolescents showed reading-writing problems, needing to be helped personally by the researchers or survey takers. Study variables The questionnaire covered different risk behaviors, but in this article we will only set out those related to tobacco and alcohol consumption. The variables of the study were collected for the previous year, except in the case of tobacco where they were also asked if they smoked at that moment. A religious factor was included with six variables to describe their situation with regards to religious beliefs (My religion is very important to me, I consider myself a believer, My religious beliefs influence my actions, I obey the commandments of my religion, I pray every day, I enjoy being with other people who are as religious as I am) with four possible answers (Strongly agree, agree, disagree, strongly disagree), with a Cronbach’s alpha of 0.906. The dependent variables were dichotomized for analysis. Information was gathered regarding the number of alcoholic drinks (glasses, mixed drinks, and alcoholic drinks) consumed on the last occasion and this was divided into two intervals: less than 5 alcoholic drinks and 5 or more alcoholic REALITIES IN A KALEIDOSCOPE 136 REVISTA DE CERCETARE SI INTERVENTIE SOCIALA - VOLUME 44/2014 drinks (binge drinking). The frequency of tobacco consumption was recorded (Never, A few times a year, Two or three times a week, At weekends, and Daily) and from this variable a dichotomous variable was derived (smokes daily or doesn’t smoke daily). Data analysis In order to test the independence of variables, a Chi-Square test or t-test was used in bivariate analysis. Logistic regression models were constructed separately for each type of consumption studied (daily smoking and binge drinking). Prevalence odds ratios (OR) were calculated with their corresponding 95% confidence intervals (95%CI). For all analysis, a level of significance of 5% was considered. These analyses were conducted with SPSS statistical package version 17. Results The age range of the students was from 12 to 18 years old, with a median and modal average of 15 years old. Table 1 shows socio-demographic data from the sample of boys and girls, which is similar in the three autonomous communities. It is noteworthy that 52.7% have repeated the school year and 59.6% planned to continue studying. Tobacco and alcohol consumption found in the sample is displayed in Table 2, showing the differences in each Autonomous Community where data was collected. There were no statistically significant differences between boys and girls in tobacco consumption at the time of the survey (p= 0.140), nor in alcohol consumption during the past year (p=0.679). We found statistically significant differences between boys and girls in couples that smoked (p=0.000), with that of girls being greater (48%) than that of boys (19.6%); and in the option of a group of friends in which all smoke (p=0.004), since it was less common for girls to have an all-smoking group of friends (7.3%) whereas it was more common for boys to have an all-smoking group of friends (14.1%). 137 Table 1. Roma adolescents socio-demographic data a) X= Average, SD= Standard deviation Total (n=569) Andalusia (n=314) n(%) Madrid (n=164) n(%) Basque Country (n=91) n(%) Boys Girls 294 (51.9) 272 (49.4) 159 (50.6) 155 (49.4) 94 (58.0) 68 (42.0) 41 (45.6) 49 (54.4) Age (X and SD)a 14.84 (1.30) 14.96 (1.39) 14.68 (1.14) 14.79 (1.25) 1st ESO 2nd ESO 3rd ESO 4th ESO Vocational Qualification Programmes 269 (47.7) 167 (29.6) 70 (12.4) 50 (8.9) 8 (1.4) 134 (42.7) 91 (29.0) 52 (16.6) 32 (10.2) 5 (1.6) 98 (59.8) 48(29.3) 5 (3.0) 10 (6.1) 3 (1.8) 37 (43.0) 28 (32.6) 13 (15.1) 8 (9.3) - Financial situation -Very comfortable financially -We do not have financial problems -Lots of financial problems 146(27.1) 278(51.7) 114(21.2) 85(28.5) 155(52.0) 58(19.5) 43(27.9) 81(52.6) 30(19.5) 18(20.9) 42(48.8) 26(30.2) Type of dwelling -Flat -House -Shack -Chalet -Other 393 (69.2) 128 (22.5) 16 (2.8) 27 (4.8) 4 (0.7) 193 (61.7) 97 (31.0) 5 (1.6) 16 (5.1) 2 (0.6) 119 (72.6) 27 (16.5) 9 (5.5) 9 (5.5) 81 (89.0) 4 (4.4) 2 (2.2) 2 (2.2) 2 (2.2) Average no. of people living with him/her (X and DS)a 4.48 (1.82) 4.18 (1.82) 5.03 (2.08) 4.55(1.90) Has repeated a school year Wants to continue studying 303 (54.7) 328 (59.6) 164 (53.4) 193 (63.9) 95 (60.5) 72 (45.6) 44 (48.9) 63 (70.0) Religious factor (X and SD)a 0.256 (1.14) - 0.048(1.15 ) 0.595(1.04) 0.777(0.89 ) Usually lives with father Usually lives with mother 445 (78.6) 504 (88.9) 234 (75.0) 276 (88.5) 138 (84.1) 153 (93.3) 73 (81.1) 75 (82.4) REALITIES IN A KALEIDOSCOPE 138 REVISTA DE CERCETARE SI INTERVENTIE SOCIALA - VOLUME 44/2014 Table 2. Use of drugs in the last 12 months n(%) a) X= Average, SD= Standard deviation. There were no differences in drinking alone several times in the last year (p=0.064), nor in the family context of consumption (p=0.235), nor in getting drunk (p=0.470). 16.2% (n=92) smoked daily and this same percentage admitted to binge drinking at the last occasion they had. In both behaviors we found significant differences between genders. Firstly, in binge drinking at the last occasion (p=0.000), 12.5% (n=26) of girls compared to 28.3% (n=66) of boys. Secondly, there was a significant correlation (p=0.011) found in daily smoking, with 21.7% (n=59) of boys smoking daily in comparison to 13.2% (n=33) of girls. Table 3 shows the results obtained from the bivariate analyses of the two behaviors analyzed (smoking daily and binge drinking), broken down for boys and girls. Table 4 shows the results obtained from the binary logistic regression analysis for each behavior studied. Being a boy or having a partner, parent or friends who smoke are all significant risk factors for smoking daily. It is worth nothing that having friends who smoke can make it fourteen times more likely to smoke daily, whilst other variables make it nearly three times more likely. Practicing sport and Drugs Total N% Andalusi a N% Madrid N% Basque Country N% p Smokes at the time of the survey 113 (21.1) 61 (20.2) 31 (21.2) 21(23.9) 0.758 No. cigarettes (X and SD)a 10.04 (8.95) 7.44(7.23) 12.04(10.54 ) 12.71(8.51) 0.022 Daily 92 (17.6) 37 (12.6) 32 (22.4) 23 (26.1) 0.013 Parents smoke Parent that smokes Father Mother 335 (62.9) 278(48.9) 127(22.3) 194 (64.9) 148(47.1) 95(30.3) 83 (56.8) 77(47.0) 20(12.2) 58 (65.9) 53(58.2) 12(13.2) 0.209 0.148 0.000 Partner All friends 108 (32.6) 59 (11.1) 59 (32.1) 20 (6.7) 25 (26.6) 25 (17.2) 24 (45.3) 14 (15.9) 0.066 0.000 Alcohol 315 (65.2) 177 (63.7) 89 (64.0) 49 (74.2) 0.253 Alcohol consumption context With family Outside of family 246(43.2) 200(35.1) 130(41.4) 124(39.5) 73(44.5) 43(26.2) 43(47.3) 33(36.3) 0.566 0.015 Drinks alone often 72 (14.4) 38 (13.5) 21 (15.6) 13 (15.7) 0.807 No. of drinks on last occasion (X and SD) 2.58 (3.87) 2.26(2.64) 2.81(4.67) 3.70(6.27) 0.035 Has drunk at a botellón 211(43.9) 131(45.5) 44(36.1) 36(50.7) 0.097 Has got drunk 217(42.5) 122(43.0) 56(40.3) 39(44.8) 0.781 Binge drinking on last occasion 92(20.8) 50(18.5) 27(22.5) 15(28.3) 0.237 139 the religious factor were not significant, although they did represent a negative coefficient. With regards to binge drinking, established as consuming five or more drinks, once again being a boy and going to a botellón4 to drink and get drunk are significantly related to this type of alcohol consumption, noting particularly that going to a botellón entails it being five times more likely to binge drink. Table 3. Daily tobacco consumption and binge drinking by gender BOYS N(%) N=294 (51.9) GIRLS N(%) N=272 (49.4) total Smokes Daily 59(20.1%) p total Smokes Daily 33(12.1%) p No. cigarettes (X and SD)a 12.8(9.726) 14.1(9.53) 0.007 6.23(6.05) 8.55(6.54) 0.000 Parents smoke Father smokes Mother smokes 165(56.1) 136(46.3) 64(21.8) 45(78.9) 61(22.4) 15 (25.4) 0.001 0.003 0.533 168(61.8%) 26(81.3) 23(69.7) 17(51.5) 0.000 0.041 0.000 Partner Friends None Some Nearly all 36(12.2) 57(19.4) 128(43.5) 87(29.6) 16 (33.3) 1(1.8) 15(26.8) 40(71.4) 0.007 0.000 72(26.5) 75(27.6) 133(48.9) 51(18.8) 20(80) 1(3) 14(42.4) 18(54.5) 0.000 0.000 Religious factor (X and SD)a 0.253(1.08) 0.317(0.99) 0.546 0.25(1.21) 0.24(1.26) 0.020 Practices sport 253(86.1) 49(87.5) 0.736 112(41.2) 16(48.5) 0.430 Total N Binge drinking 66(22.4%) p Total N Binge drinking 26(9.6%) p Drinks alcohol With family Outside of family 122(41.4) 109(37.1 35(53.0) 40(60.6) 0.061 0.000 123(45.2) 90(33.1) 18(69.2) 17(65.4) 0.021 0.000 Drinks alone often 44(15) 17(27) 0.002 27(9.9) 6(25) 0.000 Nº of drinks on last occasion (X and SD) 3.32(4.81) 8.86(5.77) 0.000 1.7(2.17) 6.01(1.28) Has drunk at a botellón 124(42.2) 49(77.8) 0.000 86(31.6) 20(87) 0.000 Has got drunk 115(39.1) 43(74.1) 0.000 101(37.1) 16(64) 0.005 Religious factor (X and SD)a 2.88(0.32) 0.18(1.09) 0.734 0.256(1.21) 0.17(1.21) 0.989 Practices sport 253(86.1) 61(92.4) 0.604 112(41.2) 9(34.6) 0.270 4 “The botellón phenomenon usually starts as a group of adolescents or young people, who are friends, buying alcoholic beverages in a supermarket or outlet and then engaging in the outdoor consumption of alcohol in public places, such as parks, disco parking lots, or isolated areas. 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