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Archivos argentinos de pediatría

Print version ISSN 0325-0075On-line version ISSN 1668-3501

Arch. argent. pediatr. vol.114 no.5 Buenos Aires Oct. 2016 


Alcohol consumption in early adolescence and medical care


Tania Borrás Santiesteban, M.D.a

a. Policlínico Mario Gutiérrez Ardaya, municipality of Holguín, province of Holguín, Cuba.

E-mail address: Tania Borrás Santiesteban, M.D.,

Funding: None.

Conflict of interest: None.

Received: 08-11-2015
Accepted: 04-26-2016



Introduction. Alcohol consumptionin adolescents is a risky behavior that can be prevented. Objective. To determine health care and alcohol consumption pattern in early adolescence and its relation to determinants of health (biological, environmental, social and health system factors).
Method. A qualitative-quantitative, crosssectional study was carried out in the four schools belonging to Popular Council 8 of Mario Gutiérrez Ardaya health sector in May, 2013. The study universe was made up of adolescents aged 10-14. The sample was determined through a simple randomized sampling. Surveys were administered to adolescents, parents, educators and senior health staff members to determine alcohol consumption, medical care quality and level of knowledge on the problem. A nominal group with health professionals was created.
Results. Two hundred and eighty eight adolescents were included. 54.5% were alcohol users, of which 30.2% were 10-11 years old. Those classified as low risk were prevailing (55.6%). 100% of the senior health staff expressed the need for a methodology of care. 90.4% of education staff considered adolescence as a vulnerable stage. Relatives reported that there should be adolescent-specific medical appointments (61.8%). The nominal group's most important opinions were based on the main features that a consultation for adolescents should have and on the problems hindering proper care.
Conclusions. Alcohol consumption was considered high and early start prevailed. Insufficient care to early adolescents who use alcohol was made evident.

Key words: Alcohol consumption; Adolescence; Determinants of health; Medical care.



According to the World Health Organization (WHO), adolescence is the period between 10 and 19 years old, in which physical, psychological, biological and social changes take place. It is classified into early adolescence (10 to 14 years old) and late adolescence (15 to 19 years old).1

In early adolescence, there is an impact on the emotional, physical and mental capacity.2

Alcohol is the most frequently used psychoactive drug among adolescents. It is associated with multiple problems: social, behavioral and developmental.3

It largely increases the risk of alcoholic disorders progression, it favors the occurrence of other risky behaviors and therefore it is a reason why interventions to delay consumption should be implemented.4,5

In the Americas, research suggests that children start drinking at the age of ten.6

In Cuba, there are high-risk drinking patterns and a tolerant attitude towards alcohol misuse.7,8

In this country, efforts have been made to update and improve the alcoholism-related program and the draft action plan, which show concern about the excessive and irresponsible consumption pattern among adolescents.9, 10

There are programs in different countries (including Cuba) for adolescence care, but there are no specific actions aimed at the group of 10- to 14-year-olds.

A study carried out in the United States suggests that intervention strategies should focus on determinants of health (biological, social, environmental and health system factors).11

Our aim was to determine health care and alcohol consumption pattern in early adolescence and its relation to determinants of health.


A descriptive, qualitative-quantitative, cross-sectional study was conducted through questionnaires administered to determinants of health (health senior staff, education

staff, family and adolescents) and to the nominal group (the pediatrician of the other Basic Working Group -Grupo Básico de Trabajo, GBT- and family doctors, belonging to the health sector and schools of the chosen Popular Council).

The research was carried out in May, 2013, in the four schools of the Popular Council 8, of the municipality of Holguin, province of Holguin, Cuba, belonging to Mario Gutiérrez Ardaya health sector, which was selected based on the results of the analysis of the health situation. In this area, there are seven wineries and four restaurants where alcoholic beverages are sold; 18.9% of identified adult alcoholics. There are a total of 892 adolescents living there, 12 family practice offices (consultorios médicos de familia, CMF), and four schools: three elementary schools and one urban secondary school. The prevailing education level is pre-university.

Four questionnaires were designed: one for adolescents, one for the polyclinic senior staff (director, assistant director of Medical Assistance, Teaching, Hygiene and Epidemiology, and heads of GBT), the third one for education staff (teachers, educational and administrative assistants in selected schools) and the fourth one for parents or guardians (Annexes 1, 2, 3, 4). These were administered by the author of the study, upon approval from the Municipal Department of Education and Health (Dirección Municipal de Educación y Salud), parents or guardians, and adolescents.

The questionnaires were validated through pilot testing in Francisco Laguado Jaime (primary) and Juan José Fornet Piña (basic secondary) schools, belonging to another Popular Council, of the same district, with similar characteristics to those of the schools where the definitive study was carried out.

Data were processed and the agreement coefficient (Cohen's kappa) was used to determine the criterion validity; a score of 0.84, showing strong agreement, was obtained.

After making the proposed changes, the final questionnaires were prepared and administered to the selected sample, with the necessary prior instructions.

The study universe was made up of 1,647 adolescents aged 10-14 years old. The sample was determined through a simple random probability sampling using the random number table. The minimum sample required was calculated on the basis of 5% of the registration of the selected groups. The following inclusion criteria were considered: adolescents residing in the area of Popular Council 8 and who agreed to take part in the investigation.

The risk was classified as no risk, low, medium and high risk; and care, as very good, good, fair and poor (Annexes 5, 6, 7, 8). The study was based on the ethical principles of the Declaration of Helsinki and the informed consents already mentioned.

The 12 family doctors working in the area of the selected Popular Council and the pediatrician of the other GBT were applied the nominal group technique with the aim of obtaining consensus on elements related to risky behavior and health care received by this age group. Although the other pediatrician does not provide direct care to the adolescents in the sample, he was included in the study because of the importance given to pediatricians in the field of early adolescence health care.


288 adolescents were included: 142 girls (49.3%) and 146 boys (50.7%). 54.5% were alcohol users, of which 30.2% were 10-11 years old (Table 1). Out of those who drunk, 43.8% still have the habit.

Table 1. Alcohol consumption according to education level, risk perception and information received

Among alcohol users, those with risk perception and who had received information on the habit prevailed; among those who did not use alcohol, most had no risk perception and had not received information (Table 1).

In the research, adolescents classified as low risk prevailed, medium risk came second and a minimum percentage were high risk; there were no adolescents classified as no risk (Table 2).

Table 2. Risk classification in adolescents according to their education level

Most adolescents said that their last visit had been in the office and the polyclinic. A high percentage reported having received information about their care. The prevailing sources of information were the family and television; only a 24.3% reported having received the information from health staff (Table 3). Most adolescents claimed that, during visits, there was no privacy, trust or confidentiality. A large percentage stated that the doctor did not explain the importance of preventing this habit and they felt that the most appropriate professionals for their care were pediatricians in the first place and then family doctors (Table 4).

Table 3. Sources of information according to participants

Table 4. Most appropriate professionals for the care of adolescents according to participants

The health professionals in the nominal group (12 family doctors and a pediatrician from another GBT) noted that adolescents' visits should be planned, educational, personalized, and comprehensive, and that the family doctor and pediatrician should both participate. They argued that the problems hindering proper care for adolescents were their failure to attend visits, and lack of privacy, teaching materials and doctors' availability.

They felt doctors were moderately trained for their care.

In the questionnaire administered to health senior staff, when asked about the roles of family doctors, they mentioned adolescent care, referrals to other specialists, risk and family assessment. As regards the roles of pediatricians, they suggested follow-up by these specialists and medical consultation with Psychology and Psychiatry professionals. All of them reported that there was no documentation that would determine alcohol consumption and that current health services did not conform to adolescents' expectations and needs.

Regarding the implementation of the Adolescents Care Program, they expressed the need for checkups and referrals to pediatricians and psychologists, and educational activities in schools and the community. All of them suggested adolescent-tailored visits should be planned.

All of them agreed that visit requirements should include qualified staff; private, nice location; appropriate environment and educational materials. The monthly meetings between the Ministry of Public Health, the Ministry of Education and the social prevention group was pointed out as a coordination between the health sector and schools. All of them mentioned the need for a methodology to set the necessary care for early adolescence.

In the questionnaire administered to parents or guardians, 65% of them reported that, during adolescence, teenagers behave in a way that may be dangerous to their health, and that the most common characteristics were confusion, inappropriate behavior and inexperience, but that these were not characteristic of their children. 61.8% reported that adolescent-tailored visits should be available and that the most appropriate time should be between 5:00 and 9:00 p.m.

The prevailing source of information was television (Table 3). They said the most appropriate specialists for their care were primarily psychologists and then family doctors; there were no great differences between pediatricians and psychiatrists (Table 4).

Regarding the questionnaire administered to education staff, the most relevant data were: the age group 20-29 years old (34.0%) prevailed; time spent on the care of adolescents was mostly from one to nine years (36.2%); 90.4% considered adolescence as a vulnerable stage; they said that early adolescence was the group that should receive the most attention (59.6%); most of them argued that there was no documentation to determine adolescent alcohol consumption (78.3%); the actions for the prevention of this behavior claimed by teaching staff were parent education, educational lectures, grade councils, methodological preparations, among others; most of them expressed the need for coordination between the health sector and schools (68.1%); all of them agreed that it was necessary to implement adolescent-tailored visits.

Motivation-related aspects were also analyzed: 70% assisted them with pleasure; 56% assisted them with patience; 88% felt committed to their assistance; and 72% often showed affection. They stated that the most frequent source of information about prevention of alcohol consumption was television, and none of them mentioned health care staff (Table 3).

Regarding the quality of care for this age group, the prevailing criterion was very good according to health senior staff; good, according to education staff and family; and fair, according to adolescents, but in this case there was a difference of only one participant in relation to those who considered it good (Table 5).

Table 5. Classification of care quality according to participants


Adolescent alcohol consumption begins at increasingly younger ages.12

This is worrying since an early start has negative consequences and a high risk of future dependence, so it is important to delay drinking onset, which agrees with the revised literature.13-16 Teenagers who use alcohol do not have a full appreciation of the damages to which they are exposed: the feeling that there are no consequences to this behavior and that they have the situation under control is characteristic of this stage.

Similar results were found in a study carried out in Chile; as per the information received, a lower percentage was obtained in that investigation.17

Adolescents' satisfaction with the quality of the care they receive matches the reviewed literature, which reveals they are satisfied in almost all aspects.18

Although in this research low-risk teenagers prevailed, it is important to take timely actions that will strengthen protective factors and reduce the risk factors, so as to prevent these teenagers from running a higher risk, which may jeopardize their health condition.

Despite the results, the need to improve care for this age group is considered to prevail because, in medical practice, it is clear that they do not receive the care they need.

When analyzing the results of the criteria set forth by health professionals, it is thought that doctors who took part in the research do not even consider facing care of early adolescents who use alcohol from the start, perhaps because they do not consider themselves well-trained. This means they need to feel supported by the psychologist and the psychiatrist, who, traditionally, are the professionals who have paid more attention to these patients.

As regards the criteria set forth by the health senior staff in relation to scheduling an adolescent-tailored visit, they agree with other authors who suggest that this age group deserves specific attention and requires the implementation of actions to improve their health; in addition, it is important to carry out further research.19,20 The view that there should be a methodology to promote care matches other studies that suggest that wider investigations with systematic methodologies are needed in order to obtain representative results on alcohol consumption.21

It is believed that current health services do not fit in with the real expectations and needs of this stage, related to the lack of professional training, lack of adolescent-tailored visits under the required conditions, and the lack of a methodology to encourage early adolescence care. These results match other authors who suggest that lack of time and training are important barriers to take into account.22-24

Regarding education staff, it is considered that they should be better prepared, as a young faculty prevailed for their care and they did not have enough experience, so it is necessary to provide training and the information they demand. It is important to remember that it is in the school environment where teenagers spend most of their time, and teachers play a key role in their development.

A strong commitment between adolescents and teachers reduces the use of substances. The school environment can protect early adolescents and their families against behaviors that pose a risk to health.25-27

The relationship between students and their school is considered an important way for reducing behavioral problems in adolescents.28

The information provided by parents or guardians evidences their ignorance and lack of risk perception. Perception of risk is a subjective judgment, which greatly depends on the person's reasoning ability, knowledge, cultural perception and social construction, the characteristics of the information they receive, the interpretation of messages, and they also influence the peculiarities of adolescence, including the lack of risk assessment. Family, school, peers, community and culture are also a great influence. Perception was not related to behavior.29-32 According to adolescents' criteria, care in CMFs should be improved. These health centers are the gateway to the national health system.

As for the relationship with the doctor, actions should be taken so that adolescents' medical visits meet the above requirements. This agrees with other authors who suggest that adolescents should trust their doctor and should provide him/her with the necessary information.33,34

This study is limited by the internal validity common in all self-report measures. Its strength lies on being the first contribution of local data necessary to estimate the size of the problem, and to trigger actions focused on improving the dissemination and implementation of preventive measures.


Alcohol consumption was considered high and early start prevailed. Insufficient care to early adolescents who use alcohol was made evident.


1. Organización Panamericana de la Salud. Las condiciones de salud de las Américas. Publicación Científica N° 524. Washington DC: OPS; 1990.         [ Links ]

2. Oliva A. La adolescencia como riesgo y oportunidad. Infanc Aprendiz 2004;27(1):115-22.         [ Links ]

3. Mckay MT, Ballantyne N, Goudiel AJ, Sumnall HR, et al. "Here for a good time, not a long time": Decision-making, future consequences and alcohol use among Northern Irish adolescents. J Subst Use 2012;17(1):1-18.         [ Links ]

4. Pérez de Corcho Rodríguez MA, Mármol Sóñora L, García Díaz G, Vizcay Castilla M. Prevención de los problemas relacionados con el alcoholismo en adolescentes. Mediciego 2013;19(2). [Acceso: 2 de mayo de 2016]. Disponible en:        [ Links ]

5. Viner RM, Ozer EM, Denny S, Marmot M, et al. Adolescence and the social determinants of health. Lancet 2012;379(9826):1641-52.         [ Links ]

6. Monteiro MG. Alcohol y salud pública en las Américas: un caso para la acción. Washington DC: Organización Panamericana de la Salud; 2007.         [ Links ]

7. Hidalgo Pereira FI, Martínez López G, Fernández Juviel AI, González Suárez V, et al. Alcoholism and risk factors: a cross-sectional study in Cumanayagua, Cuba. Medwave 2013;13(1):e5620-33.         [ Links ]

8. Betancourt Pulsán A. Intervención comunitaria para la prevención del alcoholismo en jóvenes guantanameros [tesis]. Habana: Escuela Nacional de Salud Pública; 2010.         [ Links ]

9. Cuba. Minsap. Programa nacional de prevención y control del uso nocivo del alcohol. Habana: Ciencias Médicas; 1995.         [ Links ]

10. Cuba. Minsap. Anteproyecto de plan de acciones para la actualización del Programa nacional de prevención y control del uso nocivo del alcohol. Habana: Ciencias Médicas; 2006.         [ Links ]

11. Komro KA, Toomey TL. Strategies to prevent underage drinking. Alcohol Res Health 2002;26(1):5-14.         [ Links ]

12. Pilatti A, Godoy JC, Brussino S, Pautassi RM. Underage drinking: prevalence and risk factors associated with drinking experiences among Argentinean children. Alcohol 2013;47(4):323-31.         [ Links ]

13. Ulate-Gómez D. Riesgo biopsicosocial y percepción de la función familiar de las personas adolescentes de sexto grado en la Escuela Jesús Jiménez. Acta Méd Costarric 2013;55(1):18-23.         [ Links ]

14. Heron J, Macleod J, Munafo MR, Melotti R, et al. Patterns of alcohol use in early adolescence predict problem use at age 16. Alcohol Alcohol 2012;47(2):169-77.         [ Links ]

15. Hipwell A, Stepp S, Chung T, Durand V, et al. Growth in alcohol use as a developmental predictor of adolescent girls' sexual risk-taking. Prev Sci 2012;13(2):118-28.         [ Links ]

16. Howard R, Finn P, Jose P, Gallagher J. Adolescent-onset alcohol abuse exacerbates the influence of childhood conduct disorder on late adolescent and early adult antisocial behaviour. J Forens Psychiatry Psychol 2011;23(1):7-22.         [ Links ]

17. Williams C, Poblete F, Baldrich F. Evaluación multidimensional de los servicios de salud para adolescentes en centros de Atención Primaria en una comuna de Santiago de Chile. Rev Méd Chile 2012;140(9):1145-53.         [ Links ]

18. Gould TJ. Addiction and cognition. Addict Sci Clin Pract 2010;5(2):4-14.         [ Links ]

19. Roldán C, Borile M, Melamed I, Girard G, et l. Políticas Públicas sobre Adolescencia. Declaración de Lima [Internet]. Habana: Infomed; 2012. [Acceso: 3 de enero de 2015]. Disponible en: puericultura/2012/01/07/politicas-publicas-sobre-adolescencia-2/.         [ Links ]

20. World Health Organization. Health for the world's adolescents. World Health Assembly 23 May 2014 [Internet]. Washington: WHO: 2014. [Acceso: 17 de noviembre de 2014]. Disponible en: child_adolescent/news_events/events/2014/wha-world-adolescents-health/en/.         [ Links ]

21. Karam E, Kypri K, Salamoun M. Alcohol use among college students: an international perspective. Curr Opin Psychiatry 2007;20(3):213-21.         [ Links ]

22. Moreno E. Servicios de Salud para adolescentes y jóvenes. Los desafíos de acceso y calidad. Cartagena de Indias: Organización Iberoamericana de la Juventud; 1995.         [ Links ]

23. Committee on Substance Abuse, Kokotailo PK. Alcohol use by youth and adolescents: a pediatric concern. Pediatrics 2010;125(5):1078-87.         [ Links ]

24. Ozer EM, Adams SH, Lustig JL, Gee S, et al. Increasing the screening and counseling of adolescents for risky health behaviors: a primary care intervention. Pediatrics 2005;115(4):960-8.         [ Links ]

25. Sawyer SM, Afifi RA, Bearinger LH, Blakemore SJ, et al. Adolescence: a foundation for future health. Lancet 2012;379(9826):1630-40.         [ Links ]

26. Horner SD, Rew L, Brown A. Risk-taking behaviors engaged in by early adolescents while on school property. Issues Compr Pediatr Nurs 2012;35(2):90-110.         [ Links ]

27. Lemstra M, Bennett N, Nannapaneni U, Neudorf C, et al. A systematic review of school-based marijuana and alcohol prevention programs targeting adolescents aged 10-15. Addict Res Theory 2010;18(1):84-96.         [ Links ]

28. Oelsner J, Lippold MA, Greenberg MT. Factors influencing the development of school bonding among middle school students. J Early Adolesc 2011;31(3):463-87.         [ Links ]

29. Gil-Lacruz AI, Gil-Lacruz M. Subjective valoration of risk perception and alcohol consumption among Spanish students. Salud Ment (Méx) 2010;33(4):309-16.         [ Links ]

30. Fraga S, Sousa S, Ramos E, Dias S, et al. Alcohol use among 13-year-old adolescents: associated factors and perceptions. Public Health 2011;125(7):448-56.         [ Links ]

31. Greening L, Stoppelbein L, Chandler CC, Elkin TD. Predictors of children's and adolescents' risk perception. J Pediatr Psychol 2005;30(5):425-35.         [ Links ]

32. González-Iglesias B, Gómez-Fraguela JA, Gras ME, Planes M. Búsqueda de sensaciones y consumo de alcohol: el papel mediador de la percepción de riesgos y beneficios. Anal Psicol 2014;30(3):1061-8.         [ Links ]

33. McKee MD, Rubin SE, Campos G, O'Sullivan LF. Challenges of providing confidential care to adolescents in urban primary care: clinician perspectives. Ann Fam Med 2011;9(1):37-43.         [ Links ]

34. Bird S. Adolescents and confidentiality. Aust Fam Physician 2007;36(8):655-6.         [ Links ]

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