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Dr Jeremy Segrott explains how social relationships shape young people’s health behaviours and what interventions could discourage them from alcohol abuse

LCOHOL MISUSE IS a major public health issue and a particular concern is the misuse of alcohol by children and young people, both in terms of the age

at which they begin to drink, and the frequency or quantity of alcohol which they consume. Social scientists have an important role to play in critically examining the place of alcohol in society, explaining the complex social and environmental factors which shape young people’s use of alcohol, and informing the development of policies and interventions which respond to these issues. A key policy focus is the prevention of alcohol misuse by young people, identifying ways to delay the start of frequent alcohol consumption, and reducing levels of binge drinking. While most agree that binge drinking among teenagers should be discouraged, the issue of when young people start drinking alcohol is more complex. When is it acceptable for children to first try alcohol? How and when should parents allow their children to drink regularly? And what are the best ways of providing information to young people about a substance which, although unhealthy or risky in certain circumstances, is a widely accepted part of adult life? These questions highlight the importance of ensuring that interventions to prevent alcohol misuse by young people are well informed and have identifiable actions. Giving information to young people about the health issues around alcohol is important but prevention needs to take account of the wider social and environmental influences that shape health behaviours. McLeroy’s classic socio-ecological model has been widely used to understand the different levels of influence on health – including the intrapersonal, social relationships, and the wider physical environment – and how these different influences interact. The ESRC-funded DECIPHer Centre – a

UKCRC Centre of Excellence in Public Health – uses the socio-ecological model as a framework for the development and evaluation of prevention interventions. A major strand of this work looks at how social relationships (in families and schools, for instance) shape young people’s health behaviours. A key example of this research is a randomised controlled trial of the Strengthening Families Programme 10-14, one of the first such evaluations of the programme outside the US. This programme aims to prevent substance misuse and anti- social behaviour by strengthening key protective factors found in the family, including parent-child communication, parenting styles, and helping

Healthy interventions A

young people develop life skills and positive goals. The programme addresses health behaviours such as alcohol, drug and tobacco use by recognising that they often share common risk and protective factors. Another DECIPHer study is assessing the feasibility of a school-based prevention programme – Kids, Adults, Together (KAT) – which involves parents/carers in their children’s learning, and aims to promote pro-social communication in families. While KAT provides information to young people about the health effects of alcohol, the promotion of positive family communication and relationships are crucial to the way in which the programme is intended to influence later drinking behaviours. Both these studies have resulted from strong partnerships between university-based researchers and policymakers and practitioners. Trials of such interventions to assess their long-term impact are often challenging, both in terms of the resources needed, and levels of familiarity with and acceptability of randomised controlled trials in

Interventions need to take

account of wider social and environmental influences

the field of public health. Yet such trials are vital, and we need to be aware that even well-designed interventions do not always succeed, and others may have unintentional harmful effects. The complexity and multifaceted task of

evaluating complex public health interventions increasingly calls for interdisciplinary research teams with multiple methodological and conceptual skill sets. Social scientists play a critical role in such teams, offering theoretically informed understandings of how societal factors influence individuals’ health, how such factors can be shaped in positive ways, and the key influences on intervention delivery. As the psychologist Kurt Lewin famously remarked, “There is nothing more practical than a good theory.” n

i Dr Jeremy Segrott is Research Fellow in Public Health, DECIPHer.

DECIPHer is part of a £20-million investment into public health research and is funded by the UK Clinical Research Collaboration (UKCRC) comprising the ESRC, The British Heart Foundation, Cancer Research UK, the Wellcome Trust, the Welsh Government and the Medical Research Council Email Telephone 029 2087 9609 Web


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