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Jaimon, Deligannu, and Robinson: Alcohol Use and Its Relation with Demographic, Environmental, and Psychological Factors among Adolescents in Nabawan, Sabah

Abstract

Background

Adolescence is an essential stage of a child’s development, transitioning them into adulthood. During this time, they are vulnerable to various social issues, such as experimenting with alcohol, among others. Although alcohol consumption was proven to be detrimental to physical and cognitive development toward adulthood, and almost one in 10 Malaysian adolescents aged 13 years and above are current drinkers, studies concerning the driving factors are still scarce. This cross-sectional study aimed to determine alcohol use among 244 adolescents in Nabawan, Sabah.

Methods

This study assessed the associations between alcohol use and three potential factors: demographic, environmental, and psychological. Respondents who were selected through stratified proportionate random sampling answered a set of assessment tools.

Results

Results showed that 30.7% (95% confidence interval [CI], 24.91–36.48) of Nabawan adolescents use alcohol. Analysis revealed that older age adolescents 18 years and 19 years, respectively (adjusted odds ratio [aOR], 3.93; P=0.021; aOR, 5.38; P=0.003), having parents (aOR, 4.11; P=0.001) and peers (aOR, 11.57; P<0.001) who consume alcohol were significantly associated with alcohol use. Unexpectedly, good parental monitoring (aOR, 2.46; P=0.019) and discussing serious problems with parents (aOR, 3.86; P=0.001) were significantly associated with alcohol use.

Conclusion

Conclusively, policies on alcohol-related harm reduction and prevention should be developed, especially school-based programs, programs addressing family functioning, and parent-child communication, among others, should be further looked into. Future research on the school environment, adolescents’ drinking motives, and the development of practical adolescent-friendly alcohol screening tools are recommendations for improvements.

INTRODUCTION

Each year, 3 million people die from alcohol-related causes worldwide, accounting for 5.3% of all fatalities. Drinking alcohol increases the likelihood of developing serious noncommunicable diseases like liver cirrhosis, cancers, cardiovascular diseases, and injuries from violence, car accidents, and collisions. These health issues include mental and behavioral disorders, including alcohol dependence [1]. Alcohol abuse, especially binge drinking and heavy episodic drinking, has negative health and social effects on the drinkers, their families, and society as a whole. Concerning Health Target 3.5 (“Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol”), the Sustainable Developmental Goals place special emphasis on this target.
There has not been much research done to determine the precise scope of the issues brought on by alcohol usage in Malaysia, despite being the tenth greatest consumer of the substance worldwide. Moreover, data demonstrates that it is rising yearly [2]. Among individuals who were 13 years of age or older, the prevalence of current drinkers was 11.1%, with men drinking much more than women (15.8% versus 6.2%) [3]. Adolescence is the phase of life transitioning from childhood into adulthood where it is characterized by the age group of 10 to 19 years old. It is a critical stage of human development and is essential for laying the foundation for long-term health [4].
The highest prevalence occurs in Wilayah Persekutuan Kuala Lumpur, followed by Sarawak and Sabah. Sarawak and Sabah are Malaysian states located in East Malaysia, specifically on the island of Borneo. The population in these two states differs from the states in West Malaysia as large indigenous communities comprised most of these states [5]. In Sabah specifically, research on alcohol use among adolescents is scarce, thus preventing an accurate picture of the magnitude of alcohol use, related associated factors, and its related harm.
Statistics show that Nabawan has the most numbers of Bumiputera (99.6%), mainly of Murut ethnicity; hence, it strengthens the justification to conduct an alcohol-related study since the findings by National Health and Morbidity Survey also show a high prevalence of alcohol use among the Bumiputera Sabah [6]. The difference in sociodemographics of Nabawan might provide different numbers and specific factors for this community, thus warranting this research to further determine its association.
According to World Health Organization (WHO), a current drinker is defined as one who has consumed more than just a few sips of an alcoholic beverage (one or more standard drinks excluding for religious purposes) in the past year preceding the survey [1]. Alcohol usage is influenced by factors such as sex, age, health, a nation’s economic prosperity, lifestyle preferences, religion, and cultural standards. Additionally, these elements affect how alcohol is consumed. Adolescence is the phase of life transitioning from childhood into adulthood, characterized by the age group of 10 to 19 years old [4]. The adolescence phase can be classified into three stages: early adolescence (approximately 10–13 years old), middle adolescence (approximately 14–17 years old), and late adolescence (approximately 18–19 years old) [7]. Along with the psychological and social changes that accompany the physical changes that herald the beginning of adolescence, these developments place this phase as a crucial stage in the development of adulthood.
Age, sex, ethnicity, and religion are demographic factors associated with alcohol use. Older age has higher rates of alcohol use as compared to younger age. Age and alcohol use have a clear and substantial relationship, and it was reported that there is a trend for increased alcohol consumption as age grows [8]. Alcohol consumption globally has been a male-dominated activity, as 54% of males and 32% of aged 15 years and older females worldwide consume alcohol [9]. Male prevalence of alcohol consumption is relatively higher (36%) as compared to females (10.8%), which is consistent with the findings of the Malaysia National Health and Morbidity Survey 2019 that showed alcohol consumption was significantly higher among current drinker males as compared to females [10]. Alcohol consumption is generally associated with backgrounds of ethnicity and culture. Individuals of a particular ethnic background are more likely to consume more alcoholic beverages as compared to another ethnic [11]. Less Muslim and Catholic adolescents than non-believers drank alcohol, and those who had never done so scored higher on religiousness than those who had [12]. Low The low prevalence of Muslim drinkers is highly associated with the strict Sharia rule that prohibits any Muslims from obtaining and using alcohol and alcohol-related products [13,14].
Environmental factors, especially family environment and peer influences, play an important role in alcohol consumption among adolescents. Elements of the family environment are included in a modified conceptual model of adaptation and coping with young adult alcohol consumption and the home environment [15]. Additionally, peer influences on adolescents’ drinking behaviors are bigger than parental influences, and it has been discovered that the size of the link between friends’ drinking behaviors and those of adolescents is greater than that of parental behaviors. When it came to taking chances and making dangerous decisions, adolescents were more prone than adults to do so when around their friends [16].
Alcohol consumption has been linked to stressful situations and experiences. The theory states that alcohol lessens fear that may be connected to tension or conflict, which encourages consumption. Heavy drinking is linked to a load of stress conflict, which encourages consumption. Heavy drinking is linked to a load of stress [17]. A stressful situation’s impact on someone is partly determined by the perception of their stressfulness [18]. Increasing severity of depressive symptoms was linked to earlier onset of alcohol consumption, more frequent alcohol consumption, and more frequent intoxication, even among students with mild or moderate symptoms [19]. Despite research suggesting that anxiety decreases as children age, certain kids may experience anxiety disorders that endure until adulthood. Finding children at risk for anxiety is crucial since these illnesses can seriously affect social and other essential areas of functioning [20]. A study found that higher levels of anxiety sensitivity were associated with more alcohol use days in the previous 6 months, and it was among youth who reported having little control over their anxiety. This result supports earlier studies that showed teenagers with high anxiety sensitivity might drink to manage their worry [21].

METHODS

1. Study Design and Sample Selection Process

A cross-sectional study was conducted in the district of Nabawan, Sabah, Malaysia, from 20th March 2023 until 21st April 2023. Nabawan is a district located in the interior division of Sabah. It is bordered by the Kalabakan district on the east and the Keningau and Tenom districts on the west. Meanwhile, the south part of Nabawan borders North Kalimantan of Indonesia. Nabawan district has a land area of 608,909 hectares, with forest reserves accounting for 486,441 hectares (79.8%). The topographic condition is mountainous, and most of the flat land area is located in the forest reserve [22].
The sample size was calculated based on study objectives, and the study population was selected from adolescents aged 10–19 years old in Nabawan district with the following inclusion criteria: (1) Malaysian citizen, (2) reside in Nabawan for at least 1 year, and (3) able to understand Bahasa Malaysia. Adolescents with mental health diseases, physical impairment, or chronic diseases were excluded from the study. Stratified proportionate random sampling involving two subdistricts of Nabawan was conducted, and adolescents from the 11 selected villages were sampled according to house as unit measurement. One adolescent who fulfilled the inclusion and exclusion criteria from each housing unit was taken as a respondent. A total of 230 respondents participated in this study—244 were eligible, and six adolescents were excluded. The primary tool in this study is a set of guided self-administered and validated questionnaires that consist of six parts. This study was approved by the Institutional Review Board Research of Universiti Malaysia Sabah, Malaysia (approval no., JKEtika 1/23 [25]). Informed consent was obtained from all participants included in the study.

2. Variables

Demographic characteristics of age were defined as the age of participants in 2023, while sex was the sex of participants (categorized as male or female), while ethnicity was operationally defined as the ethnicity of the participants, which were categorized as Malay, Chinese, Indian, Bumiputera Sabah, and other (ethnicity that was not mentioned). Environment-related variables include household income (estimation of monthly combined incomes for all people in the participant’s household, whereby Malaysian ringgit (RM) 3,613 is the median monthly household income of Nabawan district as reported by Department of Statistics Malaysia in 2022, peer alcohol use, parent marital status (current marital status of respondents’ parent), parent alcohol use (at least one parent reported to drink alcohol), and parents’ education (highest attained education level by father or mother).
Other environment-related variables were verbal violence (ever experienced cursing with dirty words, underestimating their abilities, and insulting from parents), physical violence (ever experienced slapping/punching/kicking/hitting, being punished by withholding food, being hit by a belt or other rough object, being forced to work for money from parents), low bonding (ever experienced any of these conditions: family never give warmth and attention, the family never shares stories and experiences, the family never helps if there is a family member who has a problem), low monitoring (ever experienced any of these conditions: parents never call or are anxious if I get home, parents did not care where I went or when parents never asked who my close friends are), and discuss serious problems (whether respondents usually talked about personal problems with their parents) [23].
Alcohol Use Disorder Identification Test 10 (AUDIT-10) was used to measure alcohol use. The AUDIT is a simple and effective method of screening for harmful alcohol use, which is defined as risky or hazardous consumption or any alcohol use disorder. This questionnaire consists of one question to define current alcohol use, which is any alcohol consumption in the past 12 months according to the WHO definition [24]. Low-risk alcohol use is defined as an AUDIT-10 score of 1–7, hazardous alcohol use score of 8–15, harmful alcohol use with a score of 16–19, and a score of 20 or more for the likelihood of alcohol dependence.
Perceived stress scale was used in this study to measure stress levels among the respondents. This 10-item self-reported perceived stress scale is widely used to assess the degree to which situations in one’s life are appraised as stressful. A Generalized Anxiety Disorder (GAD-7) questionnaire was used in this research. It is a seven-item, self-rated scale developed as a screening tool and severity indicator for generalized anxiety disorder. GAD-7 items describe some of the most salient diagnostic features of generalized anxiety disorder (for example, feeling nervous, anxious, or on edge and worrying too much about different things). In this scale, scores range from 0 to 21. Total scores correlate with the level of anxiety as such: a score of 0 is no anxiety, a score of 1–4 is minimal anxiety, a score of 5–9 is mild anxiety, a score of 10–14 is moderate anxiety, and a score of greater than 15 is severe anxiety [25]. For the measurement of depression, the Patient Health Questionnaire-9 was used in this study. It is a nine-item self-administered tool for assessing depression as it incorporates the Diagnostic and Statistical Manual of Mental Disorders-IV depression criteria with other leading major depressive symptoms into a brief self-report instrument.

3. Statistical Analysis

Simple logistic regression was used to determine the association between household income, parent’s marital status, parent’s education level, parental and peer alcohol use, ever experience of verbal and physical violence, low bonding and monitoring, respondent perceived stress, depression status, anxiety status with dependent variables of which in this study is the alcohol use status of the respondents. Factors that were found to be significantly associated with the alpha value set at 0.25 in the univariable analysis were further analyzed with multiple logistic regression. Then, significant factors were determined by multiple logistic regression. Selection of variables for the multiple logistic regression models was made by comparing both forward selection (likelihood ratio [LR]) and backward elimination (LR), and statistical significance was accepted for P-values less than 0.05.
Factors associated with alcohol use among the participants were examined using multiple logistic regression. Several variables have shown significant association with alcohol use from simple logistic regression analysis, which was demographic variables (age and sex), environment variables (parent and peer alcohol use, ever experience physical violence, low bonding, low monitoring, and ever discuss problems), and psychological factors (perceived stress, generalized anxiety, and depression). Other variables that yielded a P-value of <0.25, which is considered as statistical significance [26], were also included in the multiple logistic regression, which is parent marital status (P-value=0.196), parent education level (P-value of 0.179 and 0.140). and ever experience verbal violence (P-value=0.127) (Table 1).
Firstly, 14 variables that were entered in the first step were age, sex, parent alcohol use, peer alcohol use, parent educational level, ever experience physical violence, low bonding, low monitoring, ever discussed serious problems, perceived stress, generalized anxiety, depression, parent marital status, and ever experience verbal violence. Using a stepwise selection method (probability stepwise entry was set at 0.05 and removal at 0.1) comparing forward selection (LR) and backward elimination (LR) for better adjustment of potential confounding factors, the selection of independent variables of the preliminary model was narrowed further. Based on the forward (LR) method, the variables that yielded significant P-values are age, peer and parental alcohol use, discussing serious problems, and monitoring by parents. From the backward (LR) method, the same significant variables were yielded, excluding low bonding and experience of verbal violence, which had a P-value of more than 0.05. Hence, the forward (LR) method variables were chosen as the best fit.

RESULTS

1. General Characteristics and Prevalence of Alcohol Use among the Participants

A total of 244 adolescents participated in this study involving 11 villages. The median age among the total study population was 18 years, and the majority (54.9%) were male. Nearly all (97.1%) of the adolescents were Bumiputera Sabah, and the most reported religion was Christianity (63.5%). Table 2 shows the general characteristics of the participants based on alcohol usage (current drinkers or not current drinkers).
There is a total of 75 (30.7%) current drinkers, which yielded the prevalence of alcohol use as 30.7% (95% confidence interval [CI], 24.92–36.48). According to the AUDIT-10, a current drinker is described as consumption of alcoholic beverages within 12 months prior to conducting the study. Out of the 75 current drinkers, low-risk alcohol use reported was 25 (33.3%), hazardous alcohol consumption was reported to be 39 (52%), harmful alcohol use was reported to be 3 (4%), while likelihood of alcohol dependence was found in 8 (10.7%) of respondents (Table 3).

2. Factors Associated with Alcohol Use

Demographic, environmental, and psychological factors associated with alcohol use among the participants were examined using multiple logistic regression (Table 4). The result of the multiple logistic regression found that there are significant associations between age, parent alcohol use, peer alcohol use, and parents monitoring and discussing serious problems among adolescents in Nabawan, Sabah. The analysis showed that older age (18–19 years) adolescents are at higher odds (adjusted odds ratios [aOR] of 3.93 and 5.38, respectively) of using alcohol use as compared to the younger age groups (≤17 years). Adolescents with parents who consume alcohol also are more likely to use alcohol (AOR, 4.11; 95% CI, 1.77–9.54), and the same finding was shown in adolescents who have peers who also consume alcohol (AOR, 11.57; 95% CI, 4.11–32.52). In contrast, adolescents who reported having good monitoring by parents are more likely to consume alcohol as compared to those who reported low monitoring (AOR, 2.46; 95% CI, 1.16–5.20). The same paradoxical finding was found where adolescents who ever discuss serious problems with parents are at higher odds of alcohol use (AOR, 3.86; 95% CI, 1.72–8.67) as compared to those who reported never discussing serious problems.
Nonetheless, based on the multiple logistic regression, there is no sufficient statistical evidence to conclude that alcohol use among adolescents in Nabawan, Sabah, is associated with other demographic factors (sex, Bumiputera Sabah, Christian religion), environment factors (household income, parent marital status, parent’s education level, bonding with parents, ever experience physical or verbal violence), and psychological factors (perceived stress, generalized anxiety, depression).

DISCUSSION

The prevalence of alcohol consumption among adolescents in our cross-sectional survey was found to be 30.7% (95% CI, 24.92–36.48). The findings of this study indicate that older adolescents, specifically those in their late teens, are more likely to consume alcohol if their parents and peers also consume alcohol. On the other hand, good parental monitoring and open communication about serious issues with parents are significant factors that are associated with alcohol use among adolescents in Nabawan, Sabah.
This study has shown that there is a relatively high prevalence (30.7%) of current drinkers among adolescents in Nabawan. In comparison with Malaysia’s National Health and Morbidity Survey of 2019, where data was obtained from respondents aged ≥13 years old using the same AUDIT questionnaire, the prevalence of current drinkers was 11.1%, where Bumiputera Sabah accounted for 21.7% of the overall current drinkers. However, there was a higher prevalence among the Sarawak Dayak adolescents than in our study, at 89% [14]. From the study’s results, we may infer that the prevalence of alcohol use in rural Sabah is higher than in the national findings. Concurrently, this study implied that the Bumiputera Sabah dan Sarawak population’s alcohol use prevalence is much higher than other ethnicities.
The population of Sabah comprises 33 indigenous groups that communicate in over 50 languages and 80 ethnic dialects [27]. The largest ethnic group in Sabah, the Kadazan-Dusun, makes up over 30% of the total population (n=698,300), is the largest ethnic group in Sabah Bumiputera, followed by Bajau (n=592,400), and Murut (n=112,900). As for the administrative districts of Nabawan, it is a district with the largest percentage of Bumiputera (99%), where the Murut ethnic group makes up the bulk of the population (89%) [6]. Our study population comprises 97% of Bumiputera Sabah, with the majority being Murut sub-ethnicity. This large percentage of Bumiputera Sabah making huge discrepancy between the proportion of participants and other ethnic groups could be the factors contributing to the high prevalence of alcohol use among this adolescent group. Alcohol consumption is frequently linked to ethnic backgrounds and cultures [11], and this is especially true of the indigenous people of East Malaysia (Sabah and Sarawak), especially during festive occasions.
In our study, age demonstrated a significant association between age and alcohol use among adolescents, where late adolescents of 18 and 19 years of age are at higher odds of consuming alcohol as compared to the early-middle age group adolescents. Previous alcohol-related studies have reported age as a significant factor [8,10,14]. As for older age adolescents, it appears that parental supervision is lessened, and growing independence and self-assurance may be contributing factors to a higher predisposition to drink alcohol [28].
This study identified parental alcohol use to be associated with alcohol use among adolescents. Similar to our findings, particularly in the 17-year-old age group, both mothers’ and fathers’ alcohol consumption are significant for the risk of adolescent alcohol consumption, with increased alcohol consumption by both mothers and fathers increasing the likelihood of adolescent alcohol use while increasing the risk of adolescent inebriation [19]. This similar finding strengthens the evidence parental alcohol use affects adolescents drinking behavior, especially in the late teenage years, and that social cognitive theory, which holds that parents are significant role models, is the most likely source for this link [29]. Another significant finding was peer alcohol use association with adolescent alcohol use in our study. Adolescents were more likely than adults to take chances and make risky judgments while they were among their peers [16]. In view of the peer group usually establishing the behavioral standards for the social environment, peer interactions can significantly impact a teen’s drinking habits. As people enter adolescence, they also begin to spend less time with their parents and more time with their friends [30].
In terms of monitoring by parents, contrastingly, good monitoring by parents was found to be significantly associated with adolescents’ alcohol use, which is similar to the finding found in the previous study [31]. Adolescents view alcohol use as a stress reliever, especially when it comes to parental behaviors. Thus, if they experience stress, they turn to alcohol usage as a coping mechanism. However, this is obviously a maladaptive method of handling stress [31]. Another interesting finding is a significant association between ever discussing serious problems with parents and adolescents’ alcohol use. How frequently a child discusses serious matters with their parents measures the closeness between the child and their parents. In this situation, parents significantly influence their children’s development of attitudes, values, and lifestyle views that can promote favorable outcomes in the cultural and academic spheres [32]. Findings of good parental monitoring and discussing serious problems with parents associated with high alcohol use in multivariable analysis could explain the causality of outcomes by whether good monitoring by parents and ever discussing serious problems with parents were due to consequences of adolescents’ alcohol use or vice versa, considering that this study applied cross-sectional study design. In other words, it could be that adolescents consumed alcohol, which resulted in parents increased (good) monitoring and increased closeness (ever discussing serious problems) by parents.
This study has some limitations. First, no causal relationship could be assessed because this was a cross-sectional study. Secondly, as this study applied guided self-administered questionnaires for data collection, it might promote recall bias. At the same time, since this study has the element of sensitivity (alcohol use among adolescents), social desirability bias might occur since the questionnaire depends on the honesty and reliability of the participants. As for the same sensitivity issue, consenting participants were concentrated on those aged 18 and 19 years. These would be the limitations encountered by our study. Another limitation of this study occurred during the sampling of respondents. During data collection, most of the time, not all adolescents in one specific house are present at home. Hence, the enumerators were only able to collect data from any adolescents present during their visit.
This present study’s findings also demonstrated that older age (late) adolescents, having parents and peers who consume alcohol, good parental monitoring, and discussing serious problems with parents are the significant factors associated with alcohol use among adolescents in Nabawan, Sabah. Conclusively, policies on alcohol-related harm reduction and prevention should be developed for adolescents, especially school-based programs, programs addressing family functioning, and parent-child communication, among others, should be further looked into. School-based prevention programs that have the best chances of being effective are those that integrate the teaching of academic material with the practice of social skills, as well as focusing interventions on multiple risk factors. Strengthening social, emotional, behavioral, cognitive, and moral abilities; raising self-efficacy; enhancing social relationships with adults, peers, and younger children; and lengthier treatments are some of the factors that boost the effectiveness of the programs [33]. Hence, a school-based policy and prevention program should adapt to these factors while being suited to local settings. Future research on the school environment, adolescents’ drinking motives, and the development of practical adolescent-friendly alcohol screening tools are recommendations for improvements. Both policy and future research should take into account the appropriateness of local population settings.

Notes

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

ACKNOWLEDGMENTS

This study was funded by the Universiti Malaysia Sabah Great grant(project code: GUG0592-1/2023).

Table 1.
Simple logistic regression analysis for association between demographic, environmental, and psychological factors with alcohol use among adolescents in Nabawan, Sabah
Variable No. of alcohol use Simple logistic regression
Unadjusted OR (95% CI) P-value
Demographic
 Age (y)
  ≤17 9 Reference
  18 23 3.32 (1.40–7.83) 0.006
  19 43 4.78 (2.14–10.64) <0.001
 Sex
  Female 19 Reference
  Male 56 3.44 (1.88–6.27) <0.001
 Ethnicity
  Bumiputera Sabah 74 Reference
  Non-Bumiputera Sabah 1 0.37 (0.04–3.10) 0.358
 Religion
  Muslim 25 Reference
  Christian 50 1.22 (0.68–2.16) 0.497
Environment
 Household income
  ≤RM3,613 74 Reference
  >RM3,613 1 0.44 (0.51–3.86) 0.461
 Parent marital status
  Married 67 Reference
  Divorced/separated 8 1.89 (0.71–5.02) 0.196
 Parent education level
  No formal to primary education 5 Reference
  Secondary education 51 2.02 (0.72–5.64) 0.179
  Tertiary education 19 2.32 (0.75–7.10) 0.140
 Parent alcohol use
  No 11 Reference
  Yes 64 5.11 (2.51–10.36) <0.001
 Peer alcohol use
  No 5 Reference
  Yes 70 22.97 (8.80–59.93) <0.001
 Ever experience verbal violence
  Never 60 Reference
  Yes 15 1.76 (0.85–3.64) 0.127
 Ever experience physical violence
  Never 50 Reference
  Yes 25 2.88 (1.51–5.46) 0.001
 Low bonding
  No 51 Reference
  Yes 24 3.32 (1.70–6.45) <0.001
 Low monitoring
  Yes 25 Reference
  No 50 2.89 (1.64–5.12) <0.001
 Ever discuss problems
  Never 37 Reference
  Yes 38 6.86 (3.63–12.97) <0.001
Psychological
 Perceived stress
  Low (0–13) 2 Reference
  Moderate (14–26) 69 6.79 (1.57–29.43) 0.010
  High (27–40) 4 10.80 (1.54–75.69) 0.017
 Generalized anxiety
  No to minimal anxiety (0–4) 20 Reference
  Mild (5–9) 30 3.07 (1.569–6.001) 0.001
  Moderate to severe (10–21) 25 3.21 (1.587–6.511) 0.001
 Depression
  No to minimal (0–4) 26 Reference
  Mild to moderate (5–14) 29 1.56 (0.84–2.91) 0.158
  Moderately severe (15–19) 12 3.09 (1.26–7.59) 0.014
  Severe (20–27) 8 3.82 (1.27–11.55) 0.017

Statistically significant results are marked in bold.

OR, odds ratio; CI, confidence interval; RM, Malaysian ringgit.

Table 2.
Characteristics of the study participants according to alcohol usage
Characteristic Category Alcohol use No alcohol uses P-value*
Age (y) ≤17 9 (12.9) 61 (87.1)
18 23 (32.9) 47 (67.1) 0.006
19 43 (41.3) 61 (58.7) <0.001
Sex Male 56 (41.8) 78 (58.2)
Female 19 (17.3) 91 (82.7) <0.001
Ethnicity Bumiputera Sabah 74 (31.2) 163 (68.8)
Non-Bumiputera Sabah 1 (14.3) 6 (85.7) 0.358
Religion Muslim 25 (28.1) 64 (71.9)
Christian 50 (32.3) 105 (67.7) 0.497
Household income ≤RM3,613 74 (31.1) 164 (68.9)
>RM3,613 1 (16.7) 5 (83.3) 0.461
Parent marital status Married 67 (29.6) 159 (70.4)
Divorced/separated 8 (44.4) 10 (55.6) 0.196
Parent alcohol use Yes 64 (41.6) 90 (58.4)
No 11 (12.2) 79 (87.8) <0.001
Parents’ education level No formal to primary education 5 (18.5) 22 (81.5)
Secondary education 51 (31.5) 111 (68.5) 0.179
Tertiary education 19 (34.5) 36 (65.5) 0.140
Peer alcohol use Yes 5 (4.5) 105 (95.5)
No 70 (52.2) 64 (47.8) <0.001
Ever experience verbal violence No 60 (28.8) 148 (71.2)
Yes 15 (41.7) 21 (58.3) 0.127
Ever experience physical violence No 50 (25.8) 144 (74.2)
Yes 25 (50.0) 25 (50.0) 0.001
Low bonding No 51 (25.6) 148 (74.4)
Yes 24 (53.3) 21 (46.7) <0.001
Low monitoring Yes 25 (20.0) 100 (80.0)
No 50 (42.0) 69 (58.0) <0.001
Discuss serious problems Never 37 (20.1) 147 (79.9)
Yes 38 (63.3) 22 (36.7)
Perceived stress Low (0–13) 2 (6.9) 27 (93.1)
Moderate (14–26) 69 (33.5) 137 (66.5) 0.010
High (27–40) 4 (44.4) 5 (55.6) 0.017
Generalized anxiety No to minimal anxiety (0–4) 20 (18.2) 90 (81.8)
Mild (5–9) 30 (41.0) 44 (59.0) 0.001
Moderate to severe (10–14) 25 (41.7) 35 (58.3) 0.001
Depression No to minimal depression (0–4) 26 (23.0) 87 (77.0)
Mild to moderate (5–14) 29 (31.9) 62 (68.1) 0.158
Moderately severe (15–19) 12 (48.0) 13 (52.0) 0.014
Severe (20–27) 8 (53.3) 7 (46.7) 0.017

Values are presented as number (%). Statistically significant results are marked in bold.

RM, Malaysian ringgit.

* By simple logistic regression test.

Table 3.
Prevalence of alcohol use and demographic characteristics based on the category of current drinkers among adolescents in Nabawan, Sabah (N=244)
Variable Low risk
Hazardous consumption
Harmful consumption
Likelihood of alcohol dependence
No. (%) 95% CI No. (%) 95% CI No. (%) 95% CI No. (%) 95% CI
Total population 25 (10.2) 6.14 to 13.99 39 (15.9) 11.31 to 20.49 3 (1.2) -0.37 to 2.57 8 (3.3) 1.06 to 5.54
Demographic characteristics
 Age (y)
  10–13 0 0 1 (2.6) 0.61 to 4.59 0 0 0 0
  14–17 2 (8.0) 4.60 to 11.40 3 (7.7) 4.36 to 11.04 2 (66.7) 60.79 to 72.61 1 (12.5) 8.35 to 16.65
  18–19 23 (92.0) 88.60 to 95.40 35 (89.7) 85.89 to 93.51 1 (33.3) 27.39 to 39.21 7 (87.5) 83.35 to 91.65
 Sex
  Male 15 (60.0) 53.85 to 66.15 31 (79.5) 74.44 to 84.56 3 (100.0) 48 to 100 7 (87.5) 83.35 to 91.65
  Female 10 (40.0) 33.85 to 46.15 8 (20.5) 2.94 to 13.06 0 0 1 (12.5) 8.35 to 16.65

CI, confidence interval.

Table 4.
Factors associated with alcohol use among adolescents in Nabawan by multiple logistic regression
Variable Category Multiple logistic regression*
AOR (95% CI) P-value
Demographic
 Age (y) ≤17 Reference
18 3.93 (1.225–12.611) 0.021
19 5.38 (1.769–16.350) 0.003
Environment
 Parent alcohol use No Reference
Yes 4.11 (1.770–9.539) 0.001
 Peer alcohol use No Reference
Yes 11.57 (4.113–32.515) <0.001
 Low monitoring Yes Reference
No 2.46 (1.162–5.201) 0.019
 Ever discuss serious problems Never Reference
Yes 3.86 (1.719–8.673) 0.001

Hosmer-Lemeshow test (P-value=0.432) and classification table (overall correctly classified percentage=83.2%) were applied to check for goodness-of-fit.

AOR, adjusted odds ratio; CI, confidence interval.

* Variable selection using forward (likelihood-ratio) method.

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