Abstract
Introduction
Drinking Practices and Consequences
Studies conducted in Western contexts have shown multiple health and social risks associated with alcohol use and misuse among adolescents and young adults (Bryazka et al., 2022; Skrzynski & Creswell, 2020). Alcohol consumption affects young people’s brain development (de Goede et al., 2021). It negatively impacts their motivation to study for good grades and educational achievement more generally (El Ansari et al., 2013). Alcohol consumption may also induce aggressive and violent behaviours (Beserra et al., 2019; Whiteside et al., 2013) and can cause impaired driving, accidents, injuries, and death among youth (Hingson et al., 2017). Research across sub-Saharan Africa on alcohol-related harm is still emerging, but recent research in Uganda, as an example, also demonstrates significant self-reported alcohol-related adverse consequences among youth (Swahn et al., 2020). However, it is clear that there are important differences across cultures and countries that are important to consider when designing prevention and intervention strategies.
In Nigeria, noticeable harmful drinking practices that facilitate alcohol-related harms are common among contemporary youth (Adeloye et al., 2019; Nelson, 2018). One of the recent practices, especially amongst boys and young men, is to use
Additionally, most adolescents and young adults who consume alcohol also perform masculinity and femininity with heavy drinking in public spaces (Dumbili, 2015). Dumbili’s (2015) study demonstrates that the main reason why gender performance with alcohol is common among youth in Nigeria is that they believe that the ability to outdrink peers is a status conferral. Research in Eastern Nigeria has also shown that young people, particularly students, consume large quantities of alcohol to cope with harsh economic conditions in Nigeria and to ameliorate sorrow and heartbreaks from failed romantic relationships (Dumbili. & Onyima, 2018). Surprisingly, students also consume alcohol to boost their confidence to present oral examinations and seminars and to cope with poor academic performance (Dumbili & Onyima, 2018). As such, it is clear that there are different and perhaps also some unique reasons for alcohol use among Nigerian youth and that the drinking context is very important.
It is of great public health concern that drinking practices, per capita consumption, and heavy episodic drinking rates, are growing in Nigeria. For instance, the World Health Organization (2018) reported that per capita consumption among alcohol users in Nigeria (15 years +) rose from 11.5 L to 13.4 L between 2010 and 2016 (World Health Organization, 2018). As shown below, several single- and multi-site studies have also reported high drinking prevalence among youth. This is problematic as traditionally, youth have been protected from alcohol and harm due to cultural norms dictating that they are not supposed to use alcohol (Heap, 1998). That is, young people have been culturally constrained from taking alcohol in most communities in Southern Nigeria because drinking norms, though unwritten, permit only adult men to drink (Dumbili, 2013; Heap, 1998). However, it is clear that these cultural norms are eroding, which is problematic given the limited resources for screening and treatment for youth with problem drinking or substance use disorder (Nelson et al., 2021).
Research by Atilola et al. (2013)) found a 21.4% prevalence of alcohol (and other substances) use among 538 adolescents (mean age = 15 years) in Ibadan, Western Nigeria, and 46% of them reported problematic use. Similarly, Alex-Hart et al.’s (2015) cross-sectional study of 1080 young people (aged 12–24 years) in Port Harcourt, Southern region, found a 30.6% prevalence of current alcohol use. The study further showed that 38.1% of the current drinkers were drunk at least once in the last month, while 17.2% engaged in frequent drunkenness. Also, in another study of adolescents (aged 10–19 years) in Enugu state, Anyanwu et al. (2016) reported a 29.0% prevalence of alcohol use (Anyanwu et al., 2016). A more recent nationwide study of 4078 secondary school pupils (mean age = 14.7 years) in 32 schools found a 34% prevalence of alcohol experimentation and a 13.4% prevalence of drunkenness (Mehanović et al., 2022).
While alcohol use and misuse are common among Nigerian youth, there are no comprehensive national alcohol control policies or other effective public health interventions to mitigate the trends (Morojele et al., 2021; World Health Organization, 2018). In fact, there are few evaluated individual alcohol interventions across sub-Saharan Africa (Francis et al., 2020). Similarly, there are also few interventions targeting the structural drivers of alcohol use. In particular, alcohol marketing, alcohol availability, easy accessibility, and affordability of alcohol are largely unregulated in Nigeria due to the lack of policies (Morojele et al., 2021; World Health Organization, 2018). Aggressive alcohol marketing is a key concern and has been found to increase heavy drinking among youth in Uganda (Swahn, Culbreth, et al., 2022) and Nigeria (Dumbili & Williams, 2016). Again, there is little or no budgetary allocation from the government to treat alcohol-related problems in the country; Nigeria (and many other West African countries) lacks the human capacity to address these challenges (Swahn et al., 2022a, 2022b)
While previous studies have provided valuable insights into young people’s drinking practices in Nigeria, they are mainly quantitative studies that largely focused on university and secondary school students. Additionally, these previous studies have primarily focused on the Eastern (e.g., Anyanwu et al., 2016), Western (e.g., Atilola et al., 2013) and Northern parts of Nigeria (e.g., Nwoga et al., 2019) without a commensurate effort to examine young people’s drinking practices and outcomes in Southern Nigeria. To make matters worse, despite the fact that all the multinational alcohol companies in Nigeria have their production plants and significant marketing presence in the study site, which increases the potential for alcohol availability, accessibility and affordability (through promos), little is known about young people’s drinking in this city. These crucial gaps warrant empirical research, which the current study attempts to fill.
Drawing on qualitative data elicited from 72 youth, this current study extends the existing knowledge by exploring the perspectives of both students and non-students who use alcohol in Benin City, Southern Nigeria, an understudied region. The study aims to examine the consequences of
Materials and Methods
Procedures, Participants, Interviews, and Focus Groups
This article is based on data from a large study that examined the motivations for alcohol use and drinking practices among adolescents and young adults in Benin, Nigeria. We have drawn from the dataset to report diverse drinking practices such as drinking games (Dumbili, 2022c), determined drunkenness for fun (Dumbili, 2022b), and gender role conformity with alcohol (Dumbili, 2022a). The current article analyses the consequences of these and other drinking practices from the participants’ perspectives, demonstrating how young people’s motivations or reasons for drinking may directly facilitate alcohol socioeconomic, health, and other related burdens.
We elicited data in Benin City-a metropolitan city in Southern Nigeria with many Government offices and universities. Transnational alcohol corporations such as Diageo’s ‘Guinness Nigeria’ and Heineken-owned Nigerian Breweries have production factories in the city. According to Population Stat (2021), 1,727,000 people live in Benin as of 2020.
Multiple recruitment processes were used for this study to ensure that we included a heterogeneous population. First, we used the direct recruitment or word-of-mouth method (O'Brien et al., 2014) to reach potential participants. That is, the first author visited two University campuses to survey the environments and introduce the study to potential participants. Those who indicated an interest in the study were encouraged to recruit other potential participants who consume alcohol in their peer networks (Flick, 2014). A female Research Assistant also used a similar method to recruit nonstudent participants.
Second, we used Google Forms, distributed through social media platforms like Facebook and WhatsApp, to reach other participants. The forms contained concise information about the study and the researchers' mobile contact numbers. We also informed potential participants to supply their mobile numbers (or email), so we could reach them and explain the full details of the study to them (Tong et al., 2007). Those who indicated interests and provided their details were contacted to explicate the full details and the criteria for participation to them. The inclusion criteria were that a potential participant must be between 18 and 24 years old, must have used alcohol in the last 30 days and currently reside in Benin. We also employed the snowball technique to recruit additional participants (Ghaljaie et al., 2017).
Seventy-two University students and nonstudents were included in the study. All the students were undergraduates, while their nonstudent counterparts included hairstylists, apprentices, an auxiliary nurse, and a plumber. We elicited data between February and June 2019. We conducted three single-sex focus group discussions (FGDs- 16 females, 10 males) and fifty-three semi-structured interviews lasting between 30 and 99 minutes among 42 females and 37 males (aged 18–24 years). Five female and two male participants took part in both interviews and FGDs. The English language facilitated the interviews and FGDs, but five nonstudents spoke in Pidgin English. Some of the specific questions/probes include ‘Any time you hear about alcohol, what comes to your mind?’, ‘Where do you usually drink alcohol?’, ‘Why do you prefer that place?’ ‘Who do you drink with?’ ‘Why do you drink with them?’, ‘So, tell me, what quantity do you usually drink on a drinking occasion?’ ‘Why do you consume that quantity?’ ‘Have you ever consumed more than planned?’ For those who answered yes, we then asked them: ‘Please tell me, what led to that?’ ‘Has it ever happened again?’ ‘Please tell me, how many times has it happened?’, ‘So, do you know any outcomes of drinking large quantities of alcohol (or more than planned)?’ ‘Has it ever occurred to your friends or people you know?’ ‘Please tell me, has it ever happened to you?’ ‘Please share your experience with me’. ‘How did you feel after that experience?’ We have used pseudonyms to replace participants’ names and other identifiers. Brunel University Ethics Committee (Reference:16189-LR-Apr/2019-18748-2) approved the study, and we obtained informed consent from participants.
Analytical Procedures
The data were analysed thematically, guided by Braun and Clarke’s (2019) reflexive thematic method. Here, we utilised deductive and inductive approaches (Collins & Stockton, 2018) to identify rich and detailed patterns of meaning in the dataset (Braun & Clarke, 2019). First, all the audio recordings were transcribed verbatim and read many times to ensure accuracy. Following this, a collaborative data analysis method was used (Richards & Hemphill, 2018). Having immersed in the data, the two researchers (a male and a female) coded five transcripts utilizing some words and phrases used by the participants (Linneberg & Korsgaard, 2019). Next, the tentative codes we generated were reviewed and discussed, facilitating the coding framework development that guided the remainder of the analysis. We employed this procedure to ensure analytical rigour, transparency, and trustworthiness (Gioia et al., 2013; Richards & Hemphill, 2018). Next, we imported all the transcripts into the NVivo 12 software, which was used to manage the rest of the analysis. When all the transcripts were coded, we searched for and developed themes and subthemes (Jackson & Bazeley, 2019). We also engaged in theme refinement by moving codes/extracts to more appropriate nodes, or new ones were created for them before themes and subthemes were named. The outcomes of these iterative processes are reported in the finding section below.
Findings
The findings are presented under three interrelated themes:
Awareness and Experiences of Heavy Drinking
We asked participants to share their awareness of any consequences of taking alcohol or drinking heavily known to them. All of the participants discussed knowing several alcohol-induced health, social, economic, and other harms. Many participants discussed how alcohol, especially heavy drinking, can induce anti-social behaviour such as fighting. Participant 22 (Female, Nonstudent) noted that after drinking, some of her friends ‘
While Participant 5 learned from this singular experience not to drink gin again because of its high potency and the potential to induce inebriation, some participants intentionally repeated heavy drinking rituals. Some indicated that they repeated heavy drinking to master the act of consuming large quantities of alcohol, while others were fun seekers (see Dumbili, 2022b).
Some participants also highlighted their awareness of the consequences including physical harm of alcohol among their relatives:
Other participants shared nuanced experiences of how they or their friends had consumed large amounts of alcohol, became inebriated, and behaved in ways they would never have behaved if they had been sober. For instance, Participant 19 (Female, Nonstudent) noted,
Studies on masculinity and health (e.g., Evans et al., 2011) have shown that most men often conceal their health condition unless revealing it will enhance their masculinity and this was evident in our study. While some participants were honest about their experiences, others, especially men, were sparse with the truth about the consequences of heavy drinking. Thus, they only indicated how they were able to ‘control’ themselves under inebriation. For instance, Participant 36 (Male) shared how he had engaged in solitary drinking due to a heartbreak which resulted in heavy drinking to the extent that he spent 15–30 minutes lying on the floor on two occasions when he attempted to pick the key and open the door. On another drinking occasion, he exceeded his limit yet, claimed to be in control: “...but I already knew then that I had passed my limit. So, I just had to control myself, so I won’t misbehave” Participant 36 (Male, Student).
Our analysis also shows that some participants engaged in heavy drinking to prove to peers that they could hold their drinks. A female participant shared how she engaged in heavy drinking practices twice in a week because she wanted to demonstrate to peers that she is a ‘mature drinker’. Thus, she took six and eight bottles of alcohol on these drinking occasions. She further shared an experience of another competitive drinking episode that facilitated heavy drinking and loss of control after she had consumed 12 bottles of Smirnoff Ice:
One of the common features of our analysis is that while some participants instigated heavy drinking among peers, they also supported them when they became intoxicated. The account below is a useful example of how peers provide care in peer networks for intoxicated members:
So, when she woke up the next morning, she was like, ‘ah! I’m naked! What happened to me?’ We started laughing. We were like, ‘babe; we are the ones in the room with you’. She was like, ‘who pulled my clothes? We were like, ‘babe, we pulled it; it was not a guy.
Previous research elsewhere showed that most young people were unhappy about being videoed or photographed when intoxicated because such can result in negative publicity (Moewaka Barnes et al., 2016). In our study, most young people who became drunk and were videoed normalised and laughed off their experiences when peers showed them the videos. For example:
Together, these accounts have highlighted participants’ knowledge of the consequences of heavy drinking and the extent to which they engaged in such a drinking style which facilitated some behaviours like fighting.
Different Types of Alcohol-Related Consequences
This subsection highlights the health, economic and social consequences of drinking large amounts of alcohol, demonstrating how these outcomes are interrelated. Additionally, we show that all the alcohol-related outcomes participants reported were caused by acute/heavy episodic drinking. Almost all the participants shared many experiences of health-related drinking and getting drunk. Most of them discussed how they had vomited after consuming large quantities of alcohol:
Although Participant 32 did not disclose any sexual harassment from this experience, some women discussed near-rape experiences. Relatedly, others shared how their friends and acquaintances were sexually harassed or raped when they became intoxicated. Other participants also narrated how they vomited under inebriation. Participant 5 (Male, Nonstudent) noted that he took two bottles of Williams Dark Ale (stout with 6.5% ABV) at a party before taking gin. Following this, he became highly intoxicated, fell on the floor, and vomited:
Participant 35 (Male) did not just throw up after drinking heavily. When we probed him further, he highlighted other related consequences he had suffered:
Participants noted that one of the consequences of heavy drinking they know is losing one’s valuable personal belongings. One of them-a male noted that it is common to lose mobile phones and wallets, in that when a person sleeps off at parties after acute drinking, some men who are sober steal their items.
Participant 57- an apprentice is among those who became drunk because of free drinks. He shared his experience of suffering alcohol-related sickness after taking six bottles of
Like him, many participants’ accounts highlighted how health harms relate to economic consequences. That is, some participants lost productive hours due to alcohol-induced sicknesses that made them incapacitated and unproductive for some days. Our analysis demonstrates that vomiting, hangovers, and stomachaches were the most common health-related consequences amongst the participants. The account below further exemplifies this:
In addition to these, participants also reported body pain and weakness following heavy drinking episodes and intoxication:
One of the popular practices we observed in this study is taking different types of alcoholic beverages on a drinking occasion which facilitated intoxication and alcohol-induced sickness:
Our data highlighted that although a number of participants became drunk unintentionally, most of them were determined to get drunk for the fun of it or for other purposes (Dumbili, 2022b). Unfortunately, many experienced unintended health-related consequences as a result:
Indeed, being sick (a health-related outcome) for 3 weeks would have resulted in the loss of productivity hours (economic and other consequences as a student), which was common amongst students and their nonstudent counterparts. Interestingly, our analysis shows that being aware of the consequences of heavy drinking may not necessarily result in avoiding it. For example, in the subsection above, Participant 31 shared her father’s experience of drinking and suffering severe health-related harm. In her words,
Our analyses equally highlighted the extent to which heavy drinking affects people who engage in it and others around them. Some participants shared their experiences of second-hand effects of drinking, in that they sustained injuries from other people’s drinking. For example:
Participants not only engaged in heavy drinking rituals that facilitated health challenges, but some also engaged in what can be termed-self-medication by taking what they called drugs (e.g., paracetamol and other over-the-counter medications), while others resorted to Garri (granulated/fried cassava tuber). Our data showed that friends or relatives gave many participants Garri to soothe the effects of intoxication: ‘‘so they now forced me home; when I got home, I started vomiting, and they started giving me Garri to drink’’ (Participant 16 Female, Nonstudent). In Nigeria, there is a popular notion that consuming Garri soaked in cold water without milk or sugar reduces the intoxicating effects of alcohol or detoxifies someone inebriated (Dumbili, 2016a). Other participants shared similar accounts that further shed light on this. For instance:
These accounts have highlighted how participants engaged in heavy drinking and suffered one or more alcohol-related health challenges. Although some of our participants were light drinkers, the analysis highlighted how most of them engaged in regular heavy drinking rituals. One of the important nuances in the analyses indicated how the availability of free drinks on most occasions impacted the frequency of heavy drinking practices.
Academic-Related Consequences
Aside from the health-related consequences analysed above, our data also cast light on how heavy drinking and intoxication can (in)directly affect participants’ education. One of the interesting nuances concerning this aspect of the analyses is that heavy drinking affected their health and spilled over to their class attendance: ‘‘A few days ago, I missed class because of a hangover (
Interestingly, this aspect of our data was gendered because only men reported personal experiences of missing their lectures because they were too sick following excessive alcohol use from the previous night. In Nigerian higher institutions of learning, some semester tests are impromptu, which underlines the importance of attending lectures. From the above accounts, it is obvious that some students who miss classes on the day such an impromptu test is given because of alcohol-induced sickness will miss the tests, leading to poor grades in such modules.
Discussion
Our study explored how heavy drinking practices exacerbate alcohol-related harm among Nigerian youth who drink alcohol. There are three overarching findings. First, youth drinkers in this qualitative study are clearly aware of a range of alcohol-related harms. Second, the youth participants shared lived experiences and a range of alcohol-related health, economic and social harms to themselves and others. Third, the participants drank to excess, despite knowing of the significant harms and risks as well as previous experience. It is notable that all the consequences participants reported were caused by acute drinking practices. Taken as a whole, these findings are quite disturbing and raise important challenges for prevention and intervention efforts. Also, many participants indicated the importance of the peer context, both in positive and negative ways adding significant complexities for health promotion strategies. More specifically, the findings have shown the extent to which the youth we studied engaged in heavy drinking that resulted in intoxication and alcohol-related harm to them and to others. Citing examples from their friendship networks and families, participants demonstrated that they were highly knowledgeable about how harmful drinking practices could exacerbate serious consequences. This corroborated earlier research in another part of Nigeria, revealing that young Nigerians were aware of the deleterious effects of consuming large amounts of alcohol (Dumbili, 2020). Interestingly, the finding is at variance with the so-called ‘knowledge is power', one of contemporary Nigeria’s most famous sayings or mantras. This is because even though participants were aware of the negative impact of heavy drinking, most of them nonetheless drank excessively. In fact, most participants consumed between 3 and 12 bottles of different alcoholic beverages (beer and premixed) on a drinking occasion, while others took large quantities of spirits.
Previous studies (e.g., Adeloye et al., 2019; Alex-Hart et al., 2015; Mehanović et al., 2022) have shown that young Nigerians who engage in harmful drinking also reported alcohol-related harm, and this is in line with the current study. Our findings revealed that participants suffered health-related consequences from heavy drinking and intoxication. Many of them vomited under inebriation and suffered hangovers and stomachaches, while others were sick for some days. Incidents of falling down which may inflict injuries on them, and being injured by broken pieces of bottles that intoxicated peers broke were reported (Hingson et al., 2017). One of the serious implications of this aspect of our findings is that many participants suffered more than one health-related negative impact of heavy drinking, and many of them also experienced such negative impacts multiple times. While this indicates that they engaged in regular heavy drinking, it raises serious public health concerns for many reasons, particularly as participants were aware of drinking harms but kept on drinking regardless. The findings from this study and our related work (Dumbili, 2022a, b, c) underscore three key areas.
First, Nigeria does not have adequate/sufficient human and material resources to tackle heavy drinking and associated health burden (Nelson, 2018; Swahn et al., 2022a, 2022b). Most government hospitals in Nigeria are understaffed, rendering poor services. In private hospitals where quality services may be available, only the affluent can afford them because out-of-pocket payment is the norm, while a few have insurance coverage (Shobiye et al., 2021). Given the regular heavy episodic drinking among youth, which corroborates World Health Organization’s (2018) report, we can hypothesize that alcohol health burdens will be overwhelming soon in Nigeria unless the trend is reversed with effective public health interventions.
Second, the global alcohol corporations operating in Nigeria are making concerted efforts to ensure that alcohol is readily available, accessible, and affordable so they can increase profits (Morojele et al., 2021; Obot, 2015). As previous research shows, these corporations use female students to promote alcohol to peers in bars and nightclubs around university campuses (Dumbili, 2016b), and they also sponsor night-time youth-centred social events that promote alcogenic environments (Morojele et al., 2021). These and other strategies are helping to redefine and/or establish new drinking cultures and practices among students (and other out-of-school youth) that align with students’ drinking norms in Westernised countries (Fenton et al., 2023; Supski et al., 2017). For example, fairly recently, it was reported that students’ parties or other social events involving youth are considered incomplete without serving alcohol (Dumbili, 2018) and drinking games and other practices that promote the culture of intoxication are common in such events. Given that alcohol availability fuels consumption, the alcohol health burdens will continue to rise in Nigeria, especially because alcohol marketing is largely unregulated due to the lack of policies (Morojele et al., 2021; World Health Organization, 2018). The findings raise serious concern because, as noted, while there is a decline in drinking among young people in the Global North (Caluzzi et al., 2021; Looze et al., 2015), many young Nigerians are initiating alcohol consumption while those who do drink engage in heavy drinking (Dumbili, Okpan, et al., 2022).
Third, previous research has highlighted that providing free alcohol for guests is normative and expected in occasions (including burial ceremonies) held in Nigeria because it is a sign of hospitality (Dumbili, 2013; Umunna, 1967). This is to the extent that entertaining guests with expensive, foreign, or uncommon brands has become a status conferral (Dumbili, 2013, 2018). Also, there is a unique practice in Nigeria where only the liquid content of alcoholic beverages is sold to consumers. Unlike in Western countries, where those who buy alcohol packaged in bottles are not required to return the bottles to the seller or are mandated to pay more, buyers in Nigeria must return the bottles to the seller or pay extra fees (Dumbili, 2016b). Because of this common and peculiar practice, stewards or hosts of occasions often open the bottles of beverages so that guests can drink, allowing them to retrieve their bottles and avoid extra costs. Given that guests cannot take away bottles from an occasion (to consume when they like), some engage in heavy drinking (maybe to avoid wasting free drinks that are already opened), which often facilitates heavy drinking and intoxication. Indeed, research is warranted to examine how this peculiar practice mediates alcohol use and misuse in Nigeria.
Furthermore, we found that heavy drinking and intoxication also impacted participants’ academics. Due to intoxication and sicknesses caused by the previous day’s heavy drinking, some participants, especially men, could not attend lectures, which may facilitate poor grades. The finding aligns with previous research elsewhere, which shows that alcohol consumption affects young people’s educational attainments in diverse ways (El Ansari et al., 2013). Relatedly, participants lost ample productivity hours, in that some could not go to their workshop, which further reveals the negative economic impact of alcohol consumption (Buvik, Moan, & Halkjelsvik, 2018Buvik et al., 2018). Further research to estimate the economic impact of heavy drinking is needed in Nigeria. The unique context within Nigeria should also be factored in, especially because alcoholic beverages in Nigeria are very potent. For example, Odeigah and colleagues’ comparative study of 13 alcoholic beverages simultaneously produced in Nigeria and the United Kingdom (UK) found that Nigerian products contained larger volumes and higher ABV than their UK counterparts (Odeigah et al., 2021). Therefore, this implies that Nigerians who use alcohol consume larger volumes and more significant percentages-a factor that increases the likelihood of heavy drinking and alcohol-related harms.
Additionally, while drinking trends were not assessed in our qualitative study of drinking harm, the ease by which participants discussed their drinking and related harm raises concern about the cultural norms regarding drinking and indicate that previous social controls against drinking among youth are no longer as impactful. These findings when taken together with our previous research (Dumbili, 2022a, b) indicate that the burden of alcohol harm will likely increase in Nigeria in contrast to Western countries, which shows that young people are abstaining from alcohol or drinking less due to their knowledge of the health and other consequences of drinking (Caluzzi et al., 2021; Corre et al., 2023).
Conclusion
Our study has revealed that heavy drinking and related negative consequences are rife among young people in Benin City. The study has some key limitations to be considered when interpreting the findings. First, this study provides an in-depth examination of alcohol and related harm among youth in Benin. The findings are meant to inform prevention and intervention efforts as well as guide new studies, but not necessarily be generalizable to other regions or settings. An ethnographic study is warranted given the range of findings, particularly regarding adherence or erosion of traditional cultural norms regarding alcohol use among youth. Second, qualitative data were collected from the southern region. Nationwide quantitative and qualitative studies focusing on students and their nonstudent counterparts should be conducted for policy and other public health purposes. Third, we included an unequal number of students, nonstudents, and men and women and as such, the study was not structured to produce generalizable finding across these categories of participants.
In sum, a key finding from this study is that participants were knowledgeable about alcohol and harm. They reported many incidents with first hand lived experience. Yet, they kept drinking to excess, recounting a range of alcohol-related harms to themselves and to others. These raise serious questions and challenges for how to best prevent and delay alcohol use and harm among youth. That participants shared their awareness of the consequences of heavy episodic drinking based on first and second-hand experiences has serious implications for designing and implementing interventions to facilitate behaviour change. There may be a need to involve young people (including those with and without first-hand experience of alcohol-related harm) in feasibility studies to generate nationwide evidence that will facilitate designing and implementing effective strategies to change social norms and youth behaviours regarding alcohol consumption and heavy drinking in particular. Such tailored peer-driven interventions that will facilitate behaviour change should be prioritized instead of relying on industry-driven health warning messages and education that are ineffective.
Footnotes
Declaration of Conflicting Interests
Funding
ORCID iD
