2016. Obzornik zdravstvene nege, 50(4), pp. 280-295.
Original scientific article/Izvirni znanstveni članek
Factors associated with greater potential for alcohol misuse among the students of the Gorenjska region
Dejavniki tveganja za uživanje alkoholnih pijač pri študentih v gorenjski regiji
Sanela Pivač, Brigita Skela-Savič
ABSTRACT
Key words: drinking frequency; students; alcohol
Ključne besede: pogostost pitja; študenti; alcohol
Lecturer Sanela Pivač, MSc (Nursing), RN
Correspondence e-mail/ Kontaktni e-naslov: spivac@fzj.si
Associate Professor Brigita Skela-Savič, PhD, MSc, RN
Both/Obe: Faculty of Health Care Jesenice, Spodnji Plavž 3, 4270 Jesenice, Slovenia
Introduction: Excessive alcohol consumption can stem from different biological, social, environmental, or psychological factors (e.g. peer influence, desire to be accepted within a social group, family history with alcohol addiction, availability of alcohol beverages, poor academic performance, low self-image, etc.). The aim of study was to determine the risk factors associated with alcohol consumption among the undergraduate students in the Gorenjska region.
Methods: A quantitative non-experimental method of research was employed. The data were collected through a structured questionnaire. The purposive sample consisted of 328 first-year undergraduate students in the Gorenjska region. The research was conducted in May, October and November 2012. The data obtained were analysed using the descriptive statistics and multiple linear regression analysis.
Results: The greatest influence on drinking frequency for better sociability and relaxation has the average educational attainment in the last year of secondary education (fi = 0.168, p = 0.002). The following factors were identified to have a statistically significant impact on the frequency of alcohol consumption during leisure time: friendship (fi = 0.131, p = 0.029), frequent socializing with friends (fi = 0.127, p = 0.035), support of the family when in distress (fi = - 0. 183, p = 0.001) and the average academic achievement in the last year of secondary education (fi = 0.098, p = 0.043).
Discussion and conclusion: The risk factors associated with alcohol consumption among the students in the Gorenjska region are mainly social (lack of family support, peer pressure) and personal (low self-image, poor academic achievement and leisure time). Characteristics of the study participants in relation to alcohol consumption do not differ from the rest of the younger population.
IZVLEČEK
The article is based on the Master thesis of Sanela Pivač Attitudes of students attending junior colleges and higher education institutions in the Gorenjska region towards alcohol consumption and abuse (2013)./ Članek je nastal na osnovi magistrskega dela Sanele Pivač Odnos študentov do alkohola in alkoholne problematike na višje- in visokošolskih zavodih v gorenjski regiji (2013).
Prejeto/Received: 22. 7. 2016 Sprejeto/Accepted: 7. 11. 2016
Uvod: Pogosti dejavniki tveganja za pitje alkoholnih pijač so želja po sprejetosti s strani vrstnikov, prisotnost alkohola v družini, dostopnost alkohola, slabši študijski uspeh in nižja samopodoba študenta. Namen raziskave je bil ugotoviti dejavnike tveganja, ki so povezani z uživanjem alkoholnih pijač študentov na višje-in visokošolskih zavodih v gorenjski regiji.
Metode: Uporabljena je bila kvantitativna neeksperimentalna metoda raziskovanja. Podatki so bili zbrani s pomočjo strukturiranega vprašalnika na namenskem vzorcu 328 študentov prvih letnikov višje- in visokošolskih zavodov na področju gorenjske regije, v obdobju maj ter oktober in november 2012. Uporabljena je bila opisna statistika in linearna multipla regresijska analiza.
Rezultati: Največji vpliv na pogostost pitja zaradi komunikativnosti in sproščenosti ima povprečni učni uspeh v zadnjem letu srednješolskega izobraževanja (fi = 0,168, p = 0,002). Statistično pomemben vpliv pogostosti pitja alkoholnih pijač v prostem času predstavljajo prijateljstvo (fi = 0,131, p = 0,029), pogosto druženje s prijatelji (fi = 0,127, p = 0,035), opora družine v primeru težav (fi = -0, 183, p = 0,001) in povprečni učni uspeh v zadnjem letu srednješolskega izobraževanja (fi = 0,098, p = 0,043).
Diskusija in zaključek: Dejavniki tveganja, ki so povezani z uživanjem alkoholnih pijač študentov gorenjske regije so socialni (opora družine), vrstniški (vpliv vrstnikov) in individualni (nizka samopodoba, slabši učni uspeh in preživljanje prostega časa). Značilnosti anketiranih študentov gorenjske regije v odnosu do uživanja alkoholnih pijač ne odstopajo od ostalih vrstnikov.
http://dx.doi.org/10.14528/snr.2016.50.4.103
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Introduction
Alcohol is the oldest and most widely consumed of all legal recreational drugs during study years (Baker & Boland, 2011). According to the Ministry of Health (2008), alcohol consumption is the world's sixth largest risk factor for untimely morbidity and mortality worldwide, while in Europe it ranks the third, or the first among youth. Alcohol consumption of the young is a major public health concern (Rassool, 2007). Alcohol is the most commonly misused substance associated with different types of diseases and conditions. The trend of alcohol use among the young, and especially episodes of heavy drinking (binging), is still increasing (Hovnik Keršmanc, 2010). The problem of heavy episodic drinking is common also in other countries. The research conducted among the American students shows that binging may result in poorer academic achievement and lower self-image (Kazemi, et al., 2011).
According to the European School Survey Project on Alcohol and Other Drugs (ESPAD) 2011 (Hibell, et al., 2011), 93 % of the respondents reported using alcohol. Boys drink more frequently and in larger quantities than girls (Stergar, 2011). These results are in line with the findings of the study conducted among the first and the fourth-year students of the University of Maribor (Kolšek & Klemenc Ketiš, 2015). Alcohol drinking is a perennial problem in the Gorenjska region, widespread among younger as well as older generation. It is disturbing to note that the youngsters attribute to alcohol more positive than negative effects. The greatest positive effect cited was satisfaction and pleasure (Hovnik Keršmanc, 2011).
There are several factors which induce the youngsters to consume alcoholic beverages. These factors include their desire to be accepted by their social group, the environment, alcohol availability, exposure to alcohol advertisements, and a lot of leisure time. The consequences of problematic drinking perpetrated by college age students are varied, serious, damaging, and far reaching, including the adverse effects on their well-being, also a 'hangover', their educational performance, bodily injuries and involvement in fatal car accidents (Snyder, 2006). Several studies indicate that the increasingly stressful environment has led to the increased misuse of alcohol, tobacco and other illegal drugs among the young in the past decades (Varela & Picakrd, 2011). The peers as well as the adults may have an impact on the risk-taking behaviour of the youngsters (Etcheverry & Agnew, 2008; Kenna & Lewis, 2008). Peers act as an influential model and therefore the students are more likely to consume alcohol when accompanied by drinkers than non-drinkers (Cicognani & Zani, 2011). Seeing one's peers drinking alcohol induces the students to start drinking, which consequently leads to the increased consumption of alcohol (Champion, et al., 2015). The
most common risk factor for alcohol drinking and binging are poor family income, ineffective parenting, general social context, poor educational performance, association with deviant peers, early engagement in risk behaviours and drug misuse as well as physiological and genetic factors (Maggs & Schulenberg, 2006). It was established that higher levels of binge drinking of younger adults are associated with early onset of drinking and higher levels of anxiety and depression (McNamara, et al., 2010).
Aims and objectives
The purpose of the study was to explore the prevalence of alcohol abuse among the undergraduate students in the Gorenjska region. The study aimed to establish the drinking patterns of the students and to identify the major risk factors associated with the excessive indulgence in drinking alcoholic beverages.
The following hypothesis was formulated and tested:
H1: Student alcohol consumption is related to the following risk factors: stress, lack of social support, social interaction and group acceptance, and the academic achievement in secondary education.
Methods
The study is based on a quantitative non-experimental research method. The data were collected by using a survey with a structured questionnaire as a research instrument.
Description of the research instrument
The structured questionnaire was composed of seven sections including different number and types of questions: multiple-choice questions, control list and a 5-point Likert scale with fixed choice response formats to measure the attitudes or opinions statements. Each of the five responses was attributed a numerical value used to measure the attitude under investigation (1-Strongly Disagree, 2-Disagree, 3-Undecided, 4-Agree, 5-Strongly Agree). The questionnaire design was based on the literature review of the sources related to alcohol consumption (Watson, et al., 2006; Zalta, et al., 2008; Tremblay, et al., 2010). The reliability of the questionnaire was tested with the analysis of internal consistency.
The testing of the questionnaire reliability used on the given research sample yielded the following results:
-	Cronbach's alpha for 10 statements referring to personal characteristics and social relationships was 0.82;
-	Cronbach's alpha for 8 statements referring to the adverse effects of alcohol drinking was 0.81.
The validity of the research instrument was
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explained by the factor analysis of variables. Adequate explanation of variance was achieved. The factors obtained were used in further statistical analysis, as presented in the Results section. Principal components analysis was used to identify a smaller number of uncorrelated variables (the principal components) from a large set of data. A better structure of factor loading was obtained by factor rotation. The principal components analysis yielded three components which could explain 71.6 % of total variance (KMO = 0.932 and Barlett p < 0.001). The factor 'frequency of drinking alcohol for better sociability and relaxation', which includes three statements, explains 47.66 % of variance; the factor 'frequency of drinking during leisure time', which includes three statements, explains 13.41 % of variance; the factor 'drinking alcohol to alleviate stress and problems', which includes four statements, explains 10.60 % of variance. In further statistical analysis all three factors were considered.
Description of the research sample
The research sample consisted of undergraduate students in Gorenjska region. In this region, there are 3 colleges and 7 higher professional education institutions. The list does not include the institutions (3) where only part-time studies are available. The sample was reduced to the students of two colleges and two higher professional education institutions as the remaining ones did not give their consent to be included in the study or missed the deadline for participation. The purposive sample consisted of the following institutions: Intercompany education and training centre Kranj, Vocational college; Škofja
Table 1: The number of the first-year students enrolled in the academic years 2011/12 and 2012/13 and the number of students from higher education institutions in the Gorenjska region who participated in the study Tabela 1: Število študentov, vpisanih v prvi letnik v študijskem letu 2011/12 oz. 2012/13, in število v raziskavo vključenih študentov po gorenjskih višje- in visokošolskih zavodih
Higher education institution (academic year of enrolment)	n1	n2	%
Intercompany education and training centre Kranj, Vocational college (2012/13)	91	35	38.5
Škofja Loka School Centre (2012/13)	89	67	75.3
Faculty of Health Care Jesenice (2011/12; 2012/13)	190	131	68.9
Faculty of Organisational Sciences Kranj (2012/13)	297	95	32
Total	667	328	49.2
Legend/Legenda: nt - the number of enrolled students/število vpisanih študentov; n2 - the number of students who participated in the study/število študentov, ki so sodelovali v raziskavi; % -percentage/odstotek
Loka School Centre; Faculty of Health Care Jesenice; Faculty of Organisational Sciences Kranj. The research conducted at the Faculty of Health Care Jesenice included two generations of full-time first-year students enrolled in the academic years 2011/12 and 2012/13, while in other institutions only the fulltime first-year students enrolled in the academic year 2012/13 participated in the study. The sample included the total of 328 students, which represents 49.2 % realisation of the sample (Table 1).
The participants' age ranged from 18 to 20 years (64.6 %), only 4.3% of the students were aged over 24 years. The sample consisted of 147 (44.8 %) males and 181 (55.2 %) females. The academic attainment of the majority of the participants in the last year of their secondary education was satisfactory, and only 3.4 % of the participants completed their education with excellent grades.
Description of the research procedure and data analysis
The study was conducted in May, October and November, 2012. All higher education institutions were invited to provide their informed consent before taking part in the study. The potential research participants were prospectively informed of the purpose and time of the research. After the consent for participation was obtained, the survey was conducted according to the protocol agreed upon by the coordinators of the research in individual institutions. The participants were asked to complete the survey according to instructions. The participation was voluntary, anonymity and confidentiality of the participants was ensured. The data collected were processed by using the SPPS computer programme version 20.0 (SPSS, Chicago, IL, USA), the descriptive statistics and multiple linear regression analysis. The variables were defined on the basis of factor analysis. Linear multiple regression analysis was used to interpret the students' attitudes towards alcohol drinking. The differences with p-value of 5 % or lower were considered to be statistically significant.
Results
Table 2 shows that the majority of respondents (61.3 %) consumed their first alcoholic drink at the age of 15 to 18 years, and most of the remaining respondents (36 %) at the age of 10 to 14 years. Most of the respondents (34.5 %) consume up to 3-4 drinks per occasion and 18.3 % of the respondents consume seven or more drinks per occasion. The majority of the respondents (28.4 %) drink alcohol only on special occasions, i.e. a few times per year and 4.9 % of the respondents drink 3-6 times per week.
The aim of the study was to determine whether the students' alcohol drinking is related to the factors,
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Table 2: Characteristics of the students in relation to alcohol consumption Tabela 2: Značilnosti anketiranih študentov v zvezi z alkoholom
Statements/Trditve	n	%
Favourite drinks		
Spirits	101	30.8
Beer	90	27.4
Wine	81	24.7
Alkopop - bottled flavoured alcoholic beverages with relatively low alcohol	53	17.1
content (cca. 5% alcohol by volume)		
Total	325	100
Age at first alcohol drinking		
Never	1	0.3
Between 10 to 14 years of age	118	36.0
Between 15 to 18 years of age	201	61.3
Between 19 to 22 years of age	8	2.4
Total	328	100
The average quantity of alcohol consumed per occasion		
I do not drink alcohol	14	4.3
1-2 drinks	84	25.6
3-4 drinks	113	34.5
5-6 drinks	55	17.3
7 drinks and more	60	18.3
Total	326	100
Frequency of drinking alcohol in the previous year		
Never	11	3.4
A few times per year, on special occasions	93	28.4
1 time per month	59	18.0
2-3 times per month	82	25.0
1-2 times per week	64	19.5
3-6 times per week	16	4.9
Every day	3	0.9
Total	328	100
Legend/Legenda: n - number/število; % - percentage/odstotek
Table 3: Results of regression analysis of frequency of alcohol consumption for better sociability and relaxation Tabela 3: Rezultati regresijske analize pogostosti pitja zaradi komunikativnosti in sproščenosti
Frequency of drinking for better sociability and relaxation/ Pogostost pitja zaradi komunikativnosti in	Characteristics/ Značilnosti	b		t	P
sproščenosti					
	Constant	0.213	/	0.530	0.596
	I have a positive self-image.	-0.141	-0.126	-2.330	0.020
	What were your average point grades in the last year of secondary education?	0.238	0.168	3.130	0.002
R = 0.308 R2 = 0.095	How often do you exercise (at least 30 minutes a day)?	-0.071	-0.093	-2.013	0.045
pril. R2 =0.081	How often do you watch TV in your leisure time?	0.140	0.118	2.202	0.028
	How often do you meet and socialize with				
	friends in your leisure time (have a cup of coffee, go to a party)?	-0.196	-0.139	-2.572	0.011
Legend/Legenda: b - regression coefficient/regresijski koeficient; / - standardized regression coefficient/standardizirani regresijski koeficient; R - the correlation coefficient/korelacijski koeficient; R2 - the average of all total achievements/povprečje vseh skupnih dosežkov; pril. R2 - the explanatory proportion of variability/delež pojasnjevalne variabilnosti; t - coefficient value/vrednost koeficienta; p - statistical significance/statistična značilnost
such as lack of family support, low self-image, greater peer acceptance, and poor academic attainment in the secondary education. Results of the study revealed the following average values of the students' family
support (x = 4.3, s = 0.8), and self-image (x =3.8, s = 0.8), using a 5-point Likert's scale.
Regression analysis was used to investigate the relationships between interrelated variables. Three
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Table 4: Results of regression analysis of frequency of alcohol consumption in Tabela 4: Rezultati regresijske analize pogostosti pitja v prostem času			the respondents' leisure time		
Frequency of drinking in the respondents' leisure time/ Pogostost pitja v prostem času	Characteristics/ Značilnosti	b	¥>	t	P
	Constant	-0.384	/	-0.799	0.425
	I have a positive self-image.	0.104	0.093	1.676	0.045
	I have many friends.	0.146	0.131	2.198	0.029
	I often socialise with my friends.	0.148	0.127	2.123	0.035
R = 0.463 R2 = 0.214 pril. R2 = 0.194	My family supports me when I am in distress.	-0.207	-0.183	-3.456	0.001
	When in trouble I seek help from my teachers.	-0.201	-0.195	-3.873	0.000
	Average grades in the last year of secondary education	0.138	0.098	1.944	0.043
	How often do you spend your leisure time in nature?	0.117	0.098	1.933	0.044
	How often do you spend your leisure time with your friends? (have a cup of coffee or go to a party)?	-0.315	-0.224	-4.160	0.000
Legend/Legenda: b - regression coefficient/regresijski koeficient, / - standardized regression coefficient/standardizirani regresijski koeficient; R - correlation coefficient/korelacijski koeficient; R2 - the average of all total achievements/povprečje vseh skupnih dosežkov; pril. R2-explanatory proportion of variability/deležpojasnjevalne variabilnosti; t - coefficient value/vrednost koeficienta; p - statistical significance/statistična značilnost
regression models were developed with dependent and independent variables obtained by factor analysis: frequency of alcohol consumption for better sociability and relaxation, drinking in the respondents' leisure time, and drinking because of stress and other problems. The following average values of the factors were obtained: 3.5 (s = 1.1) for 'frequency of alcohol consumption for better sociability and relaxation', 3.2 (s = 0.9) for 'drinking in the respondents' leisure time, and 2.2 (s = 0.8) for 'drinking because of stress and other problems'.
As shown in Table 3, the following factors have a statistically significant impact on drinking frequency for better sociability and communication: positive self-image (fl = -0.126, p = 0.020), average point grades in the last year of secondary education (fl = 0.168, p = 0.002), frequency of physical exercises (at least 30 min. per day) (fl = -0.093, p = 0.045), watching TV in leisure time (fl = 0.118, p = 0.028) and socialising with friends in leisure time (fl = -0.139, p = 0.011). These factors explain 8.1 % of the total variability of the frequency of drinking because of better sociability and
Table 5: Results of regression analysis of the consequences of drinking due to stress and other problems Tabela 5: Rezultati regresijske analize pitja kot posledice blaženja stresa in težav
Drinking as a result of stress and problems/Pitje kot posledica blaženja stresa in težav	Characteristics/Znacilnosti	b	¥>	t	P
	Constant	-0.255	/	-0.484	0.629
	I often socialise with my friends.	0.131	0.113	1.958	0.051
R = 0.373 R2 = 0.139 pril. R2 = 0.120	My family supports me when I am in distress.	-0.186	-0.165	-3.032	0.003
	Average grades in the last year of secondary education	0.263	0.186	3.520	0.000
	How often do you visit shopping centres?	-0.172	-0.115	-2.138	0.033
	How often do you spend your leisure time with your friends? (have a cup of coffee or	-0.184	-0.131	-2.295	0.022
go to a party)?
Legend/Legenda: b - regression coefficient/regresijski koeficient, / - standardized regression coefficient/standardizirani regresijski koeficient; R - correlation coefficient/korelacijski koeficient; R2 - the average of all total achievements/povprečje vseh skupnih dosežkov; pril. R2 - the explanatory proportion of variability/delež pojasnjevalne variabilnosti; t - coefficient value/vrednost koeficienta; p -statistical significance/statistična značilnost
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communication. The average point grades in the last year of secondary education was the factor influencing drinking frequency to the largest extent (3 = 0.168).
The regression analysis shows a statistically significant impact of individual variables studied on the frequency of alcohol drinking in one's leisure time (Table 4). The variables referred to the positive self-image (3 = 0.093, p = 0.045), friendship (3 = 0.131, p = 0.029), frequency of meeting friends and socialising (3 = 0.127, p = 0.035), family support when in distress (3 = -0.183, p = 0.001), teachers' support when in distress (3 = -0.195, p = 0.000), average grades in the last year of secondary education (3 = 0.098, p = 0.043), spending leisure time in nature (3 = 0.098, p = 0.044) and spending leisure time with friends (3 = -0.224, p = 0.000). These factors explain 19.4 % of the total variability of the frequency of drinking during holidays and weekends.
As shown in Table 5, the frequency of drinking due to the stress and other problems is associated with family support (3 = -0.165, p = 0.003), average grades in the last year of secondary education (3 = 0.186, p = 0.000), spending leisure time in large shopping centres (3 = -0.115, p = 0.033), socialising with friends (3 = -0.131, p = 0.022). These factors explain 12 % of the total variability of the frequency of drinking as a mode of alleviating stress and coping with problems during examination period and weekdays.
Discussion
The purpose of the study was to explore the relationships between the students' attitudes, their sociodemographic characteristics and risk factors in relation to alcohol consumption. The study results indicate that alcohol use and misuse is fairly common among the studied population. Only 4.3 % of the respondents never drink alcohol. Generally, alcohol consumption is high, which can result in various alcohol-related conditions.
The age of onset for alcohol drinking in a large proportion of the respondents was 10-14 years, in which respect they do not differ from the rest of the population. The average age of alcohol initiation in Slovenia is 13 years (Institut za varovanje zdravja, 2010). Other studies have also established a high percentage of heavy and risky drinking among the students of the University of Ljubljana (Biscak, et al., 2014).
The most popular alcoholic drinks among the respondents are spirits and beer. According to the 2011 ESPAD Report, beer is the dominant beverage among boys in a large majority of the countries studied. Spirits is the most important beverage among girls in just over half of the countries. On average, these two beverages account for about 70 % of the students' total consumption (Hibell, et al., 2011). The increased average quantity and frequency of drinking has been reported in all European countries, and in Slovenia, an
increase in binge drinking, or heavy episodic drinking, has been noted. The results ofvarious studies show that the reasons to indulge in drinking include: having fun, feeling relaxed, feeling more friendly and outgoing, greater self-esteem and better self-image, feeling happy, acceptance by older peers, identification with one's role models (Jeriček Klanšček, et al., 2007).
It is apparent from this study that the factors associated with consumption of larger quantities of alcohol include drinking for better sociability and relaxation, poor average grades, negative self-image and more frequent socialising with friends. The students in Great Britain report that they drink alcohol to feel good and for relaxation purposes (Watson, et al., 2006). It is typical of today's youth to relax and have fun under the influence of alcohol. They may be shy, uncomfortable and withdrawn, but under the influence of alcohol they open up, relax and like to brag about their achievements. Getting drunk in a company makes young people do things they would never do when sober (Ramovš & Ramovš, 2007). According to Hibel and collegues (2011), the students drink alcohol in order to have fun and forget their problems.
The findings of the present research indicate that the students who suffer from negative self-image tend to use alcohol more frequently. A young person's self- image is affected by many factors, such as parental influence, friends, the media etc. Self-image is an important factor, determining the quality of life, social relations and individual's abilities. It was also established that poor academic achievement, lack of family support and frequent socialising with friends may have a significant impact on alcohol consumption. There are, however, other risk factors which were not considered in the study. Alcoholic beverages are easily available, socially acceptable and often available in home environment (Anderson & Baumberg, 2006). Slovenia is culturally similar to other wine countries where the production and consumption of home-produced alcoholic beverages is common. It is therefore not surprising that many young people have their first drink at home (Bajt & Zorko, 2006). Prohibition is only one of the measures used to restrict the availability of alcohol. Along with prohibition, there are other prevention strategies. Young people should be encouraged to follow the alcohol prevention programmes and be informed about the consequences of alcohol drinking by raising their awareness of its possible detrimental effects through social networks and health promotion workshops. Numerous educational programmes have been developed by student and non-governmental organisations which are dedicated to the prevention of harmful alcohol use and alcohol dependence among the younger population. The two most known and successful programmes in Slovenia are 'Sporočilo v steklenici' 'A message in the bottle' and 'Z glavo na zabavo' 'Use your head when going to a party'. Makivic and collegues (2013) maintain that the enforcement of
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restricted access would be an effective policy to avoid alcohol-related diseases and deaths. Slovenia has already adopted some effective measures to reduce the frequency and quantity of alcohol consumption, including higher taxation of alcoholic beverages, limited access to public drinking places and the control of alcohol use in student campuses.
The current study also identified a negative correlation between alcohol drinking and lack of family support when coping with stress and anxiety. The students drink more if they are not supported by their family, which has the central and enduring influence on children's overall growth and development. An unambiguous positive relationship has been established between favourable family environment, including high levels of parental awareness and communication, and a lowered probability of risky alcohol use. According to Osler and collegues (2006), and Choo and Shek (2013), the quality of child-parent relationship, the level of family conflict, parents' drinking patterns and family structure have a strong impact on the frequency of adolescents' drinking and drunkenness. Adolescents experiencing high family conflict more frequently indulge in drinking than those experiencing low family conflict.
Findings of the current research indicate that the frequency of alcohol drinking and harmful use of alcohol among the respondents also has a negative impact on their educational attainments. Zalta and collegues (2008) reported that the frequency of alcohol drinking and binging decreases with better academic performance. There is growing evidence that poor school performance is associated also with the abuse of other legal and illegal substances. Can and collegues (2008) argue that satisfactory academic performance may serve as a natural protective factor against risky alcohol-related behaviour.
As a significant correlation was noted between adolescents' alcohol consumption and the adolescents' academic achievement, new policies and strategies to reduce alcohol-related harm should be developed and implemented. According to the draft of the Council conclusions of 1 December 2009 on alcohol and health, all member states should consider further steps to protect children, adolescents and young people from alcohol-related harm, in particular to reduce underage drinking, binge drinking, exposure to alcohol marketing and harm to children growing up in families with alcohol problems. Based on the established data, Akmatov and collegues (2011) concluded that heavy drinking and problem drinking are common among university students. They suggest that intervention programs should be designed for students at a particularly high risk. Similar results and conclusions were reached in the study conducted among the first-year full-time students of the University of Ljubljana (Biscak, et al., 2011). It is of upmost importance to develop and implement programmes targeting to the reduction of alcohol consumption.
Alcohol may help individuals to relax and adds to their sociability or social intercourse, it temporarily enhances alleviation of stress and acceptance by peers. On the other hand, the consequences of problematic drinking may be serious, damaging and far-reaching. Heavy drinking may lead to the loss of social identity, entailing negative psychological, mental, physical as well as financial consequences. The education institutions can play a crucial role in the protection of young people from short and long-term effects of alcohol and modify their problematic drinking behaviours. They may incorporate contents related to substance abuse into the curricula and initiate the website addressing this issue. The education institutions should assume the responsibility to promote healthy lifestyle and deepen the students' knowledge and awareness of harmful and hazardous use of alcohol and other legal and illegal substances. Similar suggestions were put forward by Durkin (2008), who emphasises the importance of knowledge of alcohol policy and alcohol-related health risks.
The established association between leisure time and alcohol drinking suggests the need for organisation of various group sports activities, which should be available and accessible to all young people. Local communities could develop programmes by which adolescents and young adults may actively participate in challenging, fulfilling and health promoting activities.
A considerable amount of literature has been published in Slovenia and worldwide on various aspects of alcohol consumption, pinpointing the adverse effects of alcohol on health, and the relevance of prevention. The results of the present study along with the proposed preventive measures may nonetheless prove valuable in designing effective interventions related to alcohol consumption in Slovenia. However, with a small size of the random sample (four institutions, full-time students), caution must be applied, as the findings might not be transferable to all undergraduate students of Gorenjska region. As regression models have a small explanatory power, the list of possible reasons for alcohol consumption is not conclusive. The reasons identified in the study include cultural acceptance and expectance of alcohol drinking, availability of alcohol, drinking volume, the commercial communication of alcohol products, and everyday stress.
Contrary to our expectations, the response rate of the potential participants was low. We were surprised by the lack of interest, declination to participate, and the delayed response to our invitation.
Conclusion
Several risk factors related to student alcohol drinking have been identified. The factors which were most commonly reported by the respondents are social (family support and peer pressure and influence) and individual (poor self-image, poor academic performance, spending
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leisure time). On the other hand, good interpersonal relations (family, peers, school), environmental factors (healthy environment, healthy lifestyle) may reduce drinking frequency, drinking volume and alcohol-related harm. Public health policy makers, the cultural shift, and health promotion programmes and activities may help reduce the disturbing student alcohol consumption. The development and implementation of appropriate preventive programmes should address the prevention of alcohol-related harm in children and young people. These programmes should also help to develop the adolescents' general social skills. They may contribute to the improvement of self-esteem, and change the adolescent's drinking beliefs, attitudes and drinking behaviours that are assumed to underlie the adolescent drinking. Future research is needed to further substantiate these findings and to identify the effective and targeted measures for the reduction of alcohol misuse. Future research should include the students of various other fields in order to determine the risk factors associated with the students' alcohol-related health literacy.
Slovenian translation/Prevod v slovenščino Uvod
Alkohol je najbolj pogosto uporabljena dovoljena droga v študentskih letih (Baker & Boland, 2011). Po podatkih Ministrstva za zdravje (2008) alkohol v svetu predstavlja šesti najpomembnejši vzrok za prezgodnjo umrljivost in obolevnost, v Evropi pa celo tretjega oziroma prvega med mladimi. Uživanje alkohola predstavlja velik zdravstveni problem mladih (Rassool, 2007). Med mladimi je alkohol najbolj razširjena droga, pri čemer poseganje po njem tudi narašča, še zlasti t. i. opijanje (Hovnik Keršmanc, 2010). Problem opijanja je razširjen tudi v drugih državah. Raziskave med študenti v Združenih državah Amerike kažejo, da opijanje povzroča negativne posledice, ki se kažejo v slabšem učnem uspehu in nižjem samospoštovanju (Kazemi, et al., 2011).
Po podatkih Evropske raziskave o alkoholu in preostalih drogah med šolsko mladino ESPAD 2011 (Hibell, et al., 2011) ima v Sloveniji izkušnje s pitjem alkoholnih pijač kar 93 % respondentov. Alkoholne pijače bolj pogosto uživajo fantje kot dekleta (Stergar, 2011). Enako je tudi raziskava med študenti prvih in četrtih letnikov Univerze v Mariboru podala ugotovitev, da bolj pogosto pijejo moški kot ženske (Kolšek & Klemenc Ketiš, 2015). Alkoholna problematika je prisotna tudi v gorenjski regiji, saj je pitje alkohola razširjeno tako med mladimi kot tudi med odraslimi. Zaskrbljujoče je, da mladi alkoholu pripisujejo bolj pozitivne kot negativne učinke in kot najbolj pozitiven učinek navajajo zabavo (Hovnik Keršmanc, 2011).
Obstaja veliko dejavnikov, ki so vzrok uživanja alkoholnih pijač mladih. Le-ti so predvsem želja po
sprejetosti s strani vrstnikov, zunanje okolje, dostopnost alkohola, zapeljivi oglasi, veliko prostega časa. Negativne posledice uživanja alkoholnih pijač vplivajo na počutje študentov, povzročajo »mačka«, zmanjšujejo uspešnost v izobraževalnem procesu, privedejo do posledic, ki bi jih kasneje obžalovali, do več poškodb, prometnih nesreč in smrti (Snyder, 2006).
Številne raziskave kažejo, da je stres v zadnjih desetletjih med mladimi zelo povečan, zato je tudi raba alkohola, tobaka in tudi nedovoljenih drog med mladimi zelo razširjena (Varela & Picakrd, 2011). Na tvegano življenje mladih vplivajo tako vrstniki kot tudi odrasli (Etcheverry & Agnew, 2008; Kenna & Lewis, 2008). Mladim so njihovi vrstniki vzor, zato obstaja tudi večja verjetnost, da bodo posegali po alkoholu, če se družijo z vrstniki, ki pijejo alkoholne pijače bolj pogosto, kot če se družijo z vrstniki, ki ne uživajo alkohola (Cicognani & Zani, 2011). Opazovanje sovrstnikov, ki uživajo alkohol, spodbuja študente k pitju alkohola, kar posledično vodi do povečane rabe alkohola (Champion, et al., 2015).
Najbolj pogosti dejavniki tveganja za pitje in opijanje mladih so slabše družinske razmere, splošni družbeni kontekst, študijska neuspešnost, odnosi z vrstniki, zgodnji nastop problematičnega vedenja in uporabe drog ter fiziološki in genetski dejavniki (Maggs & Schulenberg, 2006). Na popivanje mladih vplivata tudi prisotnost anksioznosti in depresije (McNamara, et al., 2010).
Namen in cilji
Namen izvedene raziskave je bil analizirati stanje na področju zlorabe alkohola med študenti višje- in visokošolskih zavodov v gorenjski regiji. Z raziskavo smo želeli dobiti vpogled v pivske navade študentov na višje- in visokošolskih zavodih v gorenjski regiji ter identificirati dejavnike, ki so povezani z uživanjem alkoholnih pijač študentov. Postavili smo si naslednjo hipotezo: H1: Uživanje alkohola pri študentih je povezano z dejavniki, kot so stres, pomanjkanje socialne podpore, občutek boljše sprejetosti v družbi in srednješolski učni uspeh.
Metode
Raziskava temelji na kvantitativni neeksperimentalni raziskovalni metodi, podatke smo zbirali s tehniko anketiranja, kot instrument smo uporabili strukturirani vprašalnik.
Opis instrumenta
Strukturirani vprašalnik je vseboval sedem sklopov z različnim številom vprašanj: vprašanja s ponujenimi odgovori, kontrolni seznam in trditve v obliki Likertove lestvice stališč. Posamezne vrednosti te lestvice so bile definirane z oceno od 1 do 5, kjer je 1 pomenila, da
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se z navedeno trditvijo sploh ne strinjajo, 2 - se ne strinjajo, 3 - niti se ne strinjajo/niti se strinjajo, 4 -se strinjajo, in 5 - se zelo strinjajo. Vprašalnik je bil oblikovan na osnovi pregleda literature različnih avtorjev na področju alkoholne problematike (Watson, et al., 2006; Zalta, et al., 2008; Tremblay, et al., 2010). Zanesljivost vprašalnika smo preverjali z metodo analize notranje konsistentnosti.
Rezultati o zanesljivosti vprašalnika na vzorcu vključenih v raziskavo so bili naslednji:
-	Crohnbachov koeficient alfa za 10 trditev, ki se nanašajo na osebne značilnosti in socialne odnose, je znašal 0,82;
-	Crohnbachov koeficient alfa za 8 trditev, ki se nanašajo na posledice uživanja alkohola, je znašal 0,81. Veljavnost instrumenta smo pojasnili tudi s pomočjo
faktorske analize po spremenljivkah. Dosegli smo primerno pojasnitev variance in dobljene faktorje uporabili v nadaljnji statistični analizi, kar prikazujemo v rezultatih. Da bi zmanjšali število spremenljivk, smo z metodo glavnih komponent (Principal Component Analysis) analizirali njihovo medsebojno soodvisnost, bolj jasno strukturo faktorskih uteži pa smo dobili z rotacijo faktorjev. Z analizo glavnih komponent smo tako dobili tri komponente, s katerimi skupno pojasnimo 71,6 % celotne variabilnosti (KMO = 0,932 in Barlett p < 0,001). S faktorjem »pogostost pitja zaradi komunikativnosti in sproščenosti«, v katerega so se uvrstile tri trditve, pojasnimo 47,66 % variance; s faktorjem »pogostost pitja v prostem času«, v katerega so se uvrstile tri trditve, pojasnimo 13,41 % variance in s faktorjem »pitje kot posledica blaženja stresa in težav«, v katerega so se uvrstile štiri trditve, pojasnimo 10,60 % variance. V nadaljnji statistični obdelavi smo uporabili vse tri faktorje.
Opis vzorca
V raziskavo smo vključili študente višje- in visokošolskih zavodov na področju gorenjske regije. V gorenjski regiji so 3 visoko- in 7 višješolskih zavodov. Iz seznama višje- in visokošolskih zavodov smo izločili zavode, ki izvajajo le izredni študij. Tako smo pridobili 5 višje- in 3 visokošolske zavode. Vključili smo 2 višje- in 2 visokošolska zavoda, saj od vseh višje- in visokošolskih zavodov nismo pridobili soglasja za izvedbo raziskave, nekateri pa so bili kljub podanemu soglasju neodzivni oziroma so prepozno oddali termin za izvedbo raziskave. Sodelovali so naslednji (višje- in visokošolski) zavodi: Ekonomsko-storitveni izobraževalni center Kranj, Višja strokovna šola; Šolski center Škofja Loka; Fakulteta za zdravstvo Jesenice (FZJ); Fakulteta za organizacijske vede Kranj. Vzorec je bil namenski. V raziskavo FZJ smo vključili dve generaciji rednih študentov prvega letnika, vpisanih v študijskem letu 2011/12 in 2012/13, pri ostalih v raziskavo vključenih izobraževalnih zavodih pa smo zajeli redne študente prvih letnikov, vpisane
Tabela 1: Število študentov, vpisanih v prvi letnik v študijskem letu 2011/12 oz. 2012/13, in število v raziskavo vključenih študentov po gorenjskih višje- in visokošolskih zavodih
Table 1: The number of the first-year students enrolled in the academic years 2011/12 and 2012/13 and the number of students from higher education institutions in the Gorenjska region who participated in the study
Višje- oz. visokošolski zavod (študijsko leto vpisa)/ Higher education institution (academic year enrollment)	n1	n2	%
Ekonomsko-storitveni izobraževalni center Kranj, Višja strokovna šola (2012/13)	91	35	38,5
Šolski center Škofja Loka (2012/13)	89	67	75,3
Fakulteta za zdravstvo Jesenice (2011/12; 2012/13)	190	131	68,9
Fakulteta za organizacijske vede Kranj (2012/13)	297	95	32
Skupaj	667	328	49,2
Legenda/Legend: nt - število vpisanih študentov/number of enrolled students; n2 - število študentov, ki so sodelovali v raziskavi/the number of students who participated in the survey; % - odstotek/percentage
v študijskem letu 2012/13. V raziskavi je sodelovalo 328 študentov, kar predstavlja 49,2% realizacijo vzorca (Tabela 1).
Med anketiranimi študenti jih je bilo 64,6 % starih med 18 in 20 let, le 4,3 % študentov je bilo starih 24 let ali več. Med anketiranci je bilo 147 moških (44, 8%) in 181 žensk (55,2 %). Največji delež anketiranih študentov je v zadnjem letniku srednješolskega izobraževanja imelo dober uspeh (47,6 %), le 3,4 % anketiranih je imelo odličen uspeh.
Opis poteka raziskave in obdelave podatkov
Raziskava je potekala maja 2012 in od oktobra do novembra 2012. Vsem sodelujočim višje- in visokošolskim zavodom v gorenjski regiji smo poslali pismo s prošnjo za soglasje glede izvedbe raziskave in s pojasnili namena, poteka in časa anketiranja. Ko smo soglasja pridobili, smo v dogovoru s koordinatorjem raziskave v posameznih zavodih izvedli anketiranje. Anketirancem smo razložili postopek anketiranja ter počakali, da so izpolnili vprašalnike. Vsem sodelujočim smo zagotovili anonimnost.
Pridobljene podatke smo obdelali s pomočjo računalniškega programa SPSS verzija 20.0 (SPSS, Chicago, IL, USA). Uporabili smo opisno statistiko in analizo povezanosti. Spremenljivke smo oblikovali na osnovi faktorske analize. Za pojasnitev odnosa do alkohola med mladimi smo uporabili linearno multiplo regresijsko analizo. Za statistično pomembne podatke smo upoštevali razlike, kjer je bila stopnja statistične pomembnosti na ravni 0,05 in manj.
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Rezultati
Iz Tabele 2 je razvidno, da so anketiranci v največjem deležu (61,3 %) prvo alkoholno pijačo poskusili med 15. in 18. letom starosti, večina preostalih (36 %) pa med 10. in 14. letom starosti. Ob posamezni pivski priložnosti največ anketiranih študentov (34,5 %) spije največ 3-4 merice alkoholnih pijač, kar 18,3 % anketirancev pa 7 meric in več. Največji delež študentov (28,4 %) pije alkoholne pijače ob posebnih priložnostih, tj. nekajkrat na leto, 3-6-krat na teden pa 4,9 % anketirancev.
Zanimalo nas je, ali je uživanje alkohola pri študentih povezano z dejavniki, kot so pomanjkanje socialne podpore s strani družine, nižja samopodoba, občutek boljše sprejetosti v družbi med vrstniki ter nižji srednješolski učni uspeh. Rezultati raziskave kažejo, da so študenti deležni socialne podpore s strani družine (x = 4,3, s = 0,8), medtem ko zadovoljstvo s samopodobo ocenjujejo s povprečno vrednostjo 3,8 (s = 0,8) (ocenjeno po petstopenjski Likertovi lestvici).
Uporabili smo regresijsko analizo, s katero smo ugotavljali medsebojno odvisnost med več spremenljivkami, ki so bile medsebojno povezane. Zgradili smo tri regresijske modele z neodvisnimi in odvisnimi spremenljivkami, ki so bile
dobljene s faktorsko analizo: pogostost pitja zaradi komunikativnosti in sproščenosti, pitje v prostem času ter pitje kot posledica stresa in težav.
Povprečna vrednost faktorja »pogostost pitja zaradi komunikativnosti in sproščenosti« je bila 3,5 (s = 1,1), faktorja »pogostost pitja v prostem času« 3,2 (s = 0,9) in faktorja »pitje kot posledica blaženje stresa in težav« 2,2 (s = 0,8).
Iz Tabele 3 razberemo, da imajo dejavniki: zadovoljstvo s samopodobo (fl = -0,126, p = 0,020), povprečni učni uspeh v zadnjem letniku srednješolskega izobraževanja (fl = 0,168, p = 0,002), pogostost izvajanja gibalne aktivnosti (vsaj 30 minut na dan) (fl = -0,093, p = 0,045), gledanje televizije v prostem času (fl = 0,118, p = 0,028) in preživljanje prostega časa s prijatelji (fl = -0,139, p = 0,011) statistično pomemben vpliv na pogostost pitja zaradi komunikativnosti in sproščenosti. Ti dejavniki pojasnijo 8,1 % celotne variabilnosti pogostosti pitja zaradi komunikativnosti in sproščenosti. Največji vpliv na pogostost pitja ima povprečni učni uspeh v zadnjem letu srednješolskega izobraževanja (fl = 0,168).
Z regresijsko analizo smo ugotovili (Tabela 4) statistično pomemben vpliv posameznih preučevanih spremenljivk na pogostost pitja alkoholnih pijač v prostem času, pri tem gre za naslednje spremenljivke: zadovoljstvo s samopodobo
Tabela 2: Značilnosti anketiranih študentov v zvezi z alkoholom Tabel 2: Characteristics of the students in relation to alcohol consumption
Trditve/The arguments	n	%
Najljubša pijača		
Žgane pijače	101	30,8
Pivo	90	27,4
Vino	81	24,7
Pijače alkopop - ustekleničene sladke pijače s približno 5% vsebnostjo alkohola	53	17,1
Skupaj	325	100
Starost ob prvem zaužitju alkoholne pijače		
Nikoli	1	0,3
Med 10. in 14. letom	118	36,0
Med 15. in 18. letom	201	61,3
Med 19. in 22. letom	8	2,4
Skupaj	328	100
Količina običajno popite alkoholne pijače ob posamezni pivski priložnosti		
Ne pijem alkoholnih pijač	14	4,3
1-2 merici	84	25,6
3-4 merice	113	34,5
5-6 meric	55	17,3
7 meric in več	60	18,3
Skupaj	326	100
Pogostost pitja alkoholnih pijač v zadnjem letu		
Nikoli	11	3,4
Nekajkrat na leto, ob posebnih priložnostih	93	28,4
1-krat na mesec	59	18,0
2-3-krat na mesec	82	25,0
1-2-krat na teden	64	19,5
3-6-krat na teden	16	4,9
Vsak dan	3	0,9
Skupaj	328	100
Legenda/Legend: n - število/number; % - odstotek/percentage
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Tabela 3: Rezultati regresijske analize pogostosti pitja zaradi komunikativnosti in sproščenosti
Tabel 3: Results of regression analysis of frequency of alcohol consumption for better sociability and relaxation
Pogostost pitja zaradi komunikativnosti in sproščenosti/ Drinking as a result of stress and problems	Značilnosti/ Characteristics	b	P	t	P
	Konstanta	0,213	/	0,530	0,596
	Zadovoljen/-a sem s samopodobo.	-0,141	-0,126	-2,330	0,020
R = 0,308	Povprečni učni uspeh v zadnjem letniku srednješolskega izobraževanja	0,238	0,168	3,130	0,002
R2 = 0,095 pril. R2 =0,081	Kako pogosto se ukvarjate z gibalno aktivnostjo (vsaj 30 minut na dan)?	-0,071	-0,093	-2,013	0,045
	Kako pogosto v prostem času gledate TV?	0,140	0,118	2,202	0,028
	Kako pogosto greste v prostem času s prijatelji ven (na kavo, zabavo)?	-0,196	-0,139	-2,572	0,011
Legenda/Legend: b - regresijski koeficient/regression coefficient; / - standardizirani regresijski koeficient/standardized regression coefficient; R - korelacijski koeficient/the correlation coefficient; R2 - povprečje vseh skupnih dosežkov/the average of all the total achievements; pril. R2 - delež pojasnjevalne variabilnosti/the explanatory proportion of variability; t - vrednost koeficienta/coefficient value; p - statistična značilnost/statistical significance
Tabela 4: Rezultati regresijske analize pogostosti pitja v prostem času
Tabel 4: Results of regression analysis of frequency of alcohol consumption in the respondents' leisure time
Pogostost pitja v prostem času/ Frequency of drinking in the respondents' leisure time	Značilnosti/ Characteristics	b	P	t	P
	Konstanta	-0,384	/	-0,799	0,425
	Zadovoljen/-a sem s samopodobo.	0,104	0,093	1,676	0,045
	Imam veliko prijateljev.	0,146	0,131	2,198	0,029
	S prijatelji se pogosto družimo.	0,148	0,127	2,123	0,035
R = 0,463 R2 = 0,214 pril. R2 = 0,194	V primeru težav mi oporo nudi družina.	-0,207	-0,183	-3,456	0,001
	V primeru težav oporo poiščem pri visokošolskih učiteljih.	-0,201	-0,195	-3,873	0,000
	Povprečni učni uspeh v zadnjem letniku srednješolskega izobraževanja	0,138	0,098	1,944	0,043
	Kako pogosto greste v prostem času v naravo?	0,117	0,098	1,933	0,044
	Kako pogosto greste v prostem času s prijatelji ven (na kavo, zabavo)?	-0,315	-0,224	-4,160	0,000
Legenda/Legend: b - regresijski koeficient/regression coefficient; / - standardizirani regresijski koeficient/standardized regression coefficient; R - korelacijski koeficient/the correlation coefficient; R2 - povprečje vseh skupnih dosežkov/the average of all the total achievements; pril. R2 - delež pojasnjevalne variabilnosti/the explanatory proportion of variability; t - vrednost koeficienta/coefficient value; p - statistična značilnost/statistical significance
(fi = 0,093, p = 0,045), prijateljstvo (fi = 0,131, p = 0,029), pogosto druženje s prijatelji (fi = 0,127, p = 0,035), opora družine v primeru težav (fi = -0,183, p = 0,001), opora učiteljev v primeru težav (fi = -0,195, p = 0,000), povprečni učni uspeh v zadnjem letu srednješolskega izobraževanja (fi = 0,098, p = 0,043), preživljanje prostega časa v naravi (fi = 0,098, p = 0,044) in preživljanje prostega časa s prijatelji (fi = -0,224, p = 0,000). Ti dejavniki pojasnijo 19,4 % celotne variabilnosti pogostosti pitja alkoholnih pijač med počitnicami in konec tedna.
Rezultati kažejo (Tabela 5), da na pogostost pitja kot posledico blaženja stresa in težav statistično pomembno vpliva opora družine (fi = -0,165, p = 0,003), povprečni učni uspeh v zadnjem letniku srednješolskega izobraževanja (fi = 0,186, p = 0,000), preživljanje prostega časa v nakupovalnih središčih (fi = -0,115, p = 0,033), preživljanje prostega časa s prijatelji (fi = -0,131, p = 0,022). Dejavniki pojasnijo 12 % celotne variabilnosti pogostosti pitja ob izpitih in delavnikih, s katerim študenti rešujejo stres in težave.
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Tabela 5: Rezultati regresijske analize pitja kot posledice blaženja stresa in težav
Tabel 5: Results of regression analysis of the consequences of drinking due to stress and other problems
Pitje kot posledica blaženja stresa in težav/ Drinking as a result of mitigating the stress and problems	Značilnosti/ Characteristics	b	¥>	t	P
	Konstanta	-0,255	/	-0,484	0,629
	S prijatelji se pogosto družimo.	0,131	0,113	1,958	0,051
	V primeru težav mi oporo nudi družina.	-0,186	-0,165	-3,032	0,003
R = 0,373 R2 = 0,139	Povprečni učni uspeh v zadnjem letniku srednješolskega izobraževanja	0,263	0,186	3,520	0,000
pril. R2 = 0,120	Kako pogosto v prostem času obiskujete nakupovalne centre s prijatelji?	-0,172	-0,115	-2,138	0,033
	Kako pogosto greste v prostem času s prijatelji ven (na kavo, zabavo)?	-0,184	-0,131	-2,295	0,022
Legenda/Legend: b - regresijski koeficient/regression coefficient; / - standardizirani regresijski koeficient/standardized regression coefficient; R - korelacijski koeficient/the correlation coefficient; R2 - povprečje vseh skupnih dosežkov/the average of all the total achievements; pril. R2 - delež pojasnjevalne variabilnosti/the explanatory proportion of variability; t - vrednost koeficienta/coefficient; p - statistična značilnost/statistical significance
Diskusija
Da bi izpostavili dejavnike tveganja za uživanje alkohola pri študentih, smo najprej želeli pridobiti mnenja o odnosu in značilnostih študentov v povezavi z uživanjem alkoholnih pijač. Ugotovili smo, da je alkohol tudi v naši raziskovani populaciji dokaj razširjen: da alkoholnih pijač nikoli ni pilo, je npr. odgovorilo le 4,3 % anketirancev. Lahko trdimo, da je prisotnost alkohola pri študentih visoka, kar posledično lahko povzroča tveganja, povezana s pitjem alkoholnih pijač. V visokem deležu so anketiranci prvo alkoholno pijačo poskusili med 10. in 14. letom starosti, kar ne odstopa od povprečnega slovenskega mladostnika. Povprečni slovenski mladostnik je ob prvem uživanju alkoholne pijače star 13 let (Inštitut za varovanje zdravja, 2010). Ugotovljen visok odstotek tveganega in škodljivega pitja in opijanja je bil tudi med študenti Univerze v Ljubljani (Biščak, et al., 2014).
Najbolj priljubljene alkoholne pijače anketiranih študentov predstavljajo žgane pijače in nato pivo. Po podatkih raziskave ESPAD 2011 je v večini držav pivo glavna pijača med fanti, medtem ko so v nekaj več kot v polovici držav žgane pijače bolj priljubljena pijača med dekleti. Pivo in žgane pijače predstavljajo približno 70 % celotne porabe alkoholnih pijač (Hibell, et al., 2011). Pitje med mladostniki narašča po vsej Evropi, mladina v Sloveniji se čedalje pogosteje opija. Izsledki raziskav kažejo, da so razlogi, zaradi katerih mladostniki segajo po alkoholnih pijačah, številni: uživanje alkoholnih pijač kot način zabave in sprostitve, večja komunikativnost, lažje navezovanje stikov, velja samozavest oziroma boljša samopodoba, doživljanje sreče, občutek boljše sprejetosti med starejšimi sovrstniki, poistovetenje s svojimi vzorniki (Jeriček Klanšček, et al., 2007).
Rezultati naše raziskave so pokazali, da so dejavniki, ki so povezani z uživanjem večjih količin alkoholnih pijač zaradi vzpostavljanja komunikacije in boljše sproščenosti, slabši povprečni uspeh, nižja samopodoba, bolj pogosto druženje s prijatelji. Watson in sodelavci (2006) ugotavljajo, da uživanje alkoholnih pijač študentov v Veliki Britaniji povzroča občutek dobrega počutja, zaradi česar so mladi v družbi bolj sproščeni in družabni. Za današnje mlade je značilno, da se sprostijo in zabavajo pod vplivom alkohola. Dokler še niso omamljeni, so praviloma zadržani, ko pa se opijejo, postanejo bolj odprti in sproščeni in se radi bahajo s svojimi uspehi. Opijanje v družbi torej sprosti zavore za dejanja, ki jih v treznem stanju ti mladi ne bi počeli (Ramovš & Ramovš, 2007). Tudi Hibell in sodelavci (2011) ugotavljajo, da večina študentov alkohol uživa zaradi zabave in da bi pozabili na svoje probleme.
Z izvedeno raziskavo ugotavljamo, da bolj ko so študenti nezadovoljni s samopodobo, bolj posegajo po alkoholnih pijačah. Številni dejavniki vplivajo na razvoj samopodobe mladih. Samopodoba je dejavnik, ki vpliva na kakovost življenja, odnosov in sposobnosti posameznika.
Ugotovili smo, da slabši uspeh v šoli, manjša opora v družini in druženje s prijatelji vplivajo na pogostost pitja alkoholnih pijač. Vsekakor obstajajo tudi drugi dejavniki, ki jih v raziskavi nismo proučevali. Predvidevamo lahko, da študenti pogosto pijejo alkoholne pijače, ker so te lahko dostopne in tudi družbeno sprejemljive. Dostopnost alkohola izhaja velikokrat iz domačega okolja, kjer mladi odraščajo. Raziskave kažejo na to, da se mladostniki s prvo izkušnjo pitja alkohola pogosto srečajo v domačem okolju (Anderson & Baumberg, 2006), kar v Sloveniji glede na razširjeno (domačo) proizvodnjo alkoholnih
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pijač ter vpetost alkohola v kulturo niti ni posebno nenavadno (Bajt & Zorko, 2006). Menimo, da bi poleg prepovedi potrebovali tudi druge ukrepe, s katerimi bi vplivali na zmanjševanje dostopnosti do alkohola. Mlade bi morali spodbujati k izvajanju brezalkoholnih programov, obveščanje in ozaveščanje o škodljivih učinkih alkohola bi bilo treba vzpostaviti tudi preko družbenih omrežij ter mlade vključevati v zdravstvenovzgojne delavnice. Študentske in nevladne organizacije že izvajajo vrsto programov in projektov, ki so namenjeni ciljni populaciji mladih. Znana sta »Sporočilo v steklenici« in »Z glavo na zabavo«. Makivič in sodelavci (2013) menijo, da bi glede na dostopnost do alkohola potrebovali ukrepe za zmanjševanje dostopnosti do alkohola. Med ukrepi, ki se v Sloveniji že izvajajo, so se kot učinkoviti izkazali zvišanje cen alkohola, omejevanje dostopov do barov in spodbujanje nadzora nad porabo alkohola v študentskih domovih.
V naši raziskavi smo ugotovili, da je v primeru težav, s katerimi se študenti soočajo, pogostost pitja alkoholnih pijač negativno povezana z nudenjem opore znotraj družine. Manj opore s strani družine študenti imajo, bolj pogosto pijejo alkoholne pijače. Dejstvo je, da družina predstavlja temeljni proces v fazi odraščanja. Bolj kot se v družini pogovarjajo o dejavnikih tveganja, manjša je možnost za uživanje in opijanje študentov z alkoholnimi pijačami. Dobri medsebojni odnosi v družini tako predstavljajo varovalni dejavnik, ki vpliva na uživanje alkohola mladih. Da pozitivni odnosi med starši in mladostniki pozitivno vplivajo na zmanjševanje pogostosti pitja alkoholnih pijač menijo tudi Osler in sodelavci (2006) ter avtorja Choo in Shek (2013), ki pravijo, da konflikti v družini, pivsko vedenje staršev in struktura družine vplival na pivsko vedenje mladih, saj so mladi, ki so prihajali iz družin, kjer so imeli pogoste konflikte, bolj pogosto posegali po alkoholnih pijačah kot tisti, kjer so imeli manj konfliktnih situacij.
Ugotavljamo, da je prisotnost pitja alkoholnih pijač višja pri slabšem povprečnem uspehu anketirancev. Zalta in sodelavci (2008) navajajo, da z višanjem šolske uspešnosti upada pogostost pitja alkohola in pogostost opijanja z alkoholom. Nižja šolska uspešnost je povezana tudi s poseganjem po drugih dovoljenih in po nedovoljenih drogah. Can in sodelavci (2008) menijo, da so uspehi v času študija lahko naravni varovalni dejavnik pred tveganim vedenjem mladih v odnosu do alkohola in ostalih drog.
Ker škodljivo uživanje alkohola med mladostniki negativno vpliva na doseženo stopnjo izobrazbe, je treba preučiti nadaljnje korake za zaščito mladostnikov pred škodo zaradi uživanja alkohola. Skupni cilj je predvsem zmanjšati uživanje alkohola pri mladoletnikih, popivanje, izpostavljenost trženju alkohola in škodo, storjeno otrokom, ki odraščajo v družinah s problemi, povezanimi z alkoholizmom (Osnutek sklepov Sveta z dne 1. decembra 2009 o
alkoholu in zdravju, 2009). Akmatov in sodelavci (2011) glede na ugotovljeno prekomerno uživanje alkoholnih pijač med študenti prav tako poudarjajo pomen razvijanja programov za mlade s poudarkom na preprečevanju uživanja alkoholnih pijač. Potrebe po razvoju preventivnih programov, s katerimi bi vplivali na zmanjševanje porabe alkohola, so ugotovljene tudi v raziskavi, izvedeni med študenti prvih letnikov rednega študija Univerze v Ljubljani (Biščak, et al., 2011).
Uživanje alkohola lahko sprošča, povečuje komunikativnost, zmanjšuje stres, vpliva na sprejetost med sovrstniki. Toda alkohol je tudi droga, ki lahko vodi v izgubo na področju socialne identitete, uživanje alkohola ima lahko psihične, duševne in telesne posledice ter lahko povzroči finančne izgube. Za zaščito študentov pred škodljivimi vplivi alkohola morajo k reševanju alkoholne problematike pristopiti tudi izobraževalni zavodi, saj tudi samo študijsko okolje lahko predstavlja varovalni dejavnik pred zlorabo alkohola. Na področju izobraževalnih zavodov predlagamo vključitev vsebin s področja alkoholne problematike ter ostalih dovoljenih in nedovoljenih drog v kurikulume ter razvoj spletnih strani, ki bi študentom nudile koristne informacije o zdravem življenjskem slogu. Mlade je treba seznanjati z nevarnostmi, tveganji in obvladovanjem tveganj, povezanih z uživanjem alkoholnih pijač ter ostalih dovoljenih in nedovoljenih drog. Durkin (2008) ugotavlja, da bi v izobraževalnih zavodih v pedagoški proces morali vključevati pridobivanje in razširjanje znanja s področja alkoholne politike, pri čemer bi študentom podajali informacije o zlorabi alkohola in posledicah, ki jih le-ta povzroča.
Glede na povezavo prostega časa in uživanja alkohola predlagamo tudi organizacijo več skupinskih gibalnih aktivnostih, ki bi bile dostopne vsem mladim, saj bi tako lahko aktivno preživljali prosti čas. Predlagamo večjo aktivacijo lokalnih okolij na področju aktivnosti, s katerimi bi mladim omogočali zdravo in aktivno preživljanje prostega časa. Gibalne aktivnosti bi lahko uvedli tudi na višje- in visokošolskih zavodih v okviru predmeta športna vzgoja.
Zavedamo se, da je bilo na raziskovano temo narejenih veliko raziskav tako v Sloveniji kot tudi v mednarodnem prostoru, vendar želimo z analizo stanja in s spoznanji raziskave seznaniti širok krog javnosti ter s priporočili ukrepov vplivati na zajezitev družbenega problema. Pri sami interpretaciji rezultatov je treba upoštevati omejitve raziskave. V vzorec smo želeli zajeti vse višje-in visokošolske zavode v gorenjski regiji, ki izvajajo redni študij, vendar smo zajeli le štiri šolske zavode, kar vsekakor ni dovolj, da bi rezultate posploševali na celotno populacijo študentov gorenjske regije. V raziskavo smo zajeli nenaključni vzorec. Regresijski modeli imajo majhno stopnjo pojasnjevanja, zato kot omejitev navajamo, da razloge uživanja alkoholnih pijač lahko iščemo tudi drugje. Predvidevamo lahko,
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da so vzroki lahko dostopnost alkohola, alkohol kot družbeno sprejeta droga, vpliv medijev, zapeljivi oglasi, prisotnost stresnega življenja. Pri sami raziskavi smo naleteli na nekaj ovir. Predvidevali smo večjo odzivnost, interes in hitrejšo terminsko uskladitev povabljenih visokošolskih zavodov, ki smo jih želeli vključiti v raziskavo. Presenetilo nas je, da nekateri višje- oziroma visokošolski zavodi v raziskavi niso želeli sodelovati.
Zaključek
Razlogov oziroma dejavnikov, zakaj študenti posegajo po alkoholu, je več. Kot pogoste dejavnike tveganja za uživanje alkoholnih pijač pri študentih v gorenjski regiji izpostavljamo socialne (opora družine), vrstniške (vpliv vrstnikov) in individualne dejavnike tveganja (nizka samopodoba, slabši učni uspeh in preživljanje prostega časa). Na podlagi opredeljenih dejavnikov tveganja ocenjujemo, da pomembne varovalne dejavnike predstavljajo medosebni odnosi (opora družine, vrstniki, šola) in dejavniki okolja (zdravo okolje, omogočanje zdravega način preživljanja prostega časa). Glede na ugotovljeno stanje in izpostavljene dejavnike tveganja za uživanje alkoholnih pijač pri študentih menimo, da je zelo pomembna krepitev sodelovanja med različnimi akterji na področju alkoholne politike in spodbujanje promocijskih preventivnih aktivnosti. Ker je alkoholna problematika med mladimi razširjena, si ne smemo zatiskati oči, temveč moramo ustrezno pristopiti k reševanju družbenega problema. Z izvajanjem preventivnih aktivnosti in ukrepov lahko vplivamo na zmanjševanje škodljive rabe alkoholnih pijač ter tako mlade usmerjamo k oblikovanju lastne identitete, pozitivne samopodobe ter oblikovanju pozitivnih stališč do nepitja alkohola. Izsledki raziskave odpirajo nadaljnja zanimiva in uporabna področja raziskovanja. Nadaljnje raziskave bi bile smiselne na področju ugotavljanja pogostosti uživanja alkoholnih pijač ter ugotavljanja dejavnikov tveganja ob izvajanju ciljanih ukrepov za preprečevanje zlorabe alkoholnih pijač. Glede na različne strokovne smeri izobraževanja predlagamo tudi izvedbo raziskave med študenti z ugotavljanjem dejavnikov tveganja glede na študijski program.
Conflict of interest/Nasprotje interesov
The authors declare that no conflicts of interest exist./ Avtorji članka izjavljajo, da ni nasprotja interesov.
Funding/Financiranje
The study received no funding./Raziskava ni bila finančno podprta.
Ethical approval/Etika raziskovanja
The study was conducted in accordance with the Helsinki-Tokyo Declaration (World Medical Association, 2013) and the Code of ethics for nurses and nurse assistants of Slovenia (2014)./Raziskava je pripravljena v skladu z načeli Helsinško-Tokijske deklaracije (World Medical Association, 2013) in v skladu s Kodeksom etike v zdravstveni negi in oskrbi Slovenije (2014).
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Cite as/Citirajte kot:
Pivač, S. & Skela-Savič, B., 2016. Factors associated with greater potential for alcohol misuse among the students of the Gorenjska region. Obzornik zdravstvene nege, 50(4), pp. 280-295. http://dx.doi.org/10.14528/snr.2016.50.4.103