Binge Drinking and Alcohol Abuse in Kent County

BINGE DRINKING AND ALCOHOL ABUSE1

Binge Drinking and Alcohol Abuse in Kent County

Melissa Hayes, Leeann Disbrow, Cristyn Keathley,

April Beresford, Dana Raymer, Dulcebelle Pearson,

Emily Williams, andTrevor Mattarella

Ferris State University

Abstract

The purpose of the following research was focused on analyzing binge drinking and alcohol abuse throughout Kent County. Since the prevalence of binge drinking is higher in this area than other areas in Michigan, Detroit, and the United States, drinking interventions for children and young adults in Kent County should be implemented. Research has assisted in identifying high-risk groups of young adults in Kent County who are at risk of participating in binge drinking or alcohol abuse. These risk factors include exposure to alcohol abuse by family members, a loss of health insurance, a history of depression, mental illness, or experimentation with alcohol at a young age. Another factor affecting the increase in binge drinking and alcohol abuse in Kent County relates to the majority of the population, which are young adults. The ecological model demonstrates the problem with alcohol abuse in Kent County by promoting health prevention. Correlations were determined between mental health conditions in young adults and the increased occurrence of alcohol abuse. These instances placed this group of individuals at the highest need for intervention. By targeting children and young adults, and focusing on alcohol prevention, this will help to decrease the incidences of chronic alcohol abuse and binge drinking. These preventative methods ultimately affect people by decreasing disease incidence related to alcohol abuse. Preventative measure and intervention are imperative to create positive health behaviors to decrease the incidence of chronic alcohol abuse and binge drinking in Kent County.

Keywords: Kent County, alcohol abuse, binge drinking, alcohol abuse prevention

Binge Drinking and Alcohol Abuse in Kent County

Introduction

The purpose of a community health assessment is to identify a specific problem within a community, with the intention of implementing plans and interventions towards improving or rectifying the problem identified. As nurses in the healthcare field, the primary interventions are based on a prospective viewpoint. While most problems will never be completely solved or prevented, nurses and other medical professionals can work together to achieve more positive results in the future by investigating the current problem. The problem of alcohol abuse in young adults within the United States is not a new issue. Many people have suffered from this problem for centuries, causing agony amongst the ones they love as well. Improving this situation on a nationwide basis, while preferable, is not a conceivable option for a small group of community nurses to achieve. Focusing the community health assessment on a specific area which is Kent County, Michigan, allows for a more practical approach to identifying possible interventions and solutions to the issue of alcohol abuse.

As the following data and information will convey, alcohol abuse is a problem within Kent County. The targeted age range proposed displays the highest rate of abuse, which is where the assessment will be focused. Based on the assessment data, the short and long-term effects of alcohol abuse are numerous, as are the stressors that lead people to rely on alcohol as a crutch. The primary goal of this community assessment is to propose and implement interventions that will help those already partaking in this dangerous lifestyle to bring this problem to an end, but will mainly serve to intervene prior to this population succumbing to the temptation of binge drinking and alcohol abuse. Intervening at an earlier age by way of educational programs and teaching will ideally prevent this community's youth from making poor decisions, and from becoming a statistic.

Problem Statement

According to Community Health Diagnosis in Nursing published by Marjorie Muecke in 1984, a community health diagnosis is a combined application of the expanded epidemiological triangle and a nursing diagnosis, which in turn leads to the formation of a problem statement. The expanded epidemiological triangle is broken down into: the health/illness problem, which is then broken down into population characteristics and environmental characteristics. A nursing diagnosis is the identification of a problem, stated as “a (problem) related to (etiologic factors) as manifested in (signs and symptoms)”. Combining these is the formation of a problem statement, and the beginning of the evaluation of a problem, in turn leading to possible interventions and solutions at a community level(Meucke, 1984, p.6).

Using the model formed by Muecke, the problem statement for this case is: Risk for alcohol abuse in Kent County residents ages 14-24, related to socioeconomic factors, minority status, peer influence, psychological problems, poor education, familial risk factors and a lack of community interventional support, as evidenced by a 51% alcohol abuse incidence rate in Kent County residents ages 18-20, as well as an 18% overall alcohol abuse rate.

The evidence as stated are statistics given by the Kent County Community Health Needs Assessment (2011) showing Kent County’s 18% of binge drinkers as compared to a nationwide 8% binge drinkers on average, and according to the CDC (2010), "the proportion of current drinkers that binge is highest in the 18- to 20-year-old group (51%)”.

The highest rate of alcohol abuse occurs in the 18-20 age range. By expanding the risk age to 14-24 as stated in the problem statement, one is able to assess the impact of risk factors on young adults while they are adolescents in an attempt at preventative measures to avoid this younger age group from becoming one of these statistics. The risk factors addressed apply to this entire age range on both a preventative and interventional level, as research has shown that when a person starts drinking as an adolescent he/she has an increased risk of developing an alcohol use disorder at some time during their life span (Will & Sabo, 2010).

This problem statement is an example of a health/illness problem within Kent County, as alcohol abuse leads to many acute and long term problems, such as auto accidents and other traumatic injuries, liver cirrhosis, pancreatitis, brain damage, degenerative neuropathies, and social detriments such as domestic violence and sexual assault/abuse. This is certainly not a healthy lifestyle or a desirable outcome. Since public health interventions are best suited to populations who have not yet developed the disease process, addressing young adults before they succumb to a life filled with alcohol usage is the best nursing practice.

Local Data Research

The risk of alcohol abuse and binge drinking within Kent County is higher than most other metropolitan areas in the state of Michiganaccording to recent data from researchers. "The following statistics prove that immediate intervention is necessary for overall community safety. Out of 2,807 respondents, 18% of adults living in Kent County reported excessive drinking. Based off of data from 2003 to 2009, the range in Michigan for excessive drinking is 8% to 36%, overall in Michigan 19% of the population excessively drink and the national benchmark is 8% (County Health Rankings, 2011). According to County Health Rankings (2011), “The excessive drinking measure reflects the percent of the adult population that reports either binge drinking, defined as consuming more than 4 (women) or 5 (men) alcoholic beverages on a single occasion in the past 30 days, or heavy drinking, defines as drinking more than 1 (women) or 2 (men) drinks per day on average.” Seventeen percent of the population in Kent County binge drink, the national benchmark is currently non-applicable (Kent County 2011 Community Health Needs Assessment and Health Profile [KCCH], 2011). Kent County Behavior Risk Factor (2008) states, “Heavy drinking is more common among adults without health insurance (8.3%) as compared with Kent overall (4.3%).” They also state, “Binge drinking is more common among adults without health insurance (24.6%) as compared with Kent overall (15.6%).”

The acronym KOMA represents Kent, Ottawa, Muskegon and Allegan counties within Michigan. KOMA's average for heavy drinking and binge drinking were found to be worse than both the national average and the average for the state of Michigan, including Detroit. In 2007, 20% of KOMA’s population binge drank, compared to about 17% of Michigan and Detroit populations (Isely, Singh, & Ramial, 2009).
The statistics reflect Kent County’s increased problem with excessive drinking when compared to Michigan and the United States. There is a direct correlation between excessive drinking in Kent County and the lack of health insurance. “Heavy drinking is twice as common among those without health insurance (8.3%). The rates of binge drinking are similar in Kent County (15.6%) and Michigan (16.6%), but, again, binge drinking is more common among those who lack health insurance (24.6%)” (KCCH, 2011, p. 27). Fifteen percent of adults, less than 65 years old, living in Kent County are uninsured, compared to 14% in Michigan and the national benchmark of 13%. The percentage of uninsured increases to 16.9% of African Americans, 19.7% with only a high school education and 23.6% with less than a high school education (KCCH, 2011, p. 17).
The poor mental health of the residents of Kent County may also contribute to the alcohol abuse and excessive drinking. “Alcohol abuse and dependence often occur with other co-existing mental health concerns including anxiety, depression, schizophrenia and bipolar disorder. Just over nineteen percent (19.3%) of adults and 45.8% of youth less than 18 years of age served by Network 180 in 2010 had a co-occurring mental health and alcohol or other drug disorder” (KCCH, 2011, p. 28). Network 180, located in Kent County assists individuals and families with mental illness, substance use disorders and developmental disabilities. On average, Kent County citizens requested assistance from Network 180 after 14 or more days in the past month with mental health concerns, such as stress, depression. (KCCH, 2011, p. 27). Statistics proved that 3.5% reported poor mental health in the past thirty days, compared to Michigan’s 3.7% and the national benchmark of 2.3%. In the same survey 17% admitted to binge drinking in the past thirty days, compared to Michigan’s 16.6% (KCCH, 2011, p. 27). Kent County adults were also found to be more limited in activities due to mental or emotional problems when compared to other Michigan adults (KCCH, 2011, p. 21).
Many of these research studies and evidence based practice analyses were performed on the adult population and community within Kent County. However, according to KCCH (2011) “A larger proportion of young people live in Kent County than Michigan or the United States. The median age for Kent County is 34.4 whereas Michigan’s is 38.9” (KCCH, 2011,p. 6). This could be attributed to the higher drinking rates in the KOMA area, as problem drinking habits are common in teenagers and young adults. When dealing with this age group we need to keep in mind that students receiving D’s and F’s are twice as likely than their peers to engage in health risk behaviors, like drinking or drugs (KCCH, 2011, p. 3). Students receiving D’s and F’s were found to have the highest percentages in experiences with drinking when compared to the Kent County and Michigan total, all other ethnicities, genders and grades (KCCH, 2011, p. 30). After reviewing the statistics of Kent County's increased binge drinking and alcohol abuse, action must be taken to prevent this trend from worsening in the future. The interventions for the drinking problems in Kent County can be analyzed and formatted through theory models created by nursing theorists.
Concept, Model & Theory

Alcohol abuse and binge drinking by the residents of Kent County can be examined by the behavior models presented by theorists. The behavior model most relevant is the ecological model which is based on the belief that "All processes occurring within the individual people and their environment should be viewed as interdependent” (Harkness & DeMarco, 2012, p. 79). This model has four levels of reciprocal influence that can either promote risk or protective factor: ontogenic, microsystem, exosystem, and macroculture (Harkness & DeMarco, 2012). The ontogenic level refers to personal factors, microsystem refers to relationship with the environment, exosystem refers to formal and informal social structures and macroculture refers to values and beliefs of culture (Harkness & DeMarco, 2012). Race and income should be considered in the ontogenic level, relationship with family would be part of the exosystem, microsystem includes health care adherence and community values are part of the macroculture (Harkness & DeMarco, 2012). Although the ecological model has been used for health prevention and promotion, it can nevertheless encapsulate the possible explanation as to why the disparity is present between the incidence rates regarding alcohol abuse in Kent County compared to statewide figures.

At the ontogenic level, poverty has a very significant role in the alcohol abuse and binge drinking. After researching state level statistics, "The percent of children living in poverty jumped from 14 percent to 23 percent between 2000 and 2009. Even more startling is the rate of children living in extreme poverty – roughly less than $11,000 a year for a family of four – jumped from 5 percent of children to 11 percent, and in Kent County, one in five live in poverty” (Michigan League for Human Services, 2012, p. 1). The increase in poverty for residents in Kent County may be attributed to the increase in alcohol abuse and binge drinking in this region. There are social and economic factors that directly correlates with the alcohol usage in Kent County. "Social and economic factors are powerful determinants of alcohol and drug use” (World Health Organization [WHO], 2005). "Young people whose families fall below the poverty level are especially at risk due to limited access to education and preventive services. Apart from socioeconomic status, alcohol use is also associated with low level of education and low standard of living” (WHO, 2005).

In the case of binge drinking in young children and adolescents, family structure plays a crucial role. There is a proven correlation to higher incidence of alcohol abuse by the children of parents who are abusing alcohol or binge drinking. Underage drinking is even encouraged in some cases by their families and this is not limited to merely experimentation with alcohol but is more associated with dysfunctional coping observed by children from other family members (Schor, 1996, p. 1). "Parents influence their children's drinking through family interactions, modeling and reinforcing standards, and attitudes that children learn and use to guide their behavior in new situations” (Schor, 1996, p. 1).

In addition to family structure and residents living below the poverty line, there are other health disparities that have effects on risk of alcohol usage. Related to the previous risk groups are minority populations within the lower segment of the socioeconomic strata. "The health gap between white and minority populations continues to widen and findings in a minority health report show that from the United States to Kent County, Michigan the minority population continues to increase with the Hispanic population leading the way” (Grand Rapids African American Health Institute, 2011, p. 11). These statistics place the Hispanic community for at-risk drinking behaviors and alcohol usage.
An important position mentioned previously would include the population of young people who have mental health concerns such as depression, mood disorders and bipolar disorder (KCCH, 2011). This relationship between the listed mental health disorders and risky alcohol usage makes it more imperative that measures for intervention are targeted at not only adults but specifically at younger people who at risk due to mental health issues.
Research
Underage and binge drinking in fourteen to twenty-four years olds has been researched and analyzed extensively over many decades. Ironically with all the attempts made to eradicate this problem in each generation we still find ourselves discussing this topic currently. Forty years ago the National Institute on Alcohol Abuse and Alcoholism (NIAAA) was founded and at that time alcoholism was considered an adult disease caused by physiological determinants (Windle & Zucker, 2010). As the NIAAA expanded their research, new data was obtained and it became obvious that underage and young adult drinking needed to be looked at more closely (Windle & Zucker, 2010). In looking at the data the researchers discovered “early initiation of alcohol use (before age 15) was associated with a fourfold increase in the probability of subsequently developing alcohol dependence” (Windle & Zucker, 2010, p. 29). Studies have concluded that substance abuse among teens is related to academic and social problems, unintentional injuries, homicides and suicides, depression, conduct disorder, memory loss, unplanned and unwanted sexual activity, alterations in brain development, and future alcohol dependence (Will & Sabo, 2010). Research has shown that when a person starts drinking as an adolescent, he/she has an increased risk of developing an alcohol use disorder at some time during their life span (Will & Sabo, 2010).
Over the years many programs have been developed to assist with decreasing the incidence and problems associated with underage and binge drinking. The federal legislation in 1984 made a huge impact when they threatened states with withholding federal highway funds if they did not comply with the requested minimum legal drinking age to be 21 (Kiltzner, Stewart & Fisher, 1993). Through this legislation research has shown that this new law did reduce alcohol-related crashes among young people and positively affected drinking behavior and other alcohol related health problems (Kiltzner et al., 1993).