JKAN Journal of Korean Academy of Nursing J Korean Acad Nurs 2005-3673 2093-758X Korean Society of Nursing Science 10.4040/jkan.2019.49.6.701 jkan-49-701 Original Article Patterns of Drinking Behaviors and Predictors of Class Membership among Adolescents in the Republic of Korea: A Latent Class Analysis LeeHaein1 ParkSunhee2 College of Nursing · Research Institute of Nursing Science, Daegu Catholic University, Daegu College of Nursing Science · East-West Nursing Research Institute, Kyung Hee University, Seoul, Korea Address reprint requests to : Park, Sunhee, College of Nursing Science · East-West Nursing Research Institute, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea Tel: +82-2-961-0874 Fax: +82-2-961-9398 E-mail: spark@khu.ac.kr 012019 17012019 496 701712 27032019 19092019 19092019 Copyright © 2019 Korean Society of Nursing Science 2019 This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium. Abstract Purpose:

Despite the high drinking rates and the complexity of drinking behaviors in adolescents, insufficient attention has been paid to their drinking patterns. Therefore, we aimed to identify patterns of adolescent drinking behaviors and factors predicting the distinct subgroups of adolescent drinking behaviors.

 Methods:

We analyzed nationally representative secondary data obtained in 2017. Our final sample included 24,417 Korean adolescents who had consumed at least one glass of alcohol in their lifetime. To investigate patterns of drinking behaviors, we conducted a latent class analysis using nine alcohol-related characteristics, including alcohol consumption levels, solitary drinking, timing of drinking initiation, and negative consequences of drinking. Furthermore, we investigated differences in demographics, mental health status, and characteristics of substance use across the latent classes identified in our study. To do so, we used the PROC LCA with COVARIATES statement in the SAS software.

 Results:

We identified three latent classes of drinking behaviors: current non-drinkers (CND), binge drinkers (BD), and problem drinkers (PD). Compared to the CND class, both BD and PD classes were strongly associated with higher academic year, lower academic performance, higher levels of stress, suicidal ideation, lifetime conventional or electronic cigarette use, and lifetime use of other drugs.

 Conclusion:

Health professionals should develop and implement intervention strategies targeting individual subgroups of drinking behaviors to obtain better outcomes. In particular, health professionals should consider different characteristics across subgroups of adolescent drinking behaviors when developing the interventions, such as poor mental health status and other substance use among binge and problem drinkers.

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Characteristics of Drinking Behaviors (N=24,417)

Factor Unweighted frequency (weighted %)
Gender
 School year
Male Female Middle school High school
Drinking during the past 30 days
Yes 5,562 (41.4) 4,035 (38.1) 2,342 (29.0) 7,255 (44.6)
No 8,064 (58.6) 6,756 (61.9) 5,843 (71.0) 8,977 (55.4)
Binge drinking during the past 30 days
Yes 2,643 (20.1) 2,204 (21.1) 717 (9.2) 4,130 (25.3)
No 10,983 (79.9) 8,587 (78.9) 7,468 (90.8) 12,102 (74.7)
Drinking on six or more days during the past 30 days
Yes 2,535 (18.9) 1,386 (13.0) 898 (11.3) 3,023 (18.5)
No 11,091 (81.1) 9,405 (87.0) 7,287 (88.7) 13,209 (81.5)
Drinking alone
Yes 1,597 (12.0) 1,076 (10.1) 492 (6.1) 2,181 (13.3)
No 12,029 (88.0) 9,715 (89.9) 7,693 (93.9) 14,051 (86.7)
Timing of drinking initiation†
Elementary school age or younger 3,990 (27.7) 2,288 (19.7) 4,243 (51.7) 2,035 (12.7)
Middle school age or older 9,593 (72.3) 8,484 (80.3) 3,904 (48.3) 14,173 (87.3)
Family members’ or friends’ advice on reduction of
alcohol consumption††
Yes 800 (6.0) 583 (5.5) 296 (3.8) 1,087 (6.6)
No 12,826 (94.0) 10,208 (94.5) 7,889 (96.3) 15,145 (93.4)
Drunk driving or riding together with a drunk driver
Yes 582 (4.3) 195 (1.8) 165 (2.1) 612 (3.7)
No 13,044 (95.7) 10,596 (98.2) 8,020 (97.9) 15,620 (96.3)
Blackout after drinking§
Yes 1,099 (8.3) 942 (9.0) 357 (4.5) 1,684 (10.4)
No 12,527 (91.7) 9,849 (91.0) 7,828 (95.5) 14,548 (89.7)
Involvement in arguments after drinking††
Yes 546 (4.1) 262 (2.4) 164 (2.1) 644 (3.9)
No 13,080 (95.9) 10,529 (97.6) 8,021 (98.0) 15,588 (96.1)

The variable has missing data;

The total percent for middle school students was 100.1% due to rounding;

The total percent for high school students was 100.1% due to rounding.

Summary of Information for Selecting Number of Latent Classes of Adolescent Drinking Behaviors (N=24,417)

Number of latent classes G2 Degree of Freedom AIC BIC Adjusted BIC Entropy Log-likelihood
1 36,863.37 502 36,881.37 36,954.30 36,925.70 1.00 -76,173.27
2 5,247.71 492 5,285.71 5,439.67 5,379.29 0.92 -60,365.44
3 1,279.86 482 1,337.86 1,572.84 1,480.68 0.90 -58,381.52
4 721.99 472 799.99 1,116.01 992.07 0.87 -58,102.58
5 520.82 462 618.82 1,015.87 860.15 0.82 -58,002.00

Bold letters indicate the selected model.

G=the likelihood-ratio statistic; AIC=Akaike information criterion; BIC=Bayesian information criterion.

Item-Response Probabilities from Three-Latent-Class Model of Adolescent Drinking Behaviors (N=24,417)

Latent Class
Current non-drinkers Binge drinkers Problem drinkers
Probability of membership† .69 .27 .04
Item-response probabilities corresponding to a Yes†† response
Drinking during the past 30 days 0.12 1.00 1.00
Binge drinking during the past 30 days 0.00 0.51 0.86
Drinking on six or more days during the past 30 days 0.00 0.21 0.61
Drinking alone 0.00 0.29 0.78
Timing of drinking initiation 0.28 0.19 0.36
Family members’ or friends’ advice on reduction of alcohol consumption 0.00 0.10 0.72
Drunk driving or riding together with a drunk driver 0.00 0.04 0.51
Blackout after drinking 0.00 0.18 0.84
Involvement in arguments after drinking 0.00 0.03 0.63

Bold figures indicate that the item-response probability is 0.50 or above.

Rounded to two decimal places;

Recoded from original response categories.

Characteristics across Three Latent Classes of Adolescent Drinking Behaviors (N=24,417)

Sample characteristic Unweighted frequency (weighted %)
Current non-drinkers Binge drinkers Problem drinkers χ2 p
(n=18,074) (n=5,433) (n=910)
Gender
Male 9,814 (55.5) 3,217 (60.3) 595 (66.7) 49.13 <.001
Female 8,260 (44.5) 2,216 (39.7) 315 (33.3)
School year
Middle school 6,960 (34.3) 1,051 (17.0) 174 (17.3) 457.71 <.001
High school 11,114 (65.7) 4,382 (83.0) 736 (82.7)
Perceived economic status
Middle or high 15,066 (83.8) 4,378 (80.8) 703 (77.4) 39.66 <.001
Low 3,008 (16.2) 1,055 (19.2) 207 (22.6)
Subjective academic performance
High 6,447 (35.2) 1,679 (30.7) 280 (30.2) 148.72 <.001
Middle 5,273 (29.4) 1,403 (25.8) 173 (18.8)
Low 6,354 (35.4) 2,351 (43.5) 457 (51.0)
Stress
High or very high 7,365 (40.3) 2,442 (44.7) 458 (49.4) 46.39 <.001
None to a little 10,709 (59.7) 2,991 (55.3) 452 (50.6)
Suicidal ideation
Yes 2,605 (14.1) 977 (17.7) 265 (28.8) 128.25 <.001
No 15,469 (85.9) 4,456 (82.3) 645 (71.2)
Lifetime conventional or electronic cigarette use
Yes 3,851 (22.0) 2,769 (51.6) 764 (84.5) 3,264.17 <.001
No 14,223 (78.0) 2,664 (48.4) 146 (15.5)
Lifetime use of drugs other than alcohol and cigarettes
Yes 66 (0.4) 97 (1.8) 117 (12.8) 945.61 <.001
No 18,008 (99.6) 5,336 (98.2) 793 (87.2)

Predictors of Latent Class Membership in Adolescent Drinking Behaviors (N=24,417)

Predictors p Binge drinkers
 Problem drinkers
OR 95% CI OR 95% CI
Gender (ref.=male) .814 1.06 (0.98, 1.13) 1.07 (0.90, 1.27)
School year (ref.=middle school) <.001 2.48 (2.29, 2.68) 2.78 (2.31, 3.35)
Perceived economic status (ref.=low) .654 1.03 (0.95, 1.12) 1.16 (0.96, 1.39)
Subjective academic performance (ref.=low)
Middle <.001 0.82 (0.75, 0.89) 0.52 (0.43, 0.64)
High .003 0.88 (0.82, 0.96) 0.81 (0.68, 0.96)
Stress (ref.=none to a little) <.001 1.12 (1.05, 1.21) 1.54 (1.31, 1.80)
Suicidal ideation (ref.=no) <.001 1.24 (1.13, 1.37) 2.08 (1.74, 2.48)
Lifetime conventional or electronic cigarette use (ref.=no) <.001 3.13 (2.91, 3.38) 23.75 (18.93, 29.78)
Lifetime use of drugs other than alcohol and cigarettes (ref.=no) <.001 3.26 (2.42, 4.40) 13.75 (9.94, 19.03)

Reference class=current non-drinkers; ref.=reference group; OR=odds ratio; CI=confidence interval.