Background

The consumption of alcohol is widespread and entwined with numerous cultural and social activities under the Australian context. However, compared to 2013, people of Australia are drinking less frequently in 2016. There are however, no changes in the drinking pattern of the proportion of the people who are aged 18 years or less. The silver lining is, people aged between 14 to 24 years are now under “delay starting drinking” and as a result, the age at which they first tried alcohol has also increase (14.1 years in 1998 to 16.1 in 2016) (Australian Institute of Health and Welfare 2017a).

Figure: Consumed 11 or more alcoholic drinks at least once a year from 2010 to 2016

X axis = age; Y axis = percentage of drinking

(Source: Australian Institute of Health and Welfare 2017a)

According to World Health Organisation (WHO 2017), 21^st century health promotion intervention is associated with several challenges and this challenge mainly arrives from changing health burden and complex determinants of health, inequity in health, globalization and expanding democratization.

The following report aims to appraise the efficacy of the health promotion interventions drafted towards the prevention of the alcohol consumption tendencies among the youths of Australia. The analysis of the efficacy of the health promotion will be done under the 21^st century perspectives via the utilization of specific frameworks and approaches.  

The main socio-ecological determinants that influence the consumption of alcohol among the young population include individual factors, family factor or surrounding environment, community level factors, and policy level factors.

Exposure to media like advertising and product placements influences the social norms associated with the use of alcohol. Although alcohol ads are restricted in Australia, the reports published by The Guardian (2017) highlighted that the government of Australia is failing to employ potential power to regulate the alcoholic beverage industry to stop its ads reaching the young population. Sudhinaraset, Wigglesworth and Takeuchi (2016)are of the opinion that alcohol commercials specifically affect the propensity of the younger adults to consume alcohol. Target alcohol marketing results in the development of individual’s positive beliefs for alcohol thereby creating and expanding the environment where use of alcohol is socially encouraged and acceptable.

Discrimination of the people from the low socio-economic background increases the level of stress. Sudhinaraset, Wigglesworth and Takeuchi (2016) stated that people consume alcohol in order to cope up with stress including both work related stress and stress arising from racial or ethnic discrimination. According to D’Abbs (2012), the Australian aboriginals are victims of the racial discrimination both in school and while at work. Discrimination is a social stressor that elicits certain physiological response including elevated blood pressure level and stress hormones, which increase the intake of alcohol use. Since young adults are more sensitive to racial discrimination, they are more prone towards becoming an alcohol addict.

Socio-ecological determinants of Alcohol Consumption among Australian Youths

Immigration has influence over the alcohol consumption. The hardships associated with the immigration like difficulty in managing with the new society and culture with less social and emotional support increase the level of stress. This stress factor in turn increases the tendency of alcohol consumption. Younger adults who are immigrants especially who are from aboriginal community experiences stress as they are frequently bullies in schools and this provoke them to consume alcohol (White and Hingson 2013).

Community is another socio-economic determinant behind alcohol consumption. Young adults who reside in neighbourhood with poorly built environment are more likely to report heavy alcohol consumption in comparison to those who is residing in better-built environment. This is the reason why the minority classes have higher concentration of liquor stores. This potentially high access of alcohol among the minority population further increases the tendency of alcohol consumption at an early age of life (White and Hingson 2013).

Contemporary society of Australia is shaped via consumer’s capitalism and via commoditization of alcohol. Australian aboriginals are more prone towards getting addicted with alcohol abuse in comparison to the Australian aboriginals (Chan et al. 2016). According to Livingston et al. (2016) the Australian aboriginal men attempt to appear masculine and string due to certain cultural values and they think drinking alcohol exemplifies their masculinity. This trend is then replication among the young men leading to a tendency of increase in alcohol consumption.

Some of the strongest influence of the adolescent drinking behavior is family and friends. According to Dager et al. (2013), higher levels of alcohol use among the friends and family are associated with increases alcohol intake among the youths. Dager et al. (2013) also highlighted that peer pressure and socializing with alcohol are associated with alcohol misuse and binge drinking among the youth.

In the grounds of health, interventions towards the prevention of the alcohol consumption among the youth should employ developmentally appropriate strategies. These will help to delay the initiation of alcohol use. This is because the environment of the family is comparatively less influential than the influence coming from peers or the prevalence of the social norms, and advertisements among the young adults and older adolescents. Future interventions should also aim at more than one level of societal environments, starting from the community to the individual level (Sudhinaraset, Wigglesworth and Takeuchi 2016).

Ottawa Charter for Health Promotion is regarded as one of the best health promotion framework. It was document during the first international conference of health promotion of WHO (World Health Organisation) at Ottawa during 1986. The charter delivers a definite framework for optimal implementation of the health promotion in five different areas.

Health Promotion Interventions for Alcohol Consumption Prevention

Action area 1

Building healthy public health policy is pioneer in improving health. In recent years strategies, approaches undertaken to decrease the alcohol associated harm have increasingly directed on the high risk individuals (Inchley and Currie 2013). While these approaches may be perfect for specific individuals but fail to contribute little at the reduction in the alcohol burden among at the young individuals at the community level. So the HP intervention towards youth alcohol consumption is directed towards the community action strategies like restriction and regulation of alcohol sales; increase alcohol taxes, increase server liability and decrease limit of permissible blood alcohol (Inchley and Currie 2013).

Action area 2

Healthy public health policy helps in generating supportive environments that are crucial in ensuring that each and every individual’s life is enjoyable and safe. Problem of alcohol misuse does not only pertains to young population; it a problem that affects all the members of society (Sallis, Owen and Fisher 2015).  According to Sallis, Owen and Fisher (2015), in Australia, parents commonly supply alcohol to their children and providing easy alcohol access. Moreover, media ads of alcohol are frequently associated with sexual or social success and hence contravene the Alcoholic Beverages Advertising Code (Pettigrew e al. 2012). Hence, HP interventions towards youth alcohol consumption promotes supportive environment via partnership at the community level. This community level partnership will come from teachers, parents and local government such that they can exchange ideas and identify new strategies that will aim towards decreasing alcohol related harm and consumption among young people (Pettigrew e al. 2012).

Action area 3

Strengthening community action means participation of the community in decision making process and not just as an individual. Till now in Australia there has not been any significant formal consultation with the young population in the domain of legal age of alcohol consumption. So, HP interventions towards youth alcohol consumption aim towards community mobilization approaches (Carson et al. 2017). According to Carson et al. (2017), community mobilisation approaches is effective in changing the associated community factors (like underage access to alcohol) that promote use of alcohol among young people.

Action area 4

Development of personal skill is important if individuals want to control their live. Assisting people to work on their skills ensures that the individual has required knowledge to participate in informed decision making (Sørensen et al. 2012). In Australia, majority of parents find it difficult to communicate with their adolescents about alcohol misuse. Moreover, they also feel helpless to do anything about their adolescents’ alcohol misuse. HP interventions towards youth alcohol consumption aim at effective school based programs. These programs train adolescents about social skills and resistant training. This helps to teach the youth the community values and other alcohol related drug and thereby helping to increase awareness (Sørensen et al. 2012).

Ottawa Charter for Health Promotion Framework

Action area 5

Re-orienting healthcare is crucial in ensuring that the concept of health promotion is everybody’s business. So HP interventions in youth alcohol prevention in 21^st century aim to re-orient health service via fostering intersectoral collaboration between police, health sector, adolescents and parents (Ndumbe-Eyoh and Moffatt 2013).

The first principal of CSDH is improvement of the condition of daily life. According to Solar and Irwin (2010), chaotic home environments, parental abuse, ineffective parenting, lack of proper support, harsh discipline and lack of mutual attachments are core factors which increase the tendency of alcohol misuse among the youths. HP intervention (HPI) will aim towards improvement of the life conditions that will in turn reduce the tendency of the alcohol consumption or alcohol abuse among the older adolescents and younger adults (Wallhed et al. 2014).

The main approaches that will be effective for HPI include parental education towards the importance of the proper upbringing and its relation with the mental development in adolescent. Healthy surrounding environment during the initial stages of life lead to the decrease in the tendency of alcohol consumption among the young adults or older adolescents (Wallhed et al. 2014).

The second principal of CSDH deals with tackling inequitable distribution of resources. According to Solar and Irwin (2010), people who lived under disadvantaged are less likely to access their own health as good or excellent. The young population of Australia who belongs to the poor socio-economic group which is the victims of heath inequality are more prone to get victims of alcohol abuse. So the health promotion strategy is directed towards equitable access of the basic amenities among the group of population who belongs from the poor socio-economic group.

The third principle of CSDH is based on the generation of the public awareness and maintenance of the trained workforce in order to effectively address the alarming public health issue. The HPI towards youth and alcohol with mostly be directed towards community based approaches and other school-based interventions. School and community based interventions are effective in reducing long-term alcohol consumption rates via an average of 12% among the students who consumes alcohol in comparison to the placebo groups (Harvey and Chadi 2016). In the grounds of maintain a trained workforce for the proper implementation of the interventions, proper computer based and oral training is important. This will help to keep the workforce updated about the current status of young alcohol abuse and the contemporary ways to address the overall situations (Harvey and Chadi 2016).

CSDH Principles for Health Promotion Interventions

According to Kickbusch and Gleicher (2012), 5 key determinants of health of 21^st century are political, commercial, social, environmental and behavioural. Behavioural determinants of health are defined as the set of behaviours undertaken by the individuals that have significant influence (both positive and negative) over health. Behaviour of active intake of alcohol or nurturing behaviour of active alcohol intake is the main behavioural determinants of alcohol intake among the youth. The health promotion interventions are thus required to be directed towards the change in the behavioural of the youth towards the alcohol intake (MacArthur et al. 2012). This can be achieved via educating the youth about the ill-effects of drinking alcohol like cardio-vascular disease, liver disease and obesity. Enlightening about the physiological risk factors of alcohol consumption will generate awareness among the youth and thereby helping to reduce alcohol intake and promoting health.

Social determinants of health are the conditions, under which the people are born, grow and live. Social determinants of health are mostly responsible for the generation of health inequalities. Effective reduction in the social inequalities via equitable division of resources will help to reduce the alcohol abuse among the youth. Improvement of the social determinants of health can be undertaken via promotion of the education, health literacy, and health cognition and employment status (Grittner et al. 2012).

Thus overall HPI must be directed towards the improvement of the behavioural and social determinants in health in order to reduce the rate of alcohol use in the youth of Australia. However, the current health promotion intervention of youth alcohol intake is not success and the results can be clearly seen from the statistics produced by the Australian Institute of Family Studies (2017). The statistics reported that 90% of the Australian adolescents who are 14 years of age have tried full glass of alcohol and the percentage is 95% among the 17 years old teenage. Hence the HPI must be stringently directed towards the awareness (for behavioural interventions) about alcohol use along with effective government initiatives towards the promotion of health inequality.

System thinking approach in health promotion is a board paradigm which deals with the inter-relationships, boundaries and perspectives (Rosas 2017). It is not content specific nor it is influence via single discipline. The system thinking approach in health promotion is abstract, formal and structured thought process which ensures incorporation of social, political, individual and ecological factors (Rosas 2017). The system thinking approach for health promotion in alcohol and youth must encompass effective interplay of three organisations that is school or university, community health service and policy advisory organisation.

Personal Skill Development for Alcohol Prevention

Of the three organisations, school based interventions play a major role in determining the effectiveness and success of the HPI in alcohol use in youth. The main system areas of school based interventions include knowledge, modelling and networks.

Systems areas	School Health Promotion Stage
	Development	Improvement	Sustainability
Knowledge	· Determination of the types of resources · Identification of proper practices	· Examination of current feedback mechanisms · Identification of additional feedback mechanisms · Identification of daily routines	· Determination of the skills and knowledge that the system will adapt · Identification of knowledge that are required to support and whose absence hinders relationship
Modelling	· Identification of the present assumptions · Identification of the potential unintended consequences	· Examination of the theories in relation to stakeholders · Explorations of the current values guiding the policies and programs · Identification of the current assumptions that clarifies why things are done as they are	· Development of proper mechanisms to disseminate and shared the theory of change among all stakeholders
Organization	· Designing of new decision making structures · Identification of the additional need of the system	· Examination of existing relationships and decision making process · Explorations of the systems change efforts	· Anticipation of the requirement of the authority · Anticipation of the structural flexibility requirement
Networks	Identification of the social workers of the system	Examination of policies, attitudes and relationships	Anticipation of the interdependencies of the members of the networks

Table: System thinking activities

(Source: Rosas 2017)

However, under the Australian perspectives, the system thinking approach is not inherently linked with HPI especially in the school based programs. According to Teesson, Newton and Barrett (2012), existing school-based prevention programs is efficacious in Australian context. However, there are only few school based intervention programs for alcohol prevention. There is lack of proper modeling and organizational support. Teesson, Newton and Barrett (2012) highlighted that the lack of proper funding and trained workforce creates a barriers towards implementation of system thinking approach under school based interventions.

Australian government has taken steps in for the proper maintenance of the health equity towards HPI of alcohol in youth. For the example, the Australian government has implemented a range of policies for controlling the availability of alcohol, promotion and pricing (Australian Government Department of Health 2017).

Main Polices

Regulatory approaches: Enforcement and Licensing

Alcohol pricing and taxation

Regulation in physical availability

Counter measures on drink driving

Marketing restriction

Persuasion and education

Early interventions and treatment

(Source: Australian Government Department of Health 2017)

However, only few of these policies have taken the social determinants of health into consideration and the majority of these policies have potential to exacerbate inequities if framed poorly (Australian Government Department of Health 2017). 

Three broad systems that falls under the sustainability in health include sustainable environments for healthy lifestyle, sustainability in health system performance and implications in changing climate. However, aboriginals and the Torres Strait Islanders of Australia fail to enjoy sustainable environments for healthy lifestyle (Markwick et al. 2014). According to Markwick et al. (2014), the main inequalities in health between the aboriginals and non-aboriginals exist in depression, anxiety and psychosocial risk factors. All these three factors are known to increase alcohol abuse and thereby preventing comprehensive success of HPI.

Conclusion

Thus from the above discussion, it can be concluded that the HPI directed towards alcohol consumption in youths of Australia is not comprehensively compatible for 21^st century. The HPI lacks in the domain of promotion of health equity, environment sustainability and system specific thinking approach.

According to the World Health Organization (WHO) as the world is changing rapidly, the stage is set for HP to invite in promising partnerships and effective actions for HPI. In order to frame effective HPI under the perspective of 21^st century, specific changes in the interventions are required to be undertaken. These changes include, specifying the role of the state and governments towards specific HPI, increase in the participatory public policy process along with increase level of partnership among the multidisciplinary team, public sectors, NGOs, and private sectors. Moreover, proper leadership and sustainable health promotion intervention are also important for proper capacity building among the network of the HP (WHO 2017).

Community Mobilization for Alcohol Prevention

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