Alcohol use and problem drinking in Taiwanese adolescents: comparison of the Han and indigenous populations.

The population of Taiwan is 98% Han and 2% indigenous. Taiwanese Hans are, ethnically, an immigrant Chinese population. Traditionally, indigenous families make wine and, just like tea to the Hans or coffee in Western social settings, wine is served to entertain the guests in the indigenous culture. Alcohol drinking is a way of delivering a message of their conviviality. It also has a central role in traditional harvest festivals, ancestor worship and wedding ceremonies (Historical Research Commission of Taiwan Province, 1996).

In the 1960s drinking was largely an act of harvest celebration but nowadays it is a problematic behaviour.

Studies have ascertained, however, that alcohol drinking in indigenous society has changed over the past few decades (Chen, 1999). For example, in the 1960s drinking was largely an act of harvest celebration but nowadays it is a problematic behaviour. An epidemiological study found that the prevalence of alcohol misuse and alcohol dependence according to ICD–10 and DSM–III–R criteria was between 42.2% and 54.7% in the Taiwanese indigenous population, which is much higher than has been reported for the Taiwanese general population or for the United States. About 40% of alcoholics had become addicted to alcohol in their adolescence (Cheng & Chen, 1995).

Although the selling of liquor to those under 18 years of age is prohibited in Taiwan, the prevalence rates of alcohol use for adolescents aged 12 and 17 years were found to be 11.3% and 31.4% respectively.

Liou & Chou (2001) conducted an epidemiological study in Taiwan from 1991 to 1996; the results suggested that the prevalence rate of alcohol use among adolescents was substantially greater than that of smoking. The prevalence rate of alcohol use for Taiwanese adolescents (drinking at least once a month) was 16.7%. In an examination of the different ethnic groups, Taiwanese indigenous adolescents showed a higher prevalence rate of alcohol use than Han adolescents (30.2% v. 16.7%). Although the selling of liquor to those under 18 years of age is prohibited in Taiwan, the prevalence rates of alcohol use for adolescents aged 12 and 17 years were found to be 11.3% and 31.4% respectively. The trends in adolescent use of alcohol in Taiwan, the United States and European countries, also from 1991 to 1996, were similar. Therefore, the study concluded that Taiwanese adolescents are at as great a risk of developing alcohol-related problems (Chou et al, 1999).

A study of adolescent alcohol use in Taiwan

In a study by Yeh (2006), alcohol use was defined as drinking once a month. The results indicated that there were significant gender differences in alcohol use among Taiwanese adolescents – alcohol use by males was about twice that by females – but the differences between ethnic groups (the indigenous group and the Hans) were not significant. Because male adolescents may be influenced by the values of Taiwanese mainstream behaviours, they may identify alcohol use as a ‘manly behaviour’ and treat it as a key component of social interaction between peers. On the other hand, females may be concerned about personal safety issues when they consume alcohol, so they may exercise more caution in doing so (Chiang et al, 2002).

Close examination of the contributory factors related to alcohol use in the indigenous and Han groups revealed between-group differences. The main factors for the Han group were: father drinking, mother drinking, family relationships, single parent, peer relationships and peer drinking (Yeh & Chiang, 2005). These findings were congruent with the findings of a study by Olds & Thombs (2001). In contrast, the main factors affecting the indigenous group were only father drinking and peer drinking. These findings suggested that factors affecting Han alcohol use were similar to those in Western cultures (Yeh & Chiang, 2005).

Problem drinking

In Yeh’s study, the incidence of problem drinking (drunkenness at least once a month) among adolescents differed significantly between the ethnic groups: the indigenous adolescents were 2.98 times as likely to get drunk as the Han adolescents (Yeh, 2006).

Aldehyde dehydrogenase

Chen et al (1989) found that 51% of Hans lack aldehyde dehydrogenase (ALDH). Alcohol is metabolised to aldehyde and in people who have no ALDH this is stored in the blood after drinking and causes flushing. Because the indigenous people are of Malayo-Polynesian stock, among whom the rate of ALDH deficiency may be up to 6.4%, their physiological reactions to alcohol are significantly different from those of the Hans.

Results from focus groups

The results of focus groups held with indigenous adolescents indicated that alcohol use allowed them to demonstrate their adulthood and identification of male roles. They also believed that drinking relieved them from anxiety, emotional stress and the burden of social expectations. According to traditional custom among the indigenous population, drinking with others shows respect, just as the general population drinks tea with guests. In addition, the indigenous adolescents may drink to show their happiness, especially at festivals, rituals and weddings (Yeh, 2003).

Another finding was that social assimilation and territorial attitude had a negative effect upon indigenous adolescent drinking. More obvious problem drinking behaviours were found among indigenous adolescents who had negative attitudes towards the Han people (i.e. believed that Han people were taking advantage of them, did not believe that Han people could live peacefully with indigenous people, or preferred that Han people did not enter indigenous society at all) (Yeh, 2004). The study also found that the determinants of drinking behaviours included not only acculturative factors but also genetic factors, expectation for drinking and social norms.

Conclusion

Based on the results of our studies, alcohol use among Taiwanese adolescents was initially more likely to be affected by social and cultural factors, and the behaviour of parents and peers, but less by genetic factors. However, as they started to misuse alcohol, genetic factors played a major role in influencing the frequency and amount of drinking.

The results of focus groups held with indigenous adolescents indicated that alcohol use allowed them to demonstrate their adulthood and identification of male roles. They also believed that drinking relieved them from anxiety, emotional stress and the burden of social expectations.