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SMASHED: Changing the way we talk about underaged drinking

Smashed, which was launched in the Philippines through a collaboration between Diageo Philippines and PETA Plus in partnership with UK-based company Collingwood Learning. It is a groundbreaking global program that is a pillar of Diageo’s Society 2030: Spirit of Progress commitment to tackle underage drinking.

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Every parent knows you can shout at the top of your voice until you’re blue in the face, but you can’t always make children listen. Especially if what you are shouting about is something that is potentially dangerous, but their peers more commonly believe is “cool”.

It doesn’t matter if you’re right or wrong, it doesn’t matter if you have their best interests at heart, it doesn’t matter that you might have lived through the very same thing that they are and are trying to help them not make your mistakes. After kids hit a certain age, adults become the enemy.

So how do you get an important message through to adolescents? By using one of the most powerful communication tools known to man: storytelling.

Neil Gaiman, wildly successful author and graphic novelist, tells us that stories “teach us how the world is put together and the rules of living in the world, and they come in an attractive enough package that we take pleasure from them and want to help them propagate.”

Invention born of necessity

It is given that youths of today will experiment with many things as they grow older, regardless of the environment and socio-economic conditions they grew up in.

Unfortunately, this means that the vast majority of young people all across the world will come across the chance to sample substances: nicotine, alcohol, or even illegal drugs.

Smashed, which was launched in the Philippines through a collaboration between Diageo Philippines and PETA Plus in partnership with UK-based company Collingwood Learning. It is a groundbreaking global program that is a pillar of Diageo’s Society 2030: Spirit of Progress commitment to tackle underage drinking.

Chris Simes, the Managing Director for Collingwood Learning, recognizes that in order to nip the problem in the bud, one has to take a completely different approach other than lecturing the youth. “This is a real change from the usual approach to alcohol education in schools and one that makes the risks of underage drinking impossible to forget. We understand that because of the pandemic, both teachers and students are still adjusting to the current normal. But we want to help carry the learning forward by providing high-quality teaching resources for use, despite the pandemic. We’re thrilled to be working with PETA Plus and the Department of Education in the Philippines to produce new innovative online learning solutions to supplement the highly successful live approach.”

Inevitably, kids who start drinking at an early age do not have minds and bodies that are able to process alcoholic beverages. They get lured into it by seeing it as a rite of passage, a means of escape, or a social requirement.

On its second run, Smashed utilizes a novel approach, with additional features designed for more interaction with its target audience.

Conceptualized during the time when education was adapting to the new constraints of being unable to hold physical classes, the Smashed Philippine project initially launched in September 2021. It was an interactive website (online.smashedproject.org) that sought to empower Filipino teens and preteens to make better choices by harnessing their critical thinking skills.

Smashed utilized an online platform featuring a gripping story with three main characters and even has a feature that makes the viewer feel like they are actually on video calls with the characters as they follow along.

What’s the problem?

It’s easy to ignore a problem you don’t see. Teens learn how to drink from adults. They think it’s okay because they see it everyday, and sometimes, they are even encouraged to drink, especially males. Adults will sometimes allow their children to drink inside their homes with their friends because it is ‘safer’, saying, “mas okay nang dito ka mag-inom sa bahay kesa sa labas”.

But the Philippines does have an underage drinking culture. If you’re ever in doubt about this fact, just ask the kids.

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Ashley Mae Torres, a tenth-grade student from Quirino High School, points out, “Bilang kabataan, mas marami akong nakikitang proud maging alcoholic.” That’s a worrying statement indeed, but she also credits Smashed, seeing the potential good in the program. “Salamat at dahil sa Smashed mas lumawak ang aking kaalaman sa mga panganib ng alcohol,” says Ashley. “Mas magandang piliin ang tama kasya sa udyok ng ibang tao.”

The Philippines, which has a thriving drinking culture, reports that 70% of the population has consumed alcohol before the age of 14, despite it being illegal for stores and restaurants to sell or serve the substance to minors. This could be a problem.

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Sometimes the adults in the lives of young drinkers are the problem. In a scathing insight, the winner of the Smashed essay writing contest notes, “Ang problem po sa underage drinking sa bansa natin ay ine-encourage pa ng ibang family na ‘uy uminom ka’. Diyan din ako nagsimula ayaw ko pang uminom pero kinalaunan umiinom na rin ako tapos na-enjoy ko na rin.” Angel Borda, from Don Alejandro Roces Sr. Science-Technology High School emphasizes that the relatability of the situations of the characters was especially helpful in this case. “Pero ‘yun po yung mali talaga. We have to break that mindset. Napansin ko po yung kay Miko and kay Jella na yung pinagdadaanan po nila sa buhay nila, sa personal life nila is yun po yung ineexplain po nun kung bakit sila may addiction sa drinking pero it’s not an excuse sa behavior na pinapakita nila. Yung pagiging iresponsable nila, yung kawalan nila ng respeto sa ibang tao, kumbaga hindi sila main character sa buhay na ito at hindi lang sila ang maapektuhan sa buhay na ginagawa nila.”

The American-based National Institute on Alcohol Abuse and Alcoholism (NIAA) has published research that has found that those who get into the habit of alcohol consumption earlier in life may suffer more from it than those who learn to drink at an appropriate age. It states that “youthful patterns of alcohol use can mark the start of a developmental pathway that may lead to abuse and dependence”, and that continued drinking may lead to physiological reactions, such as depression or anxiety disorders, triggering an even greater reliance on the substance to alleviate the symptoms of these disorders. That’s already discounting the immediate effects of alcohol on young minds, which could lead to poor decision-making, patterns of antisocial behavior, and impaired motor skills. Finally, there is also the detrimental effect of extensive alcohol exposure on developing vital organs such as the liver and brain.

Lofty goals and marked successes

During its initial rollout in the Philippines in 2021, Smashed was supported by 120 schools in 17 regions and managed to get up in front of an audience of 17,700 young people. With the Department of Education and other academic institutions serving as partners, Smashed Online was able to equip educators and young leaders with workshops and training.

For 2023, the program’s goal is to be able to get its message through to over 25,000 students, partnering with schools and educators all over the Philippines. It is the program’s target to reach 300,000 Filipino youths by 2030 by working in close collaboration with the Department of Education.

“We are proud to support an important program to address the dangers associated with underage drinking like Smashed in the Philippines. This is part of our Society 2030: Spirit of Progress at Diageo, and we are confident that we can make a positive impact with the Filipino youths in making informed choices about alcohol and combat alcohol related harm for generations to come”, comments Shanahan Chua, Corporate Relations Director of Diageo Philippines.

According to the Philippines’ Smashed Online project manager, Gold Villar-Lim, in 2022, 93% of the total participants surveyed reported a marked attitudinal change. “Overall, the project is not only a big step in advocating for alcohol education and youth empowerment, but also in promoting applied theater and drama-in-education as effective teaching tools in the Philippines,” says Villar-Lim.

It isn’t just about making a connection with the participants, either. Smashed tries to melt the resistance that most children seem to have towards reaching out to adults to help in case they find themselves in a sticky spot due to alcohol, especially their parents. And it seems that the message is getting through.

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Even educators are impressed. “Highly recommended talaga ang Smashed PH kasi na-to-touch niya yung mga buhay at talagang nangyayari araw araw sa mga mag-aaral, says Russel Radaza, a department head at President Sergio Osmeña High School Manila. “Mas maganda kung mas maraming schools ang ma-rereach out ng Smashed PH para sila ay mag-enjoy at mas matuto about alcoholic beverages.”

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This sentiment is echoed by Jennifer Rances, a teacher at Sipocot National High School in Camarines Sur. Sa akin naman, talagang napakalaking tulong po nito na sa mga young learners lalo na ngayon iba na ang gusto nilang gawin hindi na sila nakafocus,” she says, emphasizing the lack of connection between a child’s attention span and traditional methods of education. She goes on to stress that “with these kinds of projects, talagang magiging focus nila ay […] ano ba talaga yung nangyayari sa society at ano ba talaga yung realidad. With this kind of project that Smashed Ph has, talagang sa tingin ko sobrang positive ako na madedevelop ang mga bata rito. Lahat madedevelop including their skills, pati yung mga talents nila at yung focus din even leadership skills.”

Could this change in the approach to the conversation create lasting effects in the way we approach underage drinking? Will it create deliberate and productive conversations between children at risk and the adults who are in the position to guide them? Evidence points to the possibility of both, and although only time will tell, Smashed Ph is definitely taking the necessary steps in the right direction.

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Drinking any amount of alcohol likely increases dementia risk

Even light drinking—generally thought to be protective, based on observational studies—is unlikely to lower the risk, which rises in tandem with the quantity of alcohol consumed.

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Drinking any amount of alcohol likely increases the risk of dementia, suggests the largest combined observational and genetic study to date, published online in BMJ Evidence Based Medicine.

Even light drinking—generally thought to be protective, based on observational studies—is unlikely to lower the risk, which rises in tandem with the quantity of alcohol consumed, the research indicates.

Current thinking suggests that there might be an ‘optimal dose’ of alcohol for brain health, but most of these studies have focused on older people and/or didn’t differentiate between former and lifelong non-drinkers, complicating efforts to infer causality, note the researchers.

To try and circumnavigate these issues and strengthen the evidence base, the researchers drew on observational data and genetic methods (Mendelian randomisation) from two large biological databanks for the entire ‘dose’ range of alcohol consumption.

These were the US Million Veteran Program (MVP), which includes people of European, African, and Latin American ancestry, and the UK Biobank (UKB), which includes people of predominantly European ancestry.

Participants who were aged 56–72 at baseline, were monitored from recruitment until their first dementia diagnosis, death, or the date of last follow-up (December 2019 for MVP and January 2022 for UKB), whichever came first. The average monitoring period was 4 years for the US group, and 12 for the UK group. 

Alcohol consumption was derived from questionnaire responses—over 90% of participants said they drank alcohol—and the Alcohol Use Disorders Identification Test (AUDIT-C) clinical screening tool. This screens for hazardous drinking patterns, including the frequency of binge drinking (6 or more drinks at a time).

In all, 559,559 participants from both groups were included in observational analyses, 14,540 of whom developed dementia of any type during the monitoring period:10,564 in the US group; and 3976 in the UK group. And 48,034 died: 28,738 in the US group and 19,296 in the UK group. 

Observational analyses revealed U-shaped associations between alcohol and dementia risk: compared with light drinkers (fewer than 7 drinks a week) a 41% higher risk was observed among non-drinkers and heavy drinkers consuming 40 or more drinks a week, rising to a 51% higher risk among those who were alcohol dependent. 

Mendelian randomisation genetic analyses drew on key data from multiple large individual genome-wide association studies (GWAS) of dementia, involving a total of 2.4 million participants to ascertain lifetime (rather than current) genetically predicted risks.

Mendelian randomisation leverages genetic data, minimising the impact of other potentially influential factors, to estimate causal effects: genomic risk for a trait (in this case, alcohol consumption) essentially stands in for the trait itself. 

Three genetic measures related to alcohol use were used as different exposures, to study the impact on dementia risk of alcohol quantity, as well as problematic and dependent drinking. 

These exposures were: self-reported weekly drinks (641 independent genetic variants);  problematic ‘risky’ drinking (80 genetic variants); and alcohol dependency (66 genetic variants). 

Higher genetic risk for all 3 exposure levels was associated with an increased risk of dementia, with a linear increase in dementia risk the higher the alcohol consumption. 

For example, an extra 1-3 drinks a week was associated with a 15% higher risk. And a doubling in the genetic risk of alcohol dependency was associated with a 16% increase in dementia risk.

But no U-shaped association was found between alcohol intake and dementia, and no protective effects of low levels of alcohol intake were observed. Instead, dementia risk steadily increased with more genetically predicted drinking. 

What’s more, those who went on to develop dementia typically drank less over time in the years preceding their diagnosis, suggesting that reverse causation—whereby early cognitive decline leads to reduced alcohol consumption—underlies the supposed protective effects of alcohol found in previous observational studies, say the researchers.

They acknowledge that a principal limitation of their findings is that the strongest statistical associations were found in people of European ancestry, because of the numbers of participants of this ethnic heritage studied. Mendelian randomisation also relies on assumptions that can’t be verified, they add.

Nevertheless, they suggest that their findings “challenge the notion that low levels of alcohol are neuroprotective.”

And they conclude: “Our study findings support a detrimental effect of all types of alcohol consumption on dementia risk, with no evidence supporting the previously suggested protective effect of moderate drinking. 

“The pattern of reduced alcohol use before dementia diagnosis observed in our study underscores the complexity of inferring causality from observational data, especially in ageing populations. 

“Our findings highlight the importance of considering reverse causation and residual confounding in studies of alcohol and dementia, and they suggest that reducing alcohol consumption may be an important strategy for dementia prevention.”

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Distribution of fat could influence cancer risk, study suggests

Obesity is usually measured using body mass index (BMI), but growing evidence – particularly from heart health research – suggests that BMI alone doesn’t capture the full picture when it comes to obesity-related health risks. However, the role of fat distribution in cancer risk has been relatively unexplored.  

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How fat is distributed in people’s bodies could make a difference to their risk of certain cancers, according to new research led by the University of Bristol.  The international study is published in the Journal of the National Cancer Institute (JNCI).

Scientists have already shown that having obesity increases a person’s risk of developing certain cancers. Obesity is usually measured using body mass index (BMI), but growing evidence – particularly from heart health research – suggests that BMI alone doesn’t capture the full picture when it comes to obesity-related health risks. However, the role of fat distribution in cancer risk has been relatively unexplored.  

Researchers in Bristol’s Integrative Cancer Epidemiology Programme (ICEP) investigated whether body fat at different locations across the body influences the risks of 12 obesity-related cancers – endometrial, ovarian, breast, colorectal, pancreas, multiple myeloma, liver, kidney (renal cell), thyroid, gallbladder, oesophageal adenocarcinoma, and meningioma.

They used a technique known as Mendelian randomisation, which uses statistics, computing and the natural variations in people’s genetics to identify patterns in large health data sets. 

The team found that fat distribution appears to influence cancer risk – but the relationship varies by cancer type. For some cancers, where fat is stored in the body seems more important than how much is stored; for others, the reverse is true; and, for some, both matter.  In cancers where distribution is important, the specific locations of body fat driving this seem to differ by cancer, meaning the overall picture is quite complex. 

Lead author, Dr Emma Hazelwood, who recently completed her PhD at the University of Bristol, explained: “These findings support the growing consensus that BMI, while useful for population-level trends, may be too simplistic for assessing individual health risks.

“Our results tell us that there is no ‘one-size-fits-all’ when it comes to cancer, meaning a more tailored approach to cancer prevention in people with obesity could be most effective.” 

The paper’s findings fit with recent calls for change, including the 2024 European Association for the Study of Obesity framework and the Lancet Commission on the future of obesity, which have emphasised that BMI is a flawed diagnostic tool and that fat distribution matters.  

In the future, a better understanding of how fat distribution across the body affects cancer risk could help identify those most at risk and guide more personalised approaches to obesity treatment and cancer prevention. 

The research team recommend further work is needed, using different approaches and studying non-European populations.

Dr Hazelwood added: “It is vital to understand the biological mechanisms that underpin these associations – particularly how and why different fat depots affect cancer development. In the longer term, we need to explore how obesity treatments – whether lifestyle or drug-based – influence these risk pathways.” 

Dr Julia Panina, Head of Research Funding at World Cancer Research Fund, added: “Our evidence-based Cancer Prevention Recommendations highlight the role of maintaining a healthy weight to reduce cancer risk. While this remains essential, growing scientific evidence shows that body composition – particularly how fat is distributed throughout the body – is also a crucial factor.  

“With support from our fantastic donors, we were able to co-fund the University of Bristol’s excellent team whose findings will help direct this exciting area towards possible new cancer prevention and treatments.” 

This study was funded by the World Cancer Research Fund (WCRF UK) and Cancer Research UK (Integrative Cancer Epidemiology Programme). This work was carried out at the MRC Integrative Epidemiology Unit (MRC IEU), which is supported by the Medical Research Council (MRC) and the University of Bristol. 

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Forget materialism, a simple life is happier: research

The commitment to simple living, or ‘voluntary simplicity’ as it is formally known, leads to wellbeing through providing more opportunities for personal interaction and social connection than conventional contexts of exchange, such as community gardens, sharing resources, and peer-to-peer lending platforms.

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In an age where billionaires and conspicuous consumption are increasingly on display, new Otago-led research shows a simple life really is a happier life.

The study led by University of Otago – Ōtākou Whakaihu Waka Department of Marketing researchers has recently been published in the Journal of Macromarketing.

After setting out to understand the relationship between consumption and wellbeing, the researchers found people are happier and more satisfied when adopting sustainable lifestyles and resisting the temptations of consumerism.

They analysed data from a representative sample of more than 1000 New Zealanders, made up of 51 per cent men and 49 per cent women, with a median age of 45 and a median annual household income of $50,000.

They found the commitment to simple living, or ‘voluntary simplicity’ as it is formally known, leads to wellbeing through providing more opportunities for personal interaction and social connection than conventional contexts of exchange, such as community gardens, sharing resources, and peer-to-peer lending platforms.

Women are more likely to adopt a simple life than men, although more research is needed to understand why.

Co-author Associate Professor Leah Watkins says consumer culture promotes happiness as being typically associated with high levels of income and the capability it affords to acquire and accumulate material possessions.

“However, research is clear that attitudes to, and experiences of, materialistic approaches to life do not lead to increases in happiness or wellbeing. Nor do they lead to sustainable consumption necessary for planetary health.”

Between 2000 and 2019, global domestic material consumption increased by 66 per cent, tripling since the 1970s to reach 95.1 billion metric tons.

Growing consumer affluence and higher living standards have resulted in warnings of alarming trends of environmental degradation from human consumption.

This, coupled with global warming and post-pandemic health and financial anxieties, has led researchers and policymakers to call for a better understanding of the links between simple consumer lifestyles and wellbeing.

But co-author Professor Rob Aitken says this isn’t a case of just throwing out all your worldly possessions.

“It’s not directly the commitment to material simplicity that leads to wellbeing, but the psychological and emotional need fulfilment that derives from relationships, social connection, community involvement and a sense of living a purposeful and meaningful life.

“In a world where billionaire weddings are treated like state occasions and private yachts are the new status symbols, voluntary simplicity offers a quiet, powerful counter-narrative — one that values enough over excess, connection over consumption, and meaning over materialism.”

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