Association of alcohol control policies with adolescent alcohol consumption and with social inequality in adolescent alcohol consumption: A multilevel study in 33 countries and regions

Beyond the Laws: Parental Monitoring, Perceived Acceptability of Underage Drinking and Alcohol Use Among Belgian Youth

Parental monitoring behaviors are negatively associated with adolescent substance use. Yet, the processes explaining these associations are still unclear. The current study examined adolescents' knowledge of minimum legal drinking age laws and their perceived acceptability of underage drinking as potential mediators of the links between parental monitoring behaviors and youth alcohol use. The sample included 1154 Belgian adolescents (Mage = 16.34, SD = 1.33; 71% girls), who were recruited in Wallonia (54.9%) and in Flanders (45.1%). Path analyses revealed that higher parental rule setting, but not solicitation, was related to lower alcohol use. Acceptability of underage drinking mediated this link, but not knowledge of the laws. Results suggest that beyond laws regulating the minimum legal drinking age, alcohol use prevention programs should consider the importance of parental rule setting and youth's perceived acceptability of underage drinking.

Restricting alcohol marketing to reduce alcohol consumption: A systematic review of the empirical evidence for one of the 'best buys'

BACKGROUND AND AIMS

Even though a ban of alcohol marketing has been declared a 'best buy' of alcohol control policy, comprehensive systematic reviews on its effectiveness to reduce consumption are lacking. The aim of this paper was to systematically review the evidence for effects of total and partial bans of alcohol marketing on alcohol consumption.

METHODS

This descriptive systematic review sought to include all empirical studies that explored how changes in the regulation of alcohol marketing impact on alcohol consumption. The search was conducted between October and December 2022 considering various scientific databases (Web of Science, PsycINFO, MEDLINE, Embase) as well as Google and Google Scholar. The titles and abstracts of a total of 2572 records were screened. Of the 26 studies included in the full text screening, 11 studies were finally included in this review. Changes in consumption in relation to marketing bans were determined based on significance testing in primary studies. Four risk of bias domains (confounding, selection bias, information bias and reporting bias) were assessed.

RESULTS

Seven studies examined changes in marketing restrictions in one location (New Zealand, Thailand, Canadian provinces, Spain, Norway). In the remaining studies, between 17 and 45 locations were studied (mostly high-income countries from Europe and North America). Of the 11 studies identified, six studies reported null findings. Studies reporting lower alcohol consumption following marketing restrictions were of moderate, serious and critical risk of bias. Two studies with low and moderate risk of bias found increasing alcohol consumption post marketing bans. Overall, there was insufficient evidence to conclude that alcohol marketing bans reduce alcohol consumption.

CONCLUSIONS

The available empirical evidence does not support the claim of alcohol marketing bans constituting a best buy for reducing alcohol consumption.

A spatial examination of alcohol availability and the level of disadvantage of schools in Ireland

BACKGROUND

The availability of alcohol is a major factor in underage drinking and according to the alcohol harm paradox, those living in more deprived communities are more susceptible to the negative consequences of alcohol use, despite drinking the same or less than those from more affluent areas. Alcohol availability within the vicinity of the home or school normalises alcohol for schoolchildren. For the first time in the Republic of Ireland, this study examines the number of premises licensed to sell alcohol within 300 m of all schools in Ireland and differences in this number between disadvantaged and non-disadvantaged schools.

METHODS

Using publicly available data from the Department of Education and Revenue, the addresses of all schools (n = 3,958) and all premises with at least one liquor licence (n = 14,840) were geocoded and analysed using the Geographic Information System software, Quantum GIS (QGIS). Schools were identified by their disadvantaged classification using the HP Pobal Deprivation Index and the number of liquor licences within 300 m of each school type was examined. To test for significant differences between schools' level of disadvantage, a combination of Mann-Whitney U tests, Kruskal-Wallis tests and Dunn-Bonferroni tests were used.

RESULTS

There was a mean of two licenced premises within 300 m of all schools in Ireland, but when disadvantaged schools were compared to non-disadvantaged schools, there was a significantly higher number of licenced premises around disadvantaged schools (p < .001). Primary schools are further classified according to their level of disadvantage and the results indicated that those schools classified as the most disadvantaged had a significantly greater number of liquor licences within 300 meters (p < .001). There was no significant difference in density of licenced premises when comparing disadvantaged secondary schools with non-disadvantaged secondary schools (p = .705).

CONCLUSION

Ireland is considering increasing alcohol availability through the Sale of Alcohol Bill, 2022. However, this analysis indicates already problematic numbers of licenced premises within close proximity of schools in Ireland. It is essential that the harms associated with alcohol availability are considered, especially for those living and attending school in disadvantaged communities, where higher numbers of licenced premises were identified.

Alcohol-Related Presentations to Emergency Departments on Days with Holidays, Social, and Sporting Events: An Integrative Literature Review

INTRODUCTION

Events, specifically those where excessive alcohol consumption is common, pose a risk to increase alcohol-related presentations to emergency departments (EDs). Limited evidence exists that synthesizes the impact from events on alcohol-related presentations to EDs.

STUDY OBJECTIVE

This integrative review aimed to synthesize the literature regarding the impact events have on alcohol-related presentations to EDs.

METHODS

An integrative literature review methodology was guided by the Preferred Reporting Items of Systematic Reviews and Meta-Analysis (PRISMA) Guidelines for data collection, and Whittemore and Knafl's framework for data analysis. Information sources used to identify studies were MEDLINE, CINAHL, and EMBASE, last searched May 26, 2021.

RESULTS

In total, 23 articles describing 46 events met criteria for inclusion. There was a noted increase in alcohol-related presentations to EDs from 27 events, decrease from eight events, and no change from 25 events. Public holidays, music festivals, and sporting events resulted in the majority of increased alcohol-related presentations to EDs. Few articles focused on ED length-of-stay (LOS), treatment, and disposition.

CONCLUSION

An increase in the consumption of alcohol from holiday, social, and sporting events pose the risk for an influx of presentations to EDs and as a result may negatively impact departmental flow. Further research examining health service outcomes is required that considers the impact of events from a local, national, and global perspective.

Social disparities in alcohol consumption among Canadian emerging adults

INTRODUCTION

Young adult drinking is a public health priority, but knowledge of socioeconomic status (SES) indicators and alcohol use among emerging adults (EAs; aged 18-29 years) is primarily informed by college samples, populations in their late teens and early twenties and non-Canadian data. We compared the association of three different SES indicators with monthly heavy episodic drinking (HED), less-than-monthly HED, no HED, and no drinking among Canadian EAs.

METHODS

We pooled the 2015 to 2019 waves of the Canadian Community Health Survey to include participants aged 18 to 29 years (n = 29 598). Using multinomial regression, we calculated weighted estimates of alcohol use by education, household income and area-level disadvantage, adjusting for adult roles and sociodemographic characteristics.

RESULTS

Approximately 30% of EAs engaged in monthly HED, whereas 16% did not drink at all in the past year. Compared to those in the lowest household incomes, being in the top income quintile was significantly associated with increased relative odds of monthly HED (e.g. in combined SES model, RRR = 1.21, 95% CI: 1.04-1.39). Higher levels of education, being in higher income quintiles and living in less disadvantaged areas were significantly associated with reduced relative odds of no HED and not drinking. Adjusting for adult roles did not substantially change the associations between SES and alcohol use.

CONCLUSION

Higher SES was associated with HED among EAs, although the magnitude of association was small. Universal prevention measures addressing the affordability, availability and marketing of alcohol could be complemented by interventions targeting EA populations at higher risk of HED.

Risk factors for early use of e-cigarettes and alcohol: Dimensions and profiles of temperament

Adolescent e-cigarette use has been labeled an epidemic and alcohol use during this developmental period is associated with deleterious outcomes. Though specific temperamental dimensions have been shown to predict substance use, profiles of temperament have rarely been examined as predictors. This study examines dimensions and profiles of adolescent temperament as predictors of early use of e-cigarettes and alcohol. The sample was comprised of adolescent (62.07% female, 87.59% White, 82.76% Hispanic/Latinx)/caregiver dyads (N = 146) who completed the first two timepoints (M age at second timepoint = 16.16, SD = 0.68) of a longitudinal adolescent substance use study. Models showed parent-reported effortful control predicted protection against adolescent use of e-cigarettes, whereas adolescent report of effortful control predicted protection against alcohol use. Though dissimilar in temperamental pattern, three profiles emerged from both parent- and adolescent-report-based latent profile analysis models. Adolescents characterized by parents as displaying a Resilient profile had greater odds of e-cigarette use than those characterized by a Reserved profile, whereas adolescents who self-characterized as Mixed-type had markedly greater odds of alcohol use than those who self-characterized as Resilient. Utilization of temperamental profiles may aid in identification of particularly vulnerable subgroups of adolescents who may benefit from relevant preventative programing.

Effective alcohol policies are associated with reduced consumption among demographic groups who drink heavily

BACKGROUND

Alcohol policies stand out among other noncommunicable disease-relevant policies for the lack of uptake. Composite indicators have been developed to measure the effects of alcohol control policy. We investigated whether drinking patterns among demographic groups from general population samples of drinkers from diverse countries are associated with alcohol control policy as measured by the International Alcohol Control (IAC) Policy Index.

METHODS

Representative samples of adult drinkers from 10 countries (five high-income and five middle-income) were surveyed about alcohol consumption, using beverage and location-specific questions.

MEASUREMENTS

The IAC Policy Index was analyzed with frequency, typical occasion quantity, and volume consumed. Analyses used mixed models that included interactions between country IAC Policy Index score and age group, gender, and education level.

FINDINGS

Each increase in IAC policy index score (reflecting more effective alcohol policy) was associated with a 13.9% decrease in drinking frequency (p = 0.006) and a 16.5% decrease in volume (p = 0.001). With each increase in IAC Policy Index score, both genders decreased for all three measures, but men less so than women. Women decreased their typical occasion quantity by 1.2% (p = 0.006), frequency by 3.1% (p < 0.001), and total volume by 4.2% (p < 0.001) compared to men. Low and mid-education groups decreased their typical occasion quantity by 2.6% (p < 0.001) and 1.6% (p = 0.001), respectively, compared to high education, while for drinking frequency the low education group increased by 7.0% (p < 0.001). There was an overall effect of age (F = 19.27, p < 0.0001), with 18-19 and 20-24-year-olds showing the largest decreases in typical occasion quantity with increasing IAC policy index score.

CONCLUSIONS

The IAC Policy Index, reflecting four effective policies, was associated with volume and frequency of drinking across 10 diverse countries. Each increase in the IAC Policy Index was associated with lower typical quantities consumed among groups reporting heavy drinking: young adults and less well-educated. There is value in implementing such alcohol policies and a need to accelerate their uptake globally.

Effective alcohol policies and lifetime abstinence: An analysis of the International Alcohol Control policy index

INTRODUCTION

Alcohol abstinence remains common among adults globally, although low and middle-income countries are experiencing declines in abstention. The effect of alcohol policies on lifetime abstinence is poorly understood. The International Alcohol Control (IAC) policy index was developed to benchmark and monitor the uptake of effective alcohol policies and has shown strong associations with alcohol per capita consumption and drinking patterns. Uniquely, the index incorporates both policy 'stringency' and 'impact', reflecting policy implementation and enforcement, across effective policies. Here we assessed the association of the IAC policy index with lifetime abstinence in a diverse sample of jurisdictions.

METHODS

We conducted a cross-sectional analysis of the relationship between the IAC policy index score, and its components, and lifetime abstinence among adults (15+ years) in 13 high and middle-income jurisdictions. We examined the correlations for each component of the index and stringency and impact separately.

RESULTS

Overall, the total IAC policy index scores were positively correlated with lifetime abstinence (r = 0.76), as were both the stringency (r = 0.62) and impact (r = 0.82) scores. Marketing restrictions showed higher correlations with lifetime abstinence than other policy domains (r = 0.80), including restrictions on physical availability, pricing policies and drink-driving prevention.

DISCUSSION AND CONCLUSION

Our findings suggest that restricting alcohol marketing could be an important policy for the protection of alcohol abstention. The IAC policy index may be a useful tool to benchmark the performance of alcohol policy in supporting alcohol abstention in high and middle-income countries.

Family affluence as a protective or risk factor for adolescent drunkenness in different countries and the role drinking motives play

AIMS

Previous research has shown mixed results (positive, negative or no effects) regarding socio-economic disparities in adolescent drunkenness. This study investigates whether family affluence is differently associated with frequency of adolescent drunkenness in traditional countries, at a later diffusion of innovation adopter stage according to the Theory of Diffusions of Innovations by Rogers (2003), compared with more progressive countries at a more advanced stage. Furthermore, we investigated as to whether differences in this association can be explained by differences in adolescent drinking motives.

METHODS

This study used data from the 2009/2010 survey of the Health Behaviour in School-aged Children (HBSC) study, including 25,566 alcohol-using adolescents aged 11-19 years old from 11 European countries. The Global Innovativeness Index was used to classify countries in progressive or more traditional countries. Multi-level regression analyses and structural equation modelling were conducted.

FINDINGS

In traditional countries, family affluence showed a positive association with adolescent frequency of drunkenness. A higher endorsement of social (drinking to celebrate an event) and enhancement motives (drinking to increase moods) by adolescents with a higher family affluence mediated this positive association between family affluence and frequency of drunkenness. In progressive countries, family affluence was negatively associated with frequency of drunkenness. In these countries, a higher endorsement of coping drinking motives by adolescents with a lower family affluence mediated this association.

CONCLUSION

A country's diffusion of innovation stage (i.e., traditional vs. progressive) seems to shape the direction of the association between family affluence and adolescent drunkenness including the psychological pathways that explain these socio-economic inequalities. This is most likely due to a quicker and smoother adoption of the new 'low drunkenness norms' ('it is not cool to drink to get drunk') in progressive countries and among adolescents with a higher family affluence.

Forecasting Frequent Alcohol Use among Adolescents in HBSC Countries: A Bayesian Framework for Making Predictions

(1) Aim: To summarize alcohol trends in the last 30 years (1985/6–2017/8) among 15-year-olds in Health Behaviour in School-aged Children (HBSC) countries (overall sample size: 413,399 adolescents; 51.55% girls) and to forecast the potential evolution in the upcoming 2021/22 HBSC survey. (2) Methods: Using 1986–2018 prevalence data on weekly alcohol consumption among 15-year-olds related to 40 HBSC countries/regions, a Bayesian semi-parametric hierarchical model was adopted to estimate trends making a clusterization of the countries, and to give estimates for the 2022 HBSC survey. (3) Results: An overall declining trend in alcohol consumption was observed over time in almost all the countries. However, compared to 2014, some countries showed a new increase in 2018 and 2021/22 estimates forecast a slight increase in the majority of countries, pointing out a potential bounce after a decreasing period in frequent drinking habits. (4) Conclusions: The clusterization suggested a homogenization of consumption habits among HBSC countries. The comparison between 2022 observed and expected data could be helpful to investigate the effect of risk behaviour determinants, including the pandemic impact, occurring between the last two waves of the survey.

Family and contextual factors associated with licit drug use in adolescence

OBJECTIVE:

TO evaluate the family and contextual factors associated with licit drug use among 15 to 19-year-old adolescents in the school context.

METHODS:

This is a representative, school-based, cross-sectional study conducted with 746 adolescents from 15 to 19 years old enrolled in public and private schools. Parents/guardians reported on the sociodemographic variables, while adolescents answered questionnaires on drug use, family cohesion and adaptability, oral health literacy and visits to the dentist. Information on school context was obtained at the institution and via municipal publications. Associations between variables were analyzed using unadjusted and adjusted multilevel Poisson regression models.

RESULTS:

Prevalence of licit drug use at least once and a pattern indicative of harmful drug use were 39.8% and 15.1%, respectively. After the adjusted analysis of licit drug use at least once, the variables gender (PR = 1.26; 95%CI: 1.01–1.59), family cohesion (PR = 9.81; 95%CI: 1.23–72.54), and average income of the school district (PR = 0.72; 95%CI: 0.57–0.91) remained in the final model. As for drug abuse, only the detached type (PR = 23.01; 95%CI: 2.46–214.87) and separated type (PR = 13.54; 95%CI: 1.40–130.97) of family cohesion remained in the final model.

CONCLUSION:

Experience with licit drug use was associated with family and contextual factors among the adolescents, while family cohesion was the main factor related to harmful drug use.

Effect of Personal and Contextual Factors of Regulation on Academic Achievement during Adolescence: The Role of Gender and Age

This investigation aimed to analyze the predictive differential value of personal (self-regulation, self-efficacy, procrastination) and contextual characteristics (parents’ socio-educational level), regarding academic achievement, among Colombian adolescents. A total of 430 students (from 11 to 18 years old) from both genders filled out validated self-reports and informed their academic achievement. We performed an ex-post-facto design, simple regression analyses, structural equations predictions analyses (SEM), and variance analyses (ANOVAs). The results showed that self-regulation is the most potent personal variable predictive of procrastination and achievement, positively associated with self-efficacy; additionally, the parents’ educational level was also a predictor, although to a lesser level. The female group and the elderly group negatively predicted academic achievement, behaving as modulatory variables of the above results.

The information capacity of adolescent alcohol consumption indicators along a continuum of severity: A cross-national comparison of sixteen Central and Eastern European countries

BACKGROUND

There is high variability between European countries in prevalence levels of various alcohol consumption forms. The informational value of adolescent's alcohol consumption indicators remains an issue. The present study aimed to examine information capacity and measurement invariance of different alcohol consumption indicators in adolescents coming from countries of the former Soviet (Eastern) Bloc in Central and Eastern Europe (CEE).

METHODS

Data of 15-year-old adolescents who reported to have had consumed alcohol at least once in their lifetime were analysed. Data were collected in sixteen CEE countries, as part of the 2013/2014 Health Behavior in School-aged Children (HBSC) study wave. Four binary items were selected for the analyses and measured the presence (vs. absence) of alcohol consumption in the last 30 days, lifetime drunkenness, weekly drinking frequency and binge drinking on a typical occasion. Multiple group confirmatory factor analysis and item response theory analysis were used.

RESULTS

In most of the included countries, alcohol consumption in the last 30 days and lifetime drunkenness were indicative for lower severity levels, while binge drinking and weekly drinking frequency were informative at higher severity levels of alcohol use. A low proportion of the estimated intercepts and factor loadings were non-invariant which indicated approximate cross-national invariance of these indicators.

CONCLUSIONS

Adolescent alcohol consumption indicators are informative for different severity levels and provide a cross-nationally invariant measurement. However, diverging drinking cultures in the CEE regions was suggested by different indicators with the highest discrimination capacity at the lower and the higher ends of the continuum severity.

Cross-national time trends in adolescent alcohol use from 2002 to 2014

Background

Adolescent alcohol consumption is a major public health concern that should be continuously monitored. This study aims (i) to analyze country-level trends in weekly alcohol consumption, drunkenness and early initiation in alcohol consumption and drunkenness among 15-year-old adolescents from 39 countries and regions across Europe and North America between 2002 and 2014 and (ii) to examine the geographical patterns in adolescent alcohol-related behaviours.

Methods

The sample was composed of 250 161 adolescents aged 15 from 39 countries and regions from Europe and North America. Survey years were 2002, 2006, 2010 and 2014. The alcohol consumption and drunkenness items of the HBSC questionnaire were employed. Prevalence ratios and 95% confidence intervals were estimated using Poisson regression models with robust variance.

Results

Data show a general decrease in all four alcohol variables between 2002 and 2014 except for some countries. However, there is variability both within a country (depending on the alcohol-related behaviour under study) and across countries (in the beginning and shape of trends). Some countries have not reduced or even increased their levels in some variables. Although some particularities have persisted over time, there are no robust patterns by regions.

Conclusions

Despite an overall decrease in adolescent alcohol consumption, special attention should be paid to those countries where declines are not present, or despite decreasing, rates are still high. Further research is needed to clarify factors associated with adolescent drinking, to better understand country specificities and to implement effective policies.

Trends of Healthy Lifestyles Among Adolescents: An Analysis of More Than Half a Million Participants From 32 Countries Between 2006 and 2014

The purpose of this study was to provide data regarding the prevalence and trends of adolescents' healthy lifestyles from 32 countries between 2006 and 2014 by sex and age interval. The data used in the present study were derived from the Health Behavior in School-aged Children (HBSC) 2006, 2010, and 2014 international database. Healthy lifestyle was assessed using the combination of daily physical activity, daily fruit and vegetable consumption, <2 h daily on screen-based behaviors, abstinence from alcohol, and abstinence from tobacco products. Healthy lifestyle measures were based on self-report. The final sample comprised 519,371 adolescents (aged between 10 and 16 years old). The prevalence of healthy lifestyle behaviors increased between 2006 and 2014. The healthy lifestyle score worsened with advancing age for boys and girls. Comparing countries, for boys, the highest values were observed in adolescents from Ireland (5.2%, 95% CI: 3.9, 6.4), and for girls, the highest values were observed in adolescents from Iceland (4.2%, 95% CI: 3.6, 4.7). The present study showed a slight trend to an improved healthy lifestyle among adolescents, although much more has to be done. A joint effort from multiple areas of knowledge must be made to improve adolescent health policies, since lifestyles in adolescence play an important role for the development of vulnerability and health in later life.