Effects of the local alcohol environment on adolescents' drinking behaviors and beliefs

Sustained Alcohol Service Refusal Rates to Underage Patrons in Nightlife Setting: 25-Year Follow-Up of a Swedish Alcohol Prevention Program

PURPOSE

In 1996, a multicomponent alcohol prevention intervention was launched and later institutionalized in Stockholm. This study examines the long-term effects of the program on compliance with the legal minimum age limit for alcohol service at licensed premises.

METHODS

The intervention comprised community mobilization and collaboration, training, and enforcement aimed at preventing alcohol service to underage (<18 years) or obviously intoxicated patrons. Six cross-sectional studies were conducted between 1996 and 2022 in Stockholm using pseudo-underage mystery shoppers attempting to enter licensed premises and order alcoholic beverages. The primary outcome was refusal of entry to the premises or refusal of alcohol service.

RESULTS

Throughout the study period, regular collaboration meetings were held, the number of annual inspections and trained staff increased, and the number of sanctions varied. The refusal rate of alcohol service to pseudo-underage mystery shoppers rose from 54.8% in 1996 (baseline) to 59.1% in 1998, 67.6% in 2001, 88.3% in 2007, 91.3% in 2013, and 79.6% in 2022. Compared to the reference year 1996, all rates from 2001 to 2022 showed significant increases in the odds of refusal.

DISCUSSION

The multicomponent alcohol prevention program has been successfully sustained through collaboration and community mobilization, training, and enforcement. This success is evidenced by consistently high refusal rates for alcohol sales to underage customers over an extended period.

Does geographic availability of alcohol influence drinking in adolescents? A systematic review of literature associations

BACKGROUND

The role of alcohol geographic availability in influencing adolescent drinking has been debated. However, clear literature consensus has not been reached.

OBJECTIVE

To provide a systematic review of the associations between geographic availability of alcohol outlets measured through different methodologies and drinking outcomes in adolescents.

METHODS

We conducted a systematic search (PubMed/SCOPUS/Web of Science) for articles exploring associations between alcohol availability and adolescent drinking before 2023. Original articles written in English that evaluated adolescent populations (10-19 years old), included at least one quantitative alcohol consumption outcome and its relationship with geographic availability of alcohol, and declared no conflicts of interest were selected for the review. A quality assessment of the selected articles was made using the Newcastle-Ottawa Scale and descriptive analyses were carried out to summarize results.

RESULTS

Thirty-one articles were reviewed (19 cross-sectional and 12 longitudinal studies), which included a total of 507336 participants. Alcohol availability was positively related to drinking prevalence and risky patterns in 53.3% and 60.5% of associations, respectively. Individual-level covariates, the type of alcohol outlets measured and the different methodological approaches to measure outlet density were related to differences in the direction and magnitude of these associations.

CONCLUSION

Just over half of the studies in this review demonstrate a positive association between alcohol availability and adolescent alcohol consumption with no negative associations reported. The review highlights the mix of methodological approaches that are used, which made it difficult to conduct joint analyses. Additional research is needed to explore the appropriateness, effectiveness and reliability of these methods within various contexts.

Alcohol outlet density and adolescent drinking behaviors in Thailand, 2007-2017: A spatiotemporal mixed model analysis

This study aimed to explore the relationship between alcohol outlet density and the proportion of alcohol consumption among Thai adolescents. We utilized the alcohol consumption data from the 2007, 2011, and 2017 Tobacco and Alcohol Consumption Survey in Thailand. We analyzed the relationships between alcohol sales license figures and consumption behavior using a spatiotemporal mixed model. Our data had two levels. The upper (provincial) level featured alcohol sales license density (spatial effect), the years of survey (temporal effect), and the social deprivation index. The lower (individual) level included the demographic data of the adolescents. A total of 9,566 Thai adolescents participated in this study, based on surveys conducted in 2007 (n = 4,731), 2011 (n = 3,466), and 2017 (n = 1,369). The density of alcohol sales licenses increased the odds for the one-year current drinker category (odds ratio [OR] = 1.08, 95% confidence interval [CI], 1.04-1.45), especially in male adolescents (OR = 1.09, 95% CI, 1.04-1.14). Furthermore, it increased the odds for the heavy episodic drinker category for female adolescents (OR = 1.23, 95% CI, 1.05-1.44). Increased alcohol sales licenses are associated with higher alcohol consumption among Thai adolescents. This highlights the need for government organizations to develop and apply strategies to reduce the number of licenses for the sale of alcohol.

Quantitative tools and measurements for assessing the implementation of regulatory policies in reducing alcohol consumption and alcohol-related harms: A scoping review

ISSUES

Implementation of alcohol control policy is a global priority as alcohol contributes to negative individual health and societal impacts. However, there are no available reviews that comprehensively provide tools and measurements for assessing the implementation of alcohol control policy. This study reviews tools and measurements for assessing alcohol policy implementation. Policies considered include alcohol pricing and taxation, alcohol marketing control, physical availability control and drink-driving policy.

APPROACH

We conducted a scoping review from Scopus, Web of Science and the World Health Organization's website. We included studies on policy implementation for the four most effective prevention policies published worldwide between 2000 and 2021.

KEY FINDINGS

The search yielded 11,654 articles and these were narrowed down to 39 included studies. Of these 39 studies, almost half assessed the implementation of a drink-driving policy (n = 19), followed multipolicy (n = 12) and physical availability control (n = 8). There was no single study assessing policy implementation of pricing and taxation or alcohol marketing control. The majority of the studies were conducted in high-income countries (n = 31). Globally, there is no standardised tool or guidelines for measuring the policy implementation of these four policies. The tools for measuring policy implementation mostly focused on a single policy, and few covered multiple policies.

IMPLICATIONS

We recommend developing standardised tools and measurements to monitor policy implementation across multiple policies at country levels.

CONCLUSION

This review highlighted a lack of comprehensive and standardised tools to assess policy implementation and the limited number of studies on alcohol policy implementation in low- and middle-income countries.

Association of Neighborhood Alcohol Environment With Alcohol Intake and Cardiovascular Risk Factors in India: Cross-Sectional Evidence From APCAPS

There are more and more proofs about the impact of neighborhood alcohol environment on alcohol-associated events. The relationship between the neighborhood availability and accessibility of alcohol outlet with individual level of alcohol consumption along with 11 cardiovascular risk factors was explored for the first time in India using data from the 3rd follow-up of the Andhra Pradesh children and parents study (APCAPS) (n = 6156, for liquor intake and 5,641 for heart and blood vessel risk elements). In fully adjusted models, volunteers in the lowest tertile performed worse than volunteers in the highest tertile of distance to the closest alcohol outlet were more probably to exhibit less alcohol consumption (-14.40 g/day, 95% CI: -26.21, -2.59). A unit per km2 rise in alcohol outlet density in 400 m buffering area was related to a rise in waist circumference (1.45 mm, 95% CI: 0.13, 2.77), SBP (0.29 mmHg, 95% CI: 0.09, 0.49), and DBP (0.19 mmHg, 95% CI: 0.03, 0.35). A unit per 100 m rise in distance to the closest alcohol outlet was related to a rise in waist circumference (-2.39 mm, 95% CI: -4.18, -0.59), SBP (-0.41 mmHg, 95% CI: -0.68, -0.15), and DBP (-0.29 mmHg, 95% CI: -0.51, -0.07). Neighborhood availability of alcohol outlets within immediate locality of participants' households had a closer relationship with cardiovascular risk factors than that within the whole village. Public health policies designed to limit neighborhood availability and accessibility of alcohol outlets ought to be advocated in southern India.

Exposure to Parental Alcohol Use Is Associated with Adolescent Drinking Even When Accounting for Alcohol Exposure of Best Friend and Peers

AIMS

To further disentangle the role of exposure to drinking of role models (parents, peers, best friends) in the development of young adolescent alcohol use, the current study examined (a) whether parent's alcohol use exposure was associated with alcohol use outcomes among adolescents and (b) whether this association remained significant when including best friend and peer drinking exposure.

METHODS

A longitudinal study followed 765 adolescents from the Netherlands over 3 years. Adolescents (45.6% male, Mage = 11.78, standard deviation = 0.49 at baseline) completed questionnaires every 6 months, resulting in seven measurement waves. Adolescents reported their own alcohol use and exposure to parental, best friend and peers drinking.

RESULTS

Multilevel regression analyses indicated that parental alcohol use exposure was positively associated with a higher likelihood of adolescent alcohol use in the past 6 months, drinking in the last month and binge drinking in the last month. These associations remained significant when including exposure to peer and best friend's alcohol use, also when controlling for alcohol use at the previous timepoint (i.e. change in drinking). These associations were also consistent for boys and girls.

CONCLUSIONS

Throughout early adolescence, parental alcohol exposure matters for their offspring's alcohol use, independently of whether peers or their best friend expose them to alcohol or not. Parental alcohol exposure should be considered in prevention efforts to further decrease the number of adolescents that engage in early alcohol use and binge drinking.

Relationships Between Social Host Policies, Youth Drinking Contexts, and Age

OBJECTIVE

We examined associations of city-level policies and enforcement operations (i.e., social host laws and party patrol operations) with youth drinking, heavy drinking, and drinking-related problems in private and public drinking contexts. We also examined whether these associations were modified by age.

METHOD

We surveyed 580 youth (ages 16-20 years; 53% male) living in 24 midsized California cities. We used mixed-effects negative binomial and logistic regression to calculate the frequency of youth drinking and heavy drinking and odds of drinking-related problems in each context (own home, friend's home, restaurant, bar, music venue, and outdoors).

RESULTS

There were positive associations between more comprehensive city-level social host policies and frequency of youth drinking and heavy drinking at music venues, and youth heavy drinking and drinking-related problems at restaurants. Younger youth who lived in cities with more comprehensive social host laws drank heavily less frequently in their own home than younger youth living in cities with less comprehensive social host laws. Youth ages 17 or under who lived in cities with more party patrol enforcement had higher odds of problems related to drinking outdoors in the past 12 months than those in cities with fewer party patrol operations.

CONCLUSIONS

City-level alcohol policies and enforcement targeting underage drinking may have differential effects depending on youth drinking contexts and age. Comprehensive social host policies, which aim to decrease drinking in private contexts, may displace or increase youth drinking in other contexts, such as restaurants and music venues. Comprehensive social host policies and party patrol operations may be more influential for younger youth drinking in their own home or outdoors.

First Drinking Experiences during Adolescence in South Korea: A Qualitative Study Focusing on the Internal and External Factors

This study explored the internal and external factors affecting the first drinking experience during Korean adolescence. To achieve this, we collected 34 cases revealing specific drinking experiences during adolescence in Alcoholic Anonymous (A.A.), Korea. The collected data were analyzed using a qualitative case study method, and the analysis focused on the internal and external factors influencing drinking in adolescence. As per the results, internal factors that influenced drinking in adolescence were "curiosity" and "elevated mood and stress relief", and external factors were "family", "friends", "older friends at school", "neighbors", "Korean tradition of alcohol making", "workplaces that encourage alcohol consumption", and "a generous drinking culture." Based on these findings, we suggested several practical alternatives, such as a stringent alcohol punishment system, government-led campaigns to overcome the generous alcohol culture, monitoring the drinking status of working and intern youths, and using local crime prevention guards to curb youth drinking. In future research, it is necessary to quantitatively verify the results of this study to develop theories related to adolescent drinking behavior.

[Evidence-based alcohol prevention-what does effectiveness research recommend? : Results of the 2020 BZgA review of reviews on addiction prevention]

BACKGROUND

A substantial group of adolescents and young adults engage in risky alcohol use and there is a need for alcohol prevention. The 2020 BZgA review of reviews on addiction prevention provides the best available scientific knowledge on effectiveness of prevention measures for young people.

RESEARCH QUESTION

Which approaches show preventive effects on alcohol use in different prevention settings?

METHODS

A systematic literature search in June 2017 in seven international databases resulted in 28,949 hits. Inclusion criteria were a review or meta-analysis study type, a 2012-2017 publication date, a universal or selective target group, age up to 25 years, and a target behavior of alcohol consumption. Exclusion criteria were target group people with substance use disorders and target behavior risk factors. The three authors performed a systematic content analysis of 34 alcohol-related publications and assessed their methodology using AMSTAR (A MeaSurement Tool to Assess systematic Reviews). Conclusions and recommendations were framed by consensus among all authors.

RESULTS

Based on a total number of 53 conclusions on the effectiveness of alcohol prevention approaches depending on setting (family, school, college, media, health care, and community) and target group, it can be recommended - among other things - to implement family programs and parenting training, behavioral programs targeting specific personal and social skills, brief interventions with feedback, and mentoring programs. No recent reviews that investigated the effectiveness of alcohol policies at the community or national level could be identified.

CONCLUSIONS

Behavioral alcohol prevention is effective. It is recommended to address specific age and target groups in different settings by using specific interventions. Consensus is needed with regard to what kind of evidence proves effectiveness of environmental prevention measures.

Alcohol Use and Its Affordability in Adolescents in Slovakia between 2010 and 2018: Girls Are Less Adherent to Policy Measures

BACKGROUND

The article analyzes selected indicators of alcohol use (weekly use, drunkenness within last month) and the ability of adolescents to buy alcohol in Slovakia between 2010 and 2018.

METHODS

Health Behavior in School-Aged Children (HBSC) is a cross-sectional questionnaire study. A standardized uniform questionnaire was used to create a representative sample of 15-year-old adolescents. Two surveys carried out in Slovakia in 2010 (n = 1568) and 2018 (n = 1298) were analyzed.

RESULTS

Weekly alcohol use and drunkenness declined only in boys, not in girls. Affordability of alcohol (not being prevented from buying it) declined among weekly drinking boys (from 60.4 to 34.1%) but remained almost unchanged in girls from a higher socioeconomic group compared to those from a lower one (57.9% vs. 30.6% in 2018).

CONCLUSIONS

Affordability of alcohol in boys decreased with a decline in alcohol use, corresponding with implemented legislative measures. However, it remained unchanged in girls from a higher socioeconomic group.

Retail Availability of Recreational Marijuana and Alcohol in Oregon Counties and Co-Use of Alcohol and Marijuana and Related Beliefs among Adolescents

Objective: We investigated whether recreational marijuana legalization (RML) in Oregon in 2015 and recreational marijuana and alcohol retail outlet density levels in Oregon counties were associated with increased alcohol and marijuana co-use and beliefs supportive of alcohol and marijuana use among adolescents. Method: We conducted secondary analyses of biennial data collected from 11th graders who participated in the Student Wellness Survey (SWS) in 36 Oregon counties from 2010 to 2018 (N = 71,870). Multi-level logistic regression analyses assessed changes in past-30-day co-use of alcohol and marijuana, and alcohol- and marijuana-related beliefs after RML in counties with low, medium, and high densities of licensed recreational marijuana and alcohol retail outlets. We used post-RML 2016 and 2018 SWS data to examine whether beliefs accounted for any relationship of recreational marijuana and alcohol outlet density with alcohol and marijuana co-use. Results: We found a significant post-RML increase in past-30-day alcohol and marijuana co-use in 2016 in counties with the highest density of recreational marijuana and alcohol retail outlets. There were significant post-RML increases in perceived risk and parent approval of alcohol and marijuana use. Analyses with 2016 and 2018 SWS data indicated that the relationship between level of recreational marijuana and alcohol retail outlet density and past-30-day alcohol and marijuana co-use was accounted for beliefs about marijuana and alcohol availability, approval by parents, and risk. Conclusion: RML and greater retail availability of recreational marijuana and alcohol were positively associated with alcohol and marijuana co-use among adolescents, and with beliefs favorable to alcohol and marijuana use.

State alcohol policies, taxes, and availability as predictors of adolescent binge drinking trajectories into early adulthood

BACKGROUND AND AIMS

A number of alcohol policies in the United States have been presumed to reduce underage youth drinking. This study characterized underage youth binge-drinking trajectories into early adulthood and tested associations with the strength of the alcohol policy environment, beer excise taxes and number of liquor stores.

DESIGN

Longitudinal cohort study.

SETTING

United States.

PARTICIPANTS

A national cohort of 10th graders in 2010 (n = 2753), assessed annually from 2010 to 2015.

MEASUREMENTS

Participants reported on their 30-day binge drinking [defined as consuming five or more+ (for boys) or four or more (for girls) drinks within 2 hours]. We scored the strength of 19 state-level policies at baseline and summarized them into an overall score and two subdomain scores. We also assessed state beer excise taxes (dollars/gallon) and linked the number of liquor stores in 1 km to the participants' geocoded address.

FINDINGS

We identified five binge-drinking trajectories: low-risk (32.9%), escalating (26.1%), late-onset (13.8%), chronic (15.1%) and decreasing (12.0%). Lower overall alcohol policy strength was associated with increased risk of being in the escalating versus low-risk binge-drinking class [relative risk ratio (RRR) = 1.44 per 1 standard deviation (SD) in policy score; 95% confidence interval (CI) = 1.17, 1.77)]. Higher beer excise taxes were associated with a reduced risk of being in the escalating class (RRR = 0.22 per 1-dollar increase; 95% CI = 0.09, 0.50). The number of liquor stores was not significantly associated with any binge-drinking trajectory.

CONCLUSIONS

In the United States, stronger state alcohol policies and higher beer excise taxes appear to be associated with lower risk of escalating alcohol consumption trajectories among underage youth.

The Interplay of Peer, Parent, and Adolescent Drinking

OBJECTIVE

To explore variability in the link between peer and adolescent drinking by parental drinking. Stress and differential susceptibility perspectives led to hypotheses that adolescents with drinking parents would be more reactive to peer drinking but also to peer abstention.

METHODS

Using data from the National Longitudinal Study of Adolescent to Adult Health, regressions estimated whether the association between peer alcohol use and increased drinking among adolescents was moderated by parental drinking. A regions of significance test identified the level of peer drinking that predicted adolescent drinking in the context of parental drinking.

RESULTS

Adolescents with binge-drinking parents were more likely to increase drinking at every level of peer drinking, supporting the stress perspective; such adolescents did not accrue benefits from abstaining peers, going against the differential susceptibility perspective.

CONCLUSIONS

Far from monolithic, peer influences on adolescent risky behaviors may require family environments and genetic predispositions conducive to those behaviors.

Adolescents' alcohol use and strength of policy relating to youth access, trading hours and driving under the influence: findings from Australia

AIMS

To determine (i) whether the strength of Australian alcohol control policy in three domains (youth access, trading hours and drink driving) changed during the 2000s; and (ii) estimate associations between these policies and adolescent drinking after adjusting for television alcohol advertising exposures, alcohol outlet density, alcohol price changes, exposure to negative articles about alcohol in daily newspapers and adult drinking prevalence.

DESIGN

Repeated cross-sectional surveys conducted triennially from 2002 to 2011. Multi-level modelling examined the association between alcohol control policies and drinking prevalence after adjusting for covariates.

SETTING

Four Australian capital cities between 2002 and 2011.

PARTICIPANTS

Students aged 12-17 years participating in a triennial national representative school-based survey (sample size range/survey: 9805-13 119).

MEASUREMENTS

Outcome measures were: past month drinking and risky drinking (5+ drinks on a day) in the past 7 days. Policy strength in each of three domains (youth access, trading hours, drink-driving) were the key predictor variables. Covariates included: past 3-month television alcohol and alcohol-control advertising, alcohol outlet density, alcohol price change, negatively framed newspaper alcohol articles, adult drinking prevalence and student demographic characteristics.

FINDINGS

During the study period, the strength of youth access policies increased by 10%, trading hours policies by 14% and drink-driving policies by 58%. Past-month and risky drinking prevalence decreased (e.g. past-month: 2002: 47.4% to 2011: 26.3%). Multivariable analyses that included all policy variables and adjusted for year, student and other covariates showed past-month drinking to be associated inversely with stronger trading hours policies [odds ratio (OR) = 0.80, 95% confidence interval (CI) = 0.69, 0.94], but not youth access (OR = 0.92 95% CI = 0.81, 1.04) or drink-driving (OR = 1.00, 95% CI = 0.93, 1.09). Risky drinking was associated inversely with stronger youth access policies (OR = 0.82, 95% CI = 0.69, 0.98), but not trading hours (OR = 0.85, 95% CI = 0.66, 1.09) or drink-driving (OR = 1.02, 95% CI = 0.90, 1.14) policies.

CONCLUSIONS

Population-directed policies designed to reduce alcohol availability and promotion may reduce adolescents' alcohol use.

Communities mobilizing for change on alcohol (CMCA): secondary analyses of a randomized controlled trial showing effects of community organizing on alcohol acquisition by youth in the Cherokee nation

AIMS

We evaluated the effects of a community organizing intervention, Communities Mobilizing for Change on Alcohol (CMCA), on the propensity of retail alcohol outlets to sell alcohol to young buyers without age identification and on alcohol acquisition behaviors of underage youth.

DESIGN

Random assignment of community to treatment (n = 3) or control (n = 2). Student surveys were conducted four times per year for 3 years; the cohort was in 9th and 10th grades in the 2012-13 academic year. Alcohol purchase attempts were conducted every 4 weeks at alcohol retailers in each community (31 repeated waves).

SETTING

The Cherokee Nation, located in northeastern Oklahoma, USA.

PARTICIPANTS

A total of 1399 high school students (50% male; 45% American Indian) and 113 stores licensed to sell alcohol across five study communities.

INTERVENTION

Local community organizers formed independent citizen action teams to advance policies, procedures and practices of local institutions in ways to reduce youth access to alcohol and foster community norms opposed to teen drinking.

MEASUREMENTS

Perceptions regarding police enforcement and perceived difficulty of and self-reported actual acquisition of alcohol from parents, adults, peers and stores.

FINDINGS

Alcohol purchases by young-appearing buyers declined significantly, an 18 [95% confidence interval (CI) = 3, 33] percentage-point reduction over the intervention period. Student survey results show statistically significant differences in the trajectory of perceived police enforcement, increasing 7 (4, 10) percentage points, alcohol acquisition from parents, decreasing 4 (0.1, 8) percentage points, acquisition from 21+ adults, decreasing 6 (0.04, 11) percentage points, from < 21 peers decreasing 8 (3, 13) percentage points and acquisition from stores decreasing 5 (1, 9) percentage points.

CONCLUSIONS

A community organizing intervention, Communities Mobilizing for Change on Alcohol (CMCA), is effective in reducing the availability of alcohol to underage youth in the United states. Furthermore, results indicate that the previously reported significant effects of CMCA on teen drinking operate, at least in part, through effects on alcohol access.

Adolescent Binge Drinking

Binge drinking, commonly defined as consuming five or more standard drinks per occasion for men and four or more drinks for women, typically begins in adolescence. Adolescents, although they may drink less often, tend to consume higher quantities of alcohol per occasion compared with adults. This developmental difference in pattern of alcohol consumption may result, in part, from maturational changes that involve an adolescent-specific sensitivity to certain alcohol effects and greater propensity for risk-taking behaviors, such as binge drinking. Adolescent binge drinking is associated with a range of acute alcohol-related harms, some of which may persist into adulthood. The prevalence of binge drinking, including high-intensity drinking (i.e., 10 or more and 15 or more drinks per occasion), has declined among adolescents in recent years. Overall, however, the proportion of youth who engage in binge drinking remains high. This article reviews the definition and prevalence of binge drinking in adolescence, trajectories of binge drinking and their correlates, and implications for prevention.

The relationship between hazardous alcohol use and violence among street-involved youth

BACKGROUND AND OBJECTIVES

Alcohol is a major contributor to premature disability and death among youth, often due to physical trauma, violence, and suicide. The purpose of this study was to longitudinally examine the association between hazardous alcohol use and experiences of violence among a cohort of street-involved youth.

METHODS

Data were derived from the At-Risk Youth Study (ARYS), a prospective cohort of street-involved youth who use illicit substances in Vancouver, Canada. The outcome of interest was hazardous alcohol use defined by the US National Institute on Alcohol Abuse and Alcoholism as >14 drinks/week or >5 drinks on one occasion for men, and >7 drinks/week or >4 drinks on one occasion for women. We used Generalized Estimating Equations (GEE) analyses to examine factors independently associated with hazardous alcohol use.

RESULTS

Between 2005 and 2014, 1,149 drug-using youth were recruited and 423 (36.8%) reported hazardous alcohol use in the previous 6 months at study baseline. In multivariable GEE analyses, intimate partner violence (Adjusted Odds Ratio [AOR] = 1.53, 95% Confidence Interval [95%CI] = 1.12-2.10), and non-partner physical assault (AOR = 1.39, 95%CI = 1.21-1.59) were independently associated with hazardous alcohol use after adjusting for multiple potential confounders.

DISCUSSION AND CONCLUSIONS

A considerable proportion of youth in this setting reported hazardous alcohol use, which was independently associated with experiencing recent intimate and non-partner violence.

SCIENTIFIC SIGNIFICANCE

Combined interventions for violence and hazardous alcohol use should be integrated into service provision programs for street-involved youth. (Am J Addict 2017;26:852-858).

Alcohol use from adolescence through early adulthood: an assessment of measurement invariance by age and gender

BACKGROUND AND AIMS

Studies on alcohol use and related constructs rarely test for measurement invariance to assess the reliability and validity of measures of alcohol use across different subpopulations of interest or ages. This failure to consider measurement invariance may result in biased parameter estimates and inferences. This study aimed to test measurement invariance of alcohol use across gender and age using a US nationally representative sample to inform future longitudinal studies assessing alcohol use.

DESIGN

The National Longitudinal Study of Adolescent to Adult Health, a school-based, nationally representative longitudinal study conducted in 1994-95, 2001-02 and 2008.

SETTING

All regions within the United States; participants were selected via a clustered sample design from 80 high schools that represented the national population.

PARTICIPANTS

Youth and young adults aged 13-31 years who had valid data on all three alcohol items within wave: 18 923 from wave 1; 14 315 from wave 3; and 14 785 from wave 4.

MEASUREMENTS

Alcohol use measurement models were constructed using past-year general drinking frequency, heavy episodic drinking frequency and average quantity when drinking. Configural (factor structure), metric (factor loadings) and scalar (item intercepts) measurement invariance models were tested by gender and for each year of age from 13 to 31 years.

FINDINGS

All models passed the threshold for configural invariance. Comparisons between males and females demonstrated metric (and usually scalar) non-invariance for most ages beyond middle adolescence. Nearly all 1- and 2-year contrasts passed metric invariance. Scalar non-invariance was most prevalent in age comparisons between late adolescence and early adulthood, particularly for tests using 2-year age increments.

CONCLUSIONS

Studies that do not account for the effects of gender and age on the measurement of alcohol use may be statistically biased.

Using Online Respondent Driven Sampling for Vietnamese Youths' Alcohol Use and Associated Risk Factors

OBJECTIVES

The average alcohol consumption per capita among Vietnamese adults has consistently increased. Although alcohol-related disorders have been extensively studied, there is a paucity of research shedding light on this issue among Internet users. The study aimed to examine the severity of alcohol-related disorders and other associated factors that might predispose individuals towards alcohol usage in a sample of youths recruited online.

METHODS

An online cross-sectional study was conducted with 1,080 Vietnamese youths. A standardized questionnaire was used. Respondent-driven sampling was applied to recruit participants. Multivariate logistic and Tobit regressions were utilized to identify the associated factors.

RESULTS

About 59.5% of the males and 12.7% of the total youths declared that they were actively using alcohol. From the total sample, a cumulative total of 32.3% of the participants were drinking alcohol, with 21.8% and 25.0% of the participants being classified as drinking hazardously and binge drinkers, respectively. The majority of the participants (60.7%) were in the pre-contemplative stage.

CONCLUSIONS

A high prevalence of hazardous drinking was recognized among online Vietnamese youths. In addition, we found relationships between alcohol use disorder and other addictive disorders, such as tobacco smoking and water-pipe usage. Our results highlighted that the majority of the individuals are not receptive to the idea of changing their alcohol habits, and this would imply that there ought to be more government effort towards the implementation of effective alcohol control policies.

The Myriad Influences of Alcohol Advertising on Adolescent Drinking

Purpose of Review

This review investigates effects of alcohol advertising on adolescent drinking. Prior reviews focused on behavioral outcomes and long-term effects. In contrast, the present review focuses on subgroups with greater exposure to alcohol advertising, research methods to study alcohol advertising, potential mechanisms underlying relationships between adolescent exposure to alcohol advertising and increased drinking and points to prevention/intervention strategies that may reduce effects of alcohol advertising.

Recent Findings

Alcohol advertising influences current and future drinking. Further, evidence suggests adolescents may be targeted specifically. Alcohol advertisements may influence behavior by shifting alcohol expectancies, norms regarding alcohol use, and positive attitudes. Media literacy programs may be an effective intervention strategy.

Summary

Adolescents are exposed to large quantities of alcohol advertisements, which violates guidelines set by the alcohol industry. However, media literacy programs may be a promising strategy for adolescents to increase critical thinking and create more realistic expectations regarding alcohol.

The Impact of Single-Container Malt Liquor Sales Restrictions on Urban Crime

Many US cities have adopted legal restrictions on high-alcohol malt liquor sales in response to reports of crime and nuisance behaviors around retail alcohol outlets. We assessed whether these policies are effective in reducing crime in urban areas. We used a rigorous interrupted time-series design with comparison groups to examine monthly crime rates in areas surrounding alcohol outlets in the 3 years before and after adoption of malt liquor sales restrictions in two US cities. Crime rates in matched comparison areas not subject to restrictions served as covariates. Novel methods for matching target and comparison areas using virtual neighborhood audits conducted in Google Street View are described. In Minneapolis, Minnesota, sales of single containers of 16 oz or less were prohibited in individual liquor stores (n = 6). In Washington, D.C., the sale of single containers of any size were prohibited in all retail alcohol outlets within full or partial wards (n = 6). Policy adoption was associated with modest reductions in crime, particularly assaults and vandalism, in both cities. All significant outcomes were in the hypothesized direction. Our results provide evidence that retail malt liquor sales restrictions, even relatively weak ones, can have modest effects on a range of crimes. Policy success may depend on community support and concurrent restrictions on malt liquor substitutes.

Relapse prediction: A meteorology-inspired mobile model

Predicting relapses to binge drinking in non-dependent drinkers may now be possible with smartphones. Smartphones have been shown to help individuals reduce their drinking and may help binge drinkers accelerate that process. Predicting the weather has improved greatly over the past 50 years, but predicting a binge drinking episode may be less difficult. It is hypothesized that the number of factors with high predictive value for any particular individual may not be large. Collecting data over time, a smartphone should be able to learn which combination of factors has a high probability of leading to an episode of binge drinking.

Residential environments, alcohol advertising, and initiation and continuation of alcohol consumption among adolescents in urban Taiwan: A prospective multilevel study

Background

Research indicates that place characteristics and the media environment are important contextual determinants of underage drinking behaviors in Western countries, but it is unknown whether these exposures influence adolescent alcohol consumption outside Western contexts, including in Asia׳s emerging global alcohol markets. Guided by the social ecological framework, we prospectively investigated the influences of place characteristics and alcohol advertising on initiation and continuation of alcohol consumption among adolescents in Taipei, Taiwan.

Methods

Data on individual-level characteristics, including alcohol use behaviors and perceived exposure to alcohol advertising, were obtained from two waves of a longitudinal school-based study through a stratified probability sampling method in 2010 (Grade 7/Grade 8, aged 13-14 years old) and 2011-2012 (Grade 9, aged 15 years old) from 1795 adolescents residing in 22 of 41 districts in Taipei. Data on district-level characteristics were drawn from administrative sources and Google Street View virtual audit to describe districts where adolescents lived at baseline. Hierarchical generalized linear models tested hypotheses about the associations of place characteristics and perceived alcohol advertising with underage drinking, with stratification by baseline lifetime alcohol consumption.

Results

Among alcohol-naïve adolescents, lower district-level economic disadvantage, a higher proportion of betel nut kiosks (a relatively unregulated alcohol source) compared to off-premises alcohol outlets, and exposure to television-based alcohol advertising predicted increased likelihood of alcohol initiation at one-year follow-up. Among alcohol-experienced adolescents, greater spatial access to off-premises alcohol outlets, and lower access to metro rapid transportation (MRT) and to temples were found to predict a subsequent increased likelihood of continued alcohol use. Parental drinking moderated the relationship between district-level violent crime and initiation of alcohol consumption.

Conclusions

These findings suggest that local social economic status, alcohol access, and institutional resource and individual media exposure affect underage drinking behaviors in Taiwan. We discuss potential public health implications for place-based interventions. Future research on place, media, and adolescent alcohol consumption in Asian contexts is warranted.

The association between alcohol outlet density and alcohol use among urban and regional Australian adolescents

AIMS

While recent evidence suggests that higher alcohol outlet density is associated with greater alcohol use among adolescents, influence of the four main outlet types on youth drinking within urban and regional communities is unknown. This study provides the first investigation of this relationship.

DESIGN

Repeated cross-sectional surveys with random samples of secondary students clustered by school. Mixed-effects logistic regression analyses examined the association between each outlet type and the drinking outcomes, with interaction terms used to test urban/regional differences.

SETTING

Australia, 2002-11.

PARTICIPANTS

Respondents participating in a triennial survey (aged 12-17 years); 44 897 from urban settings, 23 311 from regional settings.

MEASUREMENTS

The key outcome measures were past month alcohol use, risky drinking among all students and risky drinking among past week drinkers. For each survey year, students were assigned a postcode-level outlet density (number of licences per 1000 population) for each outlet type (general, on-premise, off-premise, clubs).

FINDINGS

Interaction terms revealed a significant association between off-premises outlet density and risky drinking among all adolescents in urban (odds ratio = 1.36, 95% confidence interval CI = 1.05-1.75, P < 0.05) but not regional areas. Similarly, club density was associated with the drinking outcomes in urban communities only. General and on-premises density was associated with alcohol use and risky drinking among all adolescents.

CONCLUSIONS

Higher densities of general, on- and off-premises outlets in an adolescent's immediate neighbourhood are related to increased likelihood of alcohol consumption among all adolescents. The density of licensed clubs is associated more strongly with drinking for urban than for regional adolescents.

Matching study areas using Google Street View: A new application for an emerging technology

Google Street View (GSV) can be used as an effective tool to conduct virtual neighborhood audits. We expand on this research by exploring the utility of a GSV-based neighborhood audit to measure and match target and comparison study areas. We developed a GSV-based inventory to measure characteristics of retail alcohol stores and their surrounding neighborhoods. We assessed its reliability and assessed the utility of GSV-based audits for matching target and comparison study areas. We found that GSV-based neighborhood audits can be a useful, reliable, and cost-effective tool for matching target and comparison study areas when archival data are insufficient and primary data collection is prohibitive. We suggest that researchers focus on characteristics that are easily visible on GSV and are relatively stable over time when creating future GSV-based measuring and matching tools. Dividing the study area into small segments may also provide more accurate measurements and more precise matching.

Impacts of New Zealand's lowered minimum purchase age on context-specific drinking and related risks

AIMS

The minimum purchase age (MPA) for alcohol in New Zealand (NZ) was reduced from 20 to 18 years in 1999. We assessed the degree to which this change was associated with alterations in uses of drinking contexts, drinking and related problems.

METHODS

NZ National Alcohol Surveys among people 14+ years of age provided demographics, frequencies and amounts consumed in drinking places, and problem measures for 1995, 2000 and 2004. Censored regression estimates of parameters of a context-specific dose-response model identified MPA-associated changes in drinking and problems.

RESULTS

The lowered MPA was associated with more frequent drinking at pubs/nightclubs among the newly of-age 18-19-year-olds (b = 15.26, P = 0.009), moderated drinking quantities at these places (b = -0.94, P = 0.034) and greater quantities consumed at home (b = 1.01, P = 0.010) and others' homes (b = 0.87; P = 0.029). Drinking frequency and quantity in the 16-17-year age group increased at home (b = 22.11, P = 0.040 and b = 1.22, P = 0.002) and others' homes (b = 11.65, P = 0.002 and b = 0.91, P = 0.021). Problems associated with drinking contexts changed post-MPA (G(2)  ≥ 27.45, P ≤ 0.002), specifically increased association with drinking in pubs/nightclubs (b = 0.09, P < 0.001) across both age groups.

CONCLUSIONS

The 1999 change in New Zealand's minimum purchase age for alcohol from 20 to 18 years appears to have been associated with substantive changes in uses of drinking contexts, drinking and associated drinking problems among 16-19-year-olds.

Relationships between social host laws and underage drinking: findings from a study of 50 California cities

OBJECTIVE

Many states and local communities have enacted social host (SH) laws to reduce underage drinking in private settings. However, little is known about whether such laws are effective. This study examined relationships between city SH laws and underage drinking in general and at parties in private settings.

METHOD

SH policy data were collected for 50 California cities in 2009, and SH policies were rated for comprehensiveness and stringency. Annual telephone interviews were conducted with a cohort of 1,483 adolescents (ages 13-16 at Wave 1) from 2009 to 2011 to assess past-year alcohol use, heavy drinking, and drinking at parties. Multilevel analyses were first conducted for the total sample to examine relationships between SH laws and adolescents' past-year drinking, with other city and individual characteristics controlled for. Parallel analyses were then conducted for a subsample of 667 youth who had reported any past-year drinking.

RESULTS

SH policy ratings were unrelated to any of the past-year drinking outcomes for the total sample of adolescents. However, among past-year drinkers, a stronger SH policy was inversely related to drinking at parties (β = -.06, p < .05) but was unrelated to past-year alcohol use and heavy drinking in general. There were no moderating effects of SH policy on change in adolescents' past-year drinking over the 3-year period.

CONCLUSIONS

Local SH policies that include strict liability and civil penalties that are imposed administratively may be associated with less frequent underage drinking in private settings, particularly among adolescents who have already initiated alcohol use.

Change in Adolescents’ Alcohol-Use Patterns, From Non-Drinking to Non-Heavy Drinking or Heavy Drinking

This study examined risk and protective factors at work when adolescents change from a non-drinking alcohol-use pattern to either non-heavy drinking or heavy drinking. Using a sample of 1,725 non-drinkers extracted from the National Longitudinal Study of Adolescent to Adult Health, we conducted multinomial logistic regression and found that likelihood of change from non-drinking to non-heavy drinking was associated positively with safe neighborhood, female, peers’ drinking, emotional maltreatment, and delinquent behaviors. We found a negative association between such likelihood and being African American. We found that likelihood of change from non-drinking to heavy drinking was associated positively with peers’ drinking, depressive feelings, drug use, and repeating a grade(s) at school. We found a negative association between such likelihood and having a married mother, being African American or some other non-Hispanic minority ethnicity, and maternal supervision. Implications for intervention and future research are discussed.

Recent Trends in Alcohol Outlet Density, Distances from Educational Institutions and Sales Campaigns in Chiang Mai Municipality (Metropolitan), Thailand: Should We Be Worried for Our Youths?

AIMS

Since 2008, alcohol control policies in Thailand have been considered quite comprehensive. The study aimed to investigate the subsequent changes in alcohol outlet density and patterns of sales promotion, which may be useful for monitoring the effectiveness of policies and helpful for planning prevention strategies to reduce alcohol-related harms.

METHODS

All accessible routes in the Chiang Mai Municipality (Metropolitan: CMM) were surveyed in 2009, 2011 and 2014. During each round of survey, the geographical coordinates of alcohol outlets and educational institutions in the CMM were recorded using the Global Navigation Satellite System (GNSS). In addition, alcohol sales campaigns were documented.

RESULTS

Three main trends emerged by 2014. The first was that alcohol outlet density had increased. Second, the average distances between alcohol outlets and educational institutions decreased with evidence of clustering near educational institutions. Lastly, increased advertising of alcohol promotions and new sales campaigns not previously seen in 2009 and 2011 promoted high volume drinking in Chiang Mai Municipality (CMM).

CONCLUSION

Our study reflects the potential gaps between some of the intended consequences of alcohol control policies and the actural trends emerging in Chiang Mai, Thailand. Young people in CMM may be at a particularly high risk for alcohol-related problems due to high exposure to alcohol outlets and sales campaigns near their educational institution.

Who drinks where: youth selection of drinking contexts

BACKGROUND

Different drinkers may experience specific risks depending on where they consume alcohol. This longitudinal study examined drinking patterns, and demographic and psychosocial characteristics associated with youth drinking in different contexts.

METHODS

We used survey data from 665 past-year alcohol-using youths (ages 13 to 16 at Wave 1) in 50 midsized California cities. Measures of drinking behaviors and drinking in 7 contexts were obtained at 3 annual time points. Other characteristics included gender, age, race, parental education, weekly disposable income, general deviance, and past-year cigarette smoking.

RESULTS

Results of multilevel regression analyses show that more frequent past-year alcohol use was associated with an increased likelihood of drinking at parties and at someone else's home. Greater continued volumes of alcohol (i.e., heavier drinking) was associated with increased likelihood of drinking at parking lots or street corners. Deviance was positively associated with drinking in most contexts, and past-year cigarette smoking was positively associated with drinking at beaches or parks and someone else's home. Age and deviance were positively associated with drinking in a greater number of contexts. The likelihood of youth drinking at parties and someone else's home increased over time, whereas the likelihood of drinking at parking lots/street corners decreased. Also, deviant youths progress to drinking in their own home, beaches or parks, and restaurants/bars/nightclubs more rapidly.

CONCLUSIONS

The contexts in which youths consume alcohol change over time. These changes vary by individual characteristics. The redistribution of drinking contexts over the early life course may contribute to specific risks associated with different drinking contexts.

It's five o'clock somewhere: An examination of the association between happy hour drinking and negative consequences

Background

This study aims to understand which young adults’ drinking behaviors change in the presence of happy hour specials, the ways in which they change, and whether a link exists between happy hour drinking behavior and negative outcomes.

Methods

Using data collected from bar-going respondents (n = 1,423) within a print survey administered to a general college sample (n = 2,349), we identify significant differences in changes in happy hour behavior between demographic groups using χ² tests and determine whether this behavior is related to six negative alcohol-related outcomes using logistical and ordinary least squares regression models with a variety of controls, including age of onset and frequency of use.

Results

Women, students under 21, non-athletes, members of Greek-affiliated organizations, more affluent and unemployed students, and students living on campus were more likely to change their drinking behavior in the presence of happy hour specials. In general, the most robust predictors of negative events are gender, alcohol use frequency, age of alcohol use onset, and increasing drinking due to happy hours/bar specials. While it was linked to various negative and illegal behaviors, altered happy hour drinking was not associated with an increased likelihood of an alcohol-related arrest.

Conclusions

This study lends support to the idea that alcohol price specials should be regulated in an effort to reduce high consumption and alcohol-related negative consequences. Future research into the relationship between happy hour drinking and negative outcomes is necessary and should examine the impact of happy hour advertisements, different types of specials, and the timing of happy hours.