Relationships between local enforcement, alcohol availability, drinking norms, and adolescent alcohol use in 50 California cities

Protective effects of ethnic enclaves: Testing pathways to alcohol use and use disorders in Mexican American young adults

Ethnic enclave residence is associated with decreased risk for drinking and related problems, but less is known about the mechanisms that explain this association. Informed by theories of social control, we used a multilevel framework to examine whether negative attitudes toward drinking mediated associations between ethnic enclave residence (i.e., neighborhood linguistic isolation) and alcohol outcomes among Mexican American young adults (N = 628) in Southern California. Model 1 assessed mediation effects in the pathways from linguistic isolation to current drinking and alcohol use disorder (AUD). Model 2 adjusted for parental drinking attitudes and neighborhood alcohol availability. There were differential associations by gender in direct effects of linguistic isolation and negative drinking attitudes on both drinking and AUD. Among women only, linguistic isolation was related to greater abstinence and decreased AUD after accounting for social control proxies of parent attitudes and alcohol availability. Young adults' own drinking attitudes did not mediate relationships between linguistic isolation and alcohol outcomes. This study offers evidence on the importance of disaggregating Hispanic national groups by gender to uncover social mechanisms within ethnic enclave settings for tailored supports in reducing risk of drinking and alcohol-related harms.

School-Level Longitudinal Predictors of Alcohol, Cigarette, and Marijuana Use

This study analyzed measures aggregated at the school level to identify key predictors of drinking alcohol, binge drinking, smoking cigarettes, and using marijuana. Using data collected from 6th through 12th grade students between 2011 and 2015, we identify school-level variables that predict school-level prevalence in the subsequent year. Data included prior year assessments of: (1) school-wide prevalence, (2) perceived ease of access to drugs, (3) perceived adult disapproval of drug use, (4) perceived peer disapproval of drug use, and (5) perceived prevalence of drug use. We regressed grade-level behaviors on predictor variables from the previous school year. In middle schools, prior grade prevalence and prior grade perceived norms were significant predictors of subsequent grade prevalence. For high schools, prior year prevalence, aggregated peer norms, and perceived ease of access predicted subsequent use. These analyses provide evidence that a school's culture is predictive of changes in prevalence over time.

The perceived impact that alcohol policy could have on Brazilian and British students' pre-drinking behaviour

BACKGROUND

Evidence on how pre-drinking (i.e., drinking in private or in unlicensed settings before going out) varies across cultures and its implications for defining policies and prevention strategies is needed. We explored the perceived impact that various alcohol policies could have on pre-drinking practices amongst Brazilian and British students that pre-drink.

METHODS

A cross-sectional, online survey amongst student drinkers aged 18-29 in England (N = 387) and Brazil (N = 1,048) explored sociodemographic, pre-drinking habits, and attitudes towards alcohol policies (increasing prices, regulating availability, and restricting promotions).

RESULTS

A greater proportion of British students were aged between 18 and 21 years old (67.2%) than Brazilian students (45.2%; p < 0.001). More British (ENG 85.8%) than Brazilian (BRA 44.8%, p < 0.001) students reported pre-drinking. Pre-drinkers' main motivation was to save money (BRA 66.5%, ENG 46.2%, p < 0.001). In multivariate analyses, in Brazil, male (Odds Ratio [OR]: 1.53, CI: 1.04-2.24) and white (OR: 1.60, CI: 1.03-2.49) pre-drinkers were more likely to believe that increasing prices policies could reduce their pre-drinking habits. In Brazil, white pre-drinkers (OR: 1.86, CI: 1.10-3.15) were more likely to believe that restricting alcohol promotions policies could reduce their pre-drinking habits. Regarding the perceived impact that the combined alcohol policies could have on students' pre-drinking practice, only in Brazil there were significant statistical results.

CONCLUSIONS

Whilst in Brazil none of the investigated alcohol policies are currently implemented, more Brazilian pre-drinkers believed that such legislation could reduce their pre-drinking practices (when compared with British pre-drinkers). These data may help legislators and stakeholders to better understand the characteristics of a more acceptable alcohol policy amongst university students.

Determinants of switching behavior to wear helmets when riding e-bikes, a two-step SEM-ANFIS approach

E-bikes have become one of China's most popular travel modes. The authorities have issued helmet-wearing regulations to increase wearing rates to protect e-bike riders' safety, but the effect is unsatisfactory. To reveal the factors influencing the helmet-wearing behavior of e-bike riders, this study constructed a theoretical Push-Pull-Mooring (PPM) model to analyze the factor's relationship from the perspective of travel behavior switching. A two-step SEM-ANFIS method is proposed to test relationships, rank importance and analyze the combined effect of psychological variables. The Partial Least Squares Structural Equation Model (PLS-SEM) was used to obtain the significant influencing factors. The Adaptive Network-based Fuzzy Inference System (ANFIS), a nonlinear approach, was applied to analyze the importance of the significant influencing factors and draw refined conclusions and suggestions from the analysis of the combined effects. The PPM model we constructed has a good model fit and high model predictive validity (GOF = 0.381, R² = 0.442). We found that three significant factors tested by PLS-SEM, perceived legal norms (β = 0.234, p < 0.001), perceived inconvenience (β = -0.117, p < 0.001) and conformity tendency (β = 0.241, p < 0.05), are the most important factors in the effects of push, mooring and pull. The results also demonstrated that legal norm is the most important factor but has less effect on people with low perceived vulnerability, and low subjective norms will make people with high conformity tendency to follow the crowd blindly. This study could contribute to developing refined interventions to improve the helmet-wearing rate effectively.

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.

Inequalities in children's exposure to alcohol outlets in Scotland: a GPS study

BACKGROUND

Alcohol use is a leading cause of harm in young people and increases the risk of alcohol dependence in adulthood. Alcohol use is also a key driver of rising health inequalities. Quantifying inequalities in exposure to alcohol outlets within the activity spaces of pre-adolescent children-a vulnerable, formative development stage-may help understand alcohol use in later life.

METHODS

GPS data were collected from a nationally representative sample of 10-and-11-year-old children (n = 688, 55% female). The proportion of children, and the proportion of each child's GPS, exposed to alcohol outlets was compared across area-level income-deprivation quintiles, along with the relative proportion of exposure occurring within 500 m of each child's home and school.

RESULTS

Off-sales alcohol outlets accounted for 47% of children's exposure, which was higher than expected given their availability (31% of alcohol outlets). The proportion of children exposed to alcohol outlets did not differ by area deprivation. However, the proportion of time children were exposed showed stark inequalities. Children living in the most deprived areas were almost five times more likely to be exposed to off-sales alcohol outlets than children in the least deprived areas (OR 4.83, 3.04-7.66; P < 0.001), and almost three times more likely to be exposed to on-sales alcohol outlets (OR 2.86, 1.11-7.43; P = 0.03). Children in deprived areas experienced 31% of their exposure to off-sales outlets within 500 m of their homes compared to 7% for children from less deprived areas. Children from all areas received 22-32% of their exposure within 500 m of schools, but the proportion of this from off-sales outlets increased with area deprivation.

CONCLUSIONS

Children have little control over what they are exposed to, so policies that reduce inequities in alcohol availability should be prioritised to ensure that all children have the opportunity to lead healthy lives.

Family Factors Associated with Problematic Use of the Internet in Children: A Scoping Review

Background

Problematic use of the internet (PUI) is a growing concern, particularly in the young population. Family factors influence internet use among children in negative ways. This study examined the existing literature on familial or parental factors related to PUI in children.

Methods

A scoping review was conducted in EBSCOhost, PubMed, ScienceDirect, JSTOR, Biomed Central, VHL Regional Portal, Cochrane Library, Emerald Insight, and Oxford Academic Journal databases. Studies reporting data on family factors associated with PUI in children, published in English in the 10 years to July 2020 were included. The following data were extracted from each paper by two independent reviewers: methodology and demographic, familial, psychiatric, and behavioral correlates of PUI in children.

Results

Sixty-nine studies fulfilled the eligibility criteria. Three themes emerged: parenting, parental mental health, and intrafamilial demographic correlates of PUI in children. Parenting styles, parental mediation, and parent-child attachment were the major parenting correlates.

Conclusion

Literature on significant familial and parental factors associated with PUI in children is scarce. More research is required to identify the interactions of familial and parental factors with PUI in children, to develop informed management strategies to address this issue.

Associations of cannabis retail outlet availability and neighborhood disadvantage with cannabis use and related risk factors among young adults in Washington State

BACKGROUND

This study examined associations of local cannabis retail outlet availability and neighborhood disadvantage with cannabis use and related risk factors among young adults.

METHODS

Data were from annual cross-sectional surveys administered from 2015 to 2019 to individuals ages 18-25 residing in Washington State (N = 10,009). As outcomes, this study assessed self-reported cannabis use at different margins/frequencies (any past year, at least monthly, at least weekly, at least daily) and perceived ease of access to cannabis and acceptability of cannabis use in the community. Cannabis retail outlet availability was defined as the presence of at least one retail outlet within a 1-kilometer road network buffer of one's residence. Sensitivity analyses explored four other spatial metrics to define outlet availability (any outlet within 0.5-km, 2-km, and the census tract; and census tract density per 1000 residents). Census tract level disadvantage was a composite of five US census variables.

RESULTS

Adjusting for individual- and area-level covariates, living within 1-kilometer of at least one cannabis retail outlet was statistically significantly associated with any past year and at least monthly cannabis use as well as high perceived access to cannabis. Results using a 2-km buffer and census tract-level metrics for retail outlet availability showed similar findings. Neighborhood disadvantage was statistically significantly associated with at least weekly and at least daily cannabis use and with greater perceived acceptability of cannabis use.

CONCLUSIONS

Results may have implications for regulatory and prevention strategies to reduce the population burden of cannabis use and related harms.

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.

Pre-Intervention Effects of a Community-Based Intervention Targeting Alcohol Use (LEF); The Role of Participatory Research and Publicity

This study explores the impact of the 'pre-intervention effects' of a community-based intervention. This refers to participatory research processes and parallel publicity in the media on changes in alcohol use and relevant mechanisms (rules and norms about alcohol, accessibility of alcohol in a formal setting) among adolescents before any intervention is implemented. The aim was to investigate the contribution of these processes (i.e., pre-intervention effects) to changes in intervention-targeted factors before any actual intervention was implemented. In a quasi-experimental study, data were collected twice by means of self-report among adolescents living in two municipalities (control and experimental condition). A regression analysis showed negative pre-intervention main effects on adolescents' perceived accessibility of alcohol in a formal setting. Moreover, among adolescents aged 15 years and older, the normative decline in strictness of rules and norms was less steep in the experimental condition compared to the control condition. Additionally, adolescents aged 14 years and younger in the experimental condition reported more weekly drinking compared to their peers in the control condition. No differential effects across gender were found. To conclude, applying a co-creational approach in the development of an intervention not only contributes to more effective interventions in the end, but the involvement of and discussions in the community when planning the intervention contribute to changes in targeted factors. This implies that public discussions about the development of intervention strategies should be considered as an essential feature of co-creation in community-based interventions.

Alcohol outlets availability in school neighborhoods and alcohol use among adolescents

This cross-sectional study investigated the association between alcohol use by adolescents and the availability of alcohol outlets in the neighborhood of public schools. We collected primary data including variables at individual and school neighborhood level. Multilevel logistic regression was used to estimate odds ratio (OR) with a 95% confidence interval (95%CI) for alcohol use with the exposure variables. A total of 18.4% (95%CI: 13.2; 24.1) of adolescents reported using alcohol, which was associated with variables on the individual level such as being 18 years or older, working, and having previously smoked. Lower alcohol use was observed among adolescents from schools that were located 250m or more from alcohol outlets (OR = 0.29; 95%CI: 0.17; 0.48). Actions to reduce the use of alcohol among adolescents should take student's and school neighborhood's characteristics into account.

The Normative Underpinnings of Population-Level Alcohol Use: An Individual-Level Simulation Model

Background. By defining what is "normal," appropriate, expected, and unacceptable, social norms shape human behavior. However, the individual-level mechanisms through which social norms impact population-level trends in health-relevant behaviors are not well understood. Aims. To test the ability of social norms mechanisms to predict changes in population-level drinking patterns. Method. An individual-level model was developed to simulate dynamic normative mechanisms and behavioral rules underlying drinking behavior over time. The model encompassed descriptive and injunctive drinking norms and their impact on frequency and quantity of alcohol use. A microsynthesis initialized in 1979 was used as a demographically representative synthetic U.S. population. Three experiments were performed in order to test the modelled normative mechanisms. Results. Overall, the experiments showed limited influence of normative interventions on population-level alcohol use. An increase in the desire to drink led to the most meaningful changes in the population's drinking behavior. The findings of the experiments underline the importance of autonomy, that is, the degree to which an individual is susceptible to normative influence. Conclusion. The model was able to predict theoretically plausible changes in drinking patterns at the population level through the impact of social mechanisms. Future applications of the model could be used to plan norms interventions pertaining to alcohol use as well as other health behaviors.

The Effects of Perceived Gambling Availability on Problem Gambling Severity

The aim of this study was to determine the moderating effects of sociodemographic characteristics, substance use, and psychosocial problems on the relationship between perceived gambling availability and problem gambling severity. Bivariate and multivariate regression analyses of the 2008 and 2009 Social and Economic Impacts of Gambling in Alberta surveys found problem gambling severity was 1.25-1.39 times higher for those reporting gambling opportunities were 'too widely available'. Factors such as age, gender, place of residence, and psychosocial problems had significant moderating effects. Our findings indicate that the perception of gambling availability has a statistically significant impact on problem gambling severity.

Trends in Binge and Heavy Drinking among Adults in the United States, 2011-2017

Background: Alcohol misuse is one of the leading causes of preventable death in the United States each year. Objectives: In the present study, we examine trends in binge and heavy drinking. We used data from the 2011-2017 Behavioral Risk Factor Surveillance System. For trend analyses, we used logistic regression for heavy drinking and binge drinking variables. Joinpoint model analysis was conducted to identify where significant changes in trend occurred. Results: The trend analysis indicated that the overall prevalence of binge drinking decreased significantly from 18.3% in 2011 to 16.0% in 2014, then increased significantly to 17.0% in 2017. This trend was also found for heavy drinking, with a significant decrease from 6.6% in 2011 to 5.8% in 2014, then increased significantly to 6.2% in 2017. This trend persisted for certain subgroups; males, females, White participants, and the 35-54 age group all had a similar decrease in prevalence followed by an increase from 2014-2017. Conclusions: Overall, our results indicate a recent significant increase in both binge and heavy drinking among the general population.

Personal Factors, Internet Characteristics, and Environmental Factors Contributing to Adolescent Internet Addiction: A Public Health Perspective

Individual characteristics, family- and school-related variables, and environmental variables have equal importance in understanding Internet addiction. Most previous studies on Internet addiction have focused on individual factors; those that considered environmental influence typically only examined the proximal environment. Effective prevention and intervention of Internet addiction require a framework that integrates individual- and environmental-level factors. This study examined the relationships between personal factors, family/school factors, perceived Internet characteristics, and environmental variables as they contribute to Internet addiction among adolescents based on the public health model. A representative sample of 1628 junior high school students from 56 regions in Seoul and Gyeonggi-do participated in the study via questionnaires with the cooperation of the Ministry of Health and Welfare and the district office of education. The study analyzed psychological factors, family cohesion, attitudes toward academic activities, Internet characteristics, accessibility to PC cafés, and exposure to Internet game advertising. About 6% of the adolescents were categorized as being in the severely addicted group. Between-group comparisons showed that the addicted group had started using the Internet earlier; had higher levels of depression, compulsivity, and aggressiveness as well as lower family cohesion; and reported higher accessibility to PC cafés and exposure to Internet game advertising. Multiple logistic regression indicated that for adolescents, environmental factors had a greater influence than family or school-related factors. Policy implications for prevention and intervention are discussed.

Do Associations Between Drinking Event Characteristics and Underage Drinking Differ by Drinking Location?

OBJECTIVE

We investigated how associations between social and situational characteristics (number of people, adult supervision, group gender composition, group age composition, ease of alcohol access, and weekend) and underage drinking are moderated by the specific locations in which drinking occurs.

METHOD

Using a case-crossover design and retrospective surveys, a sample of 385 adolescents (mean age = 16.5 years; 47.3% female) from 24 mid-size California cities reported the last time they drank alcohol in a specific location (restaurant, outdoors, home) and the last time they were at the same type of location without drinking, as well as characteristics of each drinking and nondrinking event (N = 1,096 events).

RESULTS

Results of multilevel regression models indicated that perceived ease of alcohol access was associated with drinking across all locations (adjusted odds ratios [aORs] = 2.11-2.75, all p < .01). Weekend (vs. weekday) increased the odds of drinking outdoors (aOR = 3.75, p < .001) and in the home (aOR = 4.37, p < .001), as did a lack of adult supervision (aOR = 1.70, p < .05 for outdoors; aOR = 1.64, p < .01 for home). Larger groups (aOR = 1.06, p < .001) and being with older people (aOR = 2.28, p < .001) increased the odds of drinking in the home only. Significant cross-level interaction effects between location and group size (aOR = 0.96; p < .001), group gender composition (aOR = 0.78, p < .05), group age composition (aOR = 0.70, p < .01), ease of alcohol access (aOR = 0.88, p < .05), and weekend (aOR = 0.66, p < .05) suggested that these predictors were less significant in outdoor locations compared with the home.

CONCLUSIONS

Locations moderate the social and situational characteristics of events and are important for underage drinking. Results can inform targeted prevention efforts.

[Alcohol outlet density and alcohol consumption in Galician youth]

OBJECTIVE

To assess the influence that alcohol outlet density, off- and on-alcohol premises, and alcohol consumption wield on the consumption patterns of young pre-university students in Galicia (Spain).

METHOD

A cross-sectional analysis of a cohort of students of the University of Santiago de Compostela (Compostela Cohort 2016) was carried out. Consumption prevalence were calculated for each of the municipalities from the first-cycle students' home residence during the year prior to admission. The association with risky alcohol consumption (RC) and binge-drinking (BD) was assessed with a logistic model considering as independent variables the municipality population, alcohol outlet density of off- premises, density of off- and on- premises and total density of both types of premises in the municipality.

RESULTS

The prevalence of RC was 60.5% (95% confidence interval [95%CI]: 58.4-62.5) and the BD was 28.5% (95%CI: 26.7-30.2). A great variability was observed according to the municipality of provenance. The multivariate logistic model showed municipalities with a density of 8.42-9.34 of both types of premises per thousand inhabitants presented a higher risk of RC (odds ratio [OR]: 1,39; 95%CI: 1.09-1.78) and BD (OR: 1.29; 95%CI: 1.01-1.66).

CONCLUSION

These data suggest the importance of including environmental information when studying alcohol consumption. Knowing our environment better could help plan policies that encourage healthier behaviour in the population.

Prevalence and predictors of alcohol and drug use among secondary school students in Botswana: a cross-sectional study

BACKGROUND

Alcohol and illicit drug use has been recognized as a growing problem among adolescents in Botswana. Little is known about factors affecting alcohol and drug use among Botswana's secondary school students. To aid the design and implementation of effective public health interventions, we sought to determine the prevalence of alcohol and drug use in secondary school students in urban and peri-urban areas of Botswana, and to evaluate risk and protective factors for substance use.

METHODS

We performed a 72-item cross-sectional survey of students in 17 public secondary schools in Gaborone, Lobatse, Molepolole and Mochudi, Botswana. The World Health Organization's (WHO) Alcohol Use Disorder Identification Test (AUDIT) was used to define hazardous drinking behavior. Using Jessor's Problem Behavior Theory (PBT) as our conceptual framework, we culturally-adapted items from previously validated tools to measure risk and protective factors for alcohol and drug use. Between-group differences of risk and protective factors were compared using univariate binomial and multinomial-ordinal logit analysis. Relative risks of alcohol and drug use by demographic, high risks and low protections were calculated. Multivariate ordinal-multinomial cumulative logit analysis, multivariate nominal-multinomial logit analysis, and binominal logit analysis were used to build models illustrating the relationship between risk and protective factors and student alcohol and illicit drug use. Clustered data was adjusted for in all analyses using Generalized Estimating Equations (GEE) methods.

RESULTS

Of the 1936 students surveyed, 816 (42.1%) reported alcohol use, and 434 (22.4%) met criteria for hazardous alcohol use. Illicit drug use was reported by 324 students (16.7%), with motokwane (marijuana) being the most commonly used drug. Risk factors more strongly associated with alcohol and drug use were reported alcohol availability, individual and social vulnerability factors, and poor peer modeling. Individual and social controls protections appear to mitigate risk of student alcohol and drug use.

CONCLUSIONS

Alcohol and illicit drug use is prevalent among secondary school students in Botswana. Our data suggest that interventions that reduce the availability of alcohol and drugs and that build greater support networks for adolescents may be most helpful in decreasing alcohol and drug use among secondary school students in Botswana.

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.

Characteristics of drinking events associated with heavy episodic drinking among adolescents in the United States

PURPOSE

To examine associations between characteristics of drinking events and the quantity of alcohol consumed by adolescents in the United States.

METHODS

Analyses relied on 2011-2015 data from the National Survey on Drug Use and Health (NSDUH). The study sample included 8110 adolescents, ages 12-17years old, who drank alcohol in the past 30days. A logistic regression model, weighted for national estimation, was constructed to examine factors associated with heavy episodic drinking (HED; 5+ drinks for males, 4+ drinks for females) during the underage drinker's most recent drinking event. These models were adjusted for study year and individual characteristics, including past year drinking frequency, age of drinking onset, and demographic variables.

RESULTS

Buying alcohol off-premise or from another person and being given alcohol from non-parent social sources were associated with greater odds of HED compared to being given alcohol by one of their parents. Drinking alcohol at someone else's house or multiple locations were associated with heavier alcohol consumption compared to drinking at one's own home. Being older and an earlier age of alcohol onset were associated with greater odds of HED.

CONCLUSIONS

This study identifies contextual factors associated with HED by adolescents. Compared to global association studies, the findings from these event-specific analyses provide strong evidence of the environmental conditions that contribute to HED in American adolescents. Although no level of alcohol consumption is safe for adolescents, knowledge of event-level risk factors can inform targeted interventions.

Underage drinking, group identity and access to alcohol: a qualitative study of Chinese youths

Despite substantial research into underage youth's source of alcohol, few studies have examined how they go about obtaining alcohol through various means. This study explored the nature of alcohol access by Chinese adolescents and how their own perceptions around alcohol availability influence them to source alcohol in particular ways. This research involved focus groups with 111 young people aged 14-17 in Hong Kong, China. A grounded theory analysis was conducted using NVivo 10. While participants perceived ease of obtaining alcohol from retail outlets, proxy purchasing through friendship group members was reported as routine experience primarily to avoid potential embarrassment of being turned away. Convincing vendors that they were of legal drinking age was the convention used most commonly by Chinese teen drinkers. Participants expressed resentment toward adults who were willing to supply minors with alcohol. Nevertheless, this feeling of disappointment did not alter the ways they sourced alcohol. Access activities embodied a symbol of group identity in the collectivist Chinese culture. Results suggest that greater consideration should be given to understanding the complex interplay between alcohol access and community experience within peers. The perceived importance of face saving in Chinese culture may provide avenues for preventing youth access to alcohol.

Underage Drinking: A Review of Trends and Prevention Strategies

Underage drinking and its associated problems have profound negative consequences for underage drinkers themselves, their families, their communities, and society as a whole, and contribute to a wide range of costly health and social problems. There is increased risk of negative consequences with heavy episodic or binge drinking. Alcohol is a factor related to approximately 4,300 deaths among underage youths in the U.S. every year. Since the mid-1980s, the nation has launched aggressive underage drinking prevention efforts at the federal, state, and local levels, and national epidemiologic data suggest that these efforts are having positive effects. For example, since 1982, alcohol-related traffic deaths among youth aged 16-20 years have declined by 79%. Evidence-based or promising strategies for reducing underage drinking include those that limit the physical, social, and economic availability of alcohol to youth, make it illegal for drivers aged <21 years to drive after drinking, and provide mechanisms for early identification of problem drinkers. Strategies may be implemented through a comprehensive prevention approach including policies and their enforcement, public awareness and education, action by community coalitions, and early brief alcohol intervention and referral programs. This paper focuses on underage drinking laws and their enforcement because these constitute perhaps the most fundamental component of efforts to limit youth access to and use of alcohol.

Factors Explaining Variation in Alcohol Use Disorder Prevalence Across Border and Nonborder Communities in Texas

BACKGROUND

U.S. border populations have been found to be at high risk for alcohol problems. However, results from the U.S.-Mexico Study on Alcohol and Related Conditions (UMSARC) revealed surprisingly large variation in alcohol outcomes even among Texas border sites, with alcohol use disorder (AUD) prevalence ~1.5 to 1.6 times greater in the border city of Laredo compared to both San Antonio and the border site of McAllen/Brownsville. Because a better understanding of this variation is important to identifying environmental influences on AUD, we developed and tested a conceptual model addressing variation in AUD prevalence across Texas UMSARC sites.

METHODS

Surveys involved in-person, household interviews with Mexican-origin residents of the Texas border cities Laredo (n = 751) and McAllen/Brownsville (n = 814), with San Antonio as an off-border comparison (n = 771). Interviews assessed past-year DSM-5 AUD; past-year heavy drinking; coping and enhancement motives; and 7 indicators of substance use climate and stress exposure hypothesized to mediate site effects. Analyses, conducted separately by gender, included regressions and structural equation modeling with Mplus.

RESULTS

Preliminary analyses revealed that site effects on AUD prevalence were, unexpectedly, exclusive to men, and that Laredan men were similar to McAllen/Brownsville men on demographics, acculturation, and cross-border mobility. However, sites differed dramatically on most of the hypothesized risk factors. Structural equation models confirmed that site effects on AUD were partially mediated via effects of site on indicators of a permissive climate (i.e., permissive drinking norms, high drug availability) and stress exposures (i.e., high exposure to violence/crime, low family support), and via downstream effects on drinking motives and heavy drinking.

CONCLUSIONS

Findings of very high rates of past-12-month AUD among Laredan men (35%) suggest the possibility of significant heterogeneity even within demographically similar border areas and underline the need for additional study of the border region. Findings regarding our conceptual model suggest that this model may constitute a useful initial framework for future research on alcohol problems at the border. However, additional research using representative samples is needed to confirm and expand this model to comprehensively address relevant individual and community factors.

Addressing inequities in alcohol consumption and related harms

Social determinants, or the conditions in which individuals are born, grow, live, work and age, can result in inequities in health and well-being. However, to-date little research has examined alcohol use and alcohol-related problems from an inequities and social determinants perspective. This study reviewed the evidence base regarding inequities in alcohol consumption and alcohol-related health outcomes in Australia and identified promising approaches for promoting health equity. Fair Foundations: the VicHealth framework for health equity was used as an organizing schema. The review found that social determinants can strongly influence inequities in alcohol consumption and related harms. In general, lower socioeconomic groups experience more harm than wealthier groups with the same level of alcohol consumption. While Australia has implemented numerous alcohol-related interventions and policies, most do not explicitly aim to reduce inequities, and some may inadvertently exacerbate existing inequities. Interventions with the greatest potential to decrease inequities in alcohol consumption and alcohol-related harms include town planning, zoning and licensing to prevent disproportionate clustering of outlets in disadvantaged areas; interventions targeting licensed venues; and interventions targeting vulnerable populations. Interventions that may worsen inequities include national guidelines, technological interventions and public drinking bans. There is a need for further research into the best methods for reducing inequities in alcohol consumption and related harms.

Party Characteristics, Drinking Settings, and College Students' Risk of Intoxication: A Multi-Campus Study

We examined party characteristics across different college drinking settings, associations between party characteristics and likelihood of drinking to intoxication, and the mediating role of perceived prevalence of intoxicated partygoers. Students (N = 6903) attending 14 public universities in California during the 2010 and 2011 fall semesters completed surveys on individual and party characteristics in six unique settings (e.g., residence hall). We used descriptive statistics to examine party characteristics by setting. We estimated multilevel logistic regression models to identify party characteristics associated with drinking to intoxication, and we used RMediation to determine significance of mediating effects. Individual and party characteristics varied by drinking context. Greater time at a party was associated with drinking to intoxication at five of six settings, while larger party size was significant only for outdoor settings. Enforcing the legal drinking age and refusing to serve intoxicated patrons were associated with lower likelihood of intoxication at Greek and off-campus parties. The presence of a keg was associated with drinking to intoxication at Greek, off-campus and outdoor parties; at bars, cover charges and drink promotions were positively associated with drinking to intoxication. In four of six settings, we found evidence of significant mediating effects through perceived prevalence of intoxicated partygoers. Findings highlight risk and protective characteristics of parties by drinking setting, and have prevention implications.

Comparative policy analysis for alcohol and drugs: Current state of the field

BACKGROUND

A central policy research question concerns the extent to which specific policies produce certain effects - and cross-national (or between state/province) comparisons appear to be an ideal way to answer such a question. This paper explores the current state of comparative policy analysis (CPA) with respect to alcohol and drugs policies.

METHODS

We created a database of journal articles published between 2010 and 2014 as the body of CPA work for analysis. We used this database of 57 articles to clarify, extract and analyse the ways in which CPA has been defined. Quantitative and qualitative analysis of the CPA methods employed, the policy areas that have been studied, and differences between alcohol CPA and drug CPA are explored.

RESULTS

There is a lack of clear definition as to what counts as a CPA. The two criteria for a CPA (explicit study of a policy, and comparison across two or more geographic locations), exclude descriptive epidemiology and single state comparisons. With the strict definition, most CPAs were with reference to alcohol (42%), although the most common policy to be analysed was medical cannabis (23%). The vast majority of papers undertook quantitative data analysis, with a variety of advanced statistical methods. We identified five approaches to the policy specification: classification or categorical coding of policy as present or absent; the use of an index; implied policy differences; described policy difference and data-driven policy coding. Each of these has limitations, but perhaps the most common limitation was the inability for the method to account for the differences between policy-as-stated versus policy-as-implemented.

CONCLUSION

There is significant diversity in CPA methods for analysis of alcohol and drugs policy, and some substantial challenges with the currently employed methods. The absence of clear boundaries to a definition of what counts as a 'comparative policy analysis' may account for the methodological plurality but also appears to stand in the way of advancing the techniques.

Social and Cultural Contexts of Alcohol Use: Influences in a Social-Ecological Framework

Alcohol use and misuse account for 3.3 million deaths every year, or 6 percent of all deaths worldwide. The harmful effects of alcohol misuse are far reaching and range from individual health risks, morbidity, and mortality to consequences for family, friends, and the larger society. This article reviews a few of the cultural and social influences on alcohol use and places individual alcohol use within the contexts and environments where people live and interact. It includes a discussion of macrolevel factors, such as advertising and marketing, immigration and discrimination factors, and how neighborhoods, families, and peers influence alcohol use. Specifically, the article describes how social and cultural contexts influence alcohol use/misuse and then explores future directions for alcohol research.

Alcohol Use Patterns Among Urban and Rural Residents: Demographic and Social Influences

Rates of alcohol use and alcohol use disorder (AUD) vary with geographic location. Research on risks for AUD associated with living in a rural versus urban setting is complicated by the varied systems used to classify geographic location. Studies comparing the prevalence of heavier or binge drinking and AUD based on a dichotomous urban/rural classification have mixed findings when compared with those using more detailed urban-to-rural categories. In addition, urban/rural residence interacts with other demographic factors such as age, U.S. region, and race/ethnicity to affect alcohol use. Social and cultural factors help explain the relationship between geographic location and alcohol use. However, this area of research could be improved by the use of standardized definitions as well as the analysis of a more complete urban-to-rural continuum (e.g., urban, suburban, and rural areas). Having a better understanding of how geographic characteristics influence alcohol use would help inform and improve prevention and treatment efforts.

Relations Among Internalizing and Externalizing Symptoms and Drinking Frequency During Adolescence

BACKGROUND

In adolescence, internalizing (e.g., anxious, depressive, and withdrawn) and externalizing (e.g., aggressive, oppositional, delinquent, and hyperactive) symptoms are related with alcohol use. However, the directionality among internalizing symptoms, externalizing symptoms, and alcohol use during adolescence is equivocal. Moreover, gender differences and similarities among these behaviors are not definitive in existing literature.

OBJECTIVES

This study examined longitudinal relationships between internalizing and externalizing symptoms and past-month alcohol use among adolescent boys and girls.

METHODS

Using longitudinal survey data from a study of community-dwelling adolescents (n = 724), we estimated cross-lagged structural equation models to test relations between internalizing and externalizing symptoms (as measured by the Youth Self Report, YSR [Achenbach, 1991]) and self-report alcohol use in the past month among adolescents. Gender differences were tested in a multiple group structural equation model.

RESULTS

Alcohol use at age 12 was a predictor of internalizing and externalizing symptoms at age 15 for both boys and girls. With regard to gender differences, girls demonstrated an association between internalizing symptoms and drinking at age 12, whereas boys showed a stronger association between externalizing symptoms and drinking at age 18.

CONCLUSIONS/IMPORTANCE

Early alcohol use is problematic for youth, and results of this study lend support to prevention programs for youth. Preventing or curbing early drinking may offset later externalizing and internalizing symptoms, as well as ongoing alcohol use, regardless of gender.

The effect of alcohol outlets, sales and trading hours on alcohol-related injuries presenting at emergency departments in Perth, Australia, from 2002 to 2010

BACKGROUND AND AIMS

Few studies have investigated the combined effects of alcohol sales, outlet numbers and trading hours on alcohol-related harms. This study aimed to test whether associations: (i) exist between alcohol-related emergency department (ED) injuries and alcohol sales and counts of outlets; (ii) vary between on- and off-premises outlets; and (iii) vary by trading hours conditions [extended trading permits (ETP) versus standard hours].

DESIGN

Panel study using 117 postcodes over 8 years (2002-10): 936 data points.

SETTING

Perth, Australia.

PARTICIPANTS

ED injury presentations, aggregated to postcode-level.

MEASUREMENTS

Alcohol-related injuries were identified using time-based surrogate measures: night injuries (n=51,241) and weekend night injuries (n=30,682). Measures of alcohol availability included number of outlets with standard and extended trading hours and mean sales per postcode. Negative binomial regression modelling with random effects was used to examine associations between availability and alcohol-related injury, controlling for socio-demographic characteristics.

FINDINGS

(i) Night injuries were associated significantly with counts of on-premises outlets [incident rate ratio (IRR)=1.046; 95% confidence interval (CI)=1.014-1.078] and sales per off-premises outlet (IRR=1.019; 95% CI=1.004-1.035); (ii) counts of on-premises outlets were positively associated with alcohol-related injury while counts of off-premises outlets indicated a negative association; and (iii) weekend night injuries increased by about 5% per on-premises outlet with an ETP (IRR=1.049; 95% CI=1.015-1.084) and by less than 1% for outlets with standard trading hours (IRR=1.008; 95% CI=1.004-1.013).

CONCLUSIONS

Regions of Perth, Australia with greater off-premises alcohol sales and counts of on-premises alcohol outlets, particularly those with extended trading hours, appear to have higher levels of alcohol-related injuries.

The alcohol policy environment, enforcement and consumption in the United States

INTRODUCTION AND AIMS

Many studies of alcohol policies examine the presence or absence of a single policy without considering policy strength or enforcement. We developed measures for the strength of 18 policies (from Alcohol Policy Information System) and levels of enforcement of those policies for the 50 US states, and examined their associations with alcohol consumption.

DESIGN AND METHODS

We grouped policies into four domains (underage alcohol use, provision of alcohol to underage, alcohol serving, general availability) and used latent class analysis to assign states to one of four classes based on the configuration of policies-weak except serving policies (6 states), average (29 states), strong for underage use (11 states) and strong policies overall (4 states). We surveyed 1082 local enforcement agencies regarding alcohol enforcement across five domains. We used multilevel latent class analysis to assign states to classes in each domain and assigned each state to an overall low (15 states), moderate (19 states) or high (16 states) enforcement group. Consumption outcomes (past month, binge and heavy) came from the Behavioral Risk Factor Surveillance System.

RESULTS

Regression models show inverse associations between alcohol consumption and policy class, with past month alcohol consumption at 54% in the weakest policy class and 34% in the strongest. In adjusted models, the strong underage use policy class was consistently associated with lower consumption. Enforcement group did not affect the policy class and consumption associations.

DISCUSSION AND CONCLUSIONS

Results suggest strong alcohol policies, particularly underage use policies, may help to reduce alcohol consumption and related consequences. [Erickson DJ, Lenk KM, Toomey TL, Nelson TF, Jones-Webb R. The alcohol policy environment, enforcement, and consumption in the United States. Drug Alcohol Rev 2015;●●:●●-●●].

Associations between neighborhood alcohol availability and young adolescent alcohol use

We investigated the association between alcohol outlet density and adolescent alcohol use, including whether this association differed by sociodemographic characteristics. We geocoded and mapped active license data from the year 2011 to calculate the number of outlets within multiple circular buffers of varying sizes (density), centered at households of adolescents ages 10-16 (n = 2,724). We examined 2 indicators of alcohol use: any lifetime use, but not in past month, and any past month heavy use. Cross-sectional hierarchal multivariate regression analyses were used to examine associations between alcohol outlet density and alcohol use, including the potential moderating effect of age, gender, race/ethnicity, and socioeconomic status. Analyses controlled for neighborhood-level socioeconomic status and accounted for census tract-level clustering. A higher number of on- and off-premise outlets within 0.10, 0.25, and 0.50 miles around the respondents' homes was associated with higher odds of being a heavy drinker. In addition, the number of on-premise outlets within the 0.25-mile radius was associated with greater odds of lifetime drinking. For on-premise outlets where minors were not allowed (clubs/bars), we observed a positive and significant association between clubs/bars within the 0.25-mile buffer zone and higher odds of both lifetime and heavy drinking. Findings suggest that youth who are exposed to higher densities of on-premise alcohol outlets are at risk for both lifetime use and recent heavy use. It is critical to advocate for stricter laws limiting the number of alcohol outlets in neighborhoods, including clubs/bars where minors are restricted, and putting into place more stringent enforcement of age identification requirements to limit distribution of alcohol to minors.

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.

The roles of outlet density and norms in alcohol use disorder

BACKGROUND

Alcohol outlet density and norms shape alcohol consumption. However, due to analytic challenges we do not know: (a) if alcohol outlet density and norms also shape alcohol use disorder, and (b) whether they act in combination to shape disorder.

METHODS

We applied a new targeted minimum loss-based estimator for rare outcomes (rTMLE) to a general population sample from New York City (N = 4000) to examine the separate and combined relations of neighborhood alcohol outlet density and norms around drunkenness with alcohol use disorder. Alcohol use disorder was assessed using the World Mental Health Comprehensive International Diagnostic Interview (WMH-CIDI) alcohol module. Confounders included demographic and socioeconomic characteristics, as well as history of drinking prior to residence in the current neighborhood.

RESULTS

Alcohol use disorder prevalence was 1.78%. We found a marginal risk difference for alcohol outlet density of 0.88% (95% CI 0.00-1.77%), and for norms of 2.05% (95% CI 0.89-3.21%), adjusted for confounders. While each exposure had a substantial relation with alcohol use disorder, there was no evidence of additive interaction between the exposures.

CONCLUSIONS

Results indicate that the neighborhood environment shapes alcohol use disorder. Despite the lack of additive interaction, each exposure had a substantial relation with alcohol use disorder and our findings suggest that alteration of outlet density and norms together would likely be more effective than either one alone. Important next steps include development and testing of multi-component intervention approaches aiming to modify alcohol outlet density and norms toward reducing alcohol use disorder.

Drinking behavior among older adults at a continuing care retirement community: affective and motivational influences

OBJECTIVES

The purpose of this pilot study was to describe patterns of alcohol consumption among continuing care retirement community(CCRC) residents and to explore the role of drinking motives and affective states on drinking context and consumption.

METHOD

We utilized a phone-based daily diary approach to survey older adults about their daily alcohol consumption, context of drinking (e.g. drinking alone), positive and negative affect, and their motives for drinking. Data were analyzed descriptively, and regression models were developed to examine associations between sociodemographic factors, affect, drinking context and motives, and alcohol consumption.

RESULTS

CCRC residents drank most frequently at home and were alone almost half of drinking days on average, although the context of drinking varied considerably by participant. Problem alcohol use was rare, but hazardous use due to specific comorbidities, symptoms and medications, and the amount of alcohol consumption was common. Respondents endorsed higher social motives for drinking and lower coping motives. Social motives were associated with decreased likelihood of drinking alone, but negative affect was associated with decreased likelihood of drinking outside one's home. Coping and social motives were associated with greater consumption, and higher positive affect was associated with lower consumption.

CONCLUSION

Among CCRC residents, alcohol use may be socially motivated rather than motivated by coping with negative affect. Future research should examine other motives for drinking in older adulthood. Evaluation of older adults living in CCRCs should include attention to health factors beyond problem use as other forms of hazardous use may be common in CCRCs.

State and local law enforcement agency efforts to prevent sales to obviously intoxicated patrons

Alcohol sales to intoxicated patrons are illegal and may lead to public health issues such as traffic crashes and violence. Over the past several decades, considerable effort has been made to reduce alcohol sales to underage persons but less attention has been given to the issue of sales to obviously intoxicated patrons. Studies have found a high likelihood of sales to obviously intoxicated patrons (i.e., overservice), but little is known about efforts by enforcement agencies to reduce these sales. We conducted a survey of statewide alcohol enforcement agencies and local law enforcement agencies across the US to assess their strategies for enforcing laws prohibiting alcohol sales to intoxicated patrons at licensed alcohol establishments. We randomly sampled 1,631 local agencies (1,082 participated), and surveyed all 49 statewide agencies that conduct alcohol enforcement. Sales to obviously intoxicated patrons were reported to be somewhat or very common in their jurisdiction by 55 % of local agencies and 90 % of state agencies. Twenty percent of local and 60 % of state agencies reported conducting enforcement efforts to reduce sales to obviously intoxicated patrons in the past year. Among these agencies, fewer than half used specific enforcement strategies on at least a monthly basis to prevent overservice of alcohol. Among local agencies, enforcement efforts were more common among agencies that had a full-time officer specifically assigned to carry out alcohol enforcement efforts. Enforcement of laws prohibiting alcohol sales to obviously intoxicated patrons is an underutilized strategy to reduce alcohol-related problems, especially among local law enforcement agencies.

Adolescent alcohol use: a reflection of national drinking patterns and policy?

AIMS

To analyse how adolescent drunkenness and frequency of drinking were associated with adult drinking patterns and alcohol control policies.

DESIGN, SETTING AND PARTICIPANTS

Cross-sectional survey data on 13- and 15-year-olds in 37 countries who participated in the Health Behaviour in School-Aged Children (HBSC) Study in 2010 (n = 144 788) were linked to national-level indicators on alcohol control policies and adult drinking patterns.

MEASUREMENTS

Outcome measures were self-reported weekly drinking and life-time drunkenness (drunk once or more). Data were analysed using multi-level logistic regression models.

FINDINGS

In the mutually adjusted models, adolescent drunkenness was associated significantly with high adult alcohol consumption [odds ratio (OR) = 3.15 among boys, 95% confidence interval (CI) = 2.13-4.64, OR girls = 2.44, CI = 1.57-3.80] and risky drinking patterns in the adult population (OR boys = 2.02, CI = 1.33-3.05, OR girls = 1.61, CI = 1.18-2.18). The level of abstainers in the adult population was also associated significantly with girls' drunkenness; a 10% increase in the number of abstainers in a country reduced the odds of drunkenness with 21% (OR = 0.79, CI = 0.68-0.90). Weekly drinking was associated significantly with weak restrictions on availability (OR boys = 2.82, CI = 1.74-4.54, OR girls = 2.00, CI = 1.15-3.46) and advertising (OR boys = 1.56, CI = 1.02-2.40, OR girls = 1.79, CI = 1.10-2.94).

CONCLUSIONS

Comparing data cross-nationally, high levels of adult alcohol consumption and limited alcohol control policies are associated with high levels of alcohol use among adolescents.

Teen parties: who has parties, what predicts whether there is alcohol and who supplies the alcohol?

This study explores which youth are more likely to have parties at home, what factors are associated with the presence of alcohol at parties, and who supplies the alcohol. We collected data in 2011 and 2012 through telephone interviews with 1,121 teens living in 50 mid-sized California cities. Overall, about a quarter of teens reported having had a party at their house in the past 12 months, of whom 39 % reported that there was alcohol at their last party. Multiple sources supplied alcohol for most parties. Seventy-two percent of those having a party stated that at least one of their parents knew about their last party, and 64 % reported that a parent was home at least part of the time. Seventy percent of youth who hosted a party with alcohol said that their parent(s) definitely knew that there was alcohol at the party, 24 % replied that their parent(s) probably knew, and only 5 % said that their parent(s) did not know that there was alcohol at the party. Logistic regression analyses indicated that youth with parents who host parties at home are themselves more likely to host parties at home. Having alcohol at a party was positively related to the age of the teen and the number of guests attending, and was negatively related to parents' awareness of the party. However, we found no relationship between whether a parent was at home at the time of the party and whether it included alcohol. These findings suggest that teens who have parties with alcohol at home have parents who know that there is alcohol at the party, even though only a small number of parents provided alcohol for the party.

Are alcohol policies associated with alcohol consumption in low- and middle-income countries?

AIMS

To examine the associations between alcohol control policies in four regulatory domains with alcohol consumption in low- and middle-income countries (LAMICs), controlling for country-level living standards and drinking patterns.

DESIGN

Cross-sectional analyses of individual-level alcohol consumption survey data and country-level alcohol policies using multi-level modeling.

SETTING

Data from 15 LAMICs collected in the Gender, Alcohol, and Culture: an International Study (GENACIS) data set.

PARTICIPANTS

Individuals aged 18-65 years.

MEASUREMENTS

Alcohol policy data compiled by the World Health Organization; individual-level current drinking status, usual quantity and frequency of drinking, binge drinking frequency and total drinking volume; gross domestic product based on purchasing power parity (GDP-PPP) per capita; detrimental drinking pattern scale; and age and gender as individual-level covariates.

FINDINGS

Alcohol policies regulating the physical availability of alcohol, particularly those concerning business hours or involving a licensing system for off-premises alcohol retail sales, as well as minimum legal drinking age, were the most consistent predictors of alcohol consumption. Aggregate relative alcohol price levels were associated inversely with all drinking variables (P < 0.05) except drinking volume. Greater restrictions on alcohol advertising, particularly beer advertising, were associated inversely with alcohol consumption (P < 0.05). Policies that set legal blood alcohol concentration (BAC) limits for drivers and random breath testing to enforce BAC limits were not associated significantly with alcohol consumption.

CONCLUSIONS

Alcohol policies that regulate the physical availability of alcohol are associated with lower alcohol consumption in low- and middle-income countries.

The Effect of Types of Postsecondary Education on Drinking: Does Age of Enrollment Matter?

Using longitudinal data from early adolescence through young adulthood, this study examined the association between different types of postsecondary education (PSE), age of enrollment in PSE, and the trajectory of alcohol use for Canadian young adults (N = 521). Trajectories of alcohol use were compared across young adults at 2-year colleges, 4-year universities, transfer programs (started at a 2-year college and transferred to a 4-year university), and terminal high school graduates. While initial findings revealed significant differences in the drinking trajectories of 2-year college students and 4-year university students, all differences were accounted for by variability in the age of enrollment. Overall, there were few differences in heavy drinking across types of institutions, but younger students increased their alcohol use more than older students following enrollment. However, young adults who do not attend PSE may be at greatest risk for heavy drinking over time.

The economic geography of medical cannabis dispensaries in California

BACKGROUND

The introduction of laws that permit the use of cannabis for medical purposes has led to the emergence of a medical cannabis industry in some US states. This study assessed the spatial distribution of medical cannabis dispensaries according to estimated cannabis demand, socioeconomic indicators, alcohol outlets and other socio-demographic factors.

METHODS

Telephone survey data from 5940 residents of 39 California cities were used to estimate social and demographic correlates of cannabis consumption. These individual-level estimates were then used to calculate aggregate cannabis demand (i.e. market potential) for 7538 census block groups. Locations of actively operating cannabis dispensaries were then related to the measure of demand and the socio-demographic characteristics of census block groups using multilevel Bayesian conditional autoregressive logit models.

RESULTS

Cannabis dispensaries were located in block groups with greater cannabis demand, higher rates of poverty, alcohol outlets, and in areas just outside city boundaries. For the sampled block groups, a 10% increase in demand within a block group was associated with 2.4% greater likelihood of having a dispensary, and a 10% increase in the city-wide demand was associated with a 6.7% greater likelihood of having a dispensary.

CONCLUSION

High demand for cannabis within individual block groups and within cities is related to the location of cannabis dispensaries at a block-group level. The relationship to low income, alcohol outlets and unincorporated areas indicates that dispensaries may open in areas that lack the resources to resist their establishment.

Current use of underage alcohol compliance checks by enforcement agencies in the United States

BACKGROUND

Compliance checks conducted by law enforcement agents can significantly reduce the likelihood of illegal alcohol sales to underage individuals, but these checks need to be conducted using optimal methods to maintain effectiveness.

METHODS

We conducted a national survey of local and state enforcement agencies from 2010 to 2011 to assess: (i) how many agencies are currently conducting underage alcohol compliance checks, (ii) how many agencies that conduct compliance checks use optimal methods-including checking all establishments in the jurisdiction, conducting checks at least 3 to 4 times per year, conducting follow-up checks within 3 months, and penalizing the licensee (not only the server/clerk) for failing a compliance check, and (iii) characteristics of the agencies that conduct compliance checks.

RESULTS

Just over one-third of local law enforcement agencies and over two-thirds of state agencies reported conducting compliance checks. However, only a small percentage of the agencies (4 to 6%) reported using all of the optimal methods to maximize effectiveness of these compliance checks. Local law enforcement agencies with an alcohol-related division, those with at least 1 full-time officer assigned to work on alcohol, and those in larger communities were significantly more likely to conduct compliance checks. State agencies with more full-time agents and those located in states where the state agency or both state and local enforcement agencies have primary responsibility (vs. only the local law agency) for enforcing alcohol retail laws were also more likely to conduct compliance checks; however, these agency characteristics did not remain statistically significant in the multivariate analyses.

CONCLUSIONS

Continued effort is needed to increase the number of local and state agencies conducting compliance checks using optimal methods to reduce youth access to alcohol.

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

AIMS

To examine relationships between characteristics of the local alcohol environment and adolescent alcohol use and beliefs in 50 California cities.

DESIGN

The study used longitudinal survey data collected from adolescents; city-level measures of local alcohol policy comprehensiveness, policy enforcement, adult drinking and bar density; and multi-level modeling with three levels (city, individual, time), allowing for random effects. Models included interaction terms (time × alcohol environment characteristics) and main effects, controlling for city and youth demographic characteristics. Analyses also examined possible mediating effects of alcohol-related beliefs.

SETTING

Fifty California cities (50000-500000 population).

PARTICIPANTS

Random samples of 1478 adolescents and 8553 adults.

MEASUREMENTS

Past-year alcohol use and heavy drinking, and alcohol-related beliefs (e.g. perceived alcohol availability) among adolescents; past 28-day alcohol use among adults; ratings of local alcohol control policies; funding for enforcement activities; bars per roadway mile.

FINDINGS

Local alcohol policy comprehensiveness and enforcement were associated with lower levels of past-year alcohol use (betas=-0.003 and -0.085, P<0.05). Bar density was associated with a higher level of past-year alcohol use (beta=1.086, P<0.01). A greater increase in past-year alcohol use and heavy drinking over time was observed among adolescents living in cities with higher levels of adult drinking (betas=0.224 and 0.108, P<0.01). Effects of bar density appeared to be mediated through perceived alcohol availability and perceived approval of alcohol use.

CONCLUSIONS

Adolescent alcohol use and heavy drinking are related to characteristics of the local alcohol environment, including alcohol control policies, enforcement, adult drinking and bar density. Change in adolescents' drinking appears to be influenced by community-level adult drinking. Bar density effects appear to be mediated through perceived alcohol availability and approval of alcohol use.

Adolescent alcohol use and alcohol use disorders in Mexico City

OBJECTIVE

To estimate the prevalence, sex, age distribution, and socio-demographic correlates of any alcohol use, consumption patterns, and any alcohol use disorder in a representative sample of Mexican adolescents.

METHODS

3005 youth (52.1% female) aged 12-17 from a stratified multistage area probability sample were representative of adolescents residing in the Mexico City Metropolitan Area. Alcohol use and disorder and their socio-demographic correlates were evaluated with the World Mental Health adolescent version of the Composite International Diagnostic Interview. Data were post-stratified to the total Mexico City adolescent population.

RESULTS

59% has used alcohol, this proportion increasing significantly with age. By age 17, 82.5% has used alcohol. Consumption patterns are mostly of low/moderate quantity or infrequent high quantity. Lifetime DSM-IV alcohol use disorder criteria are met by 3.8%, reaching 8.1% for 16-17 years-olds. While males have greater frequency and quantity of drinking, there are no gender differences for alcohol use disorders. Non-school attending youth have twice the odds of a lifetime (OR=2.0, 95% CI=1.13-3.53) and 12-month disorder (OR=2.1, 95% CI=1.10-4.15). Low parental monitoring is associated with 1.72 times the odds of a lifetime disorder (95% CI=1.10-2.68).

CONCLUSIONS

Over a third of 12 year-olds had ever drunk an alcoholic beverage in their lifetime suggesting that the prevention of alcohol use and disorders must begin in late childhood. Initiatives to foment parental monitoring and to prevent, identify, and treat alcohol use problems in non-school attending youth in particular should be a priority for the wellbeing of Mexico City adolescents.

Availability of tobacco products associated with use of marijuana cigars (blunts)

OBJECTIVES

This study examines factors associated with availability of tobacco products for marijuana cigars (i.e., blunts) in 50 non-contiguous mid-sized California communities.

METHODS

The study is based on data collected in 943 tobacco outlets. Neighborhood demographics, community adult marijuana prevalence, medical marijuana policy and access to medical marijuana dispensaries and delivery services were included.

RESULTS

Multilevel logistic regression analyses indicated that compared with small markets, availability of tobacco products associated with use of blunts was significantly higher in convenience stores, smoke/tobacco shops and liquor stores. None of the neighborhood demographics were associated with availability of blunt wrappers and only a small percent of Whites was positively associated with availability of blunt cigars, small cigars or cigarillos at the store. Controlling for outlet type and neighborhood demographics, higher city prevalence of adult marijuana use was associated with greater availability of blunt wrappers. Also, policy that permits medical marijuana dispensaries or private cultivation was positively associated with availability of tobacco products for blunts. Density of medical marijuana dispensaries and delivery services, however, was negatively associated with greater availability of these products at tobacco outlets.

CONCLUSIONS

Results suggest that availability of tobacco products associated with blunts is similar in neighborhoods with different socioeconomic status and racial and ethnic composition. Results also suggest the important role that community norms that support marijuana use or legalization of medical marijuana and medical marijuana policy may play in increasing availability of tobacco products associated with blunts.