Drinking Age Research Articles

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

Background Previous research found inconsistent associations between alcohol control policies and socioeconomic inequality with adolescent drinking outcomes. This study expands the focus beyond individual associations to examine whether a combination of policies is related to socioeconomic inequality in adolescent drinking outcomes and whether this relationship varies across survey years.Methods Multilevel modelling of 4 waves of repeat cross-sectional survey data (2001/02, 2005/06, 2009/10, and 2013/14) from the Health Behaviour in School-aged Children (HBSC) study was carried out. The sample was composed of 671,084 adolescents (51% girls) aged 11, 13, and 15 (mean age=13.58; SD=1.65) from 33 European and North American countries/regions. The dependent variables were lifetime alcohol consumption, weekly alcohol consumption, and lifetime drunkenness. Independent variables were of three types: individual-level variables (age, sex, Family Affluence Scale, and the Perceived Family Wealth), time-level variable (survey year), and context-level variables (minimum legal drinking age, physical availability, advertising restrictions, a total alcohol policy index, and affordability of alcohol).Results The total alcohol policy index showed a negative relationship with both lifetime and weekly consumption. Higher affordability of alcohol was related to higher lifetime and weekly consumption and higher lifetime drunkenness. Family Affluence Scale was positively related to all three alcohol measures and Perceived Family Wealth was negatively related to lifetime drunkenness, with these associations increasing across survey years. The total alcohol policy index buffered the associations of Family Affluence Scale and Perceived Family Wealth with adolescent drinking outcomes.Conclusion A combination of alcohol control policies is more effective in reducing adolescent drinking outcomes than single policy measures. Reducing the affordability of alcohol stood out as the most successful single measure. Socioeconomic inequalities (i.e. higher alcohol consumption and drunkenness in adolescents with higher family affluence and higher drunkenness in adolescents perceiving their families to be poor) have persisted and even increased across survey years. A combined alcohol control policy can help in tackling them.

Prices, alcohol use initiation and heavy episodic drinking among Chilean youth.

AimsTo examine the association between alcohol prices and age of initiation of alcohol use and the association between age of alcohol use initiation and heavy episodic drinking (HED) among adolescents in Chile.DesignWe estimated discrete‐time hazard models using retrospective data and generalized ordered probit models with repeated cross‐sectional data.SettingChile.ParticipantsA total of 248 336 urban youth who attended secondary school between 2003 and 2015 and self‐reported ever having tried alcohol.MeasurementsWe created drinking histories from self‐reported responses of age, age of alcohol use initiation and year/month of survey. From two self‐reported responses, we created a four‐category ordinal variable of heavy episodic drinking: none, one to two, three to nine and more than 10 HED episodes in the past 30 days. We constructed a monthly measure of real alcohol prices using the all‐items and alcohol component of the Consumer Price Index compiled by Chile's statistical agency, the Instituto Nacional de Estadísticas.FindingsFirst, we found negative, statistically significant and policy‐meaningful associations between alcohol prices and the age of alcohol use initiation. The estimated price elasticity of delay was −0.99 [95% confidence interval (CI) = –1.30, −0.69]. A 10% increase in real alcohol prices was associated with delayed alcohol use initiation of approximately 6.6 months. Secondly, we found that youth who had started drinking alcohol at a later age had statistically significant and substantially lower probabilities of having reported HED during the previous month. For example, youth who started drinking at 16 were 4.9 (95% CI = 4.2–5.6) percentage points more likely to have reported no HED in the previous month relative to youth who started drinking alcohol when aged 12 years or younger.ConclusionsIncreasing the price of alcohol products may delay alcohol initiation among young people in Chile. Chilean youth who start drinking alcohol later may engage in less harmful drinking practices.

Predicting Chronic Subdural Hematoma Resolution and Time to Resolution Following Surgical Evacuation.

Background: Growing evidence suggests that chronic subdural hematoma (CSDH) may have long-term adverse effects even after surgical evacuation. Hematoma recurrence is commonly reported as a short-term, postoperative outcome measure for CSDH, but other measures such as hematoma resolution may provide better insight regarding mechanisms behind longer-term sequelae. This study aims to characterize postoperative resolution times and identify predictors for this relatively unexplored metric.Methods: Consecutive cases (N = 122) of burr hole evacuation for CSDH by a single neurosurgeon at Columbia University Irving Medical Center from 2000 to 2019 were retrospectively identified. Patient characteristics, presenting factors, and date of hematoma resolution were abstracted from the electronic health record. Outcome measures included CSDH resolution at 6 months, surgery-to-resolution time, and inpatient mortality. Univariate and multivariate analyses were performed to determine predictors of outcome measures.Results: Hematoma resolution at 6 months was observed in 58 patients (47.5%), and median surgery-to-resolution time was 161 days (IQR: 85–367). Heavy drinking was predictive of non-resolution at 6 months and longer surgery-to-resolution time, while increased age was predictive of non-resolution at 6 months. Antiplatelet agent resumption was associated with non-resolution at 6 months and longer surgery-to-resolution time on univariate analysis but was not significant on multivariate analysis.Conclusion: Postoperative resolution times for most CSDHs are on the order of several months to a year, and delayed resolution is linked to heavy drinking and advanced age. Subsequent prospective studies are needed to directly assess the utility of hematoma resolution as a potential metric for long-term functional and cognitive outcomes of CSDH.

Population-based preventive measures aimed at reducing alcohol consumption: international practice and prospects for escalating measures in the Russian Federation

Aim. To conduct a review of international studies and guidelines on the implementation of population-based preventive measures aimed at reducing alcohol consumption, and identify measures recommended by the World Health Organization, which have the potential for use in the Russian Federation.Material and methods. We used the following databases: PubMed, Science Citation Index, Scopus, The Campbell Collaboration Library of Systematic Reviews. The review includes systematic and non-systematic studies of measures related to alcohol consumption. The effectiveness of the identified measures was assessed according to the following criteria: behavioral changes (consumption/sales/level); incidence changes; mortality changes.Results. According to international practice of population-based prevention, effective measures that can be implemented in the Russian Federation include reducing the blood alcohol concentration legal driving limit, increasing the minimum legal drinking age, a complete ban on alcohol advertising, and a further increase in excise taxes.Conclusion. In the Russian Federation, significant progress has been achieved in implementing alcohol restriction measures, which has led to a reduction in its consumption and related consequences. Despite this, levels of alcohol consumption remain high and the potential for introducing population-based measures to reduce it has not been exhausted.

Alcohol Brands Being Socially Responsible on Social Media? When and How Warning Conspicuity and Warning Integration Decrease the Efficacy of Alcohol Brand Posts among Under-Drinking-Age Youth

While federal regulations and alcohol industry self-regulation have been exhorting alcohol advertisers to include warnings, such as legal drinking age, on alcohol advertisements, it is rare to see this practice on social media. This study investigated the effects of warning conspicuity and warning-ad claim integration on under-drinking-age youth’s reactions to beer brand posts on social media (i.e., Instagram) and explicated the underlying mechanisms. The findings demonstrate that large-sized warnings (versus small-sized warnings) and integrated warnings (versus nonintegrated warnings) attract more visual attention, respectively. When warnings are integrated to the focal claims of the brand posts, a big-sized warning evokes greater state reactance than a small-sized one. However, when the warning is separated from the claim, a small-sized warning triggers higher reactance than a big-sized one. Underage participants’ state reactance mediates the interaction effect of warning conspicuity and warning integration on brand attitudes and intentions to interact with the brand posts, which in turn affect their intentions to drink alcohol, respectively.

Drinking Age Policy Implementation and the Practice of Federal Law in the United States

Readjusting a standardized national drinking age, particularly in the area of implementation has been a matter of concern to scholars of political science and health sciences. It is instructive to note that the national legal drinking age of 21 years is a primary alcohol-control policy initiated and implemented since 1985 in the United States. Different groups have raised public debate on the minimum drinking age and proposed reducing it to 18 years. However, recent trends in alcohol drinking and related consequences, comparative effect of the minimum legal drinking ages of 21 years and 18 years, research on drinking among high school and college students related to minimum legal drinking age are critically reviewed, using secondary data sources. This article therefore seeks to support the minimum drinking age of 21 years, rather than lowering it to 18 years. Concerted interventional roles are essential by the assistance of non-governmental organizations, public health experts, legal experts, and public office holders; for the purpose of influencing healthy decisions about alcohol among the early adults and thereby leading to reduction in alcohol consumption and its negative impacts.

(More) Party Time in School? Relative Age and Alcohol Consumption

Slightly missing a school cutoff date, and a student's relative age in their cohort, have been shown in to have important effects. For example, a student's relative age appears related to academic performance in both primary and secondary school, though how far into life relative age effects persist remains an open question. We make use of a nationwide sample of over 80,000 undergraduate students from over 600 U.S. institutions of higher education to see if relative age is related to alcohol consumption and time spent partying during college tenure. State cutoff date laws for kindergarten enrollment result in some undergraduate students reaching the legal drinking age up to a full year before others in their cohort. Results suggest students of older relative ages generally drink less alcohol than their peers during undergraduate tenure, implying the maturity effect of an older age is stronger than the legal deterrence effect. These results appear robust to alcohol type (beer, wine, and liquor), time spent at parties, and a significant list of control variables including historical alcohol consumption and partying behavior. In a secondary analysis, relative age appears to have the same negative relationship with high school drinking and partying habits.

Do Canadian Youth Use Alcohol and Cannabis as Compliments or as Substitutes?

It remains unclear as to whether cannabis and alcohol are used as substitutes or complements by Canadian adolescents. Since co-use of these two drugs can have a high economic and personal cost, and because of the recent legalization of recreational cannabis, it is essential to determine whether adolescents are using these drugs as compliments or substitutes. Using data from the Canadian Institute for Health Information’s National Ambulatory Care Reporting System, a quasi-experimental design was created to track hospital admissions marked with either alcohol or cannabis-related codes around the minimum legal drinking age (MLDA). There was a strong increase in alcohol admissions and a weak decrease in cannabis admissions after the MLDA. This is indicative of a weak substitution effect between cannabis and alcohol. The findings of this study mimic those of similar quasi-experimental studies done in the United States, but there is now a need to apply the same quasi-experimental design in the more liberal Canadian cannabis environment.

Правовые подходы к установлению минимального возраста продажи алкогольной продукции

Правовые подходы к установлению минимального возраста продажи алкогольной продукции

Comparing the potential causal influence of two indicators of early alcohol use on later alcohol use disorder symptoms.

Age of first drink (AFD) has repeatedly been found to be associated with alcohol use disorder (AUD); however, some studies suggest this is a noncausal effect that may be due to childhood risk factors or familial influences. In contrast to indicators of any early alcohol use, such as AFD, indicators of a pattern of repeated drinking may be more likely to be causally associated with later problematic alcohol use. The current study examined AFD and age of onset of regular drinking (ARD; defined as drinking at least once a month for 6 or more months) as quasicausal predictors of lifetime AUD symptoms. Participants were 3,005 adult Australian twins who reported having been regular drinkers in their lifetime. Semistructured interviews were conducted to assess AFD, ARD, AUD, externalizing symptomatology, and other substance use. Personality traits were assessed via questionnaire. Unadjusted and adjusted multilevel discordant twin models were conducted using data from 1,041 complete twin pairs; adjusted models included socioeconomic status, personality, conduct disorder, and early initiation of regular smoking and marijuana use as covariates. Results from fully adjusted models controlling for familial confounds provided evidence for a causal influence of ARD on AUD symptoms, whereby twins with an earlier age of regular drinking than their cotwin had more lifetime AUD symptoms. However, AFD did not significantly predict AUD symptoms after adjusting for confounds. These results suggest that early regular drinking may serve as a causal risk factor for future problems, while early initiation of any alcohol use may indicate genetic liability. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Patterns of alcohol consumption in 16 cohorts of Australian young adults aged 15-24 between 2001 and 2016.

Repeated cross-sectional surveys have identified substantial declines in adolescent drinking in Australia and some other countries in recent years. There is debate about whether these declines will be maintained as the cohort ages. This study modelled alcohol consumption over time to check for cohort effects reflecting a decrease in youth consumption, and then used this model to predict how decreases in youth drinking will be sustained through to adulthood. Longitudinal study using data from the Household Income and Labour Dynamics in Australia (HILDA) survey from 2001 to 2016. Piecewise latent growth models were estimated to assess consumption trajectories for each birth cohort from ages 15-18 and 18-24years. Australia. This study focused on 5320 (51.9% female) respondents aged between 15 and 22 in wave 1 (2001) to those aged between 17 and 24 in wave 16 (2016). Annual volume of alcohol consumption was calculated as the product of the quantity per occasion and the frequency of drinking expanded to represent drinking occasions per year. The model with best fit suggested that consumption increased rapidly [b=0.667, standard error (SE)=0.046, P<0.001] until the legal drinking age of 18 and then plateaued (b=-0.027, SE=0.016, P=0.088). More recent cohorts start with significantly lower levels of consumption (b=-0.145, SE=0.010; P<0.001) but increase at a faster rate (b=0.022, SE=0.003, P<0.001) between 15 and 18; however, not enough to catch up to earlier cohorts. Recent decreases in adolescent drinking in Australia may, at least in part, be attributed to lower consumption in recent cohorts of younger drinkers. Results indicate that this group may continue to drink less than previous cohorts as they age into their twenties.

Prevalence patterns of alcohol consumption and factors associated with problematic drinking on remote islands of Okinawa, Japan: a cross-sectional study.

Objective: This study aims to investigate the drinking behavior on the remote islands of Okinawa Prefecture.Patients/Materials and Method: This was a cross-sectional study conducted with residents of Okinawa Prefecture’s small, isolated islands. Between October 1 and December 3, 2014, island residents over 20 years of age who visited island clinics for an annual health checkup or influenza vaccination were recruited. An anonymous entry survey was administered to those who provided their consent. The survey included information on age, sex, presence or absence of drinking, age at drinking initiation, smoking status, comorbidities, and family and social background. The Alcohol Use Disorder Identification Test (AUDIT) was used to assess alcohol consumption. Participant characteristics were analyzed descriptively, and logistic regression analysis was conducted to assess relationships between the high-risk drinking group (AUDIT score ≥10 points) and other measured variables (age, sex, age at drinking initiation, smoking, residence, and employment status).Results: Compared to the results of a national survey in 2013, there was a significantly higher prevalence of male island residents who drank ≥40 g of alcohol per day and female island residents who drank ≥20 g/day, levels which are considered risk factors for lifestyle diseases. Among both male and female island residents, there were significantly higher proportions of those with AUDIT scores ≥8 points, referred to as high-risk drinkers, and those with AUDIT scores ≥20, individuals considered to have probable alcohol dependence, as compared to the results of the national survey. In a logistic regression analysis, factors related to high-risk drinking included younger age, male sex, smoking history, inoccupation, and underage drinking initiation.Conclusion: This is the first report on drinking behavior among inhabitants of Okinawa’s remote islands. The degree of alcohol consumption is serious and must be recognized as a regional health problem.

Minimum Legal Drinking Age and the Social Gradient in Binge Drinking

Low minimum legal drinking ages (MLDAs), as prevalent in many European countries, are severely understudied. We use rich survey and administrative data to estimate the impact of the Austrian MLDA of 16 on teenage drinking behavior and morbidity. Regression discontinuity estimates show that legal access to alcohol increases the frequency and intensity of drinking, which results in more hospital admissions due to alcohol intoxication. The effects are stronger for boys and teenagers with low socioeconomic background. The policy’s impact is not driven by access. Data from an annual large-scale field study shows that about 25 percent of all retailers sell even hard liquor to underage customers. In line with this, perceived access to alcohol is very high and hardly changes at the MLDA. However, teenagers consider binge drinking at weekends to be less harmful after gaining legal access.

Optimal Model Selection in RDD and Related Settings Using Placebo Zones

We propose a new model-selection algorithm for Regression Discontinuity Design, Regression Kink Design, and related IV estimators. Candidate models are assessed within a ‘placebo zone’ of the running variable, where the true effects are known to be zero. The approach yields an optimal combination of bandwidth, polynomial, and any other choice parameters. It can also inform choices between classes of models (e.g. RDD versus cohort-IV) and any other choices, such as covariates, kernel, or other weights. We use the approach to evaluate changes in Minimum Supervised Driving Hours in the Australian state of New South Wales. We also re-evaluate evidence on the effects of Head Start and Minimum Legal Drinking Age. We conclude with practical advice for researchers, including implications of treatment effect heterogeneity.

Legal Drinking, Injury and Harm: Evidence from the Introduction and Modifications of Age Limits in Denmark

Alcohol is considered one of the most serious threats to population health, and to mitigate its negative consequences, most countries have implemented policies such as minimum legal drinking ages (MLDAs). Denmark, a country with an exceptionally liberal youth alcohol culture, introduced a minimum age for purchasing alcoholic beverages as late as in 1998, prohibiting those below 15 to buy alcohol. Previous studies from the U.S. and a few other contexts have provided substantial evidence that MLDA legislations influence outcomes such as car accidents, but there is little evidence from Europe. Moreover, there is limited evidence for injuries other than those due to vehicle accidents. We exploit the introduction and changes in the MLDA in Denmark to estimate effects on all classes of injuries, as well as alcohol-related outcomes such as intoxication and poisoning. We bring comprehensive evidence on the effects of a total of three reforms, which affected alcohol availability along different margins – 1) establishing an off-premise alcohol purchase age of 15 (1998), 2) raising the off-premise alcohol purchase age to 16 (2004), and 3) increasing the purchase age of beverages exceeding 16.5% in alcohol content from 16 to 18 (2011). Our findings show significant impacts of all the three reforms on injuries. We find that girls responded more to two first two reforms influencing alcohol availability, whereas boys responded more to the last reform, influencing availability of strong liquor. On the other hand, no consistent differences were found across different socioeconomic groups, perhaps reflecting similar patterns of drinking.

Optimal Model Selection in RDD and Related Settings Using Placebo Zones

We propose a new model-selection algorithm for Regression Discontinuity Design, Regression Kink Design, and related IV estimators. Candidate models are assessed within a ‘placebo zone’ of the running variable, where the true effects are known to be zero. The approach yields an optimal combination of bandwidth, polynomial, and any other choice parameters. It can also inform choices between classes of models (e.g. RDD versus cohort-IV) and any other choices, such as covariates, kernel, or other weights. We use the approach to evaluate changes in Minimum Supervised Driving Hours in the Australian state of New South Wales. We also re-evaluate evidence on the effects of Head Start and Minimum Legal Drinking Age. We conclude with practical advice for researchers, including implications of treatment effect heterogeneity.

Is changing the minimum legal drinking age an effective policy tool?

In year 1991, regional governments in Spain started a period of implementation of a law that rose the minimum legal drinking age from 16 to 18years old. To evaluate the effects of this change on the consumption of legal drugs and its related morbidity outcomes, we construct a regional panel dataset on alcohol consumption and hospital entry registers and compare variation in several measures of prevalence between the treatment group (16-18years old) and the control group (20-22years old). Our findings show important differences by gender. Our main result regarding overall drinking prevalence shows a reduction of -21.37% for the subsample that includes males and females altogether. This effect on drinking is mainly driven by a reduction of -44.43% in mixed drinks and/or liquors drinking prevalence corresponding to the subsample of males. No causal effects regarding overall smoking prevalence and hospitalizations due to alcohol overdose or motor vehicle traffic accidents were found. To our knowledge, this is the first paper providing evidence on gender-based differences to policies aimed at reducing alcohol consumption. Our results have important policy implications for countries currently considering changes in the minimum legal drinking age.

A Spatial Perspective on the Econometrics of Program Evaluation

Empirical work in regional science has seen a growing interest in causal inference, leveraging insights from econometrics, statistics, and related fields. This has resulted in several conceptual as well as empirical papers. However, the role of spatial effects, such as spatial dependence (SD) and spatial heterogeneity (SH), is less well understood in this context. Such spatial effects violate the so-called stable unit treatment value assumption advanced by Rubin as part of the foundational framework for empirical treatment effect analysis. In this article, we consider the role of spatial effects more closely. We provide a brief overview of a number of attempts to extend existing econometric treatment effect evaluation methods with an accounting for spatial aspects and outline and illustrate an alternative approach. Specifically, we propose a spatially explicit counterfactual framework that leverages spatial panel econometrics to account for both SD and SH in treatment choice, treatment variation, and treatment effects. We illustrate this framework with a replication of a well-known treatment effect analysis, that is, the evaluation effect of minimum legal drinking age laws on mortality for US states during the period 1970–1984, a classic textbook example of applied causal inference. We replicate the results available in the literature and compare these to a range of alternative specifications that incorporate spatial effects.

A study on the attention networks dysfunction and its influencing factors in the patients with alcohol use disorder

Objective To explore the impairment of attention network function in male patients with alcohol use disorder(AUD) and the main influencing factors of attention network function. Methods Forty-one patients with AUD after withdrawal therapy and 34 healthy controls (HC) matched with their demographic data were selected as subjects of study.Attention function were assessed by attention network test (ANT). Results Compared with the healthy control group((30.62±19.74)ms, (98.59±1.46)%), there were significant differences in the reaction time of alerting network(t=-2.479, P=0.015) and the correct rate of the attention network test(t=-2.074, P=0.044) in the AUD group((17.02±26.42)ms, ( 95.07±10.73)%). Pearson correlation analysis showed the alert network of AUD was negatively correlated with the age of first drinking(r=-0.316, P=0.044) and was positively correlated with the score of Penn alcohol craving scale(PACS) (r=0.364, P=0.019). The correct rate of attention network function in patients with AUD was negatively correlated with the years for education(r=-0.343, P=0.028) and years for addiction(r=-0.337, P=0.031). Linear regression analysis showed the attention network function of AUD patients was affected by the age of first drinking(β=0.432, t=2.079, P=0.046), the years for addiction(β=-0.555, t=-3.127, P=0.004) and years for uncontrol drinking(β=0.309, t=2.074, P=0.047). Conclusion The AUD patients were demonstrated deficit in the alerting network.The impairment of attention function of AUD patients were influenced by their drinking condition. Key words: Alcohol use disorder; Cognitive function; Attention; Attention network test

Association of lncRNA CCAT2 and CASC8 Gene Polymorphisms with Hepatocellular Carcinoma.

The worldwide incidence of hepatocellular carcinoma (HCC), the major histological type of primary liver cancer, is heterogeneous due to the variable prevalence of etiological factors, indicating a correlation of HCC risk with genetic variations among individuals. Among long non-coding RNAs (lncRNAs) located in the chromosome 8q24 loci and involved in the carcinogenesis are colon cancer associated transcript 2 (CCAT2) and cancer susceptibility candidate 8 (CASC8). In this study, the association of CCAT2 and CASC8 gene polymorphisms with the occurrence of HCC was explored between 397 HCC patients and 1195 controls. We found that carriers of rs6983267 GG in CCAT2 were more susceptible to HCC, with the odds ratio (OR) and adjusted odds ratio (AOR) being 1.532 (95% CI, 1.103–2.129; p = 0.011) and 1.627 (95% CI, 1.120–2.265; p = 0.033), respectively. Moreover, for patients stratified by age (under 65), gender (male only), or status of drinking (habitual drinkers), a protective effect of CASC8 rs3843549 on presenting high Child–Pugh scores, metastatic vascular invasion, or large-size tumors was observed in a dominant model. Collectively, our data reveal association of CCAT2 and CASC8 gene polymorphisms with the occurrence and progression of HCC.