The Nature and Extent of Flavored Alcoholic Beverage Consumption among Underage Youth: Results of a National Brand-Specific Survey

Background: Flavored alcoholic beverages are popular among underage drinkers. Existing studies that assessed flavored alcoholic beverage use among youth relied upon respondents to correctly classify the beverages they consume, without defining what alcohol brands belong to this category. Objectives: The aim is to demonstrate a new method for analyzing the consumption of flavored alcoholic beverages among youth on a brand-specific basis, without relying upon youth to correctly classify brands they consume. Methods: Using a prerecruited Internet panel developed by Knowledge Networks, we measured the brands of alcohol consumed by a national sample of youth drinkers, aged 16–20 years, in the United States. The sample consisted of 108 youths who had consumed at least one drink of an alcoholic beverage in the past 30 days. We measured the brand-specific consumption of alcoholic beverages within the past 30 days, ascertaining the consumption of 380 alcohol brands, including 14 brands of flavored alcoholic beverages. Results: Measuring the brand-specific consumption of flavored alcoholic beverages was feasible. Based on a brand-specific identification of flavored alcoholic beverages, nearly half of the youth drinkers in the sample reported having consumed such beverages in the past 30 days. Flavored alcoholic beverage preference was concentrated among the top four brands, which accounted for almost all of the consumption volume reported in our study. Conclusions and scientific significance: These findings underscore the need to assess youth alcohol consumption at the brand level and the potential value of such data in better understanding underage youth drinking behavior and the factors that influence it.     

Trends in Drinking Habits Among Finnish Youth from 1973 to 1987

The aim of this study has been to analyze the trends in drinking habits among Finnish youth from 1973 to 1987. The data were collected by questionnaires from representative nationwide samples of 14- to 18-year-olds in 1973, and from 1977, biennially. Response rates varied between 79% (1985) and 88% (1981). The use of alcohol was common among young people in the early 1970s, decreased until the beginning of the 1980s, and then increased again beginning in 1983. The use of alcohol had increased among young people in every sociodemographic group and school type in recent years. However, the increase, per capita, of alcohol consumption in Finland has grown in recent years after a long stable period due to an increase in the availability of alcoholic beverages and better economic conditions. The spending money available to young people for their leisure time activities, including alcohol consumption, increased markedly after 1983. The liberalization of alcohol policies in connection with fast economic development had a special effect on alcohol use among young people in the early 1970s and then again in the 1980s.     

Tracking drinking behaviour from age 15-19 years

Aims The aim of this paper was to assess (1) changes in drinking behaviour over time among Danish adolescents and (2) use of which alcoholic beverages and what drinking patterns would have the strongest predictive effect on later alcohol consumption. Design, setting, participants The population was a random sample of 15‐year‐olds (baseline 1990, response rate 86%, n= 847) with a first follow‐up 4 years later (response rate 85%, n= 729). Measurements Alcohol intake was assessed by experience of drunkenness, quantity and frequency of consumption. Thresholds recommended by the Danish National Board of Health were used to discriminate high from low intake. Findings At 19 years of age at least 80% drank alcohol monthly, and 24% of the men and 11% of the women had an alcohol intake above the recommended national limits, i.e. 21 weekly units of alcohol for men and 14 for women. Consumption of alcoholic beverages at age 15 increased the risk of drinking alcohol weekly at the age of 19 [odds ratio (OR)‐values from 1.11 to 3.53]. Drunkenness among the 15‐year‐old boys and the use of spirits of the 15‐year‐old girls showed the strongest predictive relationship with excessive consumption at age 19 [OR = 2.44, confidence interval (CI): 1.38–4.29, respectively, OR = 1.97, CI: 1.15–3.38]. Conclusions Alcohol consumption as early as the age of 15 predicted weekly alcohol consumption and alcohol intake exceeding the recommended amount 4 years later. Young teenagers’ high alcohol consumption was not just a passing phenomenon. It was a behaviour that tracked into young adulthood, leaving the adolescents at increased risk of being long‐term, large‐scale consumers.     

The role of spending money and drinking alcohol in adolescent smoking

AIMS: Previous studies have shown inconsistent findings with regard to the association between amount of spending money and adolescent smoking. Drinking alcohol may be a mediator of the association between spending money and adolescent smoking. However, no studies have examined this potential role. The objective of this study was to investigate the association between amount of spending money and adolescent smoking and the potential mediation role of alcohol use in this association. DESIGN: The 2003 Ontario Student Drug Use Survey of students in grades 7-12. MEASUREMENTS: Multivariable logistic, probit and linear regression models were used to investigate the association between amount of spending money and smoking, and the contribution of drinking alcoholic beverages to this relationship. FINDINGS: Spending money was associated positively with experimental smoking, current smoking and daily consumption of cigarettes (P < 0.01). The analysis adjusted for confounders showed that students with spending money > or =$20/week were significantly more likely to be experimental smokers, students with > or =$30/week were significantly more likely to be current smokers and students with > or =$60/week smoked significantly more cigarettes/day (P < or = 0.05), compared to students with <$10/week. Alcohol use was an important mediator, responsible for 81% of the association of spending money with experimental smoking, 38% with current smoking and 37% with daily consumption of cigarettes. CONCLUSIONS: Amount of spending money was associated significantly and positively with smoking among adolescents, and alcohol use mediated this association. Integrated tobacco prevention programs may be more effective, and increasing taxes on cigarettes and alcohol would increase price sensitivity among youth and protect against adolescent smoking.     

Brand-specific consumption of flavored alcoholic beverages among underage youth in the United States

Background: Although several studies have identified flavored alcoholic beverages (FABs) as being popular among underage drinkers, no previous study has ascertained the prevalence of brand-specific FAB consumption among a national sample of underage youth. Objectives: To ascertain the brand-specific consumption prevalence and consumption share of FABs among a national sample of underage drinkers in the United States. Methods: In 2012, we conducted an online, self-administered survey of a national sample of 1031 underage drinkers, ages 13–20 years, to determine the prevalence of past 30-day consumption for each of 898 alcoholic beverage brands, including 62 FABs, and each brand's youth consumption share, based on the estimated total number of standard drinks consumed. There were three brand-specific outcome measures: prevalence of consumption, prevalence of consumption during heavy episodic drinking, and consumption share, defined as the percentage of the total drinks consumed by all respondents combined that was attributable to a particular brand. Results: The FAB brands with the highest prevalence of past 30-day consumption were Smirnoff malt beverages, 17.7%; Mike's, 10.8%; Bacardi malt beverages, 8.0%; and Four Loko/Four MaXed, 6.1%. Just five brands accounted for almost half (49.1%) of the total consumption share by volume within the FAB category. Conclusion: Flavored alcoholic beverages are highly popular among underage drinkers, and the FAB brand preferences of this group are highly concentrated among a small number of brands. To decrease the consumption of FABs by underage youth, all states should reclassify these beverages as distilled spirits rather than beer.     

Japanese national survey of adolescent drinking behavior in 1996

BACKGROUND: Despite legal prohibition of drinking by minors, there has been no systematic attempt to monitor drinking by young Japanese. This research, the first Japanese national survey of Japanese adolescent drinking behaviors, was conducted in 1996. METHODS: In this survey, information on drinking frequency was obtained from questionnaires completed by 42,183 junior high school and 72,396 senior high school students in randomly selected schools representing all areas of Japan. RESULTS: Sixty percent of junior high school students and 70% of senior high school students reported having drinking experiences; 5% of junior high school students and 10% of senior high school students drank one or more times per week. Many of the junior high school students usually drank with their families and consumed small amounts, but many of senior high school students drank on various occasions and consumed larger amounts. These Japanese high school students reported being offered alcohol frequently by their parents, found it easy to buy alcoholic beverages, and believed that they had the right to determine whether to drink. Japanese adolescents' drinking has increased over the past 20 years, whereas drinking by U.S. adolescents has decreased. CONCLUSIONS: Japanese policies aimed at decreasing adolescent drinking are inadequate. A system for monitoring and potentially modifying adolescent drinking behavior is needed.     

Decrease in the Prevalence of Adolescent Alcohol Use and its Possible Causes in Japan: Periodical Nationwide Cross-Sectional Surveys

Background:  Trends in alcohol drinking prevalence were assessed among Japanese adolescents, and possible reasons for a decrease in drinking prevalence observed in 2004.
Methods:  Cross-sectional nationwide surveys were conducted periodically. High schools were randomly sampled from throughout Japan in 1996, 2000, and 2004. All enrolled students in sampled schools were subjects of the surveys. Self-reporting anonymous questionnaires were collected from 115,814 students in 1996, 106,297 in 2000, and 102,451 in 2004. Questions about drinking prevalence of students and family members, proportion of students who have no friends, and sources of alcohol were included. Students who drunk at least one day of the 30 days preceding the survey were defined as the current drinkers.
Results:  The drinking prevalence in 2004 was decreased in comparison to that in 1996 and 2000 in both sexes and in all school grades. The current drinking rate (monthly drinker) among junior high school boys was 29.4% in 1996, 29.0% in 2000, and 20.5% in 2004, while that among senior high school boys was 49.7%, 48.7%, and 36.2%, respectively. The respective prevalence among junior and senior girls was 24.0%, 25.5%, and 20.0% and 40.8%, 42.1%, and 34.1%. The prevalent sources of alcohol beverages were searching in home, stores (convenience store, supermarket, or gas-stand), liquor shops, and bars. An analysis of the reasons for this decrease identified a decrease in drinking prevalence in students' families, especially by fathers and older brothers, and an increase in the proportion of students who had no friends.
Conclusions:  A decrease in drinking prevalence of male family members and a limitation of sources of alcoholic beverages may contribute to the decrease in adolescent drinking prevalence.     

Exposure to terrorism and Israeli youths' psychological distress and alcohol use: an exploratory study

This study examined the associations between physical and psychological proximity to terrorist attacks and post-traumatic symptoms (PTS), depressive symptoms, and alcohol use among Israeli youth. Self-administered questionnaires were completed under anonymous conditions by 1,150 high and junior high school students (51.3% boys and 48.7% girls) in a town in the Tel Aviv metropolitan area. Standardized, validated scales were used to measure psychological symptoms and alcohol use. High levels of exposure to terrorism were reported. Physical and psychological proximity to terrorist attacks were associated with more PTS symptoms and alcohol consumption. Physical proximity was also associated with symptoms of depression. The implications of terror-associated early drinking for later alcohol problems should be explored.     

Socioeconomic differences in alcohol-specific parenting practices and adolescents' drinking patterns

The aim of this study was to investigate to what extent alcohol-specific parenting practices relate to adolescents' alcohol use, binge drinking, and alcohol-related problems, and whether these associations are moderated by socioeconomic status (SES), i.e. parents' education level and family income. The present data were collected within the framework of a representative study on alcohol use among Dutch students. The present findings are based on data from respondents who had been drinking in the past year (81.5%), and of whom one of the parents had filled out a short questionnaire including SES characteristics (52%). The sample consisted of 1,344 adolescents. Adolescents were approached in a school setting; parents received a short questionnaire at the home address. The results show that applying strict rules about alcohol use and having qualitative good conversations about drinking alcohol seem to prevent adolescents from heavy drinking patterns, whereas parental alcohol use seems to promote adolescents' drinking. A positive association was found between frequency of alcohol communication and availability of alcohol at home on the one hand and adolescents' drinking on the other. Some moderating effects of SES were found.     

Intake of energy drinks in association with alcoholic beverages in a cohort of students of the School of Medicine of the University of Messina

BACKGROUND: Energy drinks (ED) are a widely used group of beverages known for their stimulant effects on central nervous system (CNS). The main components of ED are caffeine, taurine, carbohydrates, glucuronolactone, inositol, niacin, pantenol, and beta-complex vitamins. The studies evaluating the effects of ED describe improvements in attention and/or reaction times and indices of alertness. It has been also shown that combination of caffeine and glucose, fundamental constituents of ED, can ameliorate deficits in cognitive performance and subjective fatigue during extended periods of cognitive demand. Moreover, the associated ingestion of alcohol and ED has recently been observed to be becoming more and more widespread. METHODS: With the aim to know the habits and uses of students, we administered a questionnaire containing questions regarding ED drinking alone or in association with alcoholic beverages. Five hundred students of the School of Medicine of the University of Messina were interviewed, and 450 filled the questionnaire. RESULTS: A total of 56.9% of students declared using ED. A great part of users (48.4%) associate frequently ED and alcohol. In particular, 35.8% of ED + alcohol users have used ED + alcohol more than 3 times in the last month. Distinguishing the users into 2 groups (users of ED + alcohol and users of both ED and ED + alcohol), we observed in the second group a major use of cocktail containing a mix of ED and alcoholic beverages. This difference between the 2 groups is less represented about the ingestion of ED + alcohol in the night. CONCLUSIONS: Our data indicate that association of ED + alcohol is very popular among students. This behavior can be dangerous. In fact, the combination of ED + alcoholic drinks can reduce adversive symptoms of alcohol intoxication including the depressant effects. As consequence, users of ED + alcoholic beverages might not feel the signs of alcohol intoxication, thus increasing the probability of accidents and/or favoring the possibility of development of alcohol dependence.     

Alcohol outlet policies and practices concerning sales to underage people

Little is known about the relationship between alcohol outlet policies and practices in the United States and the likelihood that outlets will sell alcoholic beverages to persons under the legal drinking age. This study assessed the prevalence of such outlet-level policies and practices, and analyzed the relationships between outlet variables and outlets' actual propensity to sell alcoholic beverages to youth. The sample consisted of all outlets licensed for off-premise and a 40% random sample of outlets licensed for on-premise sale of alcoholic beverages in 15 small to medium-sized communities in Minnesota and Wisconsin (USA). Data on outlet characteristics, policies and practices were collected by a telephone survey of the owner or manager of each outlet. In addition, alcohol purchase attempts were conducted at each outlet by youthful-appearing study confederates. Generally, policies and practices that may reduce the likelihood of sales to youth were reported by a minority of outlets. Purchase success was found to be associated with a number of outlet characteristics, policies and practices. The implications of these findings for policy and future research are discussed.     

Development and pilot testing of an Internet-based survey instrument to measure the alcohol brand preferences of U.S. youth

Background: Although we know a great deal about the percentage of youth who drink alcohol, we know very little about the specific brands they choose to drink. This information gap needs to be addressed if public health officials are to develop more effective interventions. Unfortunately, there are no national youth surveys that collect data on alcohol brand consumption. In this paper, we describe the development and pilot testing of what we believe to be the first comprehensive, Internet‐based youth survey of brand‐specific alcohol use. Methods: We used online advertising in 3 U.S. cities to recruit a convenience sample of 241 respondents, ages 16 to 18 years. We used Craigslist, a network of online communities that features local classified advertisements, to recruit the sample. We used SurveyGizmo, an online software program for designing Internet surveys, collecting data, and performing basic analysis, to survey these respondents about their brand‐specific alcohol consumption patterns. The survey instrument assessed each respondent’s 30‐day drinking history, including the frequency of consumption for each alcohol brand. Results: Using Internet survey technology, we were able to collect information on 366 brands and still have respondents complete the instrument quickly and easily. The total number of brands consumed in the past 30 days ranged from 1 to 18, with a median of 4 brands. The top 5 brands consumed were beer brands, as were eleven of the top 15 brands. The remaining 4 brands in the top 15 included 3 brands of flavored alcoholic beverages and 1 brand of mixed drink. Among the top 15 alcohol brands consumed during heavy drinking episodes were 8 brands of beer, 4 brands of flavored alcoholic beverages, 2 brands of wine, and 1 brand of mixed drink. Conclusions: This pilot study helps establish the feasibility of including brand‐specific questions on federal or other national youth alcohol surveys.     

Alcohol Use Patterns of First-Year Medical Students: I. Development of Shared Norms

Freshman medical students (96% of one class; n = 116) completed questionnaires on alcohol use at orientation, and again in April (n = 106) of that same year. Quantity/frequency and self-label ratings of alcohol use were employed to define normative ranges (in ethanol oz/wk). The confidentiality of student participants was protected. Males consumed five drinks per week over the summer and dropped to four per week during school; females consumed two drinks per week over both periods. Summertime and school year consumption rates were strongly correlated. Normative ranges of drinking converged from September to April, suggesting the emerging norms were the product of social experience with classmates. Class norms described a "cutpoint" separating acceptable range from excessive drinking (more than two drinks per day). The authors conclude that reliable "community norms" for medical students could be identified, the norms evolve over time, and they can be employed to determine the boundaries of acceptable drinking for research and screening purposes.     

Substance misuse among native and rural high school students in Quebec.

A questionnaire exploring the smoking habits, past and current use of alcoholic beverages, cannabis, and other illicit drugs was distributed among Francophone and Native high school students in a rural area of Quebec. The lifetime prevalence figures indicated that use of illicit drugs was significantly higher among Native students. This held true particularly for stimulants and inhalants (p less than .001). Figures for the 1-year prevalence indicated that use of stimulants in Native students remained still significantly higher (p less than .01). However, consumption of alcoholic beverages was more important in Francophone students (p less than .05). A gender difference was observed in Native students, females reporting an earlier involvement with most substances under study. This tendency decreased with age. The implications of this study for the prevention of alcohol and substance abuse among rural and Native youths are discussed.     

Is alcopop consumption in Switzerland associated with riskier drinking patterns and more alcohol‐related problems?

OBJECTIVES: To examine (a) whether consumers of alcopops compared to consumers of other alcoholic beverages but not alcopops have riskier drinking patterns and more alcohol-related consequences (e.g. truancy, scuffles, problems with parents) and (b) whether the amount of alcopops consumed is associated independently with risky drinking patterns and alcohol-related consequences over and above those associated with the amount of other alcoholic beverages consumed. SAMPLE: As part of the ESPAD international study, a cross-sectional national representative sample of 5,444 drinkers aged 13-16 years was interviewed by means of an anonymous, self-report questionnaire administered in a classroom setting. RESULTS: Earlier initiation of consumption, more frequent risky single occasion drinking (RSOD), and a higher likelihood of negative consequences for consumers than for non-consumers of alcopops were due mainly to higher overall consumption. Other alcoholic beverages had similar effects, and whether the same amount of alcohol was consumed as alcopops or as any conventional alcoholic beverage made no difference. CONCLUSIONS: Alcopops in Switzerland do not seem to be linked to specific riskier drinking patterns or consequences per se. Like all alcoholic beverages, they add to the problems caused by drinking and seem to be consumed in addition to conventional alcoholic beverages without replacing them. As the alcohol industry will continue to launch new beverages, prevention targeting alcohol consumption in general might be more effective than focusing on new beverages only.     

Alcohol and psychoactive drug use among Israeli adolescents: an epidemiological and demographic investigation

One thousand nine hundred Israeli adolescents--51.8% males and 48.2% females--aged 15 to 18, were questioned twice about their current and "ever" substance use. The first study was undertaken during September-October 1982 and the second about a year later. The findings clearly indicated a slight rise in the incidence and a moderate growth of the prevalence of substance use among Israeli adolescents. The relationships between substance use and several background sociodemographic variables that were studied are discussed.     

Strategies for reduction and cessation of alcohol use: adolescent preferences

BACKGROUND: Although the majority of youth and adults resolve alcohol problems without formal treatment, we know little about the strategies used by youth in their efforts to decrease alcohol use. Recent studies have begun to address change efforts that adolescents report being helpful in cutting down or stopping alcohol use. The current study seeks to improve our understanding of adolescent change processes in alcohol use by examining the perceptions of high school students. METHODS: As part of a secondary alcohol intervention study of high school students (ages 12-18; 51% male), 1069 participants completed an anonymous supplemental questionnaire on change strategies for cutting down and stopping alcohol use. Based on content analysis of youth-generated responses, a classification system consisting of nine broad categories was developed (e.g., informal-interpersonal supports, formal aids, alternative activities). Participant responses were independently coded by two raters trained to criterion. Cases with full agreement (n = 934; 96%) were used for data analyses of methods for cutting down drinking, stopping drinking, and strategies recommended for a friend. RESULTS: The five most frequently youth-generated change strategies to alter drinking were environmental exposure management (e.g., avoid drinking situations, 19%); informal interpersonal supports (e.g., talk to a friend, 18%); formal aids (e.g., peer support group, counselor, 17%); behavioral self-management (e.g., limit consumption, 14%); and alternative activities (e.g., recreation, sports, 10%). Whereas informal interpersonal supports were consistently endorsed for all change situations, behavioral self-management strategies were viewed as more useful for reduction of drinking and formal aids more critical for cessation efforts. Some differences were observed in youth-generated strategies for changing their own drinking compared with efforts to help friends, with environmental changes (e.g., reducing exposure to risk situations and people, formal aids) more often considered when changing youth's own behavior, and strategies reflecting a need for personal change (e.g., education) recommended to others. CONCLUSIONS: Our findings support theoretical conceptualizations of alcohol and drug problem resolution that accommodates multiple pathways to recovery. The normative information about specific change strategies generated by youth may further aid in the design of interventions more acceptable for adolescents.     

Drinking pattern among adolescents with immigrant and Norwegian backgrounds: A two‐way influence?

AIMS: To assess the association between drinking behaviour among adolescents with both immigrant and native backgrounds with aspects of acculturation. DESIGN: Cross-sectional school survey among 15-16 year olds. SETTING AND PARTICIPANTS: All students, a total of 8361, in 10th grade during spring 2000 and 2001 in Oslo, Norway with response rate 88.3%. The sample consisted of 1213 students with an immigrant background and 4627 students with a Norwegian background. MEASUREMENTS: Indicators of the length of the acculturation process were assessed as first versus second generation and in terms of length of stay in Norway. The proportion of Muslim students in school was an indicator of social environment 'dryness'. Drinking behaviour was assessed as drinking alcohol ever, drinking frequency and intoxication frequency. FINDINGS: A smaller proportion of immigrant students were current drinkers, frequent drinkers and drank to intoxication compared with adolescents with a Norwegian background. Adjusted two-level analyses showed that alcohol drinking was less common among immigrant students with a short stay in Norway and with a large proportion of Muslim students in school. In those with a Norwegian background there was a larger proportion of abstainers, and those who drank did so less frequently and were less frequently intoxicated the larger the proportion of Muslim students there was in their school. CONCLUSION: Drinking behaviour among adolescents in a multicultural and heterogeneous society seems to reflect a bi-directional acculturation process where the majority population tend to adapt to the behaviours of the immigrant population which in turn, to a varying degree, tends to adapt to the behaviour of the majority population.     

Similarities and differences in correlates of alcohol consumption and problem behaviors among male and female adolescents

This study examined similarities and differences in correlates of alcohol consumption and problem behaviors among a random household sample of male and female adolescents between the ages of 12 and 17. Several similarities emerged between the two gender groups which were consistent with previous research, including a pattern of convergence among the variables of alcohol consumption, times drunk in the last year, and delinquent behavior; the salience of the peer context in alcohol-related behavior; and high associations between reasons, or motives, for drinking and alcohol consumption and problem behaviors. With respect to reasons for drinking, excitement-seeking, or pleasurable, reasons were highly related to outcome variables. Gender differences were reported for relationships between two indices of affective functioning, namely distress symptoms and escapist, tension-reducing reasons for drinking, and outcome variables related to delinquent behavior, school functioning, and aspects of self-concept. These differences are discussed with respect to possible differential socialization experiences among males and females.