Is commercial alcohol availability related to adolescent alcohol sources and alcohol use? Findings from a multi-level study.

PURPOSE: To examine whether compliance with underage sales laws by licensed retail establishments is related to underage use of commercial and social alcohol sources, perceived ease of obtaining alcohol, and alcohol use. METHODS: In 2005, alcohol purchase surveys were conducted at 403 off-premise licensed retail establishments in 43 Oregon school districts. A survey also was administered to 3,332 11th graders in the districts. Multi-level logistic regression analyses were used to examine relationships between the school district-level alcohol sales rate and students' use of commercial and social alcohol sources, perceived ease of obtaining alcohol, past-30-day alcohol use, and heavy drinking. RESULTS: The school district-level alcohol sales rate was positively related to students' use of commercial alcohol sources and perceived alcohol availability, but was not directly associated with use of social alcohol sources and drinking behaviors. Additional analyses indicated stronger associations between drinking behaviors and use of social alcohol sources relative to other predictors. These analyses also provided support for an indirect association between the school district-level alcohol sales rate and alcohol use behaviors. CONCLUSIONS: Compliance with underage alcohol sales laws by licensed retail establishments may affect underage alcohol use indirectly, through its effect on underage use of commercial alcohol sources and perceived ease of obtaining alcohol. However, use of social alcohol sources is more strongly related to underage drinking than use of commercial alcohol sources and perceived ease of obtaining alcohol.     

Determinants of Underage College Student Drinking: Implications for Four Major Alcohol Reduction Strategies

Guided by the assumptions of the social ecological model and the social marketing approach, this study provides a simultaneous and comprehensive assessment of 4 major alcohol reduction strategies for college campuses: school education programs, social norms campaigns, alcohol counter-marketing, and alcohol control policies. Analysis of nationally representative secondary survey data among 5,472 underage students reveals that alcohol marketing seems to be the most formidable risk factor for underage drinking, followed by perceived drinking norms (injunctive norm) and lax policy enforcement. This analysis suggests that, to make social norms campaigns and alcohol control policies more effective, alcohol reduction strategies should be developed to counter the powerful influence of alcohol marketing and promotions.     

Effects of an Online Alcohol Education Course Among College Freshmen: An Investigation of Potential Mediators

The authors investigated possible mediating effects of psychosocial variables (perceived drinking norms, positive and negative alcohol expectancies, personal approval of alcohol use, protective behavioral strategies) targeted by an online alcohol education course (AlcoholEdu for College) as part of a 30–campus randomized trial with 2,400 first–year students. Previous multilevel analyses have found significant effects of the AlcoholEdu course on the frequency of past-30-day alcohol use and binge drinking during the fall semester, and the most common types of alcohol-related problems. Exposure to the online AlcoholEdu course was inversely related to perceived drinking norms but was not related to any of the other psychosocial variables. Multilevel analyses indicated at least partial mediating effects of perceived drinking norms on behavioral outcomes. Findings of this study suggest that AlcoholEdu for College affects alcohol use and related consequences indirectly through its effect on student perceptions of drinking norms. Further research is needed to better understand why this online course did not appear to affect other targeted psychosocial variables.     

The Effect of Internal Possession Laws on Underage Drinking Among High School Students: A 12-State Analysis

Objectives. We assessed the effect of internal possession (IP) laws, which allow law enforcement to charge underage drinkers with alcohol possession if they have ingested alcohol, on underage drinking behaviors.Methods. We examined Youth Risk Behavior Survey (YRBS) data from 12 states with IP laws and with YRBS data before and after each law’s implementation. We used logistic regression models with fixed effects for state to assess the effects of IP laws on drinking and binge drinking among high school students.Results. Implementation of IP laws is associated with reductions in the odds of past-month drinking. This reduction was bigger among male than among female adolescents (27% vs 15%) and only significant among younger students aged 14 and 15 years (15% and 11%, respectively). Male adolescents also reported a significant reduction (24%) in the odds of past-month binge drinking under IP laws.Conclusions. These findings suggest that IP laws are effective in reducing underage drinking, particularly among younger adolescents.The problem of youth drinking is hardly new. The US government first took steps to address this public health issue in 1984, with the passage of a minimum legal drinking age (MLDA)1 that required states to prohibit the purchase and possession of alcohol by people younger than 21 years or risk losing vital highway funds. By 1988, all 50 states had complied.2 In the decades after the enactment of the MLDA, states and localities have implemented numerous additional policies in an attempt to reduce underage drinking. Keg registration laws, server training requirements, compliance checks performed at retail outlets, and distinctive licenses for drivers younger than 21 years are all examples of policies that seek to restrict alcohol’s availability to youths, but their breadth and enforcement vary widely from state to state. Although all states prohibit the possession of alcohol by a minor, for example, only 35 states have laws that prohibit consumption by a minor.3 Fell et al.4 examined the possession prohibition, as well as 5 other underage drinking laws. They found that a decrease in the ratio of underage drinking drivers to nondrinking drivers in fatal crashes was associated with the MLDA provisions prohibiting purchase and possession of alcohol by minors; zero tolerance laws, which make it illegal for minors to operate a vehicle with any amount of alcohol in their system; and use-and-lose laws, which allow for the suspension of driving privileges for minors guilty of alcohol violations.Closely linked with possession and consumption laws, internal possession (IP) laws prohibit minors from possessing alcohol within their bodies. This policy emerged in response to the difficulty law enforcement encountered in citing youths for violations at underage drinking parties. As 1 newspaper article described,

In the old days, they say, the teenagers at a party would drop their drinks and run when officers arrived. That would leave the police with few of the particulars—who drank what, and when—necessary to build a legal case.5

Without witnessing an underage person possessing or consuming alcohol, law enforcement was left with little evidence with which to charge an underage drinker. IP laws address this issue by allowing for underage drinkers to be cited if law enforcement determines that they have been drinking either by observing outward signs of intoxication or through the use of an objective measure such as a blood, breath, or urine test. Eight states require objective proof: Colorado, Kansas, Michigan, Missouri, New Hampshire, North Carolina, South Carolina, and Utah. In this article, we refer to those states with laws requiring only outward signs of intoxication as subjective proof states: Arizona, Idaho, Nebraska, North Dakota, Vermont, and Delaware.3As part of its effort to provide detailed information on a wide variety of alcohol-related policies in the United States at both the state and the federal levels, the Alcohol Policy Information System (APIS), funded by the National Institute on Alcohol Abuse and Alcoholism, has tracked IP laws along with 34 other relevant policies. However, research on the effectiveness of IP laws on reducing underage drinking has been limited. Fell et al.6 assessed the relationship of 16 key underage drinking laws to reductions in underage drinking drivers involved in fatal traffic crashes. In that study, IP laws were included as 1 component of possession laws but were not examined separately. Of the 16 laws examined, only the prohibition of using false identification was associated with the reduction of underage drinking drivers in fatal crashes. A second analysis focusing on purchase and possession prohibitions found that the presence of these 2 laws was associated with a decrease in the ratio of underage drinking drivers to underage nondrinking drivers in fatal crashes.We sought to fill this gap in the literature by evaluating IP laws using data from state-based surveys of high school students. Our objective was to assess the effect of IP laws on underage drinking behaviors.     

Effects of Socialization and Family Factors on Adolescent Excessive Drinking in Spain

Adolescent drinking has an important health and social impact in many countries. In Spain, this behavior often takes place in groups and in open areas (known as “botellón”). The aim of this study is to describe the prevalence of excessive drinking among Spanish adolescents and its association with socialization and family factors. A national school survey was conducted in 2006 among 26,454 students aged 14–18 years who were selected by two-stage cluster sampling (schools and classrooms). The questionnaire was self-completed with paper and pencil. The outcomes were: habitual excessive drinking or HED (average consumption ≥30 g/day of alcohol among men, and ≥20 g/day among women), binge drinking (drinking 5 or more standard alcohol units in a 2-hour interval), and drunkenness. Logistic regression models were used to estimate the effect of socialization and family factors. Monthly prevalence of HED, binge drinking and drunkenness was 11.2%, 30.9% and 25.6%, respectively. The main factors positively associated with HED were: frequently going out for fun in the evenings, high proportion of friends who drink or get drunk, early onset of alcohol use, low perceived risk of drinking, truancy, illegal drug use, and amount of money spent for personal needs. Family factors were weakly associated with outcomes. Socialization in leisure environments with friends who drink excessively is an important predictor of adolescent excessive drinking in Spain. Thus, prevention must also focus on the community level, limiting alcohol access, building socialization environments without alcohol, and increasing adolescents’ risk perception of drinking.     

Community level alcohol availability and enforcement of possession laws as predictors of youth drinking

BACKGROUND: Despite a minimum legal drinking age, many young people use alcohol. Environmental strategies to control youth drinking focus on restricting access and the enforcement of possession laws. This study examines the relationship between use of these strategies and the frequency of youth alcohol use and related problems. METHODS: Participants were 16,694 students, ages 16-17 in 92 communities in Oregon. A multi-level analysis of a repeated cross-sectional statewide student survey was conducted. The outcome measures examined include 30-day frequency of alcohol use, binge drinking, use of alcohol at school, and drinking and driving. RESULTS: The rate of illegal merchant sales in the communities directly related to all four alcohol-use outcomes. There was also evidence that communities with higher minor in possession law enforcement had lower rates of alcohol use and binge drinking. The use of various sources in a community expanded and contracted somewhat depending on levels of access and enforcement. CONCLUSIONS: This evidence provides empirical support for the potential utility of local efforts to maintain or increase alcohol access control and possession enforcement.     

Determinants of underage college student drinking: implications for four major alcohol reduction strategies

Guided by the assumptions of the social ecological model and the social marketing approach, this study provides a simultaneous and comprehensive assessment of 4 major alcohol reduction strategies for college campuses: school education programs, social norms campaigns, alcohol counter-marketing, and alcohol control policies. Analysis of nationally representative secondary survey data among 5,472 underage students reveals that alcohol marketing seems to be the most formidable risk factor for underage drinking, followed by perceived drinking norms (injunctive norm) and lax policy enforcement. This analysis suggests that, to make social norms campaigns and alcohol control policies more effective, alcohol reduction strategies should be developed to counter the powerful influence of alcohol marketing and promotions.     

Alcohol use among recent immigrant Latino/a youth: acculturation,gender, and the Theory of Reasoned Action

Objective. Latino/a youth are at risk for alcohol use. This risk seems to rise with increasing US cultural orientation and decreasing Latino cultural orientation, especially among girls. To ascertain how acculturation may influence Latino/a youth alcohol use, we integrated an expanded multi-domain model of acculturation with the Theory of Reasoned Action.

Design. Participants were 302 recent Latino/a immigrant youth (141 girls, 160 boys; 152 from Miami, 150 from Los Angeles) who completed surveys at 4 time points. Youth completed measures of acculturation, attitudes toward drinking, perceived subjective norms regarding alcohol use, intention to drink, and alcohol use.

Results. Structural equation modeling indicated that collectivistic values predicted more perceived disapproval of drinking, which negatively predicted intention to drink. Intention to drink predicted elevated alcohol use.

Conclusion. Although the association between collectivistic values and social disapproval of drinking was relatively small (β = .19, p < .05), findings suggest that collectivistic values may help protect Latino/a immigrant youth from alcohol use by influencing their perceived social disapproval of drinking, leading to lower intention to drink. Educational preventive interventions aimed at reducing or preventing alcohol use in recent Latino/a immigrant youth could promote collectivistic values and disseminate messages about the negative consequences of drinking.     

Enhanced enforcement of laws to prevent alcohol sales to underage persons--New Hampshire, 1999-2004

In 1984, the National Minimum Drinking Age Act (Public Law 98-363) was passed, requiring states to raise to 21 years the minimum age to purchase and publicly possess alcohol. Although the law has contributed to substantial reductions in underage drinking and alcohol-related motor-vehicle crashes, alcohol use and binge drinking rates among youths remain high in the United States, and efforts by youths to purchase alcohol from licensed establishments frequently are successful. To reduce alcohol sales to persons aged <21 years in Concord (2000 population: 40,687), New Hampshire, the Concord Police Department (CPD) and New Hampshire Liquor Commission (NHLC) conducted a pilot program of enhanced law enforcement with quarterly compliance checks of alcohol licenses during March 2002-February 2004. This report summarizes the results of that program, which indicated that enhanced enforcement 1) resulted in a 64% reduction in retail alcohol sales to underage youths and 2) was temporally associated with declines in alcohol use and binge drinking among Concord high school students. These findings emphasize the potential effectiveness of enhanced enforcement of minimum drinking age laws to reduce consumption of alcohol by underage youths.     

Deterring sales and provision of alcohol to minors: a study of enforcement in 295 counties in four states.

The authors analyzed patterns of criminal and administrative enforcement of the legal minimum age for drinking across 295 counties in four States. Data on all arrests and other actions for liquor law violations from 1988 through 1990 were collected from the Federal Bureau of Investigation Uniform Crime Reporting System, State Uniform Crime Reports, and State Alcohol Beverage Control Agencies. Analytic methods used include Spearman rank-order correlation, single-linkage cluster analysis, and multiple regression modeling. Results confirmed low rates of enforcement of the legal drinking age, particularly for actions against those who sell or provide alcohol to underage youth. More than a quarter of all counties examined had no Alcoholic Beverage Control Agency actions against retailers for sales of alcohol to minors during the three periods studied. Analyses indicate that 58 percent of the county-by-county variance in enforcement of the youth liquor law can be accounted by eight community characteristics. Rate of arrests for general minor crime was strongly related to rate of arrests for violations of the youth liquor law, while the number of law enforcement officers per population was not related to arrests for underage drinking. Raising the legal age for drinking to 21 years had substantial benefits in terms of reduced drinking and reduced automobile crashes among youths, despite low level of enforcement. Potential benefits of active enforcement of minimum drinking age statutes are substantial, particularly if efforts are focused on those who provide alcohol to youth.     

Propensity for Illegal Alcohol Sales to Underage Youth in Chicago

To assess youth’s ability to purchase alcohol in a city previously not assessed—Chicago, Illinois—we hired individuals aged 21 and older who appeared to be aged 18–20 (i.e., pseudo-underage buyers) to make alcohol purchase attempts without age identification in off-premise licensed alcohol establishments. We conducted two purchase attempts at each establishment across 44 community areas, resulting in a total of 652 purchase attempts. Our dependent variable was purchase attempt outcome (purchase, no purchase) and we used four categories of independent variables: characteristics of sellers, establishments, purchase attempts, and community areas. We analyzed our data using a logistic regression model, with purchase attempt outcome regressed on the independent variables. The overall purchase rate was 35.1%, ranging from 0% to 72% across community areas. Buyers were less likely to purchase alcohol in community areas that had populations with higher percentages of Hispanics (OR = 0.99; CI = 0.98, 1.0), and more likely to purchase alcohol in establishments that had more expensive beer (OR = 2.0; CI = 1.50, 2.67) and in areas with higher percentages of unemployed individuals (OR = 1.1; CI = 1.07, 1.14). Although progress has been made since the early 1990s in reducing sales to underage youth, youth still have relatively easy access to alcohol from licensed establishments. We recommend increased use of compliance checks—underage youth attempt to purchase alcohol under the supervision of enforcement agents; if alcohol is sold, the server/seller and/or license holder are penalized—which scientific studies have shown to be the most effective strategy in reducing sales to minors.     

Factors related to alcohol use among 6th through 10th graders: the Sarasota County Demonstration Project

Alcohol consumption by youth can produce negative health outcomes. This study identified correlates of lifetime alcohol use, recent alcohol use, and binge drinking among youth in sixth through 10th grade (n = 2,004) in Sarasota County, Fla. Results from a closed-ended, quantitative survey acknowledged a range of personal, social, and environmental influences. Breadth of these influences supports a need for multifaceted, community-based interventions for effective prevention of youth alcohol use. This study was unique because it represents population-specific research in which community partners are using the findings to develop community-specific social marketing interventions to prevent underage drinking and promote alternative behaviors.     

Alcohol Outlet Characteristics and Alcohol Sales to Youth: Results of Alcohol Purchase Surveys in 45 Oregon Communities

Reducing youth access to commercial sources of alcohol is recognized as a necessary component of a comprehensive strategy to reduce underage drinking and alcohol-related problems. However, research on policy-relevant factors that may influence the commercial availability of alcohol to youth is limited. The present study examines characteristics of off-premise alcohol outlets that may affect alcohol sales to youth. Random alcohol purchase surveys (N = 385) were conducted in 45 Oregon communities in 2005. Underage-looking decoys who were 21 years old but did not carry IDs were able to purchase alcohol at 34% of the outlets approached. Purchase rates were highest at convenience (38%) and grocery (36%) stores but were relatively low (14%) at other types of outlets (e.g., liquor and drug stores). Alcohol purchases were less likely at stores that were participating in the Oregon Liquor Control Commission’s Responsible Vendor Program (RVP), when salesclerks asked the decoys for their IDs, and at stores with a posted underage alcohol sale warning sign. Alcohol purchases were also inversely related to the number of salesclerks present in a store, but were not related to salesclerks’ age and gender. Findings of this study suggest that more frequent compliance checks by law enforcement agents should target convenience and grocery stores, and owners of off-premise outlets should require training of all salesclerks to ensure reliable checks of young-looking patron IDs, and should post underage alcohol sales warning signs in clear view of patrons.     

Relationships Between Alcohol-related Informal Social Control, Parental Monitoring and Adolescent Problem Behaviors Among Racially Diverse Urban Youth

The purpose of the present study is to investigate the relationships between alcohol-related informal social control and parental monitoring on alcohol use, behavior and intentions; violent behavior; and delinquent behavior in a racially diverse population of young urban adolescents. Baseline surveys were administered to 6th grade male and female students in 61 urban Chicago schools as part of Project Northland Chicago, a group randomized trial for the prevention/reduction of substance use. A subset of their parents (n = 3,034) was also surveyed regarding alcohol use, violence, and delinquency and related issues. Structural equation modeling was used to assess relationships between alcohol-related informal social control (as measured by parental perceptions of neighborhood action regarding youth drinking) and parental monitoring (as reported by parents), and three adolescent outcomes (alcohol use, behaviors and intentions; violent behavior; and delinquent behavior; as reported by teens). Associations between alcohol-related informal social control and parental monitoring were positive and significant (P < .001). Direct paths from parental monitoring to all three adolescent outcomes were negative and statistically significant (alcohol use, behaviors and intentions, P < .001; violent behavior, P < .001; and delinquent behavior, P < .001). Alcohol-related informal social control was not significantly associated with adolescent outcomes. Efforts to engage parents to be more active in monitoring adolescents’ activities may be related to lower levels of underage drinking, violence and delinquency among both female and male urban youth. Neighborhood norms and action against teenage drinking may be too distal to adolescent outcomes to be directly associated.     

Adolescent Alcohol Use: Protective and Predictive Parent,Peer, and Self-Related Factors

Adolescent alcohol use has been linked with a multitude of problems and a trajectory predictive of problematic use in adulthood. Thus, targeting factors that enhance early prevention efforts is vital. The current study highlights variables that mitigate or predict alcohol use and heavy episodic drinking. Using Monitoring the Future (MTF) data, multiple path analytic models revealed links between parental involvement and alcohol abstinence and initiation. Parental involvement predicted enhanced self-esteem and less self-derogation and was negatively associated with peer alcohol norms for each MTF grade sampled, with stronger associations for 8th and 10th graders than 12th graders. For younger groups, self-esteem predicted increased perceptions of alcohol risk and reduced drinking. Self-derogation was associated with peers’ pro-alcohol norms, which was linked to lower risk perceptions, lower personal disapproval of use, and increased drinking. Peer influence had a stronger association with consumption for 8th and 10th graders, whereas 12th graders’ drinking was related to personal factors of alcohol risk perception and disapproval. In all grades, general alcohol use had a strong connection to heavy episodic drinking within the past 2 weeks. Across-grade variations in association of parent, peer, and personal factors suggest the desirability of tailored interventions focused on specific factors for each grade level, with the overall goal of attenuating adolescent alcohol use.     

Project Northland high school interventions: community action to reduce adolescent alcohol use.

Project Northland is a randomized community trial initially implemented in 24 school districts and communities in northeastern Minnesota, with goals of delaying onset and reducing adolescent alcohol use using community-wide, multiyear, multiple interventions. The study targets the Class of 1998 from the 6th to 12th grades (1991-1998). The early adolescent phase of Project Northland has been completed, and reductions in the prevalence of alcohol use at the end of 8th grade were achieved. Phase II of Project Northland, targeting 11th- and 12th-grade students, uses five major strategies: (1) direct action community organizing methods to encourage citizens to reduce underage access to alcohol, (2) youth development involving high school students in youth action teams, (3) print media to support community organizing and youth action initiatives and communicate healthy norms about underage drinking (e.g., providing alcohol to minors is unacceptable), (4) parent education and involvement, and (5) a classroom-based curriculum for 11th-grade students. This article describes the background, design, implementation, and process measures of the intervention strategies for Phase II of Project Northland.     

Smoke-free Laws and Smoking and Drinking Among College Students

Little is known about the impact of smoke-free legislation on smoking and drinking alcohol among college students. The purpose was to examine whether strength and duration of municipal smoke-free laws are associated with cigarette and alcohol use among college students. Full-time undergraduates from two Southeastern universities participated in mailed (Site A) or electronic (Site B) surveys assessing tobacco and alcohol use and other risk behaviors pre and post comprehensive municipal smoke-free laws (Site A, N = 1,366. Site B, N = 1,404). The first cohort at each site participated prior to a municipal smoke-free law in the community. The second survey was conducted post-law (Site A, 3.5 years, Site B, 8 months). Past 30-day cigarette and alcohol use and other demographic and personal characteristics were assessed. At Site A, controlling for demographic differences and current alcohol use, the odds of being a current smoker were 32% lower post-law (28% pre-law vs. 19% post-law; odds ratio = 0.68, P = 0.02). At Site B, with demographics and drinking status in the model, the decrease in smoking rate from pre- to post-law was not significant. At both sites, controlling for demographics and current smoking status, change in the likelihood of drinking was not significant. Comprehensive smoke-free laws in the surrounding community may reduce smoking rates among college students who live, work and recreate there, particularly after the laws are well-established. While alcohol prevalence is very high among college students, enacting smoke-free legislation was not associated with alcohol use.     

Social influences, and attitudes and beliefs associated with smoking among border Latino youth

BACKGROUND: Adolescent smoking rates have declined among all ethnic groups since the late 1990s. However, despite the recent declines and intervention efforts, today smoking remains a serious problem among youth, with a quarter of adolescents being current smokers by the time they complete 12th grade. This problem is particularly prevalent among Latino youth, who have among the highest rates of lifetime and past-30-day use. The purpose of this study was to examine the association between psychosocial factors and the smoking behavior of Latino youth living along the Mexico-US border. METHODS: A convenient sample of 2471 middle and high school Latino students was surveyed in fall 2000. Logistic regression analysis was used to examine the association between study risk factors and youth smoking behavior. RESULTS: The strongest predictor of lifetime and past-30-day smoking was peer influence; however, the strength of the association was greater with recent use. There were also differences in the influence of family and attitudes and beliefs between the 2 groups. CONCLUSIONS: These differences need to be taken into consideration to guide development of tailored prevention and control interventions aimed at this specific group. These efforts should address social influences to smoke, particularly those from peers; promote changes in attitudes and beliefs toward smoking; increase understanding of the addictive nature of nicotine; and provide development of skills young people need to resist social and environmental pressures to smoke. Strict control and enforcement measures are needed to completely eliminate the sale of cigarettes to minors.