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
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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.
Leal-Lopez , E , Moreno-Maldonado , C , Inchley , J , Deforche , B , Van Havere , T , Van Damme , J , Buijs , T , Sanchez-Queija , I , Currie , D B , Vieno , A & De Clercq , B 2020 , ' 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 ' , International Journal of Drug Policy , vol. 84 , 102854 . https://doi.org/10.1016/j.drugpo.2020.102854
International Journal of Drug Policy
Copyright © 2020 Published by Elsevier B.V. This work has been made available online in accordance with publisher policies or with permission. Permission for further reuse of this content should be sought from the publisher or the rights holder. This is the author created accepted manuscript following peer review and may differ slightly from the final published version. The final published version of this work is available at https://doi.org/10.1016/j.drugpo.2020.102854.Copyright © 2020 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/BY/4.0/).
DescriptionFunding: The Health Behaviour in School-aged Children (HBSC) is an international study carried out in collaboration with WHO Europe. This research is funded by public sources in each member country. Specifically, ELL, CMM, and ISQ are supported by the Ministry de Health, Spain. CMM is supported by the VI Plan Propiode Investigación de la Universidad de Sevilla 2018, under the action “II.5B Contrato de acceso al Sistema Españolde Ciencia, Tecnología e Innovación para el Desarrollo del Programa Propio de I + D + i de la Universidad de Sevilla”. JI is supported by the UK Medical Research Council (MC_UU_12017/12) and the Chief Scientist Office (SPHSU12).
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