Sweet sixteen and never been drunk? : adolescent alcohol use, predictors and consequences

Adolescent alcohol use, especially at a young age, has many negative consequences, both on the individual and the societal level. After an introduction describing a conceptual model of predictors and consequences of adolescent alcohol use, the first two chapters in this dissertation report on two studies on alcohol intoxication related admissions of adolescents in Dutch hospitals. Data collected in 2007 and 2008 underline the societal relevance of the problem of adolescent alcohol use. The number of adolescents with alcohol intoxication increases and the symptoms become more severe. \ud \ud In the remaining seven chapters, predictors of adolescent alcohol use are the main topic. The social context of alcohol use is explored in a qualitative study in which adolescents described severe alcohol related incidents they had experienced. In the next study, parents were asked about their support for governmental alcohol control policies. Then an experimental study is described into the impact of alcohol commercials and alcohol product placement in a soap series. The last four studies involve three types of alcohol availability. Regarding economic availability, the prevalence and effects of price discounts in the catering industry were explored. The role of physical availability of alcohol was investigated in a study of private drinking places, focusing their national prevalence and the characteristics of their visitors. A third part of this study involves a large sample questionnaire in which alcohol consumption of adolescent visitors and non-visitors were compared. The last two studies focus on legal availability. These studies involve the shop floor compliance with age restrictions for alcohol sales. The first study investigates compliance levels in the Netherlands in general; the second study addresses the effects of a feedback letter intervention to improve compliance

Using the lost letter technique to measure real-life behavioral effects of alcohol use

Introduction and aims: People’s behaviors after alcohol use are more extreme and alcohol has a narrowing effect on a person’s cognitive capacity. We tested this effect, making use of the Lost-Letter Technique (LLT), in which the return rate of “lost letters” by public mail is used to measure altruistic behavior. We hypothesized that return rates would be lower when people are under the influence of alcohol, and that an anti-alcohol prime in the address would even further decrease return rates. Design and methods: 768 letters were dropped, half of those at times when some degree of intoxication was likely versus when sober passers-by were common. Three different addressees were used to convey an anti-alcohol cue, a charitable cue, and a neutral cue. Results: The average response rate was 33.1%, and was significantly lower during late bar hours than during lunch hours (20.3% versus 45.8%). Also, when envelopes were found by people who were more likely to have consumed alcohol, anti-alcohol cues gained significantly lower response rates (12.7% versus 23.1%). Discussion and conclusions: This study confirms that alcohol use causes less altruistic behavior and different responses to alcohol-related cues, suggesting that LLT is a promising method to study people’s behavior. Future research could also focus on other substances, (mood-)states, and technology as a means of data collection

Compliance with age limits for the sales of alcoholic beverages in Romania. Designing and evaluating a three year campaign

The availability of alcohol in general is the most important predictor of alcohol consumption and alcohol abuse in adolescents. Alcohol availability can divided into economic (alcohol prices and discounts), physical (number of alcohol outlets, opening hours), legal (age limits on drinking and purchasing alcohol) and social availability (at home availability, parental behavior and parenting style). When protecting youth from alcohol use, the legal availability is the strongest instrument.Of course, when legislation states that alcohol is not allowed to be sold to people under a certain age, both on-premise (e.g., bars) and off-premise (e.g.,supermarkets) alcohol outlet personnel should be trained and enforced in complying with legal age limits. In order to explore baseline compliance to this legislation a mystery shopping study was conducted in a Romanian city. Under ages and trained students tried to buy alcohol in to explore to what extent alcohol sellers comply with this legal age limits. This compliance level turned out to be 0%. Within the alcohol project, therefore, it was decided to develop a campaign in which the importance of this age limit was communicated. After this campaign, again compliance was measured. Compliance was improved in the on-premise (bars) outlets only. Despite that the results on compliance with the age limit in practice were not strong directly after the campaign, both elements from that intervention and the research method can be used in other Romanian cities to improve and measure compliance with age limits on the sales of alcohol

Young poker faces: Compliance with the legal age limit on multiple gambling products in the Netherlands

Gambling is an activity that can be performed on-premise (slot machines in casinos, bars and restaurants) or off-premise (scratch cards and lottery tickets). Although the addictive potential may depend on the specific gambling product, early onset increases the likelihood for future pathological gambling. To delay the onset of gambling behavior and to reduce gambling-related problems, many countries have introduced age limits that should decrease the availability of gambling products to underage individuals. In this study we evaluated compliance to the legal age limit, making use of a mystery shopping method. We distinguished between (1) off-premise scratch cards (n = 51); (2) off-premise lottery tickets (n = 49); (3) on-premise slot machines in casinos (n = 88); and (4) on-premise slot machines in the catering industry (n = 100), and we focus on the factors, such as characteristics of the establishment, buyer, and vendor, that may account for possible differences. The 288 visits demonstrate that gambling products are highly available and accessible to under-aged customers; young customers are still able to gamble despite the legal regulations. The compliance rates fluctuate and appear to be related to the specific gambling product in question. Furthermore, age verification activities and certain outlet- and buyer characteristics, as well as characteristics associated with the purchase attempt, may influence compliance

Mystery shopping and alcohol sales: do supermarkets and liquor stores sell alcohol to underage customers?

Purpose: \ud The Dutch national policy regarding alcohol and youth relies on retailers’ willingness to refuse to sell alcohol to underage customers. This study examined unobtrusively whether supermarkets and liquor stores do indeed comply with the legal age restrictions for alcohol sales. - \ud \ud Methods:\ud A research protocol was developed based on the methodology of mystery shopping. Using the protocol, 150 supermarkets and 75 liquor stores were visited by 15-year-old adolescents who tried to buy soft alcoholic beverages (legal age, 16 years), and 75 liquor stores were visited by 17-year-old adolescents who tried to buy strong alcoholic beverages (legal age, 18). - \ud \ud Results:\ud Of all 300 buying attempts, 86% were successful. In supermarkets, 88% of all attempts succeeded. In liquor stores, a difference was found between the purchase of strong alcohol by 17-year-olds (89%) and the purchase of soft alcoholic beverages by 15-year-olds (77%). In only 71 of all visits, mystery shoppers were asked for an ID. In 39% of these cases, they were still able to buy alcohol. Female adolescents were more successful in buying alcohol than male adolescents. - \ud \ud Conclusions:\ud The results show that supermarkets and liquor stores generally fail to see the need for extra care when young customers try to buy alcohol. Legal age restrictions without enforcement and facilitation clearly do not suffice to protect adolescents from early exposure to alcohol

Underage alcohol-purchasing strategies and alcohol availability through self-checkout lanes in supermarkets

Background: To prevent alcohol availability through retail, legal age limits forbid the sale of alcohol to minors in many countries. This study tested the effects of minors’ alcohol-purchasing strategies and knowledge of compliance with age-limit legislation on the availability of alcohol through retail in the Netherlands. Methods: Making use of exploratory, field-experimental design, eight 17-year-old minors participated as mystery shoppers over the period of one weekend. The mystery shoppers were allowed to use their own strategies to buy alcohol. The experiences of the first group were shared with the second group. Results: Out of the 134 times, the shoppers entered an outlet to buy alcohol, and 119 attempts were successful (11.2% compliance). A total quantity of 225.78 US gallons of alcohol-containing beverages was bought. The first group bought 53.93 L on their final day, and the second group bought 53.92 L on their first day, making use of the strategies of the first group. Conclusions: Current self-checkout lanes in supermarkets produce extreme alcohol availability and are even less effective than traditional checkout lanes: Policies for age verification fail. This first small-scale study shows that underage mystery shoppers learn quickly and are able to buy more alcohol with each subsequent visit