Legal age limits for buying alcohol
Peter Anderson MD, MPH, PhD
Professor, Substance Use, Policy and Practice, Institute of
Health and Society, Newcastle University, England
Professor, Alcohol and Health, Faculty of Health, Medicine
and Life Sciences, Maastricht University, Netherlands
Amsterdam 30 May 2013
At the end of 2011, in the Netherlands, 20
14-15 year old ‘mystery’ shoppers each
made 10 different purchase attempts with
the instructions to go and buy beer (legal
purchase age 16 years).
Source: van Hoof & Gosselt 2013
All 14-15 year olds were able to buy
alcohol, for 75% of the time at their first
attempt, taking less than 10 minutes to do
so.
Source: van Hoof & Gosselt 2013
In this presentation, we will consider:
1.Adolescent drinking
2.Policy measures to reduce adolescent drinking
3.Legal age limits for buying alcohol
In this presentation, we will consider:
1.Adolescent drinking
2.Policy measures to reduce adolescent drinking
3.Legal age limits for buying alcohol
Adolescent drinking
1. ESPAD data
Use of alcohol by 15-16 year olds during the past 30 days. ESPAD survey
from 36 European countries. Averages for all countries in each of 5 time
points, and for 18 countries with data across all 5 time points.
Source: Hibell et al 2012
% of 15-16 year olds reporting drinking 5+ drinks on at least one occasion during the
past 30 days. ESPAD survey from 36 European countries. Averages for all countries in
each of 5 time points, and for 14 countries with data across all 5 time points.
Source: Hibell et al 2012
Adolescent drinking
1. ESPAD data
2. Brain structure
A systematic review identified
5 studies in the age range 14-21 years
7 studies in the age range 22-40 years
that related brain structure to heavy
drinking.
Source: Welch et al 2013
There are both similarities and differences when
comparing brain structural abnormalities in
adolescents and young adults.
Women of both groups exhibit prefrontal volume
reduction, with prefrontal white matter reduction
particularly pronounced in female adolescents.
Adolescents of both genders exhibit lower
hippocampal volume, whereas reduced corpus
callosal area was only reported in young adults.
That any brain structural differences are more
consistently found in the adolescents compared
with young adults is surprising.
The young adult group will have been drinking
for longer and have consumed more alcohol, so
if brain structural differences reflected a direct
exposure-response effect, they would be
greater in this group.
That the opposite is seen suggests that
alcohol may be interacting with
maturational processes specific to late
adolescence.
White matter integrity (higher diffusivity, poorer integrity) in adolescents, mean age
18 years, followed-up for 18 months by number of days alcohol used over 18 months
Source: Bava et al 2013
Adolescent drinking
1. ESPAD data
2. Brain structure
3. Consequences
Alcohol use and problems amongst 29,445 Australians surveyed in 2004
Source: Livingstone & Room 2009
Source: Livingstone & Room 2009
Source: Livingstone & Room 2009
Source: Livingstone & Room 2009
Adolescent drinking
1.
2.
3.
4.
ESPAD data
Brain structure
Consequences
Problematic drinking in later life
Light drinker age 16
Heavy drinker at age 16
Grams alcohol/previous week
120
100
80
60
40
20
0
Age 26
Age 30
Age 34
1970 British cohort study of 17,000 people. Alcohol (g) consumed during previous
week at ages 26, 30 and 34 years by whether light or heavy drinker at age 16 years.
Source: Finlay & Flanagan 2013
3
2.5
2
<15 v 18+
15-17 v 18+
2.45
1.97
1.52
1.5
1.3
1
0.5
0
Adjusted for duration of exposure
Adjusted for 32 possible risk
factors
OR for risk of harmful alcohol use at mean age 42 years
by age at first drink amongst 22,000 US citizens
Source: Dawson et al 2008
2.8
2.4
2
1.6
1.2
<15 v 18+
15-17 v 18+
2.33
1.7
1.38
1.15
0.8
0.4
0
Adjusted for duration of exposure Adjusted for 32 possible risk factors
OR for risk of alcohol dependence at mean age 42 years
by age at first drink amongst 22,000 US citizens
Source: Dawson et al 2008
In this presentation, we will consider:
1.Adolescent drinking
2.Policy measures to reduce adolescent drinking
3.Legal age limits for buying alcohol
Policy measures to reduce adolescent drinking
1. Price
Cumulative percentage of participants
100
90
80
70
60
50
40
30
20
10
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Price per drink ($) at which drinking alcohol
is considered viable
485 Australian university students recruited on Facebook how much were they willing to pay for a drink
Source: Miller & Droste 2013
Policy measures to reduce adolescent drinking
1. Price
2. Advertising
The impact of alcohol marketing in digital media
on subsequent youth alcohol consumption was
studied amongst 6,651 students with a mean age
of 14 years from Germany, Italy, the Netherlands
and Poland in a longitudinal setting.
Source: De Bruijn et al 2013
Nearly one third of students reported using a
social media site which contained alcohol
advertisements, and two thirds reported noticing
alcohol advertisements on an internet page.
For every doubling of exposure to digital alcohol
marketing at baseline, 14 months later, students
were 20% more likely to have used alcohol during
the previous 30 days.
In this presentation, we will consider:
1.Adolescent drinking
2.Policy measures to reduce adolescent drinking
3.Legal age limits for buying alcohol
Of 33 studies of minimum legal drinking age law (MLDA)
and alcohol consumption, 11 (33%) found an inverse
relationship; only 1 found the opposite.
Of 79 analyses of MLDA and traffic crashes, 46 (58%)
found a higher MLDA related to decreased traffic crashes;
none found the opposite.
Of 23 analyses of MLDA and other problems, 8 (35%)
found a higher MLDA associated with reduced problems;
none found the opposite.
Source: Wagenaar & Toomey 2002
Compared drinking habits at median age 36
years of 39,240 US citizens born between
1949 and 1972, by whether or not citizens
lived in states with minimum legal drinking
age of <21 years or 21 years.
Source: Plunk et al 2013
Odds ratios of minimum legal drinking age
of <21 years versus 21 years on:
Binge drinking > 1/month: 1.15 (1.04-1.28)
Non-heavy drinking: 0.81 (0.71-0.94)
Of course, legal minimum age purchase
laws will only work if enforced.
A longitudinal study was undertaken in two
Dutch communities, comparing the impact
of a control community with an
intervention community with intensified
inspections on alcohol retailers on the
drinking of 1,327 13-15 year olds over a
two-year period.
Source: Schelleman-Offermans et al 2012
Hazard ratios of ease of purchase on:
Initiation weekly drinking: 1.20 (1.12-1.30)
Initiation drunkenness: 1.51 (1.20-1.89)
Hazard ratios of impact of intervention on:
Initiation weekly drinking: 1.12 (1.05-1.20)
Initiation drunkenness: 0.82 (0.72-0.95)
The problems for the inspectors in applying
fines or withdrawing licences was lack of
proof (could not verify age of adolescent) –
Hence, the importance of mystery shoppers
- to be discussed later today.
Conclusions:
1.Drinking in adolescence:
i. Negatively impacts brain structure
ii. Has more problems per gram of alcohol
iii. Leads to more problems in later life
2. Increasing the price of alcohol and
banning all forms of commercial
communications, including in social and
digital media, will reduce adolescent
drinking and its consequences.
3. Introducing a minimum legal age of
purchase for all beverages groups of at
least 18 years will reduce adolescent
drinking and its problems.
4. Enforcement of legal age of purchase
with threat of loss of license to retailer is
needed and can reduce adolescent
drinking and related problems.
5. Adolescents can very easily buy alcohol:
the use of mystery shoppers adds clarity
to enforcement.
All 14-15 year olds were able to buy
alcohol, for 75% of the time at their first
attempt, taking less than 10 minutes to do
so.
Source: van Hoof & Gosselt 2013