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
Research article
Abstract
Background
Previous research found inconsistent associations between alcohol control policies and socioeconomic inequality with adolescent alcohol consumption outcomes. This study expands the focus beyond individual associations to examine whether a combination of policies is related to socioeconomic inequality in adolescent alcohol consumption 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 alcohol intoxication. 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 age for alcohol use, 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 alcohol intoxication. Family Affluence Scale was positively related to all three alcohol measures and Perceived Family Wealth was negatively related to lifetime alcohol intoxication, 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 alcohol consumption outcomes.
Conclusion
A combination of alcohol control policies is more effective in reducing adolescent alcohol consumption 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 alcohol intoxication in adolescents with higher family affluence and higher alcohol intoxication 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.
