Youth Drinking in the United States: Relationships With Alcohol Policies and Adult Drinking

Abstract

BACKGROUND: The relationship between the alcohol policy environment (ie, the combined effectiveness and implementation of multiple existing alcohol policies) and youth drinking in the United States has not been assessed. We hypothesized that stronger alcohol policy environments are inversely associated with youth drinking, and this relationship is partly explained by adult drinking.METHODS: Alcohol Policy Scale (APS) scores that characterized the strength of the state-level alcohol policy environments were assessed with repeated cross-sectional Youth Risk Behavior Survey data of representative samples of high school students in grades 9 to 12, from biennial years between 1999 and 2011. RESULTS:In fully adjusted models, a 10 percentage point increase in APS scores (representing stronger policy environments) was associated with an 8% reduction in the odds of youth drinking and a 7% reduction in the odds of youth binge drinking. After we accounted for youth-oriented alcohol policies, the subgroup of population-oriented policies was independently associated with lower odds of youth drinking (adjusted odds ratio 0.94; 95% confidence interval 0.92-0.97) and youth binge drinking (adjusted odds ratio 0.96; 95% confidence interval 0.94-0.99). State-level per capita consumption mediated the relationship between population-oriented alcohol policies and binge drinking among youth.CONCLUSIONS: Stronger alcohol policies, including those that do not target youth specifically, are related to a reduced likelihood of youth alcohol consumption. These findings suggest that efforts to reduce youth drinking should incorporate population-based policies to reduce excessive drinking among adults as part of a comprehensive approach to preventing alcohol-related harms. Future research should examine influence of alcohol policy subgroups and discrete policies. WHAT'S KNOWN ON THIS SUBJECT:Youth drinking is associated with adult drinking. Alcohol policies can influence youth and adult drinking. However, it is unknown whether alcohol policies influence youth drinking patterns directly or through their effect on adult drinking. WHAT THIS STUDY ADDS:Alcohol policies, including population-oriented policies, are protective for youth drinking. The effect of population-oriented policies may be mediated though effects on adults. These findings suggest that efforts to reduce youth drinking should rely on policies that address all age groups. Dr Xuan helped design the study, supervised statistical analysis, interpreted data and results, and drafted and revised the manuscript; Mr Blanchette coordinated data collection on alcohol policies, contributed to the development of the Alcohol Policy Scale, conducted statistical analyses, interpreted data and results, and made critical revisions of the manuscript for important intellectual content; Dr Nelson contributed to conception and design of the study, contributed to interpretation of data results, and made critical revisions of the manuscript for important intellectual content; Ms Nguyen collect...