Community level alcohol availability and enforcement of possession laws as predictors of youth drinking

Abstract

Background. Despite a minimum legal drinking age, many young people use alcohol. Environmental strategies to control youth drinking focus on restricting access and the enforcement of possession laws. This study examines the relationship between use of these strategies and the frequency of youth alcohol use and related problems.

Methods. Participants were 16,694 students, ages 16–17 in 92 communities in Oregon. A multi-level analysis of a repeated cross-sectional statewide student survey was conducted. The outcome measures examined include 30-day frequency of alcohol use, binge drinking, use of alcohol at school, and drinking and driving.

Results. The rate of illegal merchant sales in the communities directly related to all four alcohol-use outcomes. There was also evidence that communities with higher minor in possession law enforcement had lower rates of alcohol use and binge drinking. The use of various sources in a community expanded and contracted somewhat depending on levels of access and enforcement.

Conclusions. This evidence provides empirical support for the potential utility of local efforts to maintain or increase alcohol access control and possession enforcement.

Introduction

Despite nationwide adoption of a 21-year-old minimum legal drinking age, national surveys consistently indicate that young people use alcohol frequently. For example, the 2002 Monitoring the Future (MTF) survey reveals that, by their senior year in high school, 78% of adolescents reported having experimented with alcohol, 49% report drinking within the previous month, 30% report being intoxicated during the previous month, and 29% report heavy episodic drinking (having five or more drinks in a row) during the past 2 weeks [1]. Adolescent alcohol use, and especially heavy episodic drinking, is related to a wide variety of problem behaviors including drinking and driving, fighting, truancy, theft, assault, and precocious and risky sexual activities [2], [3], [4], [5]. In addition to the immediate costs of underage drinking, early initiation to drinking may also be associated with other adverse outcomes, including increased risk for the development of alcohol abuse and dependence later in life [6].

Young people secure alcohol from a variety of commercial and social sources. Research indicates that while parties, friends, and adult purchasers are the most common sources of alcohol among adolescents [7], [8], [9], [10], commercial outlets are also used. Purchase surveys reveal that anywhere from 30% to 90% of outlets will sell alcohol to underage or apparent underage buyers, depending upon their geographical location [8], [11], [12], [13], [14], [15].

Traditionally, adolescent drinking and drinking problem prevention strategies have relied on programs that attempt to reduce demand by providing new information, teaching new skills, or countering erroneous normative beliefs [16], [17]. Demand reduction programs, however, cannot provide a complete answer to the problem of drinking by young people, as evidenced by their somewhat limited success in reducing alcohol use [18], [19], [20], [21]. In part, this limitation arises because young people are immersed in a broader social context in which alcohol is readily available and glamorized [22].

In contrast to demand reduction approaches, environmental strategies focus on policy, legal/regulatory changes, and enforcement [22], [23]. Many environmental interventions directly target the availability of alcohol to underage drinkers by increasing personal or economic costs associated with providing it. Research shows that even moderate increases in enforcement can reduce sales of alcohol to minors by as much as 35% to 40%, especially when combined with strategic media advocacy and other community and policy activities [13], [24].

Although community-level restrictions on alcohol availability to youth and increased enforcement of minor possession laws are becoming increasingly important as local intervention strategies, [25] few studies have investigated the effects of alcohol availability and possession enforcement at the local level on consumption by young people [21], [22]. As a result, little is known about how increased enforcement and resulting changes in local availability of alcohol are related to reductions in alcohol use and alcohol-related problems among young people. Measures of availability of alcohol have been found to predict drinking and related problems in adults [26], [27], [28]. More recently, alcohol outlet density has been related to ease of underage purchase of alcohol [29] and to frequency of underage drinking and driving and riding with drinking drivers [30]. In one experimental study addressing changes in availability on youth drinking [24], it was found that while a comprehensive environmentally focused program, which included enforcement of sales laws as one of several components, led to increases in checking age identification by alcohol merchants and reduced sales to minors, it had no observed effects on drinking by high school students. In part, this absence of effects may have resulted from a lack of statistical power because of the relative small number of communities in the study (N = 15). This pattern of findings may also have resulted because adolescents often obtain alcohol from a variety of non-commercial sources that may not have been affected by the program.

In the current study, we examine the strength and variations in the relationship of social and commercial alcohol access sources to youth drinking in a population-based survey conducted in 93 communities. We further investigate the community level variations in the use of these sources as a function of community level indictors of local commercial availability and enforcement of minor in possession (MIP) laws.