Numerous developmental changes occur across levels of personal organization (eg, changes related to puberty, brain and cognitive-affective structures and functions, and family and peer relationships) in the age period of 10 to 15 years. Furthermore, the onset and escalation of alcohol use commonly occur during this period. This article uses both animal and human studies to characterize these multilevel developmental changes. The timing of and variations in developmental changes are related to individual differences in alcohol use. It is proposed that this integrated developmental perspective serve as the foundation for subsequent efforts to prevent and to treat the causes, problems, and consequences of alcohol consumption.

OBJECTIVES: To document quantity and cash value of underage and adult Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)-defined abusive and dependent drinking as well as underage drinking and adult DSM-IV-defined abusive and dependent drinking combined to the alcohol industry.

DESIGN: Analysis of multiple cross-sectional national data sets.

SETTING: The 2001 National Household Survey on Drug Abuse, the 2001 Youth Risk Behavior Survey, the 2001 Behavioral Risk Factor Surveillance Survey, the 2000 US Census, the 2000 to 2001 National Epidemiological Survey on Alcohol and Related Conditions, and the 2001 Adams Business Research.

PARTICIPANTS: A total of 260,580 persons aged 12 years and older across 4 data sources.

MAIN EXPOSURE: Underage drinking or pathological drinking defined as meeting the DSM-IV criteria for abusive or dependent drinking.

MAIN OUTCOME MEASURES: Total amount of alcohol consumed and the cash value for alcohol consumed among underage and adult drinkers with DSM-IV-defined alcohol abuse and dependence as well as all underage drinkers combined with adult drinkers with DSM-IV-defined alcohol abuse and dependence.

RESULTS: The short-term cash value of underage drinking to the alcohol industry was 22.5 billion dollars in 2001-17.5% of total consumer expenditures for alcohol. The long-term commercial value of underage drinking is the contribution of underage drinking to maintaining consumption among adult drinkers with alcohol abuse and dependence, which was equal to at least 25.8 billion dollars in 2001.

CONCLUSIONS: The combined value of illegal underage drinking and adult pathological drinking to the industry was at least 48.3 billion dollars, or 37.5% of consumer expenditures for alcohol, in 2001. Alternative estimates suggest that these costs may be closer to 62.9 billion dollars, or 48.8% of consumer expenditures for alcohol.

Wagenaar et al.'s meta-analysis assessing the impact of price on drinking in this issue of Addiction is a true tour de force that will serve as an invaluable resource for researchers, public health practitioners, alcohol control advocates and policy makers for many years to come. Using state-of-the-art methods applied to a comprehensive set of English-language studies from economics and other social sciences, public health and other fields, they demonstrate clearly that higher alcoholic beverage taxes and prices reduce alcohol use. They find that this applies across beverages, with spirits and wine consumption more responsive to price than beer drinking, and that it applies to not only overall consumption, but also to measures of heavy drinking.These findings provide a strong rationale for using increases in alcoholic beverage taxes to promote public health by reducing drinking. Further support comes from the extensive literature that examines the relationships between alcoholic beverage taxes and prices and a variety of consequences of alcohol use and abuse. The Centers for Disease Control and Prevention estimate that excessive alcohol use resulted in 79 000 deaths annually in the United States from 2001 to 2005. In a recent study, Wagenaar and his colleagues found that the 1983 and 2002 alcoholic beverage tax increases in Alaska reduced alcohol-related disease mortality significantly, including deaths from liver cirrhosis, acute alcohol poisoning, alcohol-related cancers, cardiovascular diseases and others. In a series of studies, Markowitz et al. have shown that higher alcoholic beverage taxes and prices reduce violence, including spouse abuse, child abuse, suicide and other violent crime. Others have documented the reductions in fatal traffic crashes among youth, young adults and adults caused by alcohol that result from higher taxes and prices. Still others have shown that higher alcohol taxes and prices reduce other health consequences of alcohol use and abuse, including non-fatal work-place accidents , teenage pregnancy and the incidence of sexually transmitted diseases. At the same time, higher alcoholic beverage taxes and prices can improve educational outcomes among youths and young adults. In addition to the public health toll resulting from the morbidity, mortality and violence it causes, alcohol use and abuse impose substantial economic costs. The most recent estimates for the United States indicate that the economic costs of alcohol abuse were nearly $200 billion in 1998. Economists have shown that existing alcoholic beverage taxes fall well short of the costs that alcohol abusers impose on society. Despite the large and growing literature that higher alcoholic beverage taxes would reduce drinking and its consequences significantly, many governments are unwilling to raise these taxes. The stability of these taxes results in inflation eroding their value over time and, as a result, to declining real alcoholic beverage prices. In the United States, for example, rare federal tax increases and infrequent state tax increases have contributed to a sharp reduction in inflation-adjusted beer, wine and spirits prices over the past few decades. Given Wagenaar et al.'s findings on the relationships between prices and drinking, these falling prices have led to more drinking than would have been the case had taxes and prices kept pace with inflation and, as a result, greater consequences from alcohol abuse. This stands in clear contrast to cigarette taxes in the United States, which have risen sharply over the past two decades, raising inflation-adjusted cigarette prices and reducing significantly youth smoking initiation and leading many adult smokers to quit.The price elasticity estimates from Wagenaar et al.'s meta-analysis demonstrate that higher alcoholic beverage taxes can both reduce drinking and its consequences and raise new revenues for governments. The inelastic estimates they obtain for beer, wine, spirits and overall alcohol consumption imply that the quantity of alcohol consumed falls relatively less than price rises. For example, their estimated price elasticity of -0.44 for total alcohol means that a 10% increase in alcoholic beverage prices would reduce overall alcohol consumption by 4.4%. Given that alcohol beverage taxes account for only a fraction of the price of alcohol, relatively large increases in taxes will raise prices by a smaller percentage. If, for example, alcohol taxes account for one-quarter of alcoholic beverage prices, a doubling of the tax will raise the price by 25% (assuming that the tax is passed on fully to consumers). This price increase would reduce consumption by 11% while at the same time resulting in a nearly 80% rise in alcoholic beverage tax revenues.Perhaps the current economic downturn and resulting revenue needs of governments, coupled with the strong evidence-base on the benefits of higher taxes and prices reviewed thoroughly by Wagenaar et al. and others, will stimulate national and subnational governments to raise their alcoholic beverage taxes.

BACKGROUND: Entertainment media exposure may predict teenager alcohol use, but few longitudinal studies have been reported.

METHODS: A longitudinal study was conducted of 2708 German adolescents aged 10 to 16 years who had never drunk alcohol. Each adolescent was surveyed at school about daily television use, whether they had a television in their bedroom, and their exposure to movie alcohol depictions. Adolescents were resurveyed 12 to 13 months later (retention rate: 85%) to determine onset of drinking alcohol without parental knowledge and binge drinking (>/=5 consecutive drinks).

RESULTS: Overall, 885 (33%) students initiated alcohol use without parental knowledge (17% in quartile 1 movie alcohol exposure), and 387 (14%) initiated binge drinking during follow-up. After controlling for baseline covariates, exposure to movie alcohol use significantly increased percent initiating alcohol use (to 24% in exposure quartile 2, 33% in quartile 3 and 34% in quartile 4) and percent initiating binge drinking (to 8.6% in exposure quartile 2, 12% in quartile 3 and 13% in quartile 4). Having a television in the bedroom also predicted both outcomes, but daily television use did not.

CONCLUSIONS: Movie exposure and having a television in the bedroom are both independent predictors of onset of problematic alcohol use among German teenagers. Media restrictions could play a role in prevention.

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