wim van dalen; wvandalen@stap · home/ environment clear non-drinking rules, warm social live etc....

Alcohol: a poison for young people

06 June Cluj , Romania

Wim van Dalen;

wvandalen@stap.nl

Alcohol in Europe

•! The European Region has the highest levels of alcohol consumption and alcohol related harm in the entire world.

•! Alcohol is the second leading risk factor for disease burden in Europe.

•! The cost of alcohol related harm to the EU economy is estimated to be 125 billion euros a year and claims approximately 195,000 lives each year in the EU.3

But big differences between countries – Total consumption 2009 (including unrecorded)

Austria 13.0 Latvia -

Belgium 11.8 Lithuania 13.2

Bulgaria 11.5 Luxembourg 12.3

Cyprus 9.5 Malta 8.0

Czech Republic 16.6 Netherlands 9.7

Denmark 12.9 Poland 13.6

Estonia 14.0 Portugal 13.2

Finland 12.2 Romania 16.3

France 12.7 Slovakia 14.6

Germany 12.9 Slovenia 15.3

Greece 10.5 Spain 13.1

Hungary 13.5 Sweden 9.1

Ireland 12.9 United Kingdom 12.1

Italy 9.6

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Alcohol: Public health relevance

•! 3rd leading cause of disability in Europe;

•! 24% of adults hazardous/harmful drinkers; 4% alcohol dependence

•! Consumption doubled in adolescents in past 10 yrs

•! Alcohol related hospital admissions doubled in last 8 years

•! Alcohol dependence years of potential life lost: 25 years

1

2

3

4

5

6

7

0 10 20 30 40 50 60 70 80 90 100 110 120

grams alcohol per day

Rela

tive r

isk

Cancer of oral cavity

Haemorrhagic stroke

Hypertension

Pancreatitis

Breast cancer

Strangers --

Relatives or partners

Household members

Friends

Co-workers

Children

7%

11%

More serious 46%

In some way 70%

11%

5%

5%

Respondent

Survey findings: who has been affected in the last year (Room, 2012)?

•! Deaths 367

•! Hospitalisations 13,669

•! Child protection cases 19,443

•! Domestic assault police cases 24,581

•! Assaults – public places, etc. 44,852

•! Hospital costs, crash injuries $30m

•! Hospital costs, assault victims $59m

•! Child protection system costs $672m

Severe effects in 2008 from others’ drinking (Australia:

in a population of 21.3 million) Laslett, A.-M., Catalano, P., Chikritzhs, T., Dale, C., Doran, C., Ferris, J., Jainullabudeen, T., Livingston, M., Matthews, D., Mugavin,

J., Room, R., Schlotterlein, M. & Wilkinson, C. (2010) The Range and Magnitude of Alcohol’s Harm to Others. Canberra: AERF.

To summarise: harm to others (fact sheet: Harm done by alcohol ESCA, 2012)

•! Nearly 10% of children in the EU live in families suffering under alcohol misuse

•! Alcohol is a cause of child abuse in 16% of child abuse cases in Europe

•! Alcohol is a cause in 40% of all domestic violence cases in Europe

•! 19% of all homicides of children in Europe are due to alcohol

•! Alcohol is a major factor in fire fatalities impairment due to alcohol, illegal or prescription drugs is a factor in 80% of fatal House fire

•! 23% of all fatal road traffic injuries of children ages 0 to 15 are due to alcohol

Children of alcoholics (Cuypers; 2005; review study)

•! 8-27% of children have at least one parent with a drinking problem

•! Risks: problem drinking during childhood, increased risk of depression, eating and conduct disorders, delinquency, abuse etc. ;

•! But most of them will not develop any mental disorders

•! Genetics are one or the important causal factor for the increased risk of problem drinker (esp. sons of male pd)

•! Less evidence based prevention programs

Children of alcoholics: prevention programs (Cuypers; 2005; review study)

•! Components: social support, information, skills training, coping with emotional problems

•! Types op programs: -treat the parents

-primary prevention for future parents

-prevention of FAS(D).

-school-based programs

-12 step self help

-strengthening Families programs

-online programs (e-help)

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 (Hibell

et all 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 (Hibell et all 2012)

HBSC (2009/2010 report)/ ESPAD

Cross-national study of Health behaviour in School-Aged Children (11-15) and European School Survey Project on Alcohol and Other Drugs (ESPAD) (15-16); 2011,

Some conclusions:

•! Drinking levels in EU steady, not increasing

•! Risk groups: early starters (11-13) and excessive drinkers (15)

•! Remarkable differences between countries

•! Gender gap declined (1998-2006)

•! Adolescence is key-period for intervention/prevention

Alcohol use and problems amongst 29,445 Australians surveyed in 2004 (Source: Livingstone & Room 2009)

Alcohol and young people: top countries (HBSC); 2009/2010

Top early starters (11)

Top early drinkers (13)

Top early drunk (15)

Top lowest levels (11-15)

Romania Czeck Rep Denmark Norway

Armenia Ukrain Lithuania Iceland

Ukrain Romania Wales (UK) Finland

Czeck Rep. Croatia Greenland USA

Italy Wales (UK) Latvia Sweden

Risk factors and protective factors (IVO, The Netherlands, 2010)

context Risk factors Protective factors

Society Easy availibilty of alcohol

Effective local and national alcohol policy

Low price/ discounts

MUP

Marketing

Restrictions of the volume of marketing

Low legal purchasing age

Legal Age of 18/ 18+

Low compliance rate of legal age limits

Effective enforcement

Risk factors and protective factors (IVO, The Netherlands, 2010)

context Risk factors Protective factors

community Unsafe school environment

Save school environment

Low educational level High school results

Alcohol use of friends Supportive friends

Frequent visit of bars etc Effective local alcohol policy

parents Unsafe/social poor home/ environment

Clear non-drinking rules, warm social live etc.

Risk factors and protective factors (IVO, The Netherlands, 2010)

context Risk factors Protective factors

Personal Genetic/

Brain deficiences

Anxiety sensivity

Sensation seeking

Behavioral disturbances

Etc etc

Young people make up a disproportionate number of fatalities in which alcohol is a factor (fact sheet: Harm done by alcohol ESCA, 2012)

•! Binge drinking among European adolescents both male and female

is increasing: 80 million European children 15 years of age

report binge drinking once a week

Young people make up a disproportionate number of fatalities in which alcohol is a factor (fact sheet: Harm done by alcohol ESCA, 2012)

•! Worldwide, alcohol plays a factor

in 1 in every 4 deaths of young

men age 15 – 29,

approximately 320,000 deaths a year,

often due to motor traffic accidents,

suicide, violence, falls, or other injuries

Young people make up a disproportionate number of fatalities in which alcohol is a factor (fact sheet: Harm done by alcohol ESCA, 2012)

Whilst young people in Europe are starting

heavy drinking at earlier ages,

at the same time the availability and

range of inexpensive alcoholic drinks

has greatly increased, with young

drinkers being by far the most frequent

consumers of these products

Young people make up a disproportionate number of fatalities in which alcohol is a factor (fact sheet: Harm done by alcohol ESCA, 2012)

•! The adolescent brain is especially susceptible to alcohol, and the longer consumption is delayed, the less likely it is that alcoholic dependence will become a problem in adulthood.

•! Functionel activity in the brains

of two 15 year old youngsters;

right is drinking from his 12th

(Susan Tapert California)

Developmental neuroscience: brain develops well

into the third decennium

Normal cortical thinning during adolesence (Gogtay et al. 2004)

•! Developing systems are more vulnerable to disturbance

by external factors, such as alcohol

•! Developmental neuroscience: brain develops well into the third

decennium

Normal cortical thinning during adolesence (Gogtay et al. 2004)

•! Developing systems are more vulnerable to disturbance

by external factors, such as alcohol

Alcohol and pregnancy

•! Netherlands: 35-50% of pregnant

women drink (Health Council of the

Netherlands)

Spain: 45% of babies in Barcelona

heavily exposed (Garcia-Algar, 2008)

Ireland: 63% of women drink during

pregnancy (Coombe Women's Hospital, Dublin)

FAS

37

Alcohol and Pregnancy

•! Alcohol is responsible for 60,000 underweight births per year in the EU, nearly half of which are within the EU

•! FAS (foetal alcohol syndrome) and FASD (foetal alcohol spectrum disorders): prenatal exposure to alcohol can cause a range of intellectual and motor function deficits, and may be the most common cause of mental disabilities in the EU, more common than both Down

•! Some deficits associated with FAS and FASD worsen as the individuals reach adolescence, possibly contributing to an increased rate of mental health disorders in Europe.

FAS and FASD

•! Difficult to know how much

•! Passive reports underestimate

prevalence

•! Preference for "no guilty" diagnoses

(ADHD, PDD-NOS, cerebral palsy, etc.)

•! Estimated 1 to 3 per thousand full FAS

•! Estimated 5- to 10-fold more FASD

Imprinting child consumers

6 months - child is forming mental images of corporate logos and mascots

3 years old (before they can read), 20 % of US kids request brand-name products

8 years old - as children’ s thinking evolves from concrete towards more abstract ideas they can respond to structured

questions about brands

10 years old - kids start to appreciate subtle differences of brand value and imagery develop.

From 10 onwards loyalty increases sharply and peaks at about 30.

European Public Health Alliance (2005)

The tween years (8-14)

•! Not only do children influence the brands they buy for themselves and the ones bought for them like breakfast cereals or soft drinks, but they also influence many expensive household purchases. Examples include cars, furniture and adult fashion.

•! 8 out of 10 ‘tweens’ need to feel part of a group, to belong. ‘Fish streaming’ means that children with older siblings look up to tweens and aspire to use their brands and products

•! (Millward Brown interviews with 100 000 children in 35 countries)

•! European Public Health Alliance (2005)

Awareness of Alcohol marketing to young people of 13-years of age

•! adverts on TV: 77%

•! billboards or posters: 53%

•! in store promotions: 55%

•! branded clothing/other items: 66%

•! special price offers: 60%

•! mobile logos or screensavers: 24%

•! web pages or pop-ups: 12%

•! Source: ISM research (Institute for Social Marketing),

Hastings & Gordon, Brussels 2008

Sponsorship of Sports, Music, Fashion, Film

Bavaria City Racing Moscou

Heineken sneakers

Grolsch & Loveland festival

SKYY wodka & Sex and the City The Movie

Puschkin: Push the Edge parties

Internet and social media are booming business

The long term effect of exposure to alcohol marketing:

•! Start earlier with drinking alcohol;

•! Drink higher quantities of alcohol

at one occasion (binge drinking);

•! Consume alcohol more frequently.

Conclusion of a review of 13 longitudinal studies (Anderson et al 2009, Smith & Foxcroft 2009) and the Science Group of the EAHF:

Youngsters who are more exposed to alcohol advertisements:

European youth is targeted and reached

Amphora study shows that among 13 & 14 year olds in GE, IT, NL and PL:

•! 1 out of 3 received promotional e-mails from alcohol brands;

•! 1 out of 5 looked at a web site for alcohol brands/drinking;

•! 1 out of 5 downloaded a mobile phone or computer screensaver containing an alcohol brand name or logo;

•! 1 out of 3 used a profile page on social media sites like facebook with an alcohol brand or logo;

•! 2 out of 3 noticed an internet page that contained an alcohol advertisement

Ownership promotional items $

Receiving promotional email $

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Standardized Beta

Looked at a web site for alcohol brands Downloaded a mobile phone or computer screensaver containing an alcohol brand Used a profile page on social media sites containing alcohol brand

Televised alcohol advertisement

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Underage Drinking Logic Model

Underage Drinking

Social availability of alcohol to

youth (parties, peers, families)

Retail Sale of alcohol to

youth

Underage drinking

laws

Community norms about

youth drinking

Visible enforcement

Price

•! Thanks for your attention

•! Wim van Dalen

- Director of STAP (Dutch Institute for Alcohol Policy)

- President of EUCAM (European Centre for Alcohol

Marketing)

-e-mail: wvandalen@stap.nl

-tel: 00 31 6 53295544

- : @wimvandalen

Utrecht, The Netherlands

06-06-2013