Risk Taking and Big-Screen Drinking Influence Teen Bingeing

Neil Osterweil

November 15, 2013

BOSTON — Teenagers who binge on alcohol appear to be influenced more by personal attributes and popular culture than they are by proximity to liquor stores and bars, say investigators.

Adolescents who are sensation seekers and those who are exposed to drinking in movies and television are more likely to binge drink than peers, regardless of whether they live in dry counties or areas awash in retail alcohol outlets, said Heather A. Carlos, MS, a Geospatial Analyst at the Norris Cotton Cancer Center and Geisel School of Medicine at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire.

"We know that youth obtain alcohol from peer social networks, but they also buy it in retail outlets, whether it's using the 'shoulder tap' [asking a stranger to buy alcohol on their behalf], fake ID, or a clerk that looks the other way," she said here at the American Public Health Association (APHA) 141st Annual Meeting.

A 2012 meta-analysis ( Health & Place. 2012;16:349-357) found evidence to suggest that higher retail alcohol outlet density and exposure to alcohol in advertising could be associated with increased drinking, especially among adolescents. However, the studies incorporated in the meta-analysis used a wide range of exposure variables, making it impossible to accurately compare the size of the associations. In addition, most of the studies were conducted at the local or regional, rather than national, level, she noted.

To see whether they could get a better handle on the problem, Carlos and colleagues looked at data on binge drinking and alcohol availability from a cross-sectional study of 3622 adolescents, aged 13 to 19 years, from the contiguous 48 states.

They then created and compared with their participant sample a national dataset from geocoded addresses of outlets where alcohol is sold for consumption off premises, including gas stations, discount stores, department stores, convenience stores, pharmacy and drug stores, supermarkets and other grocery stores, and beer, wine, and liquor stores. Bars were included as the only on-premise sites where teenagers might drink illicitly; restaurants were excluded from the sample because adolescents do not typically get alcohol there, Carlos said.

Surprising Findings

To their surprise, the researchers found in univariate logistic regression models a significant negative association with density variables and binge drinking. In other words, the more outlets a teenager has access to, the less likely he or she is to be a binge drinker (P for association = .02535).

Conversely, and also surprisingly, there was a positive association between distance from an outlet and the likelihood of drinking, so that adolescents far away from the nearest source of alcohol were more likely to binge when they got their hands on booze (P = .03116).

When they looked at the influence of various variables, they found that sensation-seeking behavior was most strongly associated with the probability of binge drinking, followed by alcohol exposure in movies.

Although they did not see an association between alcohol outlet proximity and binge drinking, it is possible that other teenage drinking behaviors might be influenced by the availability of alcohol. The findings may also not apply to adults, Carlos acknowledged.

Discrepant Results

A clinician who was not involved in the study, Norman Giesbrecht, PhD, senior scientist at the Centre for Addiction and Mental Health at the University of Toronto, Ontario, Canada, tells Medscape Medical News that although the investigators looked at only 1 aspect of teenaged drinking, other studies have suggested an association between liquor proximity and drinking problems.

For example, when British Columbia transitioned from a system of provincially controlled sales of liquor to a partially private system, investigators there found an increase in alcohol consumption and an increase in drinking-and-driving problems associated with the increase in density of alcohol sales, Dr. Giesbrecht noted.

"In the general population, there seems to be pretty strong evidence that access, measured let's say by the density of outlets, pricing, and other measures, tends to be associated with higher damage, higher rates of problems, and higher rates of consumption," he said.

An addiction counselor who works with teenagers and parents tells Medscape Medical News that in her practice, the availability of alcohol does make a difference.

"I know that on an individual basis, we do talk about access. If somebody is trying to abstain from drinking, it might be wise to not have alcohol in the house for a little while," commented Sandra Rasmussen, PhD, RN, an addiction therapist at Williamsville Wellness in Richmond, Virginia.

There is also evidence to show that risk-taking behaviors can be both negative and positive and that the challenge for clinicians is to help adolescents channel those behaviors into positive activities as a way to lessen the need to binge, she said.

The study was internally supported. Carlos, Dr. Giesbrecht, and Dr. Rasmussen have disclosed no relevant financial relationships.

American Public Health Association (APHA) 141st Annual Meeting: Abstract 281707. Presented November 5, 2013.

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