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Parental supply of alcohol to Australian minors: an analysis of six nationally representative surveys spanning 15 years

Parental supply of alcohol to Australian minors: an analysis of six nationally representative... Background: Most adolescents begin alcohol consumption during adolescence, heavy alcohol use by adolescents is common, and alcohol-related harm amongst adolescents is a major public health burden. Parents are a common source of alcohol amongst adolescents, but little is known about how parental supply of alcohol has changed over recent years. This study examines national trends in parental supply of alcohol to adolescent children in Australia since 1998. Methods: Six Australian National Drug Strategy Household Surveys (1998–2013) yielded rates of parental supply of current and first ever alcohol consumed. Lifetime and current alcohol use were also estimated. The surveys were conducted for households across all Australian states and territories. Surveyed adolescents were aged 14–17 years (N = 7357, 47.6 % male). Measures included the reported source of currently consumed alcohol and first ever alcoholic beverage (parents/friends/others), lifetime alcohol use, number of standard alcohol units consumed on drinking days, and frequency of alcohol use. Corrected Pearson chi-squared tests were used to compare survey years. Results: There was a significant drop in parental supply of current alcohol use from 21.3 % in 2004 to 11.79 % in 2013 (p < .001). The lower prevalence of parental supply coincided with legislative changes on parental supply of alcohol to adolescents, but causality cannot be established because of the variation in the timing and reach of parental supply legislation, and small samples in some states. There were downward trends in adolescent experimentation, quantity and frequency of alcohol use across years, with the largest drop in alcohol use in 2010 and 2013. Conclusions: In Australia, there has been a substantial reduction in parental supply of alcohol to adolescents from 2010, and this factor may partially account for reductions in adolescent alcohol use. Keywords: Adolescent, Alcohol, Parent, Parental supply, Nationally representative Background have been intoxicated [13]. In Australia, 74 % of 14 year In Western countries, alcohol use and misuse amongst olds and 90.9 % of 17 year olds have ever consumed adolescents is very common. For example, in England, alcohol. Consumption of more than 4 drinks on one day 74 % of 15 year olds had consumed alcohol and 27 % in the past 7 days occurs for 2.6 % and 18.5 % of 14 and had been intoxicated in the past four weeks [11]. In the 17 year old Australians respectively [29]. Adolescent United States, 68.2 % of 12th Graders (18–19 years of alcohol use involves substantial risks, including alcohol- age) have consumed alcohol and 50 % report that they related injury and assault [17], early sexual debut [22], depression [6], adult alcohol abuse/dependence [20], and premature death [27]. Alcohol may also more adversely * Correspondence: [email protected] affect brain function in adolescents than adults [12]. Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane QLD 4072, Australia Full list of author information is available at the end of the article © 2016 Kelly et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Kelly et al. BMC Public Health (2016) 16:325 Page 2 of 8 In most Western industrialised countries there is no conducted in 1998, 2001, 2004, 20010 and 2013. The legislated minimum age for alcohol use. Age-related re- NDSHS is conducted in all Australian States and terri- strictions commonly relate to the purchase of alcohol tories, with an overall sample size of over 20,000 at each (e.g., under 21 years of age in the United States, under survey (except for 1998 where n = 10,340). For the 18 years of age in Australia and the UK), entry to present study, only data for participants aged 14–17 licensed clubs and other venues, and consumption of years of age were analyzed. The sample size for this age alcohol in unlicensed venues or spaces. The high preva- group, and demographic statistics, including age, gender, lence of alcohol use amongst minors indicates that ado- and socioeconomic advantage/disadvantage are pre- lescents frequently obtain alcohol from other sources, sented in Table 1. There were no statistically significant most often parents and/or peers [10]. Around 35-38 % differences in age and regional composition across the of adolescents in Australia and England report that a surveys. There were significant differences across the sur- parent supplied them with alcohol [7, 28, 30]. While par- veys in gender, socio-economic advantage/disadvantage, ents frequently cite harm minimization as the rationale and country of birth (ps < .05). However, the differences for supplying alcohol to their children [8, 15], there is were very small (Cramer’s V = 0.05 for socioeconomic ad- little evidence this practice is protective. A review of 22 vantage/disadvantage, 0.06 for country of birth, and 0.04 cross-sectional and longitudinal studies found that par- for gender) and the data were weighted to adjust for these ental supply increased alcohol-related risks and had few, imbalances during survey execution. The response rates if any, protective effects [14]. Some Australian research for 14–17 year old participants ranged from 46 % to 56 % suggests that effects of parental supply on adolescent across surveys (Table 1) and these rates were comparable alcohol use may be significant when alcohol use is un- to other Australian surveys [29]. supervised rather than supervised, but there is insuffi- cient research on the moderating effects of supervision Measures to draw firm conclusions [14]. In response to the high Current source of alcohol prevalence of adolescent alcohol use/misuse an parental This was assessed by ‘Where do you usually obtain your supply of alcohol, national guidelines in Australia and alcohol now?’ The response options were friend or ac- the United Kingdom on alcohol use recommend that quaintance brother or sister, parent, spouse or partner, people under 18 years of age delay the initiation of alco- other relative, stole it, purchased it myself from retailer, hol use for as long as possible, and that people under other and can’t recall. Participants were required to 15 years of age should abstain from any alcohol use mark only one response. Data on the following endorse- [5, 19]. Over the period 2010–2014, a number of ments were included in this analysis: Friend or acquaint- Australian states legislated to make it a criminal ance, Parent, Brother or sister, Other relative and offence for adults other than parents/guardians or Purchased it myself from retailer. those acting with the permission of parents to provide alcohol to persons under the legal age for alcohol Source of first alcoholic beverage purchase. Assessed by ‘Who supplied you with the first glass of The aim of this study was to examine the prevalence alcohol you consumed?’ The response categories and of adolescent alcohol use and parental supply of alcohol format were the same as for Current source of alcohol. to adolescents using nationally representative Australian survey data from 1998 to 2013. We focused on adoles- Alcohol use cents aged 14–17 years of age because these cover the Four dimensions of alcohol use were assessed–lifetime years immediately prior to when alcohol purchase and li- prevalence of trying alcohol, lifetime prevalence of ever censed venue entry is legal in Australia. It is also the consuming a full serve of alcohol, frequency of alcohol use period when alcohol use and misuse often escalates [16]. in last 12 months (Weekly/Less than weekly/Ex-drinker/ We also explored the adolescents’ reports of who Non-drinker), and number of standard drinks on a drink- supplied their first ever alcoholic beverage. Parental ing day (‘On a day that you have an alcoholic drink, how influences on alcohol use tend to be stronger during many standard drinks do you usually have?’,Non-current early adolescence than for later periods [3], so parental drinker/2 or less/3-4/5 or more). For this age group, the provision of alcohol at this age may have longer-term measure of having 5 or more drinks in a drinking day significance. wasusedasanapproximate measurefor drinking to intoxication [4]. Methods Sample Demographic variables The sample was drawn from tri-annual consecutive Socioeconomic advantage/disadvantage was based on National Drug Strategy Household Surveys (NDSHS) Socioeconomic Indexes for Areas (SEIFA) scores [1] Kelly et al. BMC Public Health (2016) 16:325 Page 3 of 8 Table 1 Sample characteristics of adolescent participants from 1998 to 2013 1998 2001 2004 2007 2010 2013 N % N % N %N %N %N % Total sample size 10340 26744 29445 23356 26648 23855 Sample size of the age group 14-17 1062 10.27 1477 5.52 1852 6.29 1066 4.56 1075 4.03 825 3.46 Male 517 48.68 718 48.61 838 45.25 503 47.19 501 46.6 404 48.97 Age 14 269 24.48 311 21.06 453 24.46 247 23.17 242 22.51 188 22.79 15 266 25.05 366 24.78 463 25.00 256 24.02 275 25.58 197 23.88 16 263 24.76 404 27.35 469 25.32 289 27.11 264 24.56 224 27.15 17 273 25.72 396 26.81 467 25.22 274 25.7 294 27.35 216 26.18 Regionality–living in major cities - - 1157 62.47 694 65.1 676 62.88 542 65.70 Socioeconomic advantage Least advantaged - 246 16.66 296 15.98 171 16.09 171 15.91 143 17.33 2nd quintile - 345 23.36 357 19.28 193 18.16 236 21.95 158 19.15 3rd quintile - 234 15.84 348 18.79 188 17.69 185 17.21 141 17.09 4th quintile - 228 15.44 433 23.38 250 23.52 226 21.02 185 22.42 Most advantaged - 424 28.71 418 22.57 261 24.55 257 23.91 198 24.00 Australian born 933 87.85 1295 87.68 1657 90.99 911 89.05 936 90.00 702 85.30 Response Rate 56 50 46 49 51 49 a b The coding for area of residence in Australia was different in 1998 and 2001, and was therefore not comparable. This information was not available in the 1998 survey. This is the overall response rate of the survey SEIFA scores are based on population census vari- letter from the Director of the AIHW and brochure de- ables related to disadvantage, such as low income, scribing the study, and the confidentiality and anonymity low educational attainment, unemployment, and of participation. Participants were provided with a dedi- dwellings without motor vehicles. Regionality was cated free call number that was set up and managed by derived from postcode and was coded as “major cit- the Australian Institute of Health and Welfare to deal ies”, “inner regional”, “outer regional” and “remote with respondent concerns and queries, as well as an- and very remote”. other dedicated free call number managed by the government-appointed survey contractors. Signed con- Procedure sent (from parents/guardians) was only obtained for Each NDSHS was approved by the Australian Institute those under 16 years of age. If participants were 16 years of Health and Welfare Ethics Committee. Access to old or older, signed consent was not required, and these survey data by the Centre for Youth Substance participants were taken to have given informed con- Abuse Research was approved by the Australian Social sent via letter/brochure scaffolding and completion of Science Data Archive and by The University of Queens- the questionnaire. If collection was not possible a land Human Research Ethics Committee. For each pre-paid, pre-addressed envelope was provided and a NDSHS, households were randomly selected using a follow-up reminder telephone call was made. multi-stage stratified design based on statistical local For the 1998, 2001, 2004 and 2007 surveys, data areas [1], with oversampling for small geographical collection was augmented by face-to-face interviews locations. and/or Computer-Assisted Telephone Interviews. For National surveys were conducted by an independent all methods the respondent was the household mem- research company under the direction of the Australian ber who was aged at least 14 or older (1998–2001) or Institute of Health and Welfare (AIHW). Interviewers 12 years or older (2004–2013) next to have a birth- were located across Australian States and Territories, day. Signed parent/guardian consent was obtained for and underwent training sessions prior to data collection. persons under 16 years of age. Individual consent was Data were predominately obtained through a ‘drop and required from respondents over the age of 16 years of collect’ method across the six surveys (60-100 %). Self- age. In cases where questionnaires were not returned completion questionnaires were delivered and collected or could not be collected, a non-response was re- to/from households. Householders were provided with a corded. Across all survey years, response rates ranged Kelly et al. BMC Public Health (2016) 16:325 Page 4 of 8 from 46-56 % (see Table 1). Further information on parents from 2007, and reductions in parental supply design and methods of the NDSHS can be found appeared more substantial than reductions in supply by elsewhere [2]. To address any potential disparity aris- friends over this period. ing from the survey design or its implementation, and Adolescents reported that friends and parents were to align the samples with the Australian population, the sources of their first alcohol beverage, with very weights were applied to the data based on geographic similar prevalence rates from 1998 to 2007 (range stratum. All analyses were performed in Stata 13 24.3 % to 27.9 %). Siblings and other sources were com- using the svy command to account for the complex paratively rare as a source of first alcoholic beverage. In survey design [26]. Corrected Pearson chi-squared 2010 and 2013 there was a substantial and significant tests were performed to compare the prevalence sta- drop (p < .05) in the proportion of adolescents reporting tistics across different year of the survey. that parents supplied their first alcoholic beverage–from 24.3 % in 2007 to 15.0 % and 13.9 % in 2010 and 2013 Results respectively (see Fig. 2). There was no evidence that the Over most survey years, friends were the dominant decrease in parental supply was compensated for by an- current sources of alcohol (varying from 28.4 % in 1998 other source of first alcoholic beverage. Friends as the to 17.8 % in 2013) and parents the second most preva- source of first alcoholic beverage did not differ between lent current source of alcohol (14.9 % in 1998 to 22.4 % 2010 and previous surveys (around a quarter of the sam- in 2007). Compared to 1998, parental supply of alcohol ple across years), and there was a significant drop in this increased in a statistically significant fashion from 1998 rate in 2013 (from 25.4 % in 2010 to 20.2 %, p = .020). (14.9 % of the total sample) to 2004 and 2007 (21.3 % The rate of obtaining the first alcoholic beverage from and 22.4 % respectively for the total sample) before de- siblings did not differ in 2010 compared to previous sur- creasing to 11.8 % of the total sample in the 2013 survey veys but there was a significant drop in this rate in 2013 (see Fig. 1). The overlap of confidence intervals for par- (from 3.09 % to 1.45 %, p = .024). There was no mean- ental supply in 1998 and 2013 suggested a return to ingful change in the prevalence of obtaining alcohol 1998 levels. Friends’ supply of alcohol showed a down- from other relatives and retail outlets. ward trend from 27.9 % in 1998 to 20.2 % in 2013. There Corresponding trends in self-reported alcohol use was no significant change in the rate of friend’s supply of are presented in Fig. 3. There were substantial de- alcohol from 1998 to 2010 but this rate dropped signifi- creases in lifetime alcohol use (ever tried any, ever cantly in 2013 (from 24.7 % in 2010 to 17.8 %). There had a full serve, see Fig. 3). From 1998 to 2007, the was a large decrease in the rate of (illegal) purchase of prevalence of ever tried alcohol was 87-90 %. This alcohol over the six surveys from 11.6 % in 1998 to dropped statistically significantly in 2010 (79.3 %) and 0.7 % in 2013 (p < .05) (see Table 2). Overall, there was a 2013 (67.8 %). There were significant and substantial reduction in the supply of alcohol from friends and drops in lifetime prevalence rates for having had a Friends Parents Siblings Other relatives Purchase 1998 2001 2004 2007 2010 2013 Fig. 1 Top five sources of current alcohol consumed Kelly et al. BMC Public Health (2016) 16:325 Page 5 of 8 Friends Parents Siblings Other relatives Purchase 1998 2001 2004 2007 2010 2013 Year Fig. 2 Top five sources of first alcohol beverage consumed full serve of alcohol from 70.1 % in 1998 to 44.4 % in Discussion 2013 (p < .05). The frequency of alcohol use also The present study used data from nationally representa- dropped significantly and substantially between 1998 tive surveys across 15 years to describe reductions in and 2013 (Fig. 4). In particular, the prevalence of adolescent (aged 14 to 17) reports of supply of current weekly drinking decreased from 20.7 % to 5.1 % in alcohol by parent and friends’ since 2007. There was also this period. This decrease was accompanied by a sig- an approximate halving of the rates at which adolescents nificant drop in the rate of heavy drinking, defined as reported parental supply of their first alcoholic beverage having 5 or more drinks in a day, which dropped (26.5 % for 1998 participants compared to 13.9 % for from 32.1 % in 1998 to 14.4 % in 2013 (Fig. 5). 2013 participants). There were reductions in the rates of A supplementary analysis was performed to examine friends’ supply of alcohol in the 2013 surveys (both first changes in parental supply of alcohol through logistic ever alcoholic beverage and currently consumed alco- regression. Whether the adolescent obtained alcohol hol), and there were reductions in the self-reported from the parent was regressed on survey year, con- rates of purchasing alcohol. There were downward trolling forage,genderand birthplace.Results from trends in most measures of alcohol use, with reduc- this analysis indicated that compared to 2004, adoles- tions falling to below 1998 rates in 2010. The rates of cents in 2010 and 2013 were significantly less likely heavy alcohol use also fell to below 1998 rates from to obtain alcohol from parents (OR = 0.50, p < .001 for 2004 onwards. These results are good news for stake- 2010 and OR = 0.49, p < .001 for 2013). holders in adolescent health. Ever tried alcohol Ever had a full serve of alcohol 1998 2001 2004 2007 2010 2013 Year Fig. 3 Trends in life time abstinence Percentage Percentage Kelly et al. BMC Public Health (2016) 16:325 Page 6 of 8 Weekly Less than weekly Ex-drinker (had alcohol in last 12 months but quit drinking) Non-drinker (past 12 months) 1998 2001 2004 2007 2010 2013 Year Fig. 4 Trends in alcohol use in past 12 months The causal role of legislative and other interventions is are consistent with other Australian research that paren- impossible to determine from survey data. Results do tal supply increases rather than decreases alcohol con- point to several feasible links between alcohol supply sumption [14]. It is also in line with Australian and sources and adolescent alcohol use. From 2007, reduc- American longitudinal research showing that adult- tions in parental supply of alcohol coincided with reduc- supervision of adolescent alcohol use is associated with tions in two of the three indices of adolescent alcohol increased alcohol use and alcohol-related harms [18]. use (weekly alcohol use and lifetime abstinence). This Our findings suggested that the decrease in parental was also the case for heavy alcohol use but it was clear supply was not compensated for by other sources of al- that heavy alcohol use was on a strong downward trend cohol. Over 2010 and 2013, there was no corresponding prior for the surveys prior to 2007. These findings are increases in rates of obtaining alcohol from these other consistent with the possibility that parental supply rates sources. Rather, the results indicated a general reduction may have a stronger impact on the initiation of alcohol in adolescent alcohol use, which is consistent with use than on heavy alcohol use, and that other factors are downward trends in their major potential sources of al- likely to have contributed to reductions in heavy alcohol cohol. Our findings are also consistent with the possibil- use. The findings in relation to changes in alcohol use ity that cultural changes in adolescent alcohol use in Australia have reduced pressure on parents to provide alcohol, at least in the early phases of alcohol use. Fur- ther research is needed on changing attitudes towards alcohol use, alcohol misuse and health enhancement and risk amongst young Australians. There is a need for further research on the impact of legislative changes with respect to supply of alcohol to people under 18 years of age (minors). In Australia, there has been considerable variability in the timing and nature of legislative changes on parental supply across Australian States and Territories. In the Australian Capital Territory (ACT), Western Australia (WA) and South Australia (SA), secondary supply of alcohol con- sumed in private residences is unregulated [21]. It is an offence for an individual other than a parent or guardian or authorized person to supply alcohol to a minor on 5+ standard drinks in a day private premises in New South Wales (NSW, introduced 2007), Northern Territory (NT, introduced 2011), 1998 2001 2004 2007 2010 2013 Queensland (QLD, introduced 2009), Tasmania (TAS, Year introduced 2009) and Victoria (VIC, introduced 2011) Fig. 5 Trends for 5+ standard drinks a day [21]. Of the five Australian jurisdictions that have Percentage Percentage Kelly et al. BMC Public Health (2016) 16:325 Page 7 of 8 secondary supply legislation, three (NT, QLD and TAS) survey data by the Centre for Youth Substance Abuse have legislated that alcohol consumption by a minor Research was approved by the Australian Social Science needs to be supervised by the responsible parent or Data Archive and by The University of Queensland guardian who supplied the alcohol [21]. There are two Human Research Ethics Committee. Signed parental basic challenges in exploring links between the passage consent was obtained for adolescents under 16 years of of parental supply legislation and adolescent alcohol age. If participants were 16 years old or older, signed use. First, there is considerable variation in the tim- consent was not required, and participants were taken to ing, extent and content of parental supply legislation have given informed consent via letter/brochure scaf- between different states and territories. Second, it is folding and completion of the questionnaire. unclear to what extent governments have been effect- ive in getting public health messages across to parents Consent for publication about supplying alcohol. A national prevention trial Not applicable. targeting parental supply is currently underway in Australia [24] and should provide clearer evidence on Availability of data and materials the impact of reduced availability of alcohol on ado- The datasets on which these findings are available lescent alcohol use. through the Australian Institute of Health and Welfare. Despite its nationally representative nature and the co- Abbreviations incidence of reduced parental supply of alcohol and ACT: Australian Capital Territory; NDSHS: national drug strategy household some measures of adolescent alcohol use, the cross- survey; NSW: New South Wales; NT: Northern Territory; QLD: Queensland; sectional data preclude strong inferences about causal SA: South Australia; TAS: Tasmania; VIC: Victoria; WA: Western Australia. factors. Parental supply may have reduced adolescent al- Competing interests cohol use, or parents may have experienced less pressure The authors declare that they have no competing interests. to supply alcohol to their adolescent children, or the two Authors’ contributions factors may be epiphenomenal to other cultural changes ABK drafted the manuscript. GCKC completed the key analyses and drafted in adolescent health behavior. The present study did not tables and figures. MW and CQ managed the databases and data coding, control for the density of liquor outlets, which is a and provided input and feedback on the results section. MJG provided feedback on the analysis and results and commented on the final draft. JPC known associate of adolescent alcohol use [23]. There assisted with the writing of sections relating to Australian alcohol policy and were also a range of other potential parental influences provided feedback on the manuscript. WDH provided feedback on the on adolescent alcohol use which were not assessed, in- manuscript and revised it for important intellectual content. All authors read and approved the final manuscript. cluding parents’ own alcohol use, general discipline, and parent–child relationship quality [25]. We could not Funding examine parental supply of alcohol in supervised versus Data analysis was supported by Australian Research Council Discovery Project DP130102015 to Adrian B. Kelly and Jason P. Connor. Jason P. Connor unsupervised settings, which is associated with variation is supported by a National Health and Medical Research Council (NHMRC) of in risky adolescent alcohol use [9]. The surveys depend Australia Career Development Fellowship (APP1031909). Matthew J. Gullo is on the reliability of adolescent reports and while there supported by a NHMRC of Australia Early Career Fellowship (APP1036365). The authors acknowledge the Australian Institute of Health and Welfare and were changes to data collection methods that coincide the Australian Data Archive as the source of the NDSHS. The authors thank with reductions in parental supply, this downward Professor Ross McD. Young for review and comments on an earlier draft of trend was consistent with findings in representative this manuscript. The Centre for Youth Substance Abuse Research receives core funding for its research from the Graeme Wood Foundation. school surveys of adolescent alcohol use [29]. The same conclusion was also reached from comparisons Author details between the drop-and-collect subsamples in 2007, and Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane QLD 4072, Australia. Centre for Youth Substance Abuse Research, 2010 and 2013 (which only used drop-and-collect Queensland University of Technology, Brisbane, Australia. School of surveys). Medicine, The University of Queensland, Brisbane, Australia. Received: 15 September 2015 Accepted: 6 April 2016 Conclusion In Australia there have been recent reductions in the rates of parental supply of alcohol to adolescents. It remains un- References clear to what extent legislative changes in parental supply 1. ABS. Socio-economic indices for areas. Canberra: Australian Bureau of Statistics; 2009. Retrieved from http://www.abs.gov.au/AUSSTATS/[email protected]/ and broader cultural changes were responsible for reduc- webpages/statistics?opendocument. tions in parental supply and adolescent alcohol use. 2. Australian_Institute_of_Health_and_Welfare. National Drug Strategy Household Survey Detailed Report: 2013. Canberra: Australian Institute of Health and Welfare; 2014. Ethics approval and consent to participate 3. Capaldi DM, Stoolmiller M, Kim HK, Yoerger K. 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Parental supply of alcohol to Australian minors: an analysis of six nationally representative surveys spanning 15 years

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Springer Journals
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2016 Kelly et al.
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1471-2458
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10.1186/s12889-016-3004-2
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Abstract

Background: Most adolescents begin alcohol consumption during adolescence, heavy alcohol use by adolescents is common, and alcohol-related harm amongst adolescents is a major public health burden. Parents are a common source of alcohol amongst adolescents, but little is known about how parental supply of alcohol has changed over recent years. This study examines national trends in parental supply of alcohol to adolescent children in Australia since 1998. Methods: Six Australian National Drug Strategy Household Surveys (1998–2013) yielded rates of parental supply of current and first ever alcohol consumed. Lifetime and current alcohol use were also estimated. The surveys were conducted for households across all Australian states and territories. Surveyed adolescents were aged 14–17 years (N = 7357, 47.6 % male). Measures included the reported source of currently consumed alcohol and first ever alcoholic beverage (parents/friends/others), lifetime alcohol use, number of standard alcohol units consumed on drinking days, and frequency of alcohol use. Corrected Pearson chi-squared tests were used to compare survey years. Results: There was a significant drop in parental supply of current alcohol use from 21.3 % in 2004 to 11.79 % in 2013 (p < .001). The lower prevalence of parental supply coincided with legislative changes on parental supply of alcohol to adolescents, but causality cannot be established because of the variation in the timing and reach of parental supply legislation, and small samples in some states. There were downward trends in adolescent experimentation, quantity and frequency of alcohol use across years, with the largest drop in alcohol use in 2010 and 2013. Conclusions: In Australia, there has been a substantial reduction in parental supply of alcohol to adolescents from 2010, and this factor may partially account for reductions in adolescent alcohol use. Keywords: Adolescent, Alcohol, Parent, Parental supply, Nationally representative Background have been intoxicated [13]. In Australia, 74 % of 14 year In Western countries, alcohol use and misuse amongst olds and 90.9 % of 17 year olds have ever consumed adolescents is very common. For example, in England, alcohol. Consumption of more than 4 drinks on one day 74 % of 15 year olds had consumed alcohol and 27 % in the past 7 days occurs for 2.6 % and 18.5 % of 14 and had been intoxicated in the past four weeks [11]. In the 17 year old Australians respectively [29]. Adolescent United States, 68.2 % of 12th Graders (18–19 years of alcohol use involves substantial risks, including alcohol- age) have consumed alcohol and 50 % report that they related injury and assault [17], early sexual debut [22], depression [6], adult alcohol abuse/dependence [20], and premature death [27]. Alcohol may also more adversely * Correspondence: [email protected] affect brain function in adolescents than adults [12]. Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane QLD 4072, Australia Full list of author information is available at the end of the article © 2016 Kelly et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Kelly et al. BMC Public Health (2016) 16:325 Page 2 of 8 In most Western industrialised countries there is no conducted in 1998, 2001, 2004, 20010 and 2013. The legislated minimum age for alcohol use. Age-related re- NDSHS is conducted in all Australian States and terri- strictions commonly relate to the purchase of alcohol tories, with an overall sample size of over 20,000 at each (e.g., under 21 years of age in the United States, under survey (except for 1998 where n = 10,340). For the 18 years of age in Australia and the UK), entry to present study, only data for participants aged 14–17 licensed clubs and other venues, and consumption of years of age were analyzed. The sample size for this age alcohol in unlicensed venues or spaces. The high preva- group, and demographic statistics, including age, gender, lence of alcohol use amongst minors indicates that ado- and socioeconomic advantage/disadvantage are pre- lescents frequently obtain alcohol from other sources, sented in Table 1. There were no statistically significant most often parents and/or peers [10]. Around 35-38 % differences in age and regional composition across the of adolescents in Australia and England report that a surveys. There were significant differences across the sur- parent supplied them with alcohol [7, 28, 30]. While par- veys in gender, socio-economic advantage/disadvantage, ents frequently cite harm minimization as the rationale and country of birth (ps < .05). However, the differences for supplying alcohol to their children [8, 15], there is were very small (Cramer’s V = 0.05 for socioeconomic ad- little evidence this practice is protective. A review of 22 vantage/disadvantage, 0.06 for country of birth, and 0.04 cross-sectional and longitudinal studies found that par- for gender) and the data were weighted to adjust for these ental supply increased alcohol-related risks and had few, imbalances during survey execution. The response rates if any, protective effects [14]. Some Australian research for 14–17 year old participants ranged from 46 % to 56 % suggests that effects of parental supply on adolescent across surveys (Table 1) and these rates were comparable alcohol use may be significant when alcohol use is un- to other Australian surveys [29]. supervised rather than supervised, but there is insuffi- cient research on the moderating effects of supervision Measures to draw firm conclusions [14]. In response to the high Current source of alcohol prevalence of adolescent alcohol use/misuse an parental This was assessed by ‘Where do you usually obtain your supply of alcohol, national guidelines in Australia and alcohol now?’ The response options were friend or ac- the United Kingdom on alcohol use recommend that quaintance brother or sister, parent, spouse or partner, people under 18 years of age delay the initiation of alco- other relative, stole it, purchased it myself from retailer, hol use for as long as possible, and that people under other and can’t recall. Participants were required to 15 years of age should abstain from any alcohol use mark only one response. Data on the following endorse- [5, 19]. Over the period 2010–2014, a number of ments were included in this analysis: Friend or acquaint- Australian states legislated to make it a criminal ance, Parent, Brother or sister, Other relative and offence for adults other than parents/guardians or Purchased it myself from retailer. those acting with the permission of parents to provide alcohol to persons under the legal age for alcohol Source of first alcoholic beverage purchase. Assessed by ‘Who supplied you with the first glass of The aim of this study was to examine the prevalence alcohol you consumed?’ The response categories and of adolescent alcohol use and parental supply of alcohol format were the same as for Current source of alcohol. to adolescents using nationally representative Australian survey data from 1998 to 2013. We focused on adoles- Alcohol use cents aged 14–17 years of age because these cover the Four dimensions of alcohol use were assessed–lifetime years immediately prior to when alcohol purchase and li- prevalence of trying alcohol, lifetime prevalence of ever censed venue entry is legal in Australia. It is also the consuming a full serve of alcohol, frequency of alcohol use period when alcohol use and misuse often escalates [16]. in last 12 months (Weekly/Less than weekly/Ex-drinker/ We also explored the adolescents’ reports of who Non-drinker), and number of standard drinks on a drink- supplied their first ever alcoholic beverage. Parental ing day (‘On a day that you have an alcoholic drink, how influences on alcohol use tend to be stronger during many standard drinks do you usually have?’,Non-current early adolescence than for later periods [3], so parental drinker/2 or less/3-4/5 or more). For this age group, the provision of alcohol at this age may have longer-term measure of having 5 or more drinks in a drinking day significance. wasusedasanapproximate measurefor drinking to intoxication [4]. Methods Sample Demographic variables The sample was drawn from tri-annual consecutive Socioeconomic advantage/disadvantage was based on National Drug Strategy Household Surveys (NDSHS) Socioeconomic Indexes for Areas (SEIFA) scores [1] Kelly et al. BMC Public Health (2016) 16:325 Page 3 of 8 Table 1 Sample characteristics of adolescent participants from 1998 to 2013 1998 2001 2004 2007 2010 2013 N % N % N %N %N %N % Total sample size 10340 26744 29445 23356 26648 23855 Sample size of the age group 14-17 1062 10.27 1477 5.52 1852 6.29 1066 4.56 1075 4.03 825 3.46 Male 517 48.68 718 48.61 838 45.25 503 47.19 501 46.6 404 48.97 Age 14 269 24.48 311 21.06 453 24.46 247 23.17 242 22.51 188 22.79 15 266 25.05 366 24.78 463 25.00 256 24.02 275 25.58 197 23.88 16 263 24.76 404 27.35 469 25.32 289 27.11 264 24.56 224 27.15 17 273 25.72 396 26.81 467 25.22 274 25.7 294 27.35 216 26.18 Regionality–living in major cities - - 1157 62.47 694 65.1 676 62.88 542 65.70 Socioeconomic advantage Least advantaged - 246 16.66 296 15.98 171 16.09 171 15.91 143 17.33 2nd quintile - 345 23.36 357 19.28 193 18.16 236 21.95 158 19.15 3rd quintile - 234 15.84 348 18.79 188 17.69 185 17.21 141 17.09 4th quintile - 228 15.44 433 23.38 250 23.52 226 21.02 185 22.42 Most advantaged - 424 28.71 418 22.57 261 24.55 257 23.91 198 24.00 Australian born 933 87.85 1295 87.68 1657 90.99 911 89.05 936 90.00 702 85.30 Response Rate 56 50 46 49 51 49 a b The coding for area of residence in Australia was different in 1998 and 2001, and was therefore not comparable. This information was not available in the 1998 survey. This is the overall response rate of the survey SEIFA scores are based on population census vari- letter from the Director of the AIHW and brochure de- ables related to disadvantage, such as low income, scribing the study, and the confidentiality and anonymity low educational attainment, unemployment, and of participation. Participants were provided with a dedi- dwellings without motor vehicles. Regionality was cated free call number that was set up and managed by derived from postcode and was coded as “major cit- the Australian Institute of Health and Welfare to deal ies”, “inner regional”, “outer regional” and “remote with respondent concerns and queries, as well as an- and very remote”. other dedicated free call number managed by the government-appointed survey contractors. Signed con- Procedure sent (from parents/guardians) was only obtained for Each NDSHS was approved by the Australian Institute those under 16 years of age. If participants were 16 years of Health and Welfare Ethics Committee. Access to old or older, signed consent was not required, and these survey data by the Centre for Youth Substance participants were taken to have given informed con- Abuse Research was approved by the Australian Social sent via letter/brochure scaffolding and completion of Science Data Archive and by The University of Queens- the questionnaire. If collection was not possible a land Human Research Ethics Committee. For each pre-paid, pre-addressed envelope was provided and a NDSHS, households were randomly selected using a follow-up reminder telephone call was made. multi-stage stratified design based on statistical local For the 1998, 2001, 2004 and 2007 surveys, data areas [1], with oversampling for small geographical collection was augmented by face-to-face interviews locations. and/or Computer-Assisted Telephone Interviews. For National surveys were conducted by an independent all methods the respondent was the household mem- research company under the direction of the Australian ber who was aged at least 14 or older (1998–2001) or Institute of Health and Welfare (AIHW). Interviewers 12 years or older (2004–2013) next to have a birth- were located across Australian States and Territories, day. Signed parent/guardian consent was obtained for and underwent training sessions prior to data collection. persons under 16 years of age. Individual consent was Data were predominately obtained through a ‘drop and required from respondents over the age of 16 years of collect’ method across the six surveys (60-100 %). Self- age. In cases where questionnaires were not returned completion questionnaires were delivered and collected or could not be collected, a non-response was re- to/from households. Householders were provided with a corded. Across all survey years, response rates ranged Kelly et al. BMC Public Health (2016) 16:325 Page 4 of 8 from 46-56 % (see Table 1). Further information on parents from 2007, and reductions in parental supply design and methods of the NDSHS can be found appeared more substantial than reductions in supply by elsewhere [2]. To address any potential disparity aris- friends over this period. ing from the survey design or its implementation, and Adolescents reported that friends and parents were to align the samples with the Australian population, the sources of their first alcohol beverage, with very weights were applied to the data based on geographic similar prevalence rates from 1998 to 2007 (range stratum. All analyses were performed in Stata 13 24.3 % to 27.9 %). Siblings and other sources were com- using the svy command to account for the complex paratively rare as a source of first alcoholic beverage. In survey design [26]. Corrected Pearson chi-squared 2010 and 2013 there was a substantial and significant tests were performed to compare the prevalence sta- drop (p < .05) in the proportion of adolescents reporting tistics across different year of the survey. that parents supplied their first alcoholic beverage–from 24.3 % in 2007 to 15.0 % and 13.9 % in 2010 and 2013 Results respectively (see Fig. 2). There was no evidence that the Over most survey years, friends were the dominant decrease in parental supply was compensated for by an- current sources of alcohol (varying from 28.4 % in 1998 other source of first alcoholic beverage. Friends as the to 17.8 % in 2013) and parents the second most preva- source of first alcoholic beverage did not differ between lent current source of alcohol (14.9 % in 1998 to 22.4 % 2010 and previous surveys (around a quarter of the sam- in 2007). Compared to 1998, parental supply of alcohol ple across years), and there was a significant drop in this increased in a statistically significant fashion from 1998 rate in 2013 (from 25.4 % in 2010 to 20.2 %, p = .020). (14.9 % of the total sample) to 2004 and 2007 (21.3 % The rate of obtaining the first alcoholic beverage from and 22.4 % respectively for the total sample) before de- siblings did not differ in 2010 compared to previous sur- creasing to 11.8 % of the total sample in the 2013 survey veys but there was a significant drop in this rate in 2013 (see Fig. 1). The overlap of confidence intervals for par- (from 3.09 % to 1.45 %, p = .024). There was no mean- ental supply in 1998 and 2013 suggested a return to ingful change in the prevalence of obtaining alcohol 1998 levels. Friends’ supply of alcohol showed a down- from other relatives and retail outlets. ward trend from 27.9 % in 1998 to 20.2 % in 2013. There Corresponding trends in self-reported alcohol use was no significant change in the rate of friend’s supply of are presented in Fig. 3. There were substantial de- alcohol from 1998 to 2010 but this rate dropped signifi- creases in lifetime alcohol use (ever tried any, ever cantly in 2013 (from 24.7 % in 2010 to 17.8 %). There had a full serve, see Fig. 3). From 1998 to 2007, the was a large decrease in the rate of (illegal) purchase of prevalence of ever tried alcohol was 87-90 %. This alcohol over the six surveys from 11.6 % in 1998 to dropped statistically significantly in 2010 (79.3 %) and 0.7 % in 2013 (p < .05) (see Table 2). Overall, there was a 2013 (67.8 %). There were significant and substantial reduction in the supply of alcohol from friends and drops in lifetime prevalence rates for having had a Friends Parents Siblings Other relatives Purchase 1998 2001 2004 2007 2010 2013 Fig. 1 Top five sources of current alcohol consumed Kelly et al. BMC Public Health (2016) 16:325 Page 5 of 8 Friends Parents Siblings Other relatives Purchase 1998 2001 2004 2007 2010 2013 Year Fig. 2 Top five sources of first alcohol beverage consumed full serve of alcohol from 70.1 % in 1998 to 44.4 % in Discussion 2013 (p < .05). The frequency of alcohol use also The present study used data from nationally representa- dropped significantly and substantially between 1998 tive surveys across 15 years to describe reductions in and 2013 (Fig. 4). In particular, the prevalence of adolescent (aged 14 to 17) reports of supply of current weekly drinking decreased from 20.7 % to 5.1 % in alcohol by parent and friends’ since 2007. There was also this period. This decrease was accompanied by a sig- an approximate halving of the rates at which adolescents nificant drop in the rate of heavy drinking, defined as reported parental supply of their first alcoholic beverage having 5 or more drinks in a day, which dropped (26.5 % for 1998 participants compared to 13.9 % for from 32.1 % in 1998 to 14.4 % in 2013 (Fig. 5). 2013 participants). There were reductions in the rates of A supplementary analysis was performed to examine friends’ supply of alcohol in the 2013 surveys (both first changes in parental supply of alcohol through logistic ever alcoholic beverage and currently consumed alco- regression. Whether the adolescent obtained alcohol hol), and there were reductions in the self-reported from the parent was regressed on survey year, con- rates of purchasing alcohol. There were downward trolling forage,genderand birthplace.Results from trends in most measures of alcohol use, with reduc- this analysis indicated that compared to 2004, adoles- tions falling to below 1998 rates in 2010. The rates of cents in 2010 and 2013 were significantly less likely heavy alcohol use also fell to below 1998 rates from to obtain alcohol from parents (OR = 0.50, p < .001 for 2004 onwards. These results are good news for stake- 2010 and OR = 0.49, p < .001 for 2013). holders in adolescent health. Ever tried alcohol Ever had a full serve of alcohol 1998 2001 2004 2007 2010 2013 Year Fig. 3 Trends in life time abstinence Percentage Percentage Kelly et al. BMC Public Health (2016) 16:325 Page 6 of 8 Weekly Less than weekly Ex-drinker (had alcohol in last 12 months but quit drinking) Non-drinker (past 12 months) 1998 2001 2004 2007 2010 2013 Year Fig. 4 Trends in alcohol use in past 12 months The causal role of legislative and other interventions is are consistent with other Australian research that paren- impossible to determine from survey data. Results do tal supply increases rather than decreases alcohol con- point to several feasible links between alcohol supply sumption [14]. It is also in line with Australian and sources and adolescent alcohol use. From 2007, reduc- American longitudinal research showing that adult- tions in parental supply of alcohol coincided with reduc- supervision of adolescent alcohol use is associated with tions in two of the three indices of adolescent alcohol increased alcohol use and alcohol-related harms [18]. use (weekly alcohol use and lifetime abstinence). This Our findings suggested that the decrease in parental was also the case for heavy alcohol use but it was clear supply was not compensated for by other sources of al- that heavy alcohol use was on a strong downward trend cohol. Over 2010 and 2013, there was no corresponding prior for the surveys prior to 2007. These findings are increases in rates of obtaining alcohol from these other consistent with the possibility that parental supply rates sources. Rather, the results indicated a general reduction may have a stronger impact on the initiation of alcohol in adolescent alcohol use, which is consistent with use than on heavy alcohol use, and that other factors are downward trends in their major potential sources of al- likely to have contributed to reductions in heavy alcohol cohol. Our findings are also consistent with the possibil- use. The findings in relation to changes in alcohol use ity that cultural changes in adolescent alcohol use in Australia have reduced pressure on parents to provide alcohol, at least in the early phases of alcohol use. Fur- ther research is needed on changing attitudes towards alcohol use, alcohol misuse and health enhancement and risk amongst young Australians. There is a need for further research on the impact of legislative changes with respect to supply of alcohol to people under 18 years of age (minors). In Australia, there has been considerable variability in the timing and nature of legislative changes on parental supply across Australian States and Territories. In the Australian Capital Territory (ACT), Western Australia (WA) and South Australia (SA), secondary supply of alcohol con- sumed in private residences is unregulated [21]. It is an offence for an individual other than a parent or guardian or authorized person to supply alcohol to a minor on 5+ standard drinks in a day private premises in New South Wales (NSW, introduced 2007), Northern Territory (NT, introduced 2011), 1998 2001 2004 2007 2010 2013 Queensland (QLD, introduced 2009), Tasmania (TAS, Year introduced 2009) and Victoria (VIC, introduced 2011) Fig. 5 Trends for 5+ standard drinks a day [21]. Of the five Australian jurisdictions that have Percentage Percentage Kelly et al. BMC Public Health (2016) 16:325 Page 7 of 8 secondary supply legislation, three (NT, QLD and TAS) survey data by the Centre for Youth Substance Abuse have legislated that alcohol consumption by a minor Research was approved by the Australian Social Science needs to be supervised by the responsible parent or Data Archive and by The University of Queensland guardian who supplied the alcohol [21]. There are two Human Research Ethics Committee. Signed parental basic challenges in exploring links between the passage consent was obtained for adolescents under 16 years of of parental supply legislation and adolescent alcohol age. If participants were 16 years old or older, signed use. First, there is considerable variation in the tim- consent was not required, and participants were taken to ing, extent and content of parental supply legislation have given informed consent via letter/brochure scaf- between different states and territories. Second, it is folding and completion of the questionnaire. unclear to what extent governments have been effect- ive in getting public health messages across to parents Consent for publication about supplying alcohol. A national prevention trial Not applicable. targeting parental supply is currently underway in Australia [24] and should provide clearer evidence on Availability of data and materials the impact of reduced availability of alcohol on ado- The datasets on which these findings are available lescent alcohol use. through the Australian Institute of Health and Welfare. Despite its nationally representative nature and the co- Abbreviations incidence of reduced parental supply of alcohol and ACT: Australian Capital Territory; NDSHS: national drug strategy household some measures of adolescent alcohol use, the cross- survey; NSW: New South Wales; NT: Northern Territory; QLD: Queensland; sectional data preclude strong inferences about causal SA: South Australia; TAS: Tasmania; VIC: Victoria; WA: Western Australia. factors. Parental supply may have reduced adolescent al- Competing interests cohol use, or parents may have experienced less pressure The authors declare that they have no competing interests. to supply alcohol to their adolescent children, or the two Authors’ contributions factors may be epiphenomenal to other cultural changes ABK drafted the manuscript. GCKC completed the key analyses and drafted in adolescent health behavior. The present study did not tables and figures. MW and CQ managed the databases and data coding, control for the density of liquor outlets, which is a and provided input and feedback on the results section. MJG provided feedback on the analysis and results and commented on the final draft. JPC known associate of adolescent alcohol use [23]. There assisted with the writing of sections relating to Australian alcohol policy and were also a range of other potential parental influences provided feedback on the manuscript. WDH provided feedback on the on adolescent alcohol use which were not assessed, in- manuscript and revised it for important intellectual content. All authors read and approved the final manuscript. cluding parents’ own alcohol use, general discipline, and parent–child relationship quality [25]. We could not Funding examine parental supply of alcohol in supervised versus Data analysis was supported by Australian Research Council Discovery Project DP130102015 to Adrian B. Kelly and Jason P. Connor. Jason P. Connor unsupervised settings, which is associated with variation is supported by a National Health and Medical Research Council (NHMRC) of in risky adolescent alcohol use [9]. The surveys depend Australia Career Development Fellowship (APP1031909). Matthew J. Gullo is on the reliability of adolescent reports and while there supported by a NHMRC of Australia Early Career Fellowship (APP1036365). The authors acknowledge the Australian Institute of Health and Welfare and were changes to data collection methods that coincide the Australian Data Archive as the source of the NDSHS. The authors thank with reductions in parental supply, this downward Professor Ross McD. Young for review and comments on an earlier draft of trend was consistent with findings in representative this manuscript. The Centre for Youth Substance Abuse Research receives core funding for its research from the Graeme Wood Foundation. school surveys of adolescent alcohol use [29]. The same conclusion was also reached from comparisons Author details between the drop-and-collect subsamples in 2007, and Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane QLD 4072, Australia. Centre for Youth Substance Abuse Research, 2010 and 2013 (which only used drop-and-collect Queensland University of Technology, Brisbane, Australia. School of surveys). 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Journal

BMC Public Health – Springer Journals

Published: Dec 1, 2016

Keywords: public health; medicine/public health, general; epidemiology; environmental health; biostatistics; vaccine

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