Etiologic mechanisms in an adapted family-based preventive intervention for underage alcohol use in Mexico: Results of an exploratory pilot study.

Alcohol use represents a global health problem, especially for Latin American youth. As part of the Global Smart Drinking Goals campaign, a family-based preventive intervention was adapted and piloted in Mexico based on an existing evidence-based program, Guiding Good Choices. In this study, we explored the malleability and session-specific mean-level changes in protective and risk factors targeted by the adapted family intervention as related to the prevention of underage alcohol use and abuse. The sample consisted of 177 parents working at four private local companies who had children between the ages of 8 and 16. Data were collected before and after each program session. Linear mixed-effects models were used to examine growth trajectories and session-specific mean differences for selected etiologic factors. Significant effects on protective and risk factors were found. Among protective factors, positive family involvement showed the most considerable linear growth over time, while clear standards for youth showed the largest within-session increase. The greatest linear decrease in risk was observed for family conflict, which also showed the greatest pre-, and post-session reduction. Our findings suggest that the adapted program helped families develop protection against, and reduce risk of, alcohol use in their adolescent children. Results from this exploratory pilot study provide support for further rigorous evaluation and dissemination of the adapted intervention for Hispanic families.

Impact of minimum unit pricing on youth alcohol consumption: insights from Lebanon.

This paper analyses the impact of introducing an alcohol minimum unit pricing policy on youth's off-premise alcohol consumption. We rely on price elasticities derived using stated preference alcohol purchase data from a survey of 1024 university students in Lebanon. Selectively targeting drinks with high ethanol concentration by applying a minimum unit pricing (MUP) corresponding to the maximum price that respondents are willing to pay per beverage achieves a reduction in ethanol intake close to 0.23 l/month (∼28% of pre-MUP ethanol intake). Imposing a flat MUP corresponding to the average price respondents are willing to pay for all alcoholic beverages decreases ethanol intake by nearly half the reduction from the previous targeted MUP. This work provides evidence in favour of MUP in conjunction with taxation capable of substantially reducing alcohol consumption. We also document a positive welfare benefit of MUP.

Youth drinking in decline: What are the implications for public health, public policy and public debate?

Youth drinking has declined across most high-income countries in the last 20 years. Although researchers and commentators have explored the nature and drivers of decline, they have paid less attention to its implications. This matters because of the potential impact on contemporary and future public health, as well as on alcohol policy-making. This commentary therefore considers how youth drinking trends may develop in future, what this would mean for public health, and what it might mean for alcohol policy and debate. We argue that the decline in youth drinking is well-established and unlikely to reverse, despite smaller declines and stabilising trends in recent years. Young people also appear to be carrying their lighter drinking into adulthood in at least some countries. This suggests we should expect large short- and long-term public health benefits. The latter may however be obscured in population-level data by increased harm arising from earlier, heavier drinking generations moving through the highest risk points in the life course. The likely impact of the decline in youth drinking on public and policy debate is less clear. We explore the possibilities using two model scenarios, the reinforcement and withdrawal models. In the reinforcement model, a 'virtuous' circle of falling alcohol consumption, increasing public support for alcohol control policies and apparent policy successes facilitates progressive strengthening of policy, akin to that seen in the tobacco experience. In the withdrawal model, policy-makers turn their attention to other problems, public health advocates struggle to justify proposed interventions and existing policies erode over time as industry actors reassert and strengthen their partnerships with government around alcohol policy. We argue that disconnects between the tobacco experience and the reinforcement model make the withdrawal model a more plausible scenario. We conclude by suggesting some tentative ways forward for public health actors working in this space.

A systematic narrative review of the effects of alcohol supply reduction policies on children and adolescents.

BACKGROUND: Children are often exposed to increased rates of secondary harm such as physical harm, motor vehicle incidents, maltreatment, and neglect because of others' or their own alcohol consumption. Alcohol supply reduction, or alcohol control policies, are often enacted to mitigate alcohol harms within the community. The current systematic narrative review aims to synthesise recent literature that examines how alcohol supply reduction policies impact the physical health, mental health, and offending behaviour of children and adolescents. METHODS: Eight databases and grey literature sources were systematically searched, and results were synthesised by policy under evaluation. Twenty-one peer reviewed articles and ten grey literature articles were included after screening of 7,135 original articles. Included articles examined the alcohol control policies of the minimum legal drinking age, price control, and trading restrictions, with the most common outcomes under evaluation being related to the physical health or offending behaviour of adolescents. RESULTS: Overall, the current review identified that the impact of alcohol policy on children and adolescents varied depending on the policy type, policy environment and assessed outcome. Common limitations within the literature include inability to control for covariates, use of alcohol related outcomes unsuitable to children and adolescents, and use of cross-sectional data and regression-discontinuity analysis in lieu of actual policy changes. CONCLUSIONS: The current review highlights the need to further evaluate the impact of actual alcohol-related policy changes on children and adolescents.

Insight into Selecting Adolescents for Drinking Intervention Programs: a Simulation Based on Stochastic Actor-Oriented Models.

Adolescent drinking remains a prominent public health and socioeconomic issue in the USA with costly consequences. While numerous drinking intervention programs have been developed, there is little guidance whether certain strategies of participant recruitment are more effective than others. The current study aims at addressing this gap in the literature using a computer simulation approach, a more cost-effective method than employing actual interventions. We first estimate stochastic actor-oriented models for two schools from the National Longitudinal Study of Adolescent to Adult Health (Add Health). We then employ different strategies for selecting adolescents for the intervention (either based on their drinking levels or their positions in the school network) and simulate the estimated model forward in time to assess the aggregated level of drinking in the school at a later time point. The results suggest that selecting moderate or heavy drinkers for the intervention produces better results compared to selecting casual or light drinkers. The intervention results are improved further if network position information is taken into account, as selecting drinking adolescents with higher in-degree or higher eigenvector centrality values for intervention yields the best results. Results from this study help elucidate participant selection criteria and targeted network intervention strategies for drinking intervention programs in the USA.

A Component Evaluation of a Randomised Control Community Intervention to Reduce Adolescent Alcohol Use in Australia.

Despite a decline in Australian adolescents reporting to have consumed alcohol, a high proportion of the adolescent population still consumes alcohol. Community-led prevention interventions that systematically and strategically implement evidence-based programs have been shown to be effective in producing population-behaviour change related to youth alcohol and drug use. This study evaluated the post-intervention effects of a multi-component community intervention in Australia. It comprised social marketing targeting adolescents and parents, and a community intervention to reduce underage alcohol sales. Structural equation modelling was used to examine direct and indirect effects of community intervention components on intention and consumption. Self-report surveys (N = 3377) and community sales data (27 communities) were analysed to evaluate the effect of the intervention components on intention and consumption before the age of 18. The intervention reduced alcohol sales to minors (OR = .82). Exposure to the social marketing was significantly associated with household no-alcohol rules (OR = 2.24) and parents not supplying alcohol (OR = .72). The intervention predicted intention not to consume alcohol before age 18; intention was associated with not consuming alcohol (OR = 5.70). Total indirect effects from the intervention through to intention were significant. However, parents setting a rule and not supplying alcohol were the only significant direct effects to intention. Parents setting a rule was directly associated with lower consumption. Overall, the intervention logic was supported by the data modelling. The study extends prior knowledge of community-based interventions to prevent adolescent alcohol use by identifying critical intervention components and effect mechanisms. ClinicalTrials.gov Identifier: ACTRN12612000384853.

Revision of the Australian guidelines to reduce health risks from drinking alcohol.

INTRODUCTION: The Australian guidelines to reduce health risks from drinking alcohol were released in 2020 by the National Health and Medical Research Council. Based on the latest evidence, the guidelines provide advice on how to keep the risk of harm from alcohol low. They refer to an Australian standard drink (10 g ethanol). RECOMMENDATIONS: •Guideline 1: To reduce the risk of harm from alcohol-related disease or injury, healthy men and women should drink no more than ten standard drinks a week and no more than four standard drinks on any one day. The less you drink, the lower your risk of harm from alcohol. •Guideline 2: To reduce the risk of injury and other harms to health, children and people under 18 years of age should not drink alcohol. •Guideline 3: To prevent harm from alcohol to their unborn child, women who are pregnant or planning a pregnancy should not drink alcohol. For women who are breastfeeding, not drinking alcohol is safest for their baby. CHANGES AS RESULT OF THE GUIDELINE: The recommended limit for healthy adults changed from two standard drinks per day (effectively 14 per week) to ten per week. The new guideline states that the less you drink, the lower your risk of harm from alcohol. The recommended maximum on any one day remains four drinks (clarified from previously "per drinking occasion"). Guidance is clearer for pregnancy and breastfeeding, and for people aged less than 18 years, recommending not drinking.

An Internet Quiz Game Intervention for Adolescent Alcohol Drinking: A Clustered RCT.

BACKGROUND AND OBJECTIVES: Interventions on adolescent drinking have yielded mixed results. We assessed the effectiveness of an Internet quiz game intervention compared to conventional health education. METHODS: In this cluster randomized controlled trial with parallel group design, we randomly allocated 30 participating schools to the Internet quiz game intervention or the conventional health education (comparison) group, with 1:1 ratio. Students of Hong Kong secondary schools (aged 12-15 years) were recruited. The intervention was a 4-week Web-based quiz game competition in which participating students answered 1000 alcohol-related multiple-choice quiz questions. The comparison group received a printed promotional leaflet and hyperlinks to alcohol-related information. RESULTS: Of 30 eligible schools, 15 (4294 students) were randomly assigned to the Internet quiz game intervention group and 15 (3498 students) to the comparison group. Average age of participants was 13.30 years. No significant between-group differences were identified at baseline. Overall retention rate for students was 86.0%. At 1-month follow-up, fewer students in the intervention group reported drinking (9.8% vs 12.1%, risk ratio 0.79, 95% confidence interval [CI] 0.68 to 0.92; P = .003), and those who drank reported drinking less alcohol (standardized difference ß -0.06, 95% CI -0.11 to -0.01; P = .02). Between-group differences remained statistically significant at 3-month follow-up (10.4% vs 11.6%, risk ratio 0.86, 95% CI 0.74 to 0.999; P = .048; ß -0.06, 95% CI -0.11 to -0.01; P = .02). CONCLUSIONS: The Internet quiz game intervention reduced underage drinking by 21% at 1-month and 14% at 3-month follow-up compared with conventional health education.

Comparing targeting strategies for network-based adolescent drinking interventions: A simulation approach.

Public health researchers and social scientists highlight the promise of network-based strategies to inform and enhance interventions that curb risky adolescent health behaviors. However, we currently lack an understanding of how different variants of network-based interventions shape the distribution of targeted behaviors. The current project considers the effectiveness of five targeting strategies that are designed to have differential impacts on the health of program participants versus non-participants. Using simulations that are empirically-grounded in 28 observed school-based networks from the PROSPER study, we evaluate how these approaches shape long-term alcohol use for intervention participants and non-participants, separately, and consider whether contextual factors moderate their success. Findings suggest that enrolling well-connected adolescents results in the lowest drinking levels for non-participants, while strategies that target groups of friends excel at protecting participants from harmful influences. These trends become increasingly pronounced in contexts characterized by higher levels of peer influence.

Company-Specific Revenues From Underage Drinking.

OBJECTIVE: Alcohol is the most commonly used illegal drug among U.S. high school students. This study aimed to estimate the proportion of drinks and sales revenue accruing to alcoholic beverage companies that were attributable to underage consumption in 2011 and 2016. METHOD: We used national survey data to estimate the number of adult and underage past-30-day drinkers, median volume of alcohol consumed, beverage preferences, and alcohol price by beverage type. We used Impact Databank to determine the total number of alcoholic drinks sold. After adjusting for underreporting, we applied the percentage of alcohol reported to be consumed by underage youth on surveys to the alcohol sales data by beverage type and assigned a beverage-specific cost. RESULTS: Underage youth drank 11.73% of the alcoholic drinks sold in the U.S. market in 2011 and 8.6% in 2016. Total sales revenue attributable to underage consumption was $20.9 billion (10.0%) out of a total of $208.0 billion in 2011 and $17.5 billion (7.4%) out of $237.1 billion in 2016. Three alcoholic beverage companies represented nearly half (43.5%) of the market share of beverages consumed by underage youth. CONCLUSIONS: Despite the alcoholic beverage industry's stated commitment to reducing underage drinking, significant revenues appear to accrue from this activity. This presents an opportunity to enact and enforce policies--such as alcohol taxes or required company funding of independently managed youth drinking prevention initiatives--that recover these revenues from the industry and use them to help achieve the goal of preventing youth alcohol consumption.

A community intervention to reduce alcohol consumption and drunkenness among adolescents in Sweden: a quasi-experiment.

BACKGROUND: Several studies have examined the effect of community interventions on youth alcohol consumption, and the results have often been mixed. The aim of this study is to evaluate the effectiveness of a community intervention known as the Öckerö Method on adolescent alcohol consumption and perceived parental attitudes towards adolescent drinking. METHOD: The study is based on a quasi-experimental design, using matched controls. Self-report studies were conducted among adolescents in grades 7-9 of compulsory education in four control and four intervention communities in the south of Sweden in 2016-2018. Baseline measures were collected in autumn 2016 before the intervention was implemented in the intervention communities. Outcomes were the adolescents' alcohol consumption, past-year drunkenness, past-month drunkenness and perceived parental attitudes towards alcohol. RESULTS: Estimating Difference-in-Difference models using Linear Probability Models, we found no empirical evidence that the intervention has any effect on adolescents' drinking habits, or on their perceptions of their parents' attitudes towards adolescent drinking. CONCLUSION: This is the first evaluation of this method, and we found no evidence that the intervention had any effect on the level of either young people's alcohol consumption or their past-year or past-month drunkenness, nor on their parents' perceived attitudes toward adolescent drinking. A further improvement would be to employ a follow-up period that is longer than the three-year period employed in this study. TRIAL REGISTRATION: ISRCTN registry: Study ID: 51635778 , 31th March 2021 (Retrospectively registered).

Do alcohol interventions affect peers who do not receive the intervention? Modeling treatment contagion effects via simulations of adolescent social networks.

OBJECTIVE: Adolescents' drinking is influenced by their friends' drinking. However, it is unclear whether individually-targeted alcohol interventions reduce drinking in the friends of individuals who receive the intervention. This study used simulations of drinking in simulated longitudinal social networks to test whether individually-targeted alcohol interventions may be expected to spread to non-targeted individuals. METHOD: Stochastic actor-based models simulated longitudinal social networks where changes in drinking and friendships were modeled using parameters from a meta-analysis of high school 10th grade social networks. Social influence (i.e., how much one's friends' drinking affects their own drinking) and social selection (i.e., how much one's drinking affects who they select as friends) were manipulated at several levels. At the midpoint of each simulation, a randomly-selected heavy-drinking individual was experimentally assigned to an intervention (changing their drinking status to non-drinking) or a control condition (no change in drinking status) and the drinking statuses of that individual's friends were recorded at the end of the simulation. RESULTS: Friends of individuals who received the intervention significantly reduced their drinking, with higher reductions occurring in networks with greater social influence. However, all effect sizes were small (e.g., average per-friend reduction of .07 on a 5-point drinking scale). CONCLUSIONS: Individually-targeted alcohol interventions may have small effects on reducing the drinking of non-targeted adolescents, with social influence being a mechanism that drives such effects. Due to small effect sizes, many adolescents may need to receive alcohol interventions to produce measurable effects on drinking outcomes for non-targeted individuals. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Consumo de alcohol y factores relacionados en estudiantes universitarios cubanos / Factors associated with alcohol consumption in Cuban university students

Introducción: El consumo de alcohol constituye un problema de salud, complejo y multifactorial. Los factores de riesgo y/o protección y la percepción de riesgo pudieran actuar como variables moduladoras del consumo de alcohol. Objetivo: Explorar la relación entre los factores de protección y/o riesgo, la percepción de riesgo y el consumo de alcohol en estudiantes universitarios cubanos. Material y Métodos: Se asumió la metodología cuantitativa con un diseño no experimental transversal (ex-post-facto) con un alcance correlacional. Participaron 1 377 estudiantes universitarios. Se utilizaron como instrumentos el Autorreporte Vivencial, Cuestionario para la evaluación de factores protectores de la salud mental en estudiantes universitarios, Cuestionario para la evaluación de la percepción de riesgo sobre consumo de alcohol y el Cuestionario para la identificación de trastornos asociados con el alcohol. Se empleó la estadística descriptiva e inferencial para analizar las relaciones entre las diferentes variables. Resultados: Los hombres mostraron mayores dificultades en la adecuación de la percepción de riesgo y un mayor consumo de alcohol que las mujeres. Se establecieron relaciones altamente significativas entre la percepción de riesgo, los factores de protección, el consumo de alcohol y otras variables sociodemográficas incluidas en el estudio como el año académico, la condición de ser becado y la zona de residencia. Se encontró una relación directa entre el desarrollo de los factores de protección y la percepción de riesgo y una relación inversa entre esta última y el consumo de alcohol en los estudiantes universitarios. Conclusiones: Se analizó, de forma exploratoria, la relación entre los factores de riesgo y protección, la percepción de riesgo y el consumo de alcohol en estudiantes universitarios(AU)

Introduction: Alcohol consumption is a complex and multifactorial health-related problem. Risk and/or protective factors and risk perception may act as modulating variables of alcohol consumption. Objective: To explore the relationship between protective and/or risk factors, risk perception and alcohol consumption in Cuban university students. Material and Methods: A quantitative non-experimental cross-sectional ex post facto correlation study was conducted. A total of 1,377 university students participated in the study. The instruments used included the Experiential Self-Report, a questionnaire for the evaluation of protective factors of mental health in university students, a questionnaire for the evaluation of risk perception of alcohol consumption, and the Alcohol Use Disorders Identification Test. Descriptive and inferential statistics were used to analyze the relationships between the different variables. Results: Men showed greater difficulties in the adequacy of risk perception and higher alcohol consumption than women. Highly significant relationships were established between risk perception, protective factors, alcohol consumption and other sociodemographic variables included in the study such as academic year, the condition of being granted a scholarship, and area of residence. A direct relationship between the development of protective factors and risk perception and an inverse relationship between the latter and alcohol consumption were found in university students. Conclusions: The relationship between risk and protective factors, risk perception and alcohol consumption in university students was analyzed. Introducción: El consumo de alcohol constituye un problema de salud, complejo y multifactorial. Los factores de riesgo y/o protección y la percepción de riesgo pudieran actuar como variables moduladoras del consumo de alcohol(AU)

Interventions for adolescent alcohol consumption in Africa: protocol for a scoping review including an overview of reviews.

BACKGROUND: Harmful alcohol use is a leading risk to the health of populations worldwide. Within Africa, where most consumers are adolescents, alcohol use represents a key public health challenge. Interventions to prevent or substantially delay alcohol uptake and decrease alcohol consumption in adolescence could significantly decrease morbidity and mortality, through both immediate effects and future improved adult outcomes. In Africa, these interventions are urgently needed; however, key data necessary to develop them are lacking as most evidence to date relates to high-income countries. The purpose of this review is to examine and map the range of interventions in use and create an evidence base for future research in this area. METHODS: In the first instance, we will conduct a review of systematic reviews relevant to global adolescent alcohol interventions. We will search the Cochrane Database of Systematic Reviews, MEDLINE (Ovid), CINAHL, Web of Science, Global Health and PubMed using a broad search. In the second instance we will conduct a scoping review by drawing on the methodological framework proposed by Arksey and O'Malley. We will search for all study designs and grey literature using the Cochrane Database of Systematic Reviews, MEDLINE (Ovid), CINAHL, Web of Science and Global Health, Google searches and searches in websites of relevant professional bodies and charities. An iterative approach to charting, collating, summarising and reporting the data will be taken, with the development of charting forms and the final presentation of results led by the extracted data. In both instances, the inclusion and exclusion criteria have been pre-defined, and two reviewers will independently screen abstracts and full text to determine eligibility of articles. DISCUSSION: It is anticipated that our findings will map intervention strategies aiming to reduce adolescent alcohol consumption in Africa. These findings are likely to be useful in informing future research, policy and public health strategies. Findings will be disseminated widely through peer-reviewed publication and in various media, for example, conferences, congresses or symposia. PROTOCOL REGISTRATION: This protocol was submitted to the Open Science Framework on May 03, 2021. www.osf.io/qnvba.

Exploratory and confirmatory factor analysis of the parental rules toward adolescent drinking questionnaire: Two factors are better than the original one.

The parental rules toward drinking questionnaire (PRQ; Van der Vorst et al., 2005) assesses strictness toward adolescent drinking situations. The aim of the current study was to address a gap in the literature on the psychometric testing and evaluation of the factor structure of the PRQ. The current sample consisted of Dutch adolescents (N = 2922) who participated in a randomized control trial with three intervention groups (parent, student, and parent + student) and a control. PRQ and frequency of alcohol use (past month and year) were measured at baseline (T1) and 12 months later (T2). Results from Exploratory and Confirmatory Factor Analyses revealed two reliable factors: (a) rules about normative drinking situations and (b) rules about non-normative drinking situations (both αs ≥ 0.88). Regression analyses conducted to examine the prospective effects of the interventions revealed that both parent conditions predicted increases in strictness toward normative drinking situations relative to the control condition, while only the parent + student condition affected the original PRQ (single factor). Further, the normative subscale predicted increases in drinking (past month and year), as did the original PRQ. Significant effects with the normative subscale indicate that rules toward these drinking situations are ones that account for the effects in the original PRQ, and that the original PRQ can mask effects. The results illustrate that the PRQ is multidimensional. The effects of the normative subscale suggest that intervention efforts should focus on preventing drinking situations that parents normally permit their adolescents to engage in.

Alcohol, youth and sport: recommendation and good practice examples from the FYFA European project.

Focus on Youth Football and Alcohol (FYFA) is a European project (EC, 3rd Health Program, HP-PJ-2016) involving research institutions from Belgium, Finland, Italy, Poland, Slovenia and the UK. The Istituto Superiore di Sanità (ISS), was the project leader of Work Package 5: "Review of national policies and practice in six Member States related to alcohol, young people, sport, marketing and football." The aim of WP5 was to determine the status quo of the policies and practices to reduce heavy episodic drinking related to young people, alcohol and sport at national level. This work investigates knowledge, attitudes and perceptions of experts from sport settings and from the prevention area giving insights on the perceived obstacles and facilitators, whenever available, to promote strategies to reduce alcohol related harm in youth within sport contexts. The presented work describes laws, regulations and attitudes. Furthermore, the results help identifying areas requiring development, highlighting examples of good practices. It emerges that prevention of alcohol-related harm to youth is important within sport settings and should be a priority for all FYFA countries. Despite the presence of regulations, there is a low level of knowledge and enforcement at national level and in the sport contexts; and there is the need of cooperation across organizations to implement alcohol policies for youth within sport settings. More efforts and resources are needed to overcome the main obstacles for effective implementation of alcohol policies, such as regulations on advertising and sponsorship, and alcohol selling, serving and consumption for young players. It is necessary to implement information strategies, prevention initiatives, training programs and to support the dialogue between sporting and prevention settings.

An Examination of the Longer-Term Impact of a Combined Classroom and Parental Intervention on Alcohol-Related Harms and Heavy Episodic Drinking.

Although fewer adolescents are consuming alcohol than was the case in previous decades, those who are consuming alcohol are still exposed to alcohol-related harms. While the evidence for the effectiveness of universal, school-based interventions is limited, a recent cluster randomised controlled trial (The STAMPP Trial) reported a significant effect at 10 months post-intervention of a combined classroom/parental intervention on heavy episodic drinking (HED) in the previous 30 days, but no significant effect on the number of self-reported alcohol-related harms (ARH) experienced in the previous 6 months. This follow-up study sought to examine intervention effects 24 months after delivery of the intervention (+ 57 months from baseline, or + 34 months post-intervention). Participants were 5029 high school students in STAMPP (38% of 12,738 pupils originally randomised into the trial), from 87 schools (82.3% of schools recruited in the original STAMPP trial). Outcomes were assessed using two-level random intercepts models (logistic regression for HED and negative binomial for number of ARH). Results of the present study show that the intervention effect for HED deteriorated over the following 2 years (OR declined from 0.60 to 0.97), and there was still no difference in ARH. This was due to an increase in the prevalence of intervention students' HED rather than a reduction in prevalence in control students. Results are discussed in the context of prevention initiatives.

Characteristics and Effectiveness of Alcohol Website Age Gates Preventing Underage User Access.

AIMS: Examine and evaluate the overall effectiveness of age gates preventing access of underage users to alcohol websites. METHODS: Assess the characteristics of digital age gates among the top 25 alcohol brands among American adolescents, including type of age gate employed and resulting actions of repeated access requests indicating the user was under the legal drinking age. RESULTS: All official alcohol brand websites examined included an age gate, requiring either entering one's date of birth (DOB, 91%) or clicking a yes/no box indicating they were of legal drinking age (9%). Only one out of every five alcohol websites blocked futures attempts to gain access after entering a response indicating the user was under the legal drinking age. Users were allowed indefinite attempts to enter a DOB that was of legal drinking age, with the majority of websites subsequently granting access even after multiple underage entries. CONCLUSIONS: Alcohol website visitors with minimal arithmetic abilities, such as very young youth, are able to employ 'trial and error' to eventually enter an acceptable legal drinking DOB and gain access. Alcohol brand age gates are weak, at best, and likely an inconsequential barrier that someone with limited math abilities can easily overcome.

Evaluation of a Mystery Shopper Intervention to Reduce Sales of Alcohol to Minors in Zacatecas and Guadalupe, Mexico.

We report the results of a quasi-experimental evaluation of a mystery shopper intervention in Zacatecas and Guadalupe, Mexico. Underage youth attempted to purchase beer at 50 Modelorama stores and 32 Oxxo stores (intervention groups), and at 19 comparison convenience stores in March, July, and August 2018. After each attempt, intervention store operators were informed if a sale was made. Modelorama operators also received training and were warned that repeated sales to minors could jeopardize their franchise. Average sales rates to minors were 63.8% at Modeloramas, 86.5% at Oxxo stores, and 98.2% at comparison stores. The findings suggest that mystery shopper interventions with training, feedback to store operators, and sanctions after repeated sales to underage youth may reduce sales to minors in low- and middle-income countries.

Evaluation of a Cognitive-Behavioral Game Design-Based Mobile Game on Alcohol Use for Adolescents.

Objective: Determine the effectiveness of a cognitive behavioral game design (CBGD) based mobile game as an alcohol use intervention. Materials and Methods: Experimental design with 140 participants randomly assigned to either play a mobile game (n = 69) or watch a video documentary (n = 71). Results: Both groups displayed a decrease in intent to use and an increase in knowledge. The video intervention was superior in affecting actual use. Conclusion: Mobile game affects intent to use and is superior to the video in affecting knowledge.