Youth and Alcohol

8/3/2019 Youth and Alcohol

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+ALCOH OLVIOLEN CE

HARMFUL AND HAZARDOUS alcohol use are risk actors both

or being victimized and perpetrating youth violence. Youth violence

takes many orms including bullying, gang violence, sexual aggres-

sion, and assaults occurring in streets, bars and nightclubs. The

victims and perpetrators alike are young people, and the consequences

o youth violence can be devastating. Across the world an average

o 565 young people aged 0 to 9 die every day through interper-

sonal violence, with males at greater risk, and or each death there

are an estimated 0 to 40 youth that require hospital treatment or

a violence-related injury (). The impact o youth violence reaches all

sectors o society, placing huge strains on public services and damag-

ing communities. Reducing harmul alcohol use and violence among

young people should thus be considered a priority or policy makers

Harmul use o alcohol is dened as a pattern o alcohol use that causes damage to health.

Hazardous alcohol use is dened as a pattern o alcohol use that increases the risk o

harmul consequences or the user (World Health Organization,http://www.who.int/

substance_abuse/terminology/who_lexicon/en/).

Following the World report on violence and health() youth are dened as young people aged09.

Youth violenceand alcohol

W H O F A C T S O N
http://www.who.int/-substance_abuse/terminology/who_lexicon/en/http://www.who.int/-substance_abuse/terminology/who_lexicon/en/http://www.who.int/-substance_abuse/terminology/who_lexicon/en/http://www.who.int/-substance_abuse/terminology/who_lexicon/en/


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and practitioners across a broad range o agencies, with public

health proessionals having a key role in leading partnerships and

prevention. This act sheet summarizes the role o alcohol in youth

violence, the magnitude o the problem, risk actors or involve-

ment in alcohol-related youth violence, prevention measures andthe role o public health.

Links between alcohol and violence affecting young people

Alcohol use directly aects cognitive and physical unction.

Hazardous alcohol use can reduce sel-control and the ability to

process incoming inormation and assess risks, and can increase

emotional lability and impulsivity, to make certain drinkers more

likely to resort to violence in conrontation (,3). Similarly,

reduced physical control and ability to recognize warning signs

in potentially dangerous situations can make some drinkers easy

targets or perpetrators (4,5).

Individual and societal belies about the eects o alcohol (e.g.

increased condence, increased aggression) can mean that alco-

hol is consumed as preparation or involvement in violence (6). Experiencing or witnessing violence can lead to the harmul use

o alcohol as a way o coping or sel-medicating (7).

Uncomortable, crowded and poorly managed drinking venues

contribute to increased aggression among drinkers (8,9).

Alcohol and violence may be related through a common risk ac-

tor (e.g. anti-social personality disorder) that contributes to the

risk o both heavy drinking and violent behaviour (0,). Alcohol and violence can be linked ritualistically as part o youth

gang cultures (see Box ).

Hazardous and harmul levels o alcohol use are key risk actors

or intimate partner violence (), which can eature in relation-

ships between young people (3).

Prenatal alcohol exposure (resulting in etal alcohol syndrome

or etal alcohol eects) is associated with behavioural and

social problems, including delinquent behaviour (4).


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Magnitude of alcohol-related youth violence

At a global level, uniorm data or cross-national comparisons o

youth alcohol consumption are scarce. However, a range o inter-

national and regional surveys (e.g. World Health Survey [6],WHO global school-based student health survey [7], the Euro-

pean Schools Survey on Alcohol and Other Drugs [8]) show

levels and patterns o alcohol consumption vary widely between

countries. Thus, the World Health Survey shows abstinence rates

among 84 year olds to range rom 6.7% in Latvia to 98.6% in

the Comoros, with the percentage o heavy episodic drinkers3 rang-

ing rom 0.% in Lebanon and Malaysia to 0.% in the Czech

Republic (6). Particularly in the WHO European Region and the

WHO Region o the Americas, young adults (aged 84) are

more likely to engage in heavy episodic drinking than the general

adult population (e.g. Brazil, Czech Republic, Spain, Dominican

Republic [6]). Increasing consumption among young people else-

3 Heavy episodic drinking is dened as: consumption o six or more drinks in one

sitting at least once a week or Lebanon; consumption o ve or more drinks inone sitting at least once a week or Malaysia and Czech Republic.


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where (e.g. Israel [9], Philippines [0]) is raising concerns that

a youth culture o excessive drinking is spreading internationally.

Further, while in most countries heavy episodic drinking is more

common in males, alcohol consumption by emales is increas-

ing and in some countries heavy episodic drinking is now reportedmore by girls than boys (e.g. Australia, age 49; Lithuania, age

56 [6]).

Levels o youth violence also vary widely between countries.

Mortality rates rom homicide among 09 year olds range

rom 84.4 per 00 000 population (56.3 or males and .9

or emales) in Colombia to less than per 00 000 (males and

emales) in Japan and France (). Globally, across all age groups,

alcohol is estimated to be responsible or 6% and 6% o years

o lie lost through homicide by males and emales respectively4.

This ranges rom 8% or males and % or emales in high

mortality developing countries5 (where there is high mortality

rom other causes such as disease and amine) to 4% and 3%

respectively in developed countries6(6). While non-atal violence

is more dicult to measure cross-nationally, studies conducted in

numerous countries identiy links between non-atal youth violence

and harmul alcohol consumption by both perpetrators and vic-

tims. Findings include:

In Israel, 6 year olds who reported both drinking ve or

more drinks per occasion and having ever been drunk were twice

as likely to be perpetrators o bullying, ve times as likely to be

injured in a ght and six times as likely to carry weapons ().

In Finland, 45% o all violent incidents reported by 8 year

olds involved drinking by the perpetrator and/or victim ().

In the Philippines, where 4% o 54 year olds reported

physically hurting someone through violence in the previous

4 based on disability-adjusted lie years (DALYs)(6).

5 WHO regional sub grouping codes AFR-D, AFR-E, AMR-D, EMR-D, SEAR-D

(see World Health Report 00, available rom:http://www.who.int/whr/00/

en/index.html).

6 WHO regional sub grouping codes AMR-A, EUR-A, EUR-B, EUR-C, WPR-A.
http://www.who.int/whr/2002/en/index.htmlhttp://www.who.int/whr/2002/en/index.htmlhttp://www.who.int/whr/2002/en/index.htmlhttp://www.who.int/whr/2002/en/index.html


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three months, such violence was signicantly associated with

drinking (0).

In England and Wales, 84 year olds males who report eel-

ing very drunk at least monthly are more than twice as likely to

have been involved in a ght in the previous year, and emalesmore than our times as likely, than regular but non-binge drink-

ers (3).

Among 08 year olds participating in the Caribbean Youth

Health Survey7, having used alcohol in the last year was signi-

icantly associated with weapon-related violence or both males

and emales (5).

In a community sample o 830 year olds in the United States

o America, almost 5% o men and % o women had expe-

rienced violence or aggression in or around a licenced bar during

the previous year (4).

Risk factors for alcohol-related youth violence

A wide range o actors have been identied that increase young

peoples risks o becoming both victims and perpetrators o youthviolence (see Box ). While alcohol use is itsel a risk actor or

involvement in youth violence, many studies (mostly in developed

countries) have specically examined alcohol-related violence and

its associated risk actors.

Males are more likely than emales to be both perpetrators

and victims o alcohol-related youth violence (3,5). However,

in some countries harmul alcohol consumption has been associ-

ated with disproportionate increases in levels o violent behaviour

among girls (e.g. Israel [], Caribbean countries [5]), despite

their overall levels o alcohol and violence being generally lower

than male counterparts. Within the youth age category, levels

o alcohol-involvement in violence increase with age throughout

7 Participating countries: Antigua and Barbuda; the Commonwealth o the

Bahamas; Barbados; British Virgin Islands; the Commonwealth o Dominica;

Grenada; the Republic o Guyana; Jamaica, and Saint Lucia.


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adolescence (e.g. Finland []),

with recent experience o alco-

hol-related violence peaking within

the late teenage years and early

twenties (69 year olds in Eng-land and Wales [6], 04 year

olds in Australia [7]). Other ac-

tors that have been associated with

increased risk o involvement in

alcohol-related violence include

low educational attainment (8),

low college expectations (9), emo-

tional distress in adolescence (30),

involvement in other orms o anti-

social behaviour, having delinquent

(3) or alcohol-drinking (3) peers,

and high levels o aggression-acil-

itating personality characteristics

(e.g. hostility and anger) (3).

Associations between alcohol and

violence can also vary within soci-

eties by ethnicity. In the United

States stronger links have been

ound between alcohol and ght-

ing among Mexican-American

youths than non-Hispanic White

youths (33). In Israel, the relation-

ship between alcohol consumption

and being a perpetrator o bullying

is stronger among Jewish youths,

yet the relationship between alco-

hol and both being injured in a ght

and carrying weapons is greater

among Arab youths ().Levels o alcohol consumption

BOX 2:Risk factors for youth violence

Individual factors

Male

Delivery complications at birth

Personality and behaviour disorders

Low intelligence/academic

achievement

Impulsiveness and attention

problems

Alcohol use

Relationship factors Poor parental supervision

Harsh parental physical punishment

Parental confict

Large number o children in the

amily

Young age o mother (e.g. teenager)

Poor amily cohesion

Single parent household Low socio-economic status o

amily

Having delinquent riends

Community and societal factors

Presence o gangs, guns and drugs

Availability o alcohol

Poor social integration/low socialcapital

Rapid demographic change in youth

populations

Modernisation and urbanisation

Income inequality

Weak governance

Culture supportive o violence

Krug et al. 00 ()


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among young people are strongly related to their risk o violence,

with those who start drinking at an earlier age, drink requently

and drink large quantities at increased risk o being both perpetra-

tors and victims (9,34,35,36). Research among schoolchildren

in Switzerland ound that having been drunk more than once waspositively associated with perpetration o bullying and violence,

yet reduced the risks o being a victim o bullying, particularly

amongst socially integrated individuals (37).

Risks o committing alcohol-related violence are also aected by

societal and individual belies about the eects o alcohol. Stron-

ger links between alcohol and violence are seen in societies where

alcohol is less integrated into daily lie (38) and in individuals who

expect alcohol to increase aggression (3). Much alcohol-related

violence occurs at night, particularly at weekends (39), and oten

takes place in and around drinking venues (Box 3). Venue charac-

teristics associated with a greater likelihood o violent behaviour

include: low comort levels (e.g. crowded, lacking seating and

ventilation, hot and noisy); unattractive and poorly maintained

premises; oer discounted alcoholic drinks; employ aggressive

door supervisors; have a high proportion o intoxicated patrons,

and have a permissive attitude towards anti-social behaviour (e.g.


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serving underage or drunk customers and allowing swearing and

overt sexual activity) (8,40,4). Greater concentration o drinking

establishments in an area is also associated with increased preva-

lence o violence (4).

Impact

The consequences o youth violence are ar reaching, aecting

the health and well being o victims, relationships with amily and

riends, levels o ear within communities, and pressure on health

and other public services. For victims, alcohol-related violence

can be more likely to result in physical injury (), with alcohol

consumption oten leading to more severe injury (46). In Wales,7% o assault patients presenting at an Accident and Emergency

department at weekend nights had some orm o acial injury (47),

while across the United Kingdom 8% o acial injuries sustained in

assaults were inficted with the paraphernalia o alcohol use (i.e.

the use o glasses and bottles as weapons [46]). Such injuries can

cause permanent scarring and emotional and psychological trauma

(48). Further, victims o violence during adolescence report higherlevels o alcohol consumption in later lie (7). For perpetrators o

alcohol-related violence, judicial penalties can also aect uture

prospects in terms o education and employment (49).

Health and criminal justice surveys requently show young people

to account or the largest proportion o treatment demands and

criminal justice responses or alcohol-related violence (e.g. Nor-

way [50], the USA [5]), with substantial economic costs. In the

United States, the costs o violent crime related to harmul alcohol

use among youth were estimated at US$ 9 billion in 996 (998

prices [5]). In England and Wales, violent crime is estimated to

cost 4.4 billion annually (approximately US$ 44 billion; includ-

ing medical treatment, criminal justice, lost earnings and physical

and emotional costs to victims [53]). Hal o this violence is

alcohol-related and hal is committed by youths aged 64 (54).


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Prevention

A range o prevention programmes targeting parents and children

rom inancy to adolescence have shown success in reducing youth

violence, with most research conducted in high-income countries.

Such programmes include: pre- and post-natal services; home vis-

iting during inancy; parenting skills training; social development

training or children, adolescents and gang members, and amily

therapy (). In at least some cases (e.g. home visiting [55]), such

programmes can also reduce uture levels o alcohol consumption

among young people.

Specically or alcohol-related violence, interventions address-

ing access to alcohol can reduce both consumption levels andviolence. Research in the United States indicates that increased

alcohol prices through higher taxation can reduce the requency

o drinking and the chance o heavy alcohol consumption among

young people (56). In the United States it has also been estimated

that a ten percent increase in beer price would reduce the num-

ber o college students involved in violence by 4% (57). In Brazil

(Diadema) the prohibition o alcohol sales ater 3:00 helped pre-vent an estimated 73 murders (all ages) over a two year period

(58); in Australia, extended licensing hours in public houses were

associated with increased alcohol consumption and violence (59).

Legislation on the minimum legal age o alcohol purchase can

reduce access to alcohol or young people, and where such laws

exist minimum ages range rom 5 (e.g. the Republic o Slove-

nia) to (e.g. the United States). While illegal underage sales

can be common (60), they can be reduced through server training

programmes and strict enorcement o age o purchase legis-

lation (6) (e.g. test purchasing and penalties including license

revocation). Few studies have measured the eectiveness o such

interventions on violence and most research has been conducted

in the United States. Restricting access to alcohol or underage

youths in parts o the United States reduced disorderly conduct

violations among 57 year olds (6).


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Research in the United States has also ound some evidence that

programmes which alter social norms (i.e. correct misperceptions

o peer drinking habits) can reduce harmul alcohol consump-

tion levels among college students (63), and thus may be useul

in reducing alcohol-related violence. At the individual level, alco-hol consumption among those at risk o alcohol-related violence

can be reduced through brie interventions. One intervention tar-

geted at young males with alcohol-related acial injuries in an oral

and maxilloacial surgery department resulted in signicant reduc-

tions in consumption (65). Further, brie interventions delivered to

male violent oenders in a criminal justice setting (magistrates

court), reduced participants risks o injury through assault in the

ollowing year (as measured Accident and Emergency Department

presentations) yet had no eect on re-oending (66).

Modiying drinking settings can also impact alcohol-related

youth violence. For example, improving management and sta

practice through training programmes (67), implementing codes

o good practice, and strictly enorcing licencing legislation (68)

creates environments less conducive to violence. In wider night-

time environments, the presence o large numbers o intoxicated

individuals at the end o the night increases potential or violent

conrontations (69). Here interventions such as provision o sae

late-night transport (68), improvements to street lighting (70)

and use o closed circuit television (7) have been shown to help

reduce alcohol-related violence around licenced premises. Judicial

interventions can also be used to deter individuals rom anti-social

behaviour, such as the use o nes or low-level alcohol-related

oences (e.g. public drunkenness) and banning orders preventing

oenders o alcohol-related aggression accessing drinking venues.

However the eectiveness o such interventions has not been ully

assessed.

Interventions that involve collaboration between dierent sec-

tors and groups to implement an integrated package o prevention

measures have successully reduced alcohol-related violence inboth high-income and low- to middle-income countries (Box 4). In


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some low- and middle-income countries, single-sector interven-

tions such as legislation on the legal minimum age or purchase

o alcohol, and eorts to strengthen and expand the licencing o

liquor outlets could be o great value in reducing alcohol-related

youth violence. For example, there is no legal minimum age osale or alcohol in the Peoples Republic o China or the Repub-

lic o Gambia, and in the Republic o South Arica it is estimated

that 8090% o liquor outlets are unlicensed. Further, in many

low- to middle-income societies a large proportion o alcohol con-

sumed is produced at home, meaning strategies to increase alcohol

price may be less eective and may switch drinkers to cheaper

home produce (74). More research is needed in low- to middle-

income countries to identiy successul interventions or tackling

alcohol-related violence and to examine opportunities to regulate

production and sale.

The role of public health

The public health approach to violence prevention uses a wide

range o data and research to provide a better understanding othe extent, causes and risks o violence and to implement eective

interventions through collective action. For alcohol-related youth

violence, priorities or public health include:

Collecting and collating inormation on the levels and patterns

o youth drinking, incidence o youth violence, and the involve-

ment o alcohol in such violence.

Promoting, conducting and evaluating research on the links

between youth violence and alcohol consumption by both vic-

tims and perpetrators. This should improve understanding o

the extent o the problem as well as risk and protective actors.

Such research is particularly needed in low- to middle-income

countries.

Measuring and disseminating inormation on the health, eco-

nomic and wider associated sociological costs o harmul use

alcohol and violence.


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Developing, evaluating and widely implementing interventions

that show promise in prevention.

Promoting multi-agency partnerships to tackle youth violence by

raising awareness o the links between the harmul use o alco-

hol and violence, the cyclical nature o violence and associatedalcohol use, impacts on society and eective and cost-eective

interventions.

Advocating or whole systems approaches to alcohol and

violence education in schools that incorporate parents, local ser-

vices and communities.

Advocating or policies to limit access to alcohol, age o initia-

tion to alcohol, hazardous drinking and associated harms among

young people.

Policy

Both the harmul and hazardous use o alcohol and violence have

been recognized internationally as key public health issues requir-

ing urgent attention. At both national and international levels,

health organizations have a key role in advocating or policies thataddress the relationships between alcohol use and violence and in

doing so promote prevention initiatives that will improve public

health. The World Health Organization (WHO) runs comprehen-

sive programmes on both issues to instigate and conduct research,

identiy eective prevention measures, and promote action by

Member States to implement successul interventions and align

policy towards reducing hazardous and harmul drinking and

violence.

For alcohol, this includes collating and disseminating scien-

tic inormation on alcohol consumption, developing global and

regional research and policy initiatives on alcohol, supporting

countries in increasing national capacity or monitoring alcohol

consumption and related harm, and promoting prevention, early

identication and management o alcohol use disorders in primary

health care (75). A World Health Assembly resolution on Public


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health problems caused by harmful use of alcohol(WHA58.6

[76]) o 005 recognizes the health and social consequences asso-

ciated with harmul alcohol use and requests Member States to

develop, implement and evaluate eective strategies or reducing

such harms, while calling on WHO to provide support to MemberStates in monitoring alcohol-related harm, implementing and eval-

uating eective strategies and programmes, and to reinorce the

scientic evidence on eectiveness o policies.

For violence, this includes the WHO Global Campaign or Vio-

lence Prevention. Launched in 00, the Campaign aims to raise

international awareness about the problem o violence (including

youth violence), highlight the role o public health in its preven-

tion, and increase violence prevention activities globally, regionally

and nationally. The approach to preventing violence is set out in

the WHO World report on violence and health (). World Health

Assembly resolution WHA56.4 (77) o 003 encourages Member

States to implement the recommendations set out in the report,

and calls on the Secretariat to cooperate with Member States in

establishing science-based public health policies and programmes

or the implementation o measures to prevent violence and to

mitigate its consequences. Complementary to this, the Violence

Prevention Alliance has been established to provide a orum or

the exchange o best practice inormation between governments

and other agencies working to reduce violence around the world.


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All references used in this document are available at:

http://www.who.int/violence_injury_prevention/publications/

violence/en/index.html

For further information please consult:

http://www.who.int/violence_injury_prevention

http://www.who.int/substance_abuse/en

http://www.who.int/substance_abuse/terminology/who_lexicon/en

Or contact:

Department of Injuries and Violence Prevention

Dr Alexander Butchart ([email protected],

fax + 41-22-791-4332, telephone + 41-22-791-4001)

Department of Mental Health and Substance Abuse

Dr Vladimir Poznyak, ([email protected], fax +41-22-791-4160,

telephone +41-22-791-4307)

World Health Organization

20 Avenue Appia

CH-1211 Geneva 27,

Switzerland

John Moores University, Centre for Public Health

Prof Mark Bellis ([email protected],

fax +44-(0)-151-231-4515, telephone +44-(0)-151-231-4511)

Centre for Public Health

Liverpool L3 2AV

UK

World Health Organization 006

Design by Ins www.inis.ie
http://www.who.int/violence_injury_prevention/publications/violence/en/index.htmlhttp://www.who.int/violence_injury_prevention/publications/violence/en/index.htmlmailto:[email protected]:[email protected]://www.who.int/violence_injury_prevention/publications/violence/en/index.htmlhttp://www.who.int/violence_injury_prevention/publications/violence/en/index.html

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