title: Teenage drinking, alcohol availability and pricing: a cross-sectional study of risk and protective factors for alcohol-related harms in school children.
abstract: BACKGROUND
  There is a lack of empirical analyses examining how alcohol consumption patterns in children relate to harms. Such intelligence is required to inform parents, children and policy relating to the provision and use of alcohol during childhood. Here, we examine drinking habits and associated harms in 15-16 year olds and explore how this can inform public health advice on child drinking.
  
  
  METHODS
  An opportunistic survey of 15-16 year olds (n = 9,833) in North West England was undertaken to determine alcohol consumption patterns, drink types consumed, drinking locations, methods of access and harms encountered. Cost per unit of alcohol was estimated based on a second survey of 29 retail outlets. Associations between demographics, drinking behaviours, alcohol pricing and negative outcomes (public drinking, forgetting things after drinking, violence when drunk and alcohol-related regretted sex) were examined.
  
  
  RESULTS
  Proportions of drinkers having experienced violence when drunk (28.8%), alcohol-related regretted sex (12.5%) and forgetting things (45.3%), or reporting drinking in public places (35.8%), increased with drinking frequency, binge frequency and units consumed per week. At similar levels of consumption, experiencing any negative alcohol-related outcome was lower in those whose parents provided alcohol. Drunken violence was disproportionately associated with being male and greater deprivation while regretted sex and forgetting things after drinking were associated with being female. Independent of drinking behaviours, consuming cheaper alcohol was related to experiencing violence when drunk, forgetting things after drinking and drinking in public places.
  
  
  CONCLUSIONS
  There is no safe level of alcohol consumption for 15-16 year olds. However, while abstinence removes risk of harms from personal alcohol consumption, its promotion may also push children into accessing drink outside family environments and contribute to higher risks of harm. Strategies to reduce alcohol-related harms in children should ensure bingeing is avoided entirely, address the excessively low cost of many alcohol products, and tackle the ease with which it can be accessed, especially outside of supervised environments.
authors.affiliation: Centre for Public Health, Faculty of Applied Health and Social Science, Liverpool John Moores University, Fifth Floor Kingsway House, Hatton Garden, Liverpool L3 2AJ, UK. m.a.bellis@ljmu.ac.uk
authors.forename: Mark A
authors.initials: MA
authors.lastname: Bellis
authors.forename: Penelope A
authors.initials: PA
authors.lastname: Phillips-Howard
authors.forename: Karen
authors.initials: K
authors.lastname: Hughes
authors.forename: Sara
authors.initials: S
authors.lastname: Hughes
authors.forename: Penny A
authors.initials: PA
authors.lastname: Cook
authors.forename: Michela
authors.initials: M
authors.lastname: Morleo
authors.forename: Kerin
authors.initials: K
authors.lastname: Hannon
authors.forename: Linda
authors.initials: L
authors.lastname: Smallthwaite
authors.forename: Lisa
authors.initials: L
authors.lastname: Jones
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000428:Alcohol Drinking / Q000453:epidemiology*; D000434:Alcoholic Beverages / Q000191:economics* / Q000706:statistics & numerical data; D000435:Alcoholic Intoxication / Q000453:epidemiology; D003132:Commerce / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003625:Data Collection; D004739:England / Q000453:epidemiology; D005260:Female; D040261:Harm Reduction; D006801:Humans; D008297:Male; D008569:Memory Disorders / Q000139:chemically induced; D012309:Risk-Taking; D012725:Sexual Behavior; D014754:Violence / Q000706:statistics & numerical data*