Principal investigator: Bruno Benevit
Original title: Minimum legal drinking age and the social gradient in binge drinking
Authors: Alexander Ahammer, Stefan Bauernschuster, Martin Halla and Hannah Lachenmaier
Location of the Intervention: Austria
Sample Size: 91.208 individuals
Sector: Health Economics
Primary Variable of Interest: Alcohol consumption
Type of Intervention: Minimum age for consuming alcoholic beverages
Methodology: RDD
Summary
Alcohol consumption is associated with various social costs, such as illnesses and traffic accidents. The adoption of legal minimum ages for alcohol consumption is a measure aimed at mitigating this problem. To analyze the impacts of this type of policy, this study examined how alcohol consumption affects adolescents in Austria, where the established minimum age is 16 years. Using a regression discontinuity methodology, the results revealed that legal access to alcohol increases the frequency and intensity of alcohol consumption among adolescents, increasing hospitalizations due to intoxication, especially among boys and young people from low-income backgrounds. Additionally, it was observed that the perception of access to alcohol is high regardless of the minimum age policy, although young people tend to underestimate the risks of excessive alcohol consumption after legal permission.
- Policy Problem
Excessive alcohol consumption is associated with a number of negative consequences for health and society. In particular, young people are relatively more impacted by this behavior, since their developing brains are more susceptible to the effects of alcohol. In Europe, where alcohol consumption levels are among the highest in the world, substance abuse is responsible for a significant portion of deaths and years of life lost due to disabilities (AHAMMER et al., 2022). Beyond direct health effects such as liver and nervous system damage, excessive alcohol consumption is also linked to fatal accidents, increased crime, and impaired educational performance.
Minimum drinking age (MBA) policies are widely adopted in various countries, especially in Europe, where legal limits vary significantly. While most nations set the MBA at 18, some countries allow the consumption of beer and wine from the age of 16, as is the case in Austria, Belgium, Denmark, Germany, and Switzerland. However, such flexibility has been associated with patterns of early consumption among young people. On the other hand, it is argued that controlled exposure to alcohol at younger ages could promote more responsible consumption in the future.
The regulation of the Minimum Age for Childhood Development (MACD) has been the subject of studies seeking to understand its impacts on risk behavior, health, and even social indicators such as accidents and crime. Despite this, research on the effects of MACD is still limited, focusing mainly on data from the United States and Canada, where the minimum age is higher. This leaves important gaps in understanding the impacts of these policies in contexts with lower MACDs, such as in Europe, and how these effects may vary among different socioeconomic groups.
- Policy Implementation Context
In Austria, alcohol consumption has historically been at high levels, standing out among Western industrialized countries. Since 1960, per capita consumption of pure alcohol in the country has been high, at 8,7 liters, and has increased over the decades, reaching 10,4 liters in 2014, the highest rate among the nations analyzed. Furthermore, more than 50% of alcohol consumers aged 15 or older reported at least one episode of excessive alcohol consumption.binge drinkingIn the last month, a percentage significantly higher than in other countries, Austria's pattern of intense and frequent consumption places it in a prominent position for studies on the effects of alcohol-related policies, especially with regard to IMCA (International Alcohol Content Index).
Currently, the IMCA regulation in Austria is established by the Child and Youth Protection Act. Before 2019, the rules varied among the nine federal states, with most allowing access to non-distilled beverages, such as beer and wine, from the age of 16, and to distilled beverages from the age of 18. However, some states, such as Burgenland, Lower Austria, and Vienna, allowed universal access to all types of alcohol from the age of 16. Following the harmonization of laws in 2019, the IMCA was set at 16 years for non-distilled beverages and 18 years for distilled beverages nationwide.
Violations of these rules are considered administrative offenses, with penalties varying according to the severity and type of offender. For minors, sanctions may include participation in awareness meetings, community service, or fines of up to 500 euros. Adults and business owners who supply alcohol to minors may face fines of up to 20.000 euros and, in extreme cases, imprisonment for up to six weeks. Despite these measures, enforcing penalties for adults and business owners is considered challenging, while minor offenders generally receive lighter sanctions, such as small fines or guidance.
- Evaluation Details
The study used data from two main sources: school surveys and administrative records from the health system. The first database was derived from... European School Survey Project on Alcohol and other Drugs (ESPAD), a project that collects information on substance use among adolescents in various countries. For the analysis, a survey conducted in Austria in 2015 was used, which includes 9th and 10th grade students, born between 1997 and 2001, from different types of schools, except for special education schools. The research was conducted through anonymous online questionnaires, applied in schools between March and July 2015.
The sample considered in this study consisted of young people aged between 14 and 18 years, 53% of whom were female and 64% of whom had mothers who had completed at least high school, indicating a higher socioeconomic level. Participants provided detailed information about their alcohol consumption, including frequency, quantity, and type of beverage consumed in the last seven days, as well as instances of binge drinking over the past 30 days. They also assessed the perception of risk associated with alcohol consumption and the ease of access to distilled and non-distilled beverages.
The second source of data is administrative, originating from the Austrian healthcare system, specifically from... Upper Austrian Health Insurance Fund (UAHIF), covering approximately 75% of the population of Upper Austria. The sample includes all live births between 1991 and 1995 in the region, totaling 91.208 adolescents followed from ages 13 to 22. The database records information on hospitalizations due to alcohol intoxication.
Despite broad coverage, only cases requiring hospitalization are recorded, which may underestimate the incidence of intoxications treated on an outpatient basis. The probability of an adolescent being hospitalized for alcohol intoxication between the ages of 13 and 22 is 3,2%, with most cases occurring only once. The sample is balanced in terms of gender (48% are women), and 69% of mothers have high socioeconomic status, defined by their level of education.
- Method
The study used Sharp's regression discontinuity method (RDD) to estimate the impact of IMCA in Austria. The approach compared adolescents just below and above the age of 16, the age at which access to non-distilled beverages becomes legal in the country. RDD allows impacts on behavior to be attributed to IMCA, assuming that individuals around the 16-year cutoff were comparable. In addition to the latent variable as a function of age, covariates such as gender, type of school, and socioeconomic level were considered.
To assess the effects on alcohol consumption behavior, data from the ESPAD survey were used, which provided detailed information on the frequency and amount of alcohol consumed. Thus, both consumption in the last seven days and cases of binge drinking over the last 30 days. The analysis considered linear and quadratic specifications for the age function, as well as non-parametric models.
Additionally, the effect of IMCA on hospitalizations for alcohol intoxication was verified based on administrative data from UAHIF. The probability of hospitalization for intoxication was modeled as a function of age, with controls for individual and socioeconomic characteristics. The analysis also explored socioeconomic differences and family history of alcohol abuse, using regressions that distinguished between families with and without a history of alcohol-related problems. Furthermore, the possibility of alcohol substitution with other drugs was investigated, using data on the use of illicit substances.
Finally, the study examined the effects of IMCA on alcohol access and risk perception. Data from test purchases made by minors were used to assess objective access to alcoholic beverages in commercial establishments. The perception of access to alcohol was analyzed based on responses from the ESPAD survey, which included questions about the ease of obtaining alcoholic beverages. Furthermore, the perception of risk associated with alcohol consumption was assessed through questions that measured the perception of physical harm and other risks related to daily consumption and to binge drinking.
- Main results
The results showed that legal access to alcohol at age 16 significantly increased the frequency and quantity of consumption among adolescents. The average number of days adolescents consumed alcohol in the past week rose by 0,276 days, representing an increase of approximately 39%. Furthermore, consumption of pure alcohol increased by about 50 grams, representing a 90% increase compared to the period before age 16. The effect was more pronounced in boys and in adolescents from low socioeconomic backgrounds, who were more likely to consume alcohol in larger quantities and to engage in episodes of excessive alcohol consumption.
Analysis of administrative data revealed a significant increase in hospitalizations for alcohol poisoning after age 16. The probability of hospitalization jumped by 0,04 percentage points (pp), representing a 42% increase. This effect was stronger in boys and in adolescents from low socioeconomic backgrounds, who were more likely to be hospitalized due to excessive alcohol consumption. Regarding the influence of age on this behavior, the difference between socioeconomic groups persisted until age 22, with low-income adolescents having a 40% higher probability of hospitalization compared to high-income adolescents.
Adolescents from families with a history of alcohol abuse did not show a significant increase in hospitalizations for intoxication after age 16, unlike those without this family history. However, these adolescents already had twice the incidence of alcohol intoxication before age 16. This result suggests that parental behavior influences children's alcohol consumption regardless of the legal drinking age.
Results regarding access to alcohol and risk perception indicated that this type of beverage was relatively accessible to young people before the age of 16, with 23% of purchase attempts by minors being successful. The perception of access to alcohol was already high among 15-year-olds, with 84% reporting that it was easy to obtain non-distilled beverages, increasing slightly after age 16, especially in states where distilled beverages were permitted at that age. Regarding risk perception, the belief that daily alcohol consumption is harmful remained stable, but the risk perception associated with... binge drinking On weekends, consumption dropped significantly, from 70% to 60%, after the age of 16. This suggests that legislation has influenced social norms, making excessive alcohol consumption more acceptable after the legal drinking age.
- Lessons in Public Policy
In this article, the authors conducted several empirical approaches to identify how the adoption of a 16-year-old IMCA (International Age for Childhood and Adolescence) in Austria impacted alcohol consumption behavior among adolescents. The results indicate that legal access to alcohol at age 16 significantly increased the frequency and quantity of consumption, with particular emphasis on episodes of... binge drinking and hospitalizations due to alcohol poisoning. This effect was more pronounced among boys and adolescents from low socioeconomic backgrounds. Furthermore, it was identified that the perception of risk associated with excessive alcohol consumption decreased after the age of 16, while physical access to alcohol was already relatively easy even before that age.
The evidence presented in this article helps to understand the mechanisms behind the increase in alcohol consumption after the legal drinking age, providing relevant information for the formulation of public policies. The authors emphasize that, given the observed negative impacts, awareness campaigns about the risks of early consumption can be effective in mitigating these effects, especially for young people with a family history of alcohol abuse. Furthermore, promoting policies that reduce the availability of alcohol to adolescents and reinforce the perception of risk associated with its consumption has the potential to contribute to reducing problems related to alcohol abuse in this age group.
References
AHAMMER, A. et al. Minimum legal drinking age and the social gradient in binge drinking. Journal of Health Economics, v. 81, p. 102571, Jan. 2022.
