YAAP Study


Principal Investigator

Timothy Naimi, MD, MPH

Key Personnel

Toben Nelson, Sc.D., Co-Investigator, PI of University of Minnesota Subcontract

Ziming Xuan, Sc.D., Senior Analyst, Boston University School of Public Health

Timothy Heeren, PhD, Biostatistician, Boston University School of Public Health

Project Coordinator

Jason Blanchette, MPH


Thien Nguyen, Research Assistant

Grant Abstract

Underage youth who drink are more likely to suffer alcohol-related health and social problems during adulthood than are those who do not, and youth drinking contributes substantially to the three leading causes of death among adolescents (unintentional injuries including motor vehicle crashes, suicide, and homicide). Youth drinking also contributes to a variety of other adverse outcomes including interpersonal violence, other substance use, academic problems, and unsafe sexual practices. The prevalence of youth drinking differs widely across states in the U.S.

Alcohol control policies, which also differ between states, comprise the laws, regulations and practices designed to reduce excessive alcohol consumption and its related harms. Because alcohol consumption by youths is widely perceived as an age-specific problem, many recent, widely publicized policy interventions have targeted youthful drinkers primarily or exclusively.  Such policy design may not be ideal, however, because youth learn drinking behaviors from older persons and obtain most alcoholic beverages from legal-aged adults.  Furthermore, some policies that target the general population, such as increased alcohol taxes, also reduce youth drinking.  Therefore, the perception that youth drinking is an age-specific phenomenon that should be remedied by youth-specific policies may result in inadequate policy efforts to reduce youth drinking.

Although it is well established that tobacco smoking by youth has been most effectively reduced by implementing multiple policies that target both youth and the general population, a critical gap in our present understanding of alcohol control policies is whether the presence of multiple policies targeting youth, adults, or both is similarly effective in reducing youth drinking.  In part this is because most previous alcohol policy studies have understandably focused on the effectiveness of single policies. Furthermore, studies that evaluate policy effects on youth drinking rarely consider their influence on adult drinking as a moderating factor.

Therefore, the long-term goal of this four-year project is to understand the effects of alcohol control policies and adult drinking patterns exert on youth drinking, and to determine whether stronger policy environments, including those targeting the general population, might reduce youth drinking. To accomplish this goal, we will test three hypotheses:  (i) the presence of a strong policy environment is protective against youth drinking and legal-aged adult drinking; (ii) adult drinking patterns are strongly related to those of youth; and (iii) a strong alcohol policy environment protects against youth drinking, even after accounting for the effects of youth-specific policies and the moderating effect of adult drinking patterns.

To assess youth and adult drinking behaviors from 1999-2009, we will use data from two large, population-based surveys (the Youth Risk Behavior Survey [YRBS] and the Behavioral Risk Factor Surveillance System Survey [BRFSS]) to do longitudinal analyses using multilevel modeling.  With the assistance of an expert panel, we will develop novel composite indices to describe policy strength (by state and year) using data from the Alcohol Policy Information System (APIS), and will disaggregate policies into those that are population-based (i.e., primarily adult-oriented) and those that are youth-specific.  The outcomes of interest will be drinking behaviors at the level of the individual, and will control for individual and state-level covariates, including those related to alcohol policy.

The specific aims are:

Aim 1:  To determine the association between alcohol control policies, including those that are adult-oriented and youth-specific, and youth drinking behaviors.

Aim 2:  To determine the association between adult drinking behaviors and youth drinking behaviors.

Aim 3:  To determine the association between adult-oriented alcohol policies and adult drinking behaviors.

Aim 4:  To determine whether adult-oriented alcohol control policies protect against youth drinking, while assessing the effects of youth-specific policies and the moderating effects of adult drinking patterns.