Young Drinkers of Flavored, Supersized Alcohol at Increased Risk

Underage drinkers of flavored alcoholic beverages who exclusively consume the supersized versions are more than six times as likely to report suffering alcohol-related injuries as underage youths who drink other types of alcoholic beverages, according to a new study co-authored by School of Public Health (SPH) researchers.

The study, published in the American Journal of Public Health, is believed to be the first study to document an association between the consumption of different types of flavored alcoholic beverages by youth ages 13 to 20, risky drinking behaviors, and self-reported injuries related to alcohol consumption. In previous studies by the same research team, which includes the Center on Alcohol Marketing and Youth at the Johns Hopkins Bloomberg School of Public Health, nearly half of underage drinkers in the US reported having consumed flavored alcoholic beverages in the past 30 days.

Flavored alcoholic beverages, also known as alcopops, can be classified into three categories: malt-based flavored beverages (e.g., Mike’s Hard Lemonade or Smirnoff Ice); spirits-based premixed, ready-to-drink cocktails (e.g., Jack Daniel’s Country Cocktails); and supersized alcopops (e.g., Four Loko or Joose). Supersized alcohol beverages can contain the equivalent of between four and five alcoholic drinks.

For their study, the researchers surveyed 1,031 underage youth, ages 13 to 20, who had consumed at least one drink of alcohol during the past 30 days between December 2011 and May 2012. In an online, self-administered survey, respondents identified what brands of alcohol they had consumed in the past 30 days, the number of days on which each brand was consumed, and the typical number of drinks of each brand that were consumed on those days.

Heavy episodic drinking was reported by nearly 70 percent of pre-mixed/ready-to-drink cocktail users, by about 75 percent of supersized alcopop users, and by almost 80 percent of those who consumed more than one type of flavored alcoholic beverage—compared with 45 percent of non-flavored alcohol users. Consumption of any combination of two or more flavored alcoholic beverage was also strongly associated with reports of heavy episodic drinking, fighting, and alcohol-related injuries.

“These findings raise important concerns about the popularity and use of flavored alcoholic beverages among young people, particularly for the supersized varieties,” said study author Alison Albers, an assistant professor of community health sciences at SPH. “Public health practitioners and policymakers would be wise to consider what further steps could be taken to keep these beverages out of the hands of youth.”

Drink size does not appear to be the only factor at work. The researchers found that among underage drinkers, those who reported three types of exclusive flavored-alcoholic beverage use—pre-mixed/ready-to-drink cocktails only, supersized alcopops only, and any combination of two or more flavored alcoholic beverages—were more likely to consume a higher number of drinks per day, to drink more days in a month, and to engage in heavy episodic drinking.

Alcohol is the most commonly used drug among youth in the US and is responsible for the deaths of approximately 4,300 underage persons each year.

Besides Albers, researchers on the study include: Michael Siegel and William DeJong, professors of community health sciences at SPH; David Jernigan and Rebecca Ramirez of the Bloomberg School; and Craig Ross of Fiorente Media, Inc.

Funding came from the National Institute on Alcohol Abuse and Alcoholism.