Introduction The underage drinking problem is becoming a cause for concern in Hong Kong as young people are exposed to an environment with easy access to alcohol. In particular, the off-premise sales of alcohol to underage youth are entirely subject to the industry voluntary code of conduct. Without appropriate legislative changes and enforcement measures, underage youth in Hong Kong could find it relatively easy to obtain the alcoholic beverage in off-premise outlets. Different studies were published to evaluate the effectiveness of interventions for reducing the sale of alcohol to underage youth in off-premise outlets. Aim and Objectives 1. To identify the effectiveness of interventions on restricting off-premise alcohol sales to underage youth 2. To suggest policy and intervention measures to regulate the off-premise alcohol sales to adolescents in Hong Kong based on the findings presented in this review. Methods Literature in this review included articles published in the last 10 years (2003-2013). The literature search was undertaken in the following two pronged method. 1. To identify relevant articles, the following databases were used: PubMed and MEDLINE. The search term: "Alcohol Drinking/legislation and jurisprudence"[MeSH Terms] AND ("2003/01/01"[PDAT]: "2013/12/31"[PDAT]) AND ("adolescent"[MeSH Terms]) were applied. 2. Manual search was conducted according to the bibliographies and reference lists of the articles that were being reviewed. Inclusion and exclusion criteria were applied. Results Numerous articles have been identified regarding interventions to reduce underage access to alcohol in off-premises and shift retailers' behavior in the sale. Such interventions included, but were not limited to responsible beverage sales and service training, intensified compliance check, enhancement of non-compliance penalties, reward and reminder visit and media advocacy. Community based interventions targeting off-premises sale were found to be successful in affecting the behaviour of the retail staff. There was a variation in the magnitude of effects among the studies and this was associated with the intensity of the interventions and the publicity. A decaying effect of interventions was also observed. Conclusion This review identified that implementing a legal purchasing age combined with intensification of compliance check and enhancement of penalties were effective in reducing sales of alcohol to underage youth in off-premise venues. On the basis of the findings, policy suggestions for Hong Kong were presented. / published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Alcohol consumption, the third largest contributing risk factor towards global morbidity, has increased in the past 5 years despite global calls for action to reduce its significant impact on public health. Compared to most developed nations, Hong Kong has been shown to have lower levels of alcohol consumption by previously conducted research. However, Hong Kong’s low alcohol taxes, wide availability of alcohol, and lax restrictions on marketing practices have the potential to increase the prevalence of alcohol use and binge drinking particularly among young adults 18-25 of age, lending them towards increased risks of neurological damage, unsafe sex, intentional and unintentional injuries, and impacts on school and work performance in addition to chronic health harms in the future. This thesis employs a mixed-methods approach to comprehensively examine the behavioral and environmental contexts of Chinese young adult drinking behavior, as well as to generate feasible, effective strategies at the health promotion and policy levels to reduce alcohol-related harm among this population subgroup. / Cantonese-speaking young adults of Hong Kong (n=684) were invited between April and September 2011 to participate in a cross-sectional random telephone survey, during which they were asked about their drinking patterns and perceptions on a set of alcohol expectancy statements. Twelve focus groups (n=63) were then conducted between June 2012 – May 2013 to explore individual motivations to drink as well as possible environmental and social facilitating factors. A series of interviews conducted in January – April 2014 with key policy stakeholders, including representatives of law enforcement, education, government, food and beverage sectors, non-governmental organizations, and the alcohol industry, (n=16) then aimed to produce appropriate, actionable policies and interventions which can be undertaken as a means to reduce alcohol-related harm among young adults in Hong Kong. / At the behavioural level, positive outcome expectancies were found to be significantly associated with various levels of alcohol use. Those who held social facilitation of drinking to a high regard were significantly more likely (OR=6.67; 95% CI: 2.87,15.49) to have had at least one binge drinking episode in the past month. Qualitative investigations also illustrated drinking among Hong Kong young adults as heavily focused on planned socializing and self-presentation in personal and business situations, and further enabled by the availability of local drinking games and granting and losing face, a Chinese cultural concept based on dignity with competitive undertones. Drinking occasions were also facilitated by the convenience of bars and lounges, viewed as accommodating alternatives to homes for social gatherings. Point-of sale promotions providing inexpensive or free drinks further strengthened alcohol use as a convenient and normal practice among young adults. / Instead of adopting strategies to limit access to alcohol as recommended by global alcohol experts, key policy stakeholders of alcohol issues in Hong Kong expressed preference for softer approaches such as health education campaigns to properly inform young adults about the physical harms of alcohol. For legislative actions, only those that aim to limit alcohol’s physical availability, restrictions on discounted drink specials, and bans on event-centric promotions were favored as viable options. / This series of studies marks the first attempt in alcohol research to comprehensively establish a profile of drinking behavior of Chinese young adults at individual, social, and environmental levels. Based on these findings, a deeper understanding of the previously unexplored cultural context of Chinese drinking, particularly those involving face-based interactions and business situations, is warranted in future behavioral research on alcohol use among this ethnic subgroup. Health campaigns and community interventions challenging the perceives social benefits of drinking among young adults may be useful at the community level in reducing alcohol-relates harms among Chinese youth, but further research is required to ascertain their actual effectiveness in Hong Kong. The government-endorsed Liquor Licensing Board may also expand its current role in limiting the physical availability of alcohol in Hong Kong by imposing a licensing system on outlets that sell alcohol for consumption outside of their premises (off-premise sales), and restricting point-of-sale promotions of alcoholic beverages at licensed venues. / 飲酒為全球發病率的第三大危險因素。儘管酒精危害對公共衛生的影響何其嚴重，世界在過去五年飲酒量始終持續上升的趨勢。傳統來說，香港飲酒的份量與大多數發達國家相對較低。然而，香港針對酒類飲品的價格、供應、和營銷的限制極為寬鬆，這種情況有機會增加18-25歲青少年飲酒和暴飲的流行性，神經損傷、不安全性行為、和蓄意及非蓄意的傷害的風險亦有機會因此增加，在學校和工作表現也會受到影響。有見及此，本論文內描述的研究旨在採取混合研究方式，分析青少年飲酒行為的個人和環境因素，導出在健康促進和政策層面內可行、有效的措施，從而減少香港青少年酒精相關危害。 / 本研究首先採用電話問卷方式於2011年四月至九月之間對本地青少年作一項橫斷式調查(n=684)，主要調查他們的酒精使用頻率以及對使用效果的期望。此外亦於2012年六月至2013年九月之間經十二組的焦點團體訪談(n=63)探討青少年使用酒精飲品的個人動機，以及任何社會或環境層面的促進因素和影響。最後是項研究於2014年一月至四月之間進行一系列的採訪(n=16)，了解相應持份者對在香港實施減少青少年酒精相關危害的社區或政策行動的可行性與預期影響。。 / 在行為層面上，飲酒正向使用效果的期望與各級酒精頻率顯著相關。對酒精在社交帶來的正面效果抱著頗高期望的人士更有較大機會於一個月內有暴飲的情況(OR = 6.67; 95% CI: 2.87,15.49)。質性調查亦顯示，香港青少年飲酒行為很大程度上圍繞於酒精在社交場面上的表現和自我映照所需的正面影響，並透過本地式飲酒遊戲和面子的基礎上進一步引生出競爭式暴飲行為。飲酒場合（例如酒吧及類似的休憩場所）的方便及舒適程度，更令他們取代住所成為社交聯歡的主要地點。酒精飲品的特惠和特別促銷活動亦經常提供廉價或免費的飲料，進一步加強了酒精使用於青少年群組當中成為一種方便及正常行為。 / 相對於國際酒精使用研究專家提出的適當策略來限制人們和酒精的接觸，相應持份者傾向採取較柔和的應對方法，例如健康教育活動以正確地告知青少年酒精對身體的危害。使用法律手法當中，只有管制酒精供應和禁止特惠及特別促銷活動是被看好為本地可行的選擇。 / 這一系列的研究代表了學術界中首次在個人、社會、和環境層面上探究中國的年輕人飲酒行為。根據是項研究的結果，未來中國人飲酒行為的研究可針對未曾探索的文化背景作更深層的了解，特別是涉及面子和為工作而需應酬的飲酒場合。針對青年人認為飲酒的社交效果的健康及社區教育計劃也可能是有效的干預方向，但仍需作進一步研究以確定在香港的有效性。政府認可的酒牌局也能擴大現有的管制系統來限制零售店舖的酒精供應，以及任何售酒處所的銷售方式。本論文亦基於研究結果對未來行為的研究、健康促進的實踐、和政策發展的影響作進一步的討論。 / Wong, Ho Cheuk Alvin. / Thesis Ph.D. Chinese University of Hong Kong 2014. / Includes bibliographical references (leaves 194-230). / Abstracts and appendixes also in Chinese. / Title from PDF title page (viewed on 18, October, 2016). / Wong, Ho Cheuk Alvin. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only.