In England, the proportion of young people aged between 11-15 who reported having drunk alcohol decreased from 62% to 54%, between 1988 and 2007. However, the amount consumed by the young people who drink increased from 6.4 units per week in 1994 to 12.7 units per week in 2007 [1]. The largest increase was seen in 14 year olds who increased their alcohol consumption from 6.1 to 9.9 units per week over this period. Furthermore, this increase was not gender specific. For both boys and girls there was a substantial increase in
the amount of alcohol consumed [1]. Moreover, one in four young people aged 14 reported consuming over 10 units of alcohol on their last drinking occasion; this level of consumption increased to one in three by the age of 15 [2]. In 2001 it was reported that young people’s drinking tends to be confined to fewer days than adults, and in particular at weekends .

Thus young people (aged 11-15), who drink, tend to do less frequently but at a higher intensity than adults.

In young people (aged 16-24), the latest NHS Information Statistics on Alcohol (2008) reported that 26% of males and 24% of females drink over the recommended weekly limits for low risk drinking in adults, which are 21 units for men and 14 units for women. Moreover it is shown that 9% of young males and 6% of young females drank over 50 units per week which is indicative of high risk drinking in adults . It is not clear whether current adult guidance on low risk drinking is pertinent to young people or if specific recommendations are required for individuals who are in the midst of ongoing physiological and emotional
development.

During the last 30 years the number of deaths due to chronic liver disease and cirrhosis has risen steadily in England and this trend is particularly marked in the 25-34 year group with the number rising from 16 in 1970 to 68 in 2000 for men and from 7 in 1970 to 60 in 2000 for women . The majority of liver disease in this country is due to heavy drinking . However, the most significant physical health risks associated with alcohol consumption in young people at the present moment are those relating to accidents and injuries. The ESPAD study reported that 13% of all 15-16 year olds had been involved in an accident or had an injury as a result of drinking .

In Scotland, it has been reported that on a daily basis, 15 children under the age of 17 attend Emergency Departments, intoxicated and in need of medical assistance or treatment .Indeed an audit of 21 emergency departments over a 6 week period showed that 648 children and young people under the age of 17 required medical treatment; 15 of these cases were below the age of 12 and one was as young as 8 years old. On average these young people had consumed 13 units of alcohol within the 24 hours leading up to their attendance . If this number were to be extrapolated for England it would give an estimate of around 1245 young people per week requiring medical assistance or treatment in England (64,750 per year).

In England some 35,472 young people aged 16-24 were admitted to hospital in 2005 with alcohol-related conditions . The largest proportion (19,533) were male and the figures increased with increasing age. Whilst it is clear from these figures that excessive drinking by young people is a significant concern in the UK, it is not clear what impact this alcohol misuse has on their health and well-being beyond the immediate hospital episode.

Heavy drinking by young people is more pronounced in areas with high social deprivation. The highest levels of alcohol consumption are reported by young people in the North-East of England and Yorkshire and Humberside where they are 1.5 times more likely to have drunk alcohol during the last week than young people living in the rest of England . In 2008, a survey of 1,250 young people living in deprived communities in Britain found that over a third did not know what a unit of alcohol was and did not understand the term binge drinking. Of
these young people, 39% drank up to 20 units per week and 15% drank over 20 units per week . Thus the adverse effects of social deprivation on young people may be compounded by possible health and social problems related to heavy drinking.

In a survey of school children aged 15 and 16 from the North West of England, participants reported that being aged 16, receiving a greater amount of income per week and not having a hobby or being a member of a club or sports team was associated with higher levels of alcohol . In addition, a higher percentage of girls reported drinking in public places whilst a higher percentage of binge drinkers were male . The 2005/2006 Health Behaviour in School-aged Children (HBSC) Survey (on patterns of health among young people in 41 countries and regions across Europe and North America) provides an international comparison . Notably, findings suggest that young people in the UK have some of the
highest rates of drunkenness internationally. England had the highest proportion of girls (24%) that reported that they had first been drunk at the age of 13 or younger. Rates for English boys were also high 23% reported they had been drunk at age 13 or younger .

Thus there are clear grounds for concern about alcohol consumption in young people in England and it seems that many aspects of young people’s drinking may be situational or culturally determined. Moreover, whilst there is some evidence that parents’ attitudes about alcohol may shape their children’s views (particularly in younger children) about drinking, it seems that other direct mechanisms such as access to pocket money and involvement in diversionary activities (or not) may also determine if, when and how much their children
drink. However, it is currently not clear to parents what risks arise for their children from early exposure to, or different levels of, alcohol consumption. Many parents may feel that early introduction to alcohol by them is preferable to its use in unsupervised experimentation.

However, there is currently insufficient information to base such decisions on.
In adults there are some health and social benefits associated with alcohol consumption. However, the health benefits are linked to cardio-protective effects of low to moderate consumption of alcohol which have generally been identified in older adults, that is men aged over 40 and post-menopausal women . The positive social effects of drinking are well known to the majority of the adult population that chooses to drink alcohol, although these effects are rarely studied in research terms. In young people, it is not clear whether there is any health benefits associated with drinking in early life. It is likely that young people will
perceive positive social effects of drinking . However, it is possible that these may be tempered by adverse consequences that may arise from drinking at an age before alcohol is legal.

On the basis of current epidemiological evidence on adverse consequences of drinking, particularly in young people who become intoxicated, the alcohol harm reduction strategy for England has highlighted that underage drinking is a major public health priority and outlined three objectives for tackling it:

• 1.Delaying the onset of regular drinking, primarily by changing the attitudes of 11-15 year olds and their parents about alcohol.
• 2. Reducing harm to young people who have already started to drink.
• 3. Creating a culture in which young people feel they can have fun without needing to drink.

Recent NICE guidelines on alcohol interventions in schools and the Government’s recent Youth Alcohol Action Plan also set out clear priorities concerning alcohol and young people under the age of 18. One of the actions in the Action Plan is to issue advice to parents about young people and alcohol, which will include guidelines for low risk drinking

This ‘guidance will also offer wider information on the health and social impacts of
drinking at young ages, sources of help and support for parents including evidence-based approaches for them to use with their children. Furthermore, the 2007 Chief Medical Officers Report recognised that young people’s health is the key to the nation’s future. He identified six priority risk-taking areas of which one was alcohol and drugs . In order to inform the proposed guidelines on alcohol and young people, this review was commissioned to identify published evidence on both the harms and benefits of drinking in early life. Given that there was a limited time-frame available for the work, the commissioning brief asked for a focus on existing reviews in this field. The purpose of this work was to provide an assessment of this evidence to an expert group of clinicians/researchers
convened by the Department for Children, Families and Schools to enable them to make recommendations to parents about their children’s drinking.

The aim of the study were to:

• produce a thorough review of the most up-to-date, robust and reliable evidence on the harms and benefits of alcohol consumption for children and young people;
• undertake a systematic search of existing reviews and weigh-up the quality of the evidence base;
• communicate and discuss the findings with the expert panel on alcohol and young people;
• support the Department in accurately and appropriately interpreting and using the evidence;
• ensure the guidance for parents is based on a firm evidence base; and
• identify evidence gaps that longer term research needs to address.

The following electronic databases were searched for relevant reviews:

• ETOH Alcohol and Alcohol Problems Science database (1972-2003)
• TRIP (May 2008)
• MEDLINE (1950-May 2008)
• EMBASE (1980-May 2008)
• CINAHL (1982-May 2008)
• PsycINFO (1806-May 2008)
• Social Science Citation Index (1970-May 2008)
• Science Citation Index (1970-May 2008)
• Scopus (1996-May 2008)

We also used key words (see below) to search the following websites

• Institute http://www.intute.ac.uk/
• Department for Children, Schools and Families http://www.dcsf.gov.uk/
• Department of Health http://www.dh.gov.uk/en/Publicationsandstatistics/index.htm
• Home office http://www.homeoffice.gov.uk/rds/alcohol1.html
• UK Statistics Authority http://www.statistics.gov.uk
• EU Statistics UK http://www.eustatistics.gov.uk/
• NHS Information Centre http://www.ic.nhs.uk/
• UK Data Archive http://www.data-archive.ac.uk/
• NICE http://www.nice.org.uk/
• WHO http://www.who.int/topics/alcohol_drinking/en/
• Alcohol Concern http://www.alcoholconcern.org.uk/
• Alcohol Education and Research Council http://www.aerc.org.uk/
• National Center on Addiction and Substance Abuse http://www.casacolumbia.org/
• Alcohol and Drug Abuse Institute http://depts.washington.edu/adai/
• Australian Drug Information Network http://www.adin.com.au/
• SoRAD http://www.sorad.su.se/
• Diversity Health Institute Clearinghouse
http://www.dhi.gov.au/clearinghouse/default.htm
• European Alcohol Policy Alliance http://www.eurocare.org/
• ADCA library http://tinyurl.com/4t8ds2
• DrinkandDrugs.net http://www.drinkanddrugs.net/
• Daily Dose http://www.dailydose.net/
• Google and Google Scholar http://www.google.co.uk
• NIAAA: http://www.niaaa.nih.gov/