Category Archives: Research

Global Prevalence of Fetal Alcohol Spectrum Disorder Among Children and Youth A Systematic Review and Meta-analysis

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Shannon Lange, MPH1,2; Charlotte Probst, MSc1,3; Gerrit Gmel, MSc1,4; et alJürgen Rehm, PhD1,2,3,5,6; Larry Burd, PhD7; Svetlana Popova, PhD1,2,5,8
Author Affiliations
JAMA Pediatr. 2017;171(10):948-956. doi:10.1001/jamapediatrics.2017.1919

Key Points

Question  What is the prevalence of fetal alcohol spectrum disorder among children and youth in the general population?

Findings  In this meta-analysis of 24 unique studies and 1416 unique children and youth with fetal alcohol spectrum disorder, approximately 8 of 1000 in the general population had fetal alcohol spectrum disorder, and 1 of every 13 pregnant women who consumed alcohol during pregnancy delivered a child with fetal alcohol spectrum disorder. The prevalence of fetal alcohol spectrum disorder was found to be notably higher among special populations.

Meaning  The prevalence of fetal alcohol spectrum disorder among children and youth in the general population exceeds 1% in 76 countries, which underscores the need for universal prevention initiatives targeting maternal alcohol consumption, screening protocols, and improved access to diagnostic services, especially in special populations.

Abstract

Importance  Prevalence estimates are essential to effectively prioritize, plan, and deliver health care to high-needs populations such as children and youth with fetal alcohol spectrum disorder (FASD). However, most countries do not have population-level prevalence data for FASD.

Objective  To obtain prevalence estimates of FASD among children and youth in the general population by country, by World Health Organization (WHO) region, and globally.

Data Sources  MEDLINE, MEDLINE in process, EMBASE, Education Resource Information Center, Cumulative Index to Nursing and Allied Health Literature, Web of Science, PsychINFO, and Scopus were systematically searched for studies published from November 1, 1973, through June 30, 2015, without geographic or language restrictions.

Study Selection  Original quantitative studies that reported the prevalence of FASD among children and youth in the general population, used active case ascertainment or clinic-based methods, and specified the diagnostic guideline or case definition used were included.

Data Extraction and Synthesis  Individual study characteristics and prevalence of FASD were extracted. Country-specific random-effects meta-analyses were conducted. For countries with 1 or no empirical study on the prevalence of FASD, this indicator was estimated based on the proportion of women who consumed alcohol during pregnancy per 1 case of FASD. Finally, WHO regional and global mean prevalence of FASD weighted by the number of live births in each country was estimated.

Main Outcomes and Measures  Prevalence of FASD.

Results  A total of 24 unique studies including 1416 unique children and youth diagnosed with FASD (age range, 0-16.4 years) were retained for data extraction. The global prevalence of FASD among children and youth in the general population was estimated to be 7.7 per 1000 population (95% CI, 4.9-11.7 per 1000 population). The WHO European Region had the highest prevalence (19.8 per 1000 population; 95% CI, 14.1-28.0 per 1000 population), and the WHO Eastern Mediterranean Region had the lowest (0.1 per 1000 population; 95% CI, 0.1-0.5 per 1000 population). Of 187 countries, South Africa was estimated to have the highest prevalence of FASD at 111.1 per 1000 population (95% CI, 71.1-158.4 per 1000 population), followed by Croatia at 53.3 per 1000 population (95% CI, 30.9-81.2 per 1000 population) and Ireland at 47.5 per 1000 population (95% CI, 28.0-73.6 per 1000 population).

Conclusions and Relevance  Globally, FASD is a prevalent alcohol-related developmental disability that is largely preventable. The findings highlight the need to establish a universal public health message about the potential harm of prenatal alcohol exposure and a routine screening protocol. Brief interventions should be provided, where appropriate.

Retrieved from: https://jamanetwork.com/journals/jamapediatrics/article-abstract/2649225?utm_source=twitter&utm_campaign=content-shareicons&utm_content=article_engagement&utm_medium=social&utm_term=101717#.Web6R23_fvc.twitter

With Heavy Drinking On The Rise, How Much Is Too Much?

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Binge-drinking sounds like an all-night bender, but here’s a reality check: Many social drinkers may “binge” without knowing it. Women who drink four or more drinks on an occasion are binge-drinking.

If one glass of wine takes the edge off, why not drink a few more?

This thinking may help explain the findings of a new study that points to an increase in drinking among adults in the U.S., especially women.

“We found that both alcohol use and high-risk drinking, which is sometimes called binge-drinking, increased over time,” says Deborah Hasin, a professor of epidemiology at the Columbia University Medical Center and an author of the study.

To assess drinking trends, researchers conducted face-to-face interviews with thousands of adults. Researchers asked a series of questions, such as: Did you ever drink four or more drinks on an occasion, and if so, how often? The study compares the findings from two surveys. One was carried out in 2001-2002; the other was from 2012-2013.

So what’s behind the increase? The study wasn’t designed to answer this question, but Hasin says there could be a combination of factors.

“Increasing numbers of people feel pessimistic about their economic chances,” she says. So this might help explain the increase in drinking among low-income Americans. As we’ve reported, economists have linked the economy to so-called deaths of despair from causes including opioid overdoses and alcohol abuse.

When it comes to explaining the increase found among women, the way alcohol is marketed may play a role, too. Hasin says she is speculating here, “but just looking at display windows in liquor stores,” they seem designed to appeal to women. “Everything is pink, it’s all rose,” she says.

And beer-makers have sharpened their pitch to female drinkers too, as this Advertising Age article points out. A recent campaign for Coors Light features women competing in races and climbing mountains. “Every climb deserves a refreshing finish,” the ad’s narrator intones.

So if the makers of wine, beer and spirits are enticing us to drink, are some of us ignoring the risks of excessive drinking? Or maybe many women don’t realize when they’re drinking too much?

Not all national surveys have pointed to an increase in drinking. In fact, the National Survey on Drug Use and Health found a slight decline in alcohol use disorders between 2002 and 2013. But even if there’s been no increase, public health experts say excessive alcohol consumption has long been a problem in the U.S.

“Excessive alcohol use is a huge public health problem in the United States,” says physician Bob Brewer, who leads the alcohol program at the National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention. The CDC estimates that there are about 88,000 deaths due to excessive alcohol use in the U.S. each year.

“Ninety percent of people in the U.S. who drink to excess are binge-drinking,” Brewer says.

Binge-drinking, to me, always sounds like a term for an all-night bender. But here’s the reality check: It’s easier to “binge” than you might think.

The definition of binge-drinking is “four or more drinks for a woman on an occasion, five or more for a man,” Brewer explains.

So think of an evening out: Perhaps you start with a cocktail, then add beer or wine with dinner. The drinks can add up faster than you think.

“It can be tricky sometimes for people to really keep track of the number of drinks they’re consuming,” Brewer says.

A 5-ounce serving of wine counts as one drink. And a 1.5-ounce shot of spirits (such as vodka, gin, or bourbon) counts as a drink, too. But often, cocktails contain more than one shot. (Exactly what counts as “a drink” is detailed here.)

“A lot of beers now, particularly craft beers, may have higher alcohol content,” Brewer says. “So, if you have a 12-ounce beer that [contains] 9 percent alcohol, you’re really drinking the equivalent of close to two drinks,” Brewer says.

There are tips to help you guard against drinking too much, especially at a festive event or social gathering, such as an office party. One tip: Make a pact with yourself or with somebody else to take a break before each drink. And another: Alternate between glasses of water and alcohol.

Brewer says it’s worth reminding everyone that the U.S. Dietary Guidelines recommend that women limit alcohol to one drink per day, two for men.

Retrieved from: http://www.npr.org/sections/thesalt/2017/08/16/543965637/women-who-love-wine-are-you-binge-drinking-without-realizing-it?utm_campaign=storyshare&utm_source=twitter.com&utm_medium=social

FASD Justice and Reconciliation: Tough Questions, New Collaborations

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Final Report- FASD Justice & Reconciliation (final 07-17)

Fetal Alcohol Spectrum Disorder (FASD) is an umbrella term used to describe a spectrum of physical, neurological, cognitive, socio-emotional, and behavioural impairments that may result from prenatal exposure to alcohol. In addition to these impairments, secondary challenges (such as involvement with the criminal justice system) may be experienced in the absence of appropriate supports and services. FASD is often discussed in the context of the criminal justice system, as individuals with FASD are understood to be overrepresented in the justice system.

In 2015, the Truth and Reconciliation Commission of Canada released 94 Calls to Action, directed at various levels of government and to all Canadians. TRC Calls to Action 33 and 34 specifically address FASD. The Calls to Action provided an opportunity to bring together policy makers, front-line workers, parents/caregivers, and students to discuss how the TRC can be considered in justice practices. The Symposium took a holistic look at how justice programs at the local and national level may incorporate culturally-appropriate programming. This included discussions on how individuals and families can be best supported in the community and, when necessary, in the justice system.

Moreover, the Symposium drew attention to the need for programs that are attentive to the broader contexts that impact Indigenous peoples with FASD, particularly when in contact with the justice system. Indigenous voices and programs were at the centre of the discussion. Justice programs that have solidly incorporated Indigenous perspectives were also explored—from smaller community-based projects to larger programs embedded in province-wide judicial initiatives. The goal was for participants to be exposed to programs from across Canada, to gain a broader understanding of the complexity of issues when discussing FASD in the justice system and to be introduced to new tools and networks to respond to the TRC Calls to Action.

The Symposium featured six presenters who led an exploration of how justice system programming supports people with FASD, focusing on the experiences of Indigenous individuals. This included the perspectives of parents, front-line community workers, and diagnosticians. Participants engaged in discussions focused on current practices, future directions, and the path forward. From the feedback collected throughout the event, Dr. Stewart’s research team has produced 6 key findings and 18 recommendations for moving forward.

Key Findings and Recommendations

1 Culturally and Historically-Informed Practices

Participants noted that there is often a lack of culturally and historically-informed programming for individuals with FASD across systems.

Recommendation 1: Develop relationships between agencies and Indigenous communities.

Recommendation 2: Develop training focused on the TRC and the history of residential schools and colonialism in Canada for agencies.

Recommendation 3: Explore the potential for culturally and historically-informed practices within the health system.

2 Trauma

Participants recognized the role of trauma in the lived-experience of individuals with FASD, particularly in relation to the potential for re-traumatization within the justice system.

Recommendation 4: Develop and distribute training on trauma-informed practices.

Recommendation 5: Establish the capacity for trauma to be incorporated as a mitigating factor in sentencing.

Recommendation 6: Develop outreach and training material for frontline health professionals about practices surrounding diagnosis and care.

3 Advocacy

Participants discussed the ways in which individuals with FASD, families, and support agencies can advocate for greater awareness of FASD and confront the stigma surrounding FASD.

Recommendation 7: Facilitate collaborative spaces that are inclusive and welcoming of candid discussions.

Recommendation 8: Create spaces for individuals with FASD and caregivers to engage directly with policy-makers and program managers.

Recommendation 9: Facilitate spaces for individuals with FASD and families to access training.

Recommendation 10: Implement and integrate changes to programs and practices that honour Indigenous perspectives.

Recommendation 11: Establish keeping families together as a top priority informed by Indigenous perspectives.

4 Resources

Participants expressed that, while some jurisdictions have demonstrated success in establishing supports for individuals with FASD and their families, there are substantial gaps in services particularly in rural or remote communities.

Recommendation 12: Identify wise practices that best support individuals with FASD across the lifespan informed by Indigenous perspectives.

Recommendation 13: Prioritize community driven requests for supports and services with an emphasis on sustained funding.

Recommendation 14: Fund culturally appropriate diagnoses, mentorship, and respite for families, lifeskills and mentoring for individuals, and ongoing support that changes across the lifespan.

5 Interagency Collaboration

Participants noted that a primary challenge to the provision of appropriate supports and services to individuals with FASD is the “silo effect” (agencies working in isolation) which prohibits effective collaboration.

Recommendation 15: Facilitate regular opportunities for interdisciplinary teams to come together to share resources.

Recommendation 16: Strike working groups comprised of federal, provincial/territorial stakeholders, and policy-makers in collaboration with Indigenous communities to implement TRC Calls 33 and 34.

6 Challenging Systems and Policy

Participants noted many barriers to individuals with FASD accessing services, including the need for maternal confirmation and justice-specific concerns (such as conditions of release and use of legal jargon).

Recommendation 17: Complete a program and policy review through a TRC lens to make appropriate modifications to programs, practices, and protocols.

Recommendation 18: Undertake a review of culturally modified/culturally appropriate diagnostic practices to modify or enhance current diagnostic practices.

FASD, JUSTICE & RECONCILIATION: TOUGH QUESTIONS, NEW COLLABORATIONS n FEBRUARY 22 & 23, 2017 n EXECUTIVE SUMMARY

 

 

Why Americans—Especially Women—Are Drinking More Alcohol

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More Americans are drinking high amounts of alcohol, and the greatest increases are seen among women and older adults, according to a new study published in JAMA Psychiatry.

In the new report, researchers at the National Institute on Alcohol Abuse and Alcoholism compared two large studies of people who self-reported their drinking habits. The first was a study of more than 43,000 adults from 2001-2002, and the second included more than 36,000 adults from 2012-2013.

The number of Americans who said they drank alcohol in the last year increased 11%. High-risk drinking—defined as having four or more drinks per day at least once a week, every week, for a year, and five or more for men—increased almost 30%. Alcohol use disorders increased nearly 50%; they were determined if a person was found to be dependent on alcohol, based on American Psychiatric Association criteria.

Though the figures represent just a snapshot in time, researchers say the increases are higher than what they’ve observed in prior studies.

These increases were apparent in everyone, but they were much higher in women. For men, high risk drinking increased 15% and alcohol use disorder increased close to 35%. For women, high-risk drinking increased close to 60%, and alcohol use disorder increased nearly 84%.

Older adults also appeared to be drinking substantially more than in the past. Among adults age 65 and older, high-risk drinking increased 65% and alcohol use disorders increased close to 107%. These increases were “substantial and unprecedented” compared to earlier surveys, the study authors write.

It is not yet clear why women and older adults had higher increases in this type of drinking, but the researchers have some ideas. Over the years, cultural norms about drinking have changed, and it has become more acceptable for women to drink in similar ways as men, the researchers note. “Increases in educational and occupational opportunities and rising numbers of women in the workforce” may also have contributed to higher drinking levels in the last decade, they write.

Added stress is another factor that might drive anyone, regardless of their sex, to drink more. High-risk drinking was higher among minority groups, and the authors argue that wealth inequality between minorities and whites has widened during and after the 2008 recession, which may have led to “increased stress and demoralization.” Income and educational disparities, as well as “unemployment, residential segregation, discrimination, decreased access to health care, and increased stigma associated with drinking,” may also play a role, the authors write.

Drinking levels in the United States have reached a “public health crisis,” the researchers say, and more effort is needed to address the individual, environmental and societal factors that might be contributing.

By Alexandra Sifferlin

Retrieved from: http://time.com/4893108/alcohol-use-disorder-drinking/

Headlines, research and prevention: Do research findings on risks of alcohol use during pregnancy improve prevention efforts?

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When you sign up for online alerts regarding new FASD research, a lot of research articles come your way. Some offer hope like the recent article on a possible future treatment for newborns diagnosed with FASD (see Common drugs reverse signs of fetal alcohol syndrome in rats). But most are headlines about newly identified risks associated with alcohol-exposed pregnancies.

For instance, these four recent headlines:

Drinking alcohol during pregnancy could have transgenerational effects

Prenatal exposure to alcohol increases likelihood of addiction later in life

Any alcohol consumption during pregnancy affects craniofacial development

Foetus absorbs mother’s alcohol and nicotine intake in just 2 hours

From a scientific research standpoint, it’s important to fully understand effects of alcohol -exposed pregnancies. But, from a prevention point of view, does it add anything to our efforts to know one more reason drinking alcohol during pregnancy is risky? Does it lessen the stigma these women face? Would one more identified risk be the thing a woman needed to hear in order to stop drinking in her pregnancy or while trying to become pregnant?

Obviously, the full picture of effects is important, and this kind of medical and scientific research should continue. At the same time, it would be helpful to see more headlines on what has been discovered around prevention – focusing on programs that support the mother child dyad, efforts to reduce stigma, and implementation of trauma-informed and FASD-informed practices and policies.

How about five headlines like these?

Relational treatment programs reduce risk of alcohol-exposed pregnancies and FASD

Connection to culture is key to prevention for many women

Changes in alcohol policy contribute to reduction of violence against women and incidence of alcohol-exposed pregnancies

Secure housing contributes to reduction in alcohol-exposed pregnancies

Women who can safely discuss alcohol with their health provider are  more likely to stop risky drinking

This real headline deserves more coverage: “ If we want to save lives, control alcohol. ”

We have lots of information of the risks of alcohol-exposed pregnancies. The work now is about prevention and we will work to bring you those “headlines.”

For more information on these topics, see these previous posts:

REACHING AND ENGAGING WOMEN: WHAT WORKS AND WHAT’S NEEDED MAY 15, 2017

THUNDER BAY’S FAMILY HEALTH PROGRAM PUBLISHES RESEARCH REPORT FOR PREVENTING ALCOHOL-EXPOSED PREGNANCY OCTOBER 4, 2016>

THE WORK OF THE NETWORK ACTION TEAM ON FASD PREVENTION FROM A WOMEN’S HEALTH DETERMINANTS PERSPECTIVE (CANFASD RESEARCH NETWORK) APRIL 11, 2016

FASD ISSUE PAPERS FROM THE CANADA FASD RESEARCH NETWORK PROVIDE A QUICK OVERVIEW OF RECENT RESEARCH DECEMBER 1, 2014

SUPPORTING PREGNANT WOMEN WHO USE ALCOHOL OR OTHER DRUGS: A GUIDE FOR PRIMARY HEALTH CARE PROFESSIONALS MAY 15, 2016

FREE WEBINAR: UPDATED RESOURCES ON WOMEN AND ALCOHOL: APPLYING RESEARCH TO PRACTICE – MAY 8, 2014 APRIL 21, 2014

FASD PREVENTION RESEARCH AND KNOWLEDGE TRANSLATION: DEVELOPING A PAN-CANADIAN AGENDA WORKSHOP JANUARY 29, 2014

FASD INFORMED PRACTICE FOR COMMUNITY BASED PROGRAMS MARCH 27, 2014

RESEARCH MAKES LINKS BETWEEN GENDER, ETHNICITY, CHILDHOOD ABUSE AND ALCOHOL USE APRIL 2, 2013

TRAUMA MATTERS: GUIDELINES FOR TRAUMA‐INFORMED PRACTICES IN WOMEN’S SUBSTANCE USE SERVICES APRIL 17, 2013

Retrieved from: https://fasdprevention.wordpress.com/2017/08/07/headlines-research-and-prevention-do-research-findings-on-risks-of-alcohol-use-during-pregnancy-improve-prevention-efforts/

USA: The Problem With Penalizing Women Who Drink While Pregnant

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A new study, published today in Alcohol and Alcoholism, is the first published piece in a large-scale project examining state-level policies regarding alcohol use during pregnancy. Researchers looked at the prevalence of these policies, the different kinds of policies that exist, their correlation to reproductive rights laws, and will eventually put together a comprehensive analysis of when and how policies can effectively combat the public health crisis of alcohol use during pregnancy.

One key element of the research was separating these policies into two categories; punitive policies (designed to punish women for drinking while pregnant by civilly committing them, mandating reporting of those who use alcohol to law enforcement and/or child protective services, or initiating child welfare proceedings to remove children from the mother’s custody) and supportive policies (which attempt to address the issue of alcohol use during pregnancy through education and treatment).

The study, from Advancing New Standards in Reproductive Health (ANSIRH), a reproductive health research group based at the University of California San Francisco, found that states with punitive policies tend to also have a history of restrictive reproductive rights laws, as opposed to states that have supportive policies.

“People who want to reduce harms due to the consumption of alcohol by pregnant women should be concerned that policymaking in this area appears to be more about restricting women’s reproductive autonomy than addressing the issue itself,” said the study’s lead author, Sarah Roberts, Dr.P.H., associate professor of obstetrics, gynecology, and reproductive sciences at ANSIRH.

During this first phase of the project, Roberts said, they were really focusing on determining whether policymaking around alcohol use during pregnancy was more similar to policymaking related to reproductive rights, or to more general public-health-oriented policies. Their findings of a strong connection to state-level policy around reproductive rights, which raises questions as to whether these punitive policies are beneficial to public health at all, or if they’re really about restricting the autonomy of pregnant women.

“It doesn’t seem to be at all related to policymaking related to reducing health harms from alcohol use in general,” Roberts said. “It raises some concerns that policymaking in this area isn’t coming from a process that we generally like to see in terms of public health policies where they’re actually looking at the data about the outcome and designing policies based on everything we know about affecting that outcome.”

The study shows that there has been an increase in state-level policies around alcohol use during pregnancy since 1970, and that they’ve become increasingly punitive since then. Between 2003 and 2012, the number of states that consider alcohol use during pregnancy child abuse and/or neglect has increased by 40 percent, but the number of states that give pregnant women priority access to substance abuse treatment hasn’t increased—meaning women are more likely to be punished for drinking, but not any more likely to get help if they try to stop.

Roberts says they’ll need more time to analyze the date before they can say definitively whether punitive policies are effective in preventing alcohol abuse during pregnancy (or whether they’re more or less effective than supportive policies), but that’s something they’re working toward determining. But, she says, her past research has indicated that similar punitive policies regarding drug use during pregnancy cause women to avoid necessary prenatal care out of fear. “That’s one of the outcomes that we’re investigating here,” Roberts said.

BY

Retrieved from: https://www.glamour.com/story/the-problem-with-penalizing-women-who-drink-while-pregnant

Parents warned against giving children alcohol in attempt to supervise drinking

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By Lauren Waldhuter

Parents who introduce their teenage children to alcohol in the hope it encourages better drinking habits in adulthood could be doing more harm than good, researchers have found.

The University of Adelaide team surveyed 2,800 students aged from 12 to 17 to provide a comprehensive snapshot of their drinking habits and influences.

While rates of teen drinking are reducing, the research found 7.6 per cent of children as young as 12 drank alcohol occasionally, but the figure rose to 66.3 per cent by the age of 17.

At 16 years of age the number of drinkers exceeded the number of non-drinkers at 59.5 per cent.

Lead researcher Jacqueline Bowden said parents were mistaken if they believed it was better to introduce underage teenagers to alcohol.

“[Parents] are thinking they should be doing the right thing by encouraging drinking within the safe environment of the home,” she said.

“But we’re actually saying don’t be purchasing alcohol for teenagers because it encourages heavier drinking, and drinking in the earlier ages.”

She said, surprisingly, the results showed young people did pay attention to what their parents thought about alcohol.

Joshua Laviolette with his motherPHOTO: Joshua Laviolette (right) has chosen not to drink, saying it was not a hard decision. (ABC News: Lauren Waldhuter)

 

“What we found was that teenagers that were aware their parents didn’t condone their alcohol consumption were much less likely to drink alcohol,” Ms Bowden said.

“The evidence is really clear: role modelling is really important so we need to be aware of our drinking around our children.

“We also need to be setting clear expectations around alcohol consumption in children.”

Joshua Laviolette, 17, has chosen not to drink alcohol largely because of his mother’s own attitude.

Vodka Cruiser advertisementPHOTO: A Vodka Cruiser marketing campaign was pitched at young girls. (Supplied: Cancer Council)

 

“My mum doesn’t drink at all. I’ve never seen her drink at the house,” he said.

“I’ve never seen her drink out, so I just decided not to because I think it’s the right thing to do.

“It’s not really that hard. I just tell [friends] I don’t want to drink because I don’t really feel like it.”

The report found neither social disadvantage nor gender were significant factors, and that young people were most likely to access alcohol if they could afford it.

Ads on Instagram target teen girls

Vodka Cruiser adPHOTO: This ad was recently slammed for promoting ways of disguising a hangover. (Supplied: Cancer Council)

 

Asahi Premium Beverages was recently slammed for its Vodka Cruiser marketing campaign, pitched at young women.

Advertisements on an Instagram account depicted a young woman with glitter under her eyes, with the caption “how to cover your dark eye circles the morning after”.

A report by the Advertising Standards Bureau said the posts depicted “a face of a girl who appears to be a young teenager”, and that “other Vodka Cruiser Instagram posts also appear to be directed to children”.

The ads have since been pulled, after a complaint by the Cancer Council’s Victorian branch.

Cancer link ignored by teens

Adelaide University’s research found the majority of young people were not thinking about the long-term health effects of alcohol, which can contribute to a range of diseases including cancer.

Only 28.5 per cent of those surveyed thought alcohol could increase a person’s risk of cancer.

“This latest evidence highlights the need to educate young people about the consequences of alcohol consumption and for parents to demonstrate responsible drinking behaviour,” Cancer Council SA chief executive Lincoln Size said.

“We need to get the message through that what may be considered harmless fun actually has lifelong consequences.”

Retrieved from: http://www.abc.net.au/news/2017-07-20/teen-alcohol-drinking-in-family-homes-backfiring-study-says/8728338

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