ISE12/16-17

• According to the World Health Organization ("WHO"), alcohol consumption is the third largest risk factor for ill health in developed countries after tobacco consumption and hypertension.^{1Legend symbol denoting See World Health Organization (2002).} It has been linked to more than 60 types of diseases, and alcohol-related illnesses include cirrhosis, hepatitis, pancreatitis, cancer, cardiovascular disease, diabetes and a weakened immune system.
• The harmful effects of alcohol can be more pronounced for young people than adults as their brains are still developing during the teen years. More importantly, early initiation of drinking is associated with a higher frequency of drinking as well as a higher chance of alcohol abuse in later life. Indeed, as reported by WHO, alcohol use is the single biggest risk factor for deaths among young people aged 15 to 29.^{2Legend symbol denoting According to the World Health Organization (2015), the number of deaths due to alcohol is 30% higher than the number of combined deaths from the next two leading risk factors, occupational risks and illicit drug use.}
• Harmful drinking among young people is an increasing concern in many places and Hong Kong is no different. Based on the latest figures available, in 2012, there were a total of 35 hospital discharges and deaths due to alcohol-related illness or injuries among people aged below 18 in Hong Kong. Mental and behavioural disorders due to use of alcohol accounted for 100% of these cases.^{3Legend symbol denoting See Centre for Health Protection (2014).}
• Against the above, the Government plans to introduce regulation prohibiting commercial sale and supply of alcohol to persons under the age of 18. This is to plug the loophole in the current regulation which does not forbid the sale of alcohol to persons aged under 18 in retail stores such as supermarkets and convenience stores. This issue of Essentials provides an overview of the prevalence of underage drinking in Hong Kong and the current regulatory regime and legislative changes for the sale and supply of alcohol to underage persons. This is followed by a discussion of multi-pronged approach adopted by overseas places in preventing underage drinking, featuring the use of both legislative and non-legislative measures.

Underage drinking in Hong Kong

• The rates of youth alcohol use in Hong Kong are lower than that reported in western countries.^{4Legend symbol denoting Ibid.} However, alcohol drinking is still prevalent among young people. According to the latest data available,^{5Legend symbol denoting Data were collected from Primary 4 and 6 and Secondary 2, 4 and 6 students who attended the Student Health Service Centres of the Department of Health and completed the self-administered questionnaires in the first seven months in the 2015-2016 school year.} 3.4% of Primary 4 students and 12.1% of Secondary 6 students had at least one experience of binge-drinking, defined as having five or more glasses/cans of alcoholic drinks in a row within several hours.^{6Legend symbol denoting For students in other education-level cohorts, 3.1% of Primary 6 students, 5.5% of Secondary 2 students and 7.9% of Secondary 4 students had at least one experience of binge-drinking.} Moreover, 1.2% of Primary 4 students and 2% of Secondary 6 students were reported to have binge drinking as a monthly habit.^{7Legend symbol denoting For students in other education-level cohorts, 0.9% of Primary 6 students, 1.3% of Secondary 2 students and 1.6% of Secondary 4 students had binge-drinking at least once a month.} A number of surveys also pointed to the prevalence of underage drinking in Hong Kong, including one suggesting that some ever-drinking secondary students first tried alcohol at the age of about 11 or younger.^{8Legend symbol denoting According to the survey conducted by the University of Hong Kong, 49% of ever-drinking Primary 4 to 6 students first tried alcohol at the age of 8 or younger, while 56% of ever-drinking secondary school students first tried alcohol at the age of 11 or younger. Likewise, a survey conducted by the Hong Kong Polytechnic University observed that 38% of the 840 Secondary 3 students interviewed had drinking experience dating back on average to just under the age of 11.} According to the Department of Health, young people obtained alcohol from various sources, including parents and self-purchasing.^{9Legend symbol denoting See Department of Health (2017c).}
• The problem of underage drinking has been compounded by the trend of those who start consuming alcohol at young age being more likely to develop a higher frequency of drinking or binge-drinking later in life, as evidenced by the study commissioned by the Department of Health in 2015 on drinking behaviour of adults in Hong Kong.^{10Legend symbol denoting The study surveyed more than 2 500 adults aged 18 to 64, and found that 64.8% of those who drank more than three times a week reported having their first sip of alcohol before 18, whereas 64.6% of those who drank less than once a month or only on special occasions reported having their first sip of alcohol on or after 18. See Department of Health (2017a).}

Current regulatory regime and proposed legislative changes for the sale and supply of alcohol to underage persons

• Amid the prevalence of underage drinking in Hong Kong, there have been calls for early intervention to be put in place to protect young people from alcohol-related harm. Of particular importance is to restrict access to alcohol by persons aged under 18. Since 2000, Hong Kong has put in place a liquor licensing system, as laid down in the Dutiable Commodities (Liquor) Regulations (Cap. 109B), under which no licensee shall permit any persons under the age of 18 to drink any intoxicating liquor on any licensed premises such as bars, restaurants and clubs. However, there is currently no regulation that prohibits the retail sale of alcohol to persons under the age of 18 in licensed premises for off-premises consumption, or sale of alcohol to persons aged below 18 in retail stores.^{11Legend symbol denoting Some organizations have adopted a voluntary code of conduct to restrict the sale of alcohol to young people. For example, the Hong Kong Retail Management Association states in its code of practice that its members should not sell any alcoholic beverages to persons aged under 18 years.}
• In view of the above, the Government plans to introduce the Dutiable Commodities (Amendment) Bill 2017 in the 2016-2017 legislative session, in an effort to protect young people from alcohol-related harm and plug the legislation loophole. The proposed regulation will prohibit commercial sale and supply of intoxicating liquor to underage persons, including face-to-face distribution and remote distribution. The activities to be regulated include sale or supply of alcohol through mail order or any electronic means (e.g. internet), sale from vending machines and giving alcohol for the purpose of promotion or advertisement. Other measure includes requiring a prescribed notice prohibiting the sale or supply of intoxicating liquor to underage persons be visibly and prominently displayed at the point of sale or place of promotion. Under the proposed regulatory regime, the Government will not introduce a licensing system for the sale and supply of intoxicating liquor, but will impose a penalty for non-compliance with the age limit.

Multi-pronged approach for preventing underage drinking

• Indeed, Hong Kong is lagging behind many overseas places in developing a comprehensive framework to help address underage drinking. The ensuing paragraphs discuss the legislative measures in England and the multi-stakeholder approach in Finland. These measures are considered effective in reducing the consumption of alcohol among young people. It has also been well-documented that the use of multi-pronged approach is more effective in preventing underage drinking.^{12Legend symbol denoting See World Health Organization (2014).}

Legislative measures in England

• In England, selling alcohol to an underage person is prohibited under the Licensing Act 2003 ("the Act").^{13Legend symbol denoting In England, individuals or businesses, such as pubs and supermarkets, who want to sell or supply alcohol must have a licence. Under the previous alcohol licensing regime, the laws governing sale of alcohol to underage applied only to licensed premises. The Act has made it an offence to sell alcohol to persons under 18 anywhere.} Since the Act came into force in 2005, the proportion of young people aged 11-15 in England who had ever drunk alcohol had decreased from 58% in 2005 to 38% in 2014.^{14Legend symbol denoting See Health and Social Care Information Centre (2015).} Some have suggested that the enforcement of the age limit could be a possible contributing factor to the decline.^{15Legend symbol denoting See Birdwell & Wybron (2015). However, the Institute of Alcohol Studies (2016) suggested that other factors, such as, declining affordability, were more likely to have substantially reduced underage drinking than stricter legal enforcement of minimum purchase ages.} The following are the key features of the legislative regime for preventing and reducing underage drinking in England:
  
  

  (a)	Age limit: It is illegal for anyone to sell alcohol to, or buy or try to buy alcohol for, a person aged under 18. It is also illegal for a person aged under 18 to buy or try to buy or drink alcohol16Legend symbol denoting It is legal for a person aged 16 or 17 to drink beer, wine or cider with a meal, if he or she is accompanied by an adult.;
  (b)	Age verification: Premises which sell or supply alcohol, including internet sale, must have an age verification policy in place, requiring persons who look under 18 to produce proof of age.17Legend symbol denoting The age verification is a mandatory licensing condition imposed by the licensing authority to promote one of the four licensing objectives, namely the "protection of children from harm". Some local governments have issued guidelines to help with due diligence for internet sale, such as placing age verification checks at the point of delivery, and using online age verification software that makes use of various sources of information in order to check a purchaser's age;
  (c)	Defence: It is a defence for someone charged with selling alcohol to a person aged under 18 that he or she believed the person was aged 18 or over and either he or she had taken all reasonable steps to establish the individual's age or nobody could reasonably have suspected from the person's appearance that they were aged under 18;
  (d)	Enforcement: The regime is supported by a range of inspection powers and enforcement, including test purchasing which is proven to be effective in creating a deterrent effect and improving compliance with the age limit;18Legend symbol denoting See European Commission (2013). and
  (e)	Sanctions: There is a range of punitive measures against the sale of alcohol to underage, including cautions, monetary fines, prosecutions as well as revocations or suspensions of licences. In addition, the government introduced tougher sanctions for persistent sale of alcohol to underage persons through a "two strikes" policy. Shop owners will face prosecution, if he or she has committed the offence of selling alcohol to an underage person twice within three months. Yet, the shop owner concerned may accept a voluntary closure of his or her shop between two days to two weeks as an alternative to prosecution.

Non-legislative measures in Finland

• The Finland's Local Alcohol Policy ("PAKKA") project is a showcase community-based programme in reducing alcohol availability to persons under 18. When the PAKKA project was evaluated for its effectiveness after three years of implementation, results showed an increase in refusals to sell alcohol to those below the legal age limit, as well as an increased perception among young people that alcohol is difficult to purchase in the communities.^{19Legend symbol denoting The PAKKA project was implemented between 2004 and 2007, which aimed at reducing alcohol availability to persons under 18, among other goals. See Holmila & Warpenius (2012).}
• The PAKKA project was a collaboration between the Finnish government and stakeholders from the alcohol industry, media and academics.^{20Legend symbol denoting In Hong Kong, the Department of Health has recently launched the "Young and Alcohol Free" campaign, a collaboration with young people and parent groups, schools, healthcare professionals to step up efforts to prevent and reduce underage drinking. Core components of the campaign include a public health movement targeting at young people, a territory-wide mass publicity campaign targeting at parents/general public, and liaising with different stakeholders.} The components of the project included not only mass publicity campaigns and educational programmes targeting at parents and young people, but also strengthening law enforcement and a half-day voluntary training programme for servers and sellers of alcohol on the alcohol laws and practical working methods to implement them.

Concluding remarks

• Underage drinking can lead to serious health problems and is a common problem throughout the world. Most of the countries in the world have put in place a legal minimum age for the purchase of alcohol to restrict access to alcohol by underage persons. Apart from age-limit laws, a multi-pronged approach, combining elements of enforcement with education and prevention, is required to educate alcohol sellers, parents as well as young people themselves on the importance of preventing underage persons from alcohol-related harm.

Prepared by Samantha LAU
Research Office
Information Services Division
Legislative Council Secretariat
24 April 2017