Young People s Drinking Behavior in Japan

Young People s Drinking Behavior in Japan Susumu Higuchi, MD, PhD 1 Kenji Suzuki, MD 1 Sachio Matsushita, MD 1 Yoneatsu Osaki, MD, PhD 2 1 National Hospital Organization, Kurihama Alcoholism Center, Yokosuka, Kanagawa, Japan 2 Department of Social Medicine, Tottori University School of Medicine, Yonago, Tottori, Japan Introduction In this article, young people are divided into two broad groups: youths under the legal drinking age or the underage and young adults. The definition of underage drinking and legal provisions that often accompany it vary from country to country. In Japan, the minimum drinking age is set at age 20, according to the Law Prohibiting Minors from Drinking. Young adults are the youngest group of the legal drinking age, operationally defined here as 20 to 29-year-olds. Based on this classification and referring to the results of two large-scale cross-sectional national surveys and to an on-going longitudinal study, we first look at the current drinking behavior among underage Japanese youths. Data on young adults is extracted from the national survey of Japan s adult population, conducted in 2003, and is compared with the results of the 1984 national survey. Before taking up the main topic, we briefly describe traditions and norms related to alcohol consumption in Japan. Since it is difficult to cover every area, we focus on those items that may help readers understand the specifics of young people s drinking in that country. Drinking in Japan Drinking norms Traditionally, the Japanese society was relatively tolerant of alcohol consumption by middle-aged men, while disapproving of such behavior among young people and women. As a reflection of these long-established drinking norms, lifetime alcohol intake of an average Japanese adult represented a bell curve, with the highest consumption observed among the middle-aged population for both genders. In addition, a significant difference in the amount of alcohol used persisted between genders at all ages: women in general drank less than men. These norms and patterns, however, have been changing in recent years. Per capita alcohol consumption Unlike in most industrially developed countries and until recently, per capita alcohol 1

consumption in Japan had steadily increased since the end of the World War II. For the last several years, however, it has fluctuated around 6.5 liters a year, indicating that a plateau consumption level was reached. Preferred alcohol beverages Japan s traditional drinks are sake, rice wine, and shochu, a distilled wine made from various ingredients including rice, wheat, or sweet potato. Like in many other countries, however, beer replaced these traditional beverages as the most popular drink in Japan. Vending machines Japan is the only country in the world, where alcohol can be purchased from vending machines. Such machines are usually located outside of liquor stores, convenience stores, and supermarkets that sell alcohol. In 1996, approximately 186,000 machines were in operation throughout the country. However, due to voluntary regulation by the beverage alcohol industry and retailers, this number had dropped to 68,000 in 2003. Law Prohibiting Minors from Drinking As discussed above, the Law Prohibiting Minors from Drinking regulates minimum drinking age in Japan. This law, first enacted in 1922, consists of only 4 articles (Table1). Beyond barring those under age 20 from purchasing and consuming alcohol, the law also prohibits adults from procuring alcohol for minors. However, like in other countries, law enforcement in Japan has not been sufficient to ensure compliance with these regulations. Table 1. Law Prohibiting Minors from Drinking Article 1 1. Persons under 20 years of age must not consume beverage alcohol. 2. When persons with parental rights or persons acting as guardians in place of parents learn that minors are drinking beverage alcohol, they must stop such consumption. 3. Enterprises involved in selling or giving beverage alcohol must not do so if they learn that these beverages are to be consumed by persons under 20 years of age. 4. Enterprises selling or giving beverage alcohol are required to confirm the age of consumers and take other measures necessary to prevent alcohol intake by persons under 20 years of age. Article 2 Beverage alcohol or containers of alcohol possessed by persons under 20 years of age for the purpose of consumption may be subject to the necessary measures, such as confiscation or disposal, based on administrative decisions. 2

Article 3 1. Persons violating the provisions of Article 1, Paragraph 3, will be subject to a fine of not less than 500,000. 2. Persons violating the provisions of Article 1, Paragraph 2, will be subject to a minor fine. Article 4 When an individual or a representative of a corporation, or any agent, employee, or other worker of a corporation commits a violation, in connection with the business of the corporation or individual, as specified in Article 3, Paragraph 1, not only the person committing the violation will be punished, but also the corporation or individual will be subject to punishment as specified in the same article. (Translated by the authors) Underage Drinking National Survey of Junior and Senior High School Students 1. Outline This large-scale survey was initiated with two main goals: to determine the current status of underage drinking in Japan and to monitor changes in drinking behavior over time. The first survey was conducted in 1996 (Minowa et al., 1996; Suzuki et al., 2001; Osaki et al., 2003), followed by the second survey in 2000 (Kamihata et al., 2000; Suzuki et al., 2003). The third survey is scheduled for 2005. 2. Methods The survey was cross-sectional and used a stratified 1-stage cluster sampling method. The subjects of the survey were junior high school and senior high school students nationwide. 1 After the country was divided into 12 geographic areas for junior high schools and 6 areas for senior high schools, 122 junior and 109 senior high schools were randomly selected. With the cooperation of teachers, self-reported anonymous questionnaires were then administered to students on a voluntary basis. Questionnaires from 80 junior and 73 senior high schools were returned in 1996, resulting in approximately 116,000 valid responses. A similar sampling procedure in 2000 collected approximately 106,000 valid responses. This represented roughly 1% of junior and 2% of senior high school students in Japan. Aggregate response rates for the survey subjects were 63% in 1996 and 62% in 2000. Since in Japan all children are required to attend junior high school (ages 12 to 15), and more than 95% of them go on to senior high school 1 Japanese education system consists of five main stages: Kindergarten (age 3-6), Elementary School (age 6-12), Junior High School (age 12-15), Senior High School (age 15-18), College or University. 3

(ages 15 to 18), the surveys results may be deemed broadly illustrative of Japan s teens. The questionnaire was prepared utilizing the contents of previous surveys conducted both in Japan and in other countries. Themes covered by the 2000 questionnaire included drinking behavior, knowledge about alcohol, family environment, and other items related to friends, school, and habits. Although, as the survey organizers, we tried to incorporate questions on drinking behavior in accordance with major American and European surveys, cultural and linguistic differences hindered such efforts in some cases. For example, because the terms standard drink and binge drinking are not popular in Japan, these items could not be incorporated. 3. Summary of the results The results of two national surveys can be summarized as follows: 1) Despite the law prohibiting underage drinking, around 50% of junior high school and 70% of senior high school students reported some experience with alcohol. 2) As in other countries, instances of alcohol consumption, regular drinking, and alcohol-related problems show a constant and dramatic increase with age. 3) Differences are not too wide for drinking patterns of boys and girls. However, boys still exhibit more drinking problems such as fighting, vomiting, hangover, and blackouts. 4) The major source of beverage alcohol for junior and senior high school students was their own homes, followed by convenience stores. Percentage of students obtaining alcohol from vending machines decreased in both junior and senior high school students, as fewer vending machines selling alcohol became available. 5) The choice of alcohol beverage appeared to be gender-linked. Male students preferred beer, while female respondents preferred sweet or fruit-flavored cocktails. 6) Drinking behavior did not change dramatically between 1996 and 2000. It was noted however, that, while overall alcohol consumption appeared to decrease, drinking problems in female students increased during this period. Prospective Longitudinal Survey 1. Outline and methods Apart from the cross-sectional studies, the first longitudinal cohort study of underage drinking in Japan was initiated in 1997 (Suzuki et al., 2002). In the study, 802 subjects were recruited from four junior high schools in Kanagawa prefecture. These students were enrolled in grades 7 to 9, with a mean age of 13.5 years in 1997. The survey was repeated annually by mail, using self-reported questionnaires concerning drinking patterns and alcohol-related problems. Although the follow-up rate has gradually declined, it was still 70% during the 5-year follow-up in 2002. 4

2. Summary of the results A 5-year longitudinal study of junior high school students revealed the following: 1) Drinking behavior changes dramatically during junior and senior high school years. 2) Over the 5-year period, the percentage of young people consuming alcohol doubled. Drinking in the family tended to be replaced by drinking with friends. 3) The prevalence of alcohol-related problems increased sharply since students were first surveyed in 1997. For example, the percentage of problem drinkers, identified according to the Japanese version of the Quantity-Frequency Scale (Suzuki et al., 1994), increased more than 100 times over the 5-year period, as students progressed from junior to senior high school. 4) Risk factors found to be associated with drinking problems were: earlier age of the first drink, susceptibility to peer pressure, and lack of communication with parents. Drinking among Young Adults National Surveys on the Adult Population 1. Outline and methods As mentioned above, data on drinking behavior among young Japanese adults aged 20 to 29 can be extracted from the 2003 national survey of Japan s adult population (Higuchi et al., 2003). To allow for monitoring time series changes, the data were compared with those from the 1984 national survey (NIAAA and NIA, 1991; Higuchi et al., 1994). The subjects of the 2003 survey were 3,500 Japanese, representative of the country s general population aged 20 or older and selected through the stratified 2-stage random sampling method. The questionnaire asked the respondents for their demographic characteristics, drinking patterns and outcomes, and included several screening tests for alcohol-related problems. Each subject underwent a face-to-face interview and was administered self-report screening tests. The response rate to the latter was 73%. The 1984 survey was conducted as part of the USA-Japan collaborative epidemiological study. Area probability sampling of 4 study sites in Japan and face-to-face interviews yielded valid responses from 1,225 subjects, aged 18 and older. 2. Summary of the results The data on drinking behavior among young adults can be summarized as follows: 5

1) Over the last two decades, alcohol consumption and instances of alcohol-related problems among adult Japanese women have dramatically increased, while relatively few changes occurred in the male population. 2) Among female adults of all age groups, young women reported the highest alcohol consumption and prevalence of alcohol dependence. 3) Among male adults of all age groups, young men were the exception to the general continuity of drinking patterns: alcohol consumption by young men aged 20 to 29 increased since 1984. 4) As a result of these changes, the age structure of drinking behavior among Japanese adults seems to be shifting from the traditional Japanese style discussed above to the Western style, with the highest alcohol consumption and the level of related problems occurring during earlier stages of adulthood. General Summary and Future Studies Taking the results of these studies together with other recent literature, young people s drinking in Japan may be summarized as follows: 1) Underage alcohol consumption in Japan has already reached a high level. 2) Drinking behavior undergoes a significant change, as students progress from junior to senior high school. 3) Survey results reveal that alcohol consumption and the level of alcohol-related problems among young adults, especially among young women, have sharply increased. 4) Although conclusive evidence is lacking, it is reasonable to speculate that changes in drinking behavior among Japan s underage population may have led to those in young adults. Based on these findings, two research areas may become important in future studies: continuation of systematic national surveys and the longitudinal study, and comprehensive preventive research targeted at the underage group. The results of such research would contribute to international efforts for prevention of drinking problems among young people. References Higuchi, S., Parrish, K.M., Dufour, M.C., Towle, L.H., Harford, T.C. (1994). Relationship between age and drinking patterns and drinking problems among Japanese, Japanese-Americans, and Caucasians. Alcoholism: Clinical and Experimental Research, 18(2), 305-310. Higuchi, S., Osaki, Y., Shirasaka, T., Hiro, H., Matsushita, S. (2003). Report on the study of drinking behavior of the adult population and prevention of alcohol-related problem. Health Science Research Project, Ministry of Health, Labor and Welfare. Yokosuka, 6

Japan: Authors. Kamihata, T., Suzuki, K., Wada, K., Yamaguchi, N., Minowa, M., Oida, T., Osaki, Y. (2000). Report on the National Survey of Underage Smoking and Drinking, 2000. Special Scientific Research Project for the Fiscal Year 2000, Ministry of Health, Labor and Welfare. Tokyo, Japan: Authors. Minowa, M., Suzuki, K., Wada, K., Osaki, Y. (1996). Report on the National Survey of Underage Drinking, 1996, Special Scientific Research Project for the Fiscal Year 1996, Ministry of Health, Labor and Welfare. Tokyo, Japan: Authors. National Institute on Alcohol Abuse and Alcoholism and National Institute on Alcoholism (1991). Alcohol consumption patterns and related problems in the United States and Japan: Summary report of a joint Japan-USA Alcohol Epidemiology Project. Rockville, MD: Authors. Osaki, Y., Minowa, M., Suzuki, K., Wada, K. (2003). Adolescent alcohol use in Japan, 1996. Yonago Acta Medica, 46(2), 35-43. Suzuki, K., Matsushita, S., Higuchi, S., Takeda, A. (1994). Quantity-Frequency Scale (QF Scale) for adolescent problem drinking. Japanese Journal of Alcohol & Drug Dependence, 29(3), 168-178. Suzuki, K., Minowa, M., Osaki, Y., Wada, K. (2001). Drinking behaviors of Japanese adolescent problem drinkers: Report of 1996 national survey. Japanese Journal of Alcohol & Drug Dependence, 36(1), 39-52. Suzuki, K., Takeda, A., Matsushita, S., Higuchi, S., Shirakura, K. (2002). A cohort study of Japanese adolescent alcohol use and misuse (1): Observation for 2 years. Japanese Journal of Alcohol and Drug Dependence, 37(6), 577-585. Suzuki, K., Osaki, Y., Minowa, M., Wada, K., Ohida, T., Doi, Y., Tanihata, T. (2003). Japanese national survey of adolescent drinking behavior: Comparison between 1996 and 2000 surveys. Japanese Journal of Alcohol Studies and Drug Dependence, 38(5), 425-433. 7