**13. Prevention**

Alcohol use in adolescents is influenced by internal and external factors. In the first place, health interventions such as government campaigns for mass media as well as smaller programs attempt to decrease youth alcohol use. Some studies show effects on knowledge, attitude and behavior. However, the effect is uncertain and these health effects can disappear over time (45).

Secondly, the alcohol industry has a major influence via alcohol commercials and brand visibility. Advertisements attempt to make the customer feel positive about a specific product or brand. Not only adults, but adolescents as well are persuaded to adopt a positive attitude towards alcohol and even drink more alcohol (46). Policies concerning alcohol advertisement focus on specific high-risk groups. Restricting outdoor alcohol advertisements near schools, banning alcohol commercials from television early in the evening or on youth-oriented channels and specific advertisement related rules are laid down in the law.

significant quantities of alcohol increases the proportion of transferrin with low saturation of sialic acid residues. They are referred to as carbohydrate-deficient transferrins (CDT).

Sialic acid is a monosaccharide carbohydrate. As a consequence of excessive alcohol consumption, saturation of transferrin with sialic acid decreases and total serum sialic acid rises. Determination of TSA provides a means of detecting alcohol abuse. 5 hydroxytryptophol (5-HTOL) is a human metabolite of serotonin (5-hydroxytryptamine, 5- HT) and is excreted in the urine, where it mainly occurs conjugated with a glucuronic acid and, to a lesser extent, in free form or conjugated as a sulphate. After alcohol consumption,

The value of these new biomarkers for screening purposes is still under discussion. Several factors are of importance; such as detection period after abstinence, patterns of alcohol use (episodic drinking, non-heavy chronic patterns, etc.), associated medical disorders, demographic differences and cost and availability. Sensitivity and specificity are of particular interest and are highly dependent on cut-off points, which have not yet been

The indirect marker CDT and direct marker EtG seem to have the most advantages for allaround utility. Combinations of different markers, especially CDT and GGT, have been studied, and application at multiple time points could significantly increase their usefulness. Still, little research has been done among adolescents. Some studies among adults include a sub-analysis of patients under 20 years of age, and these show minimal association of

In conclusion, biomarkers of alcohol use are of interest to pediatricians dealing with adolescents at the outpatient clinic for obtaining useful information on drinking patterns, which would otherwise be obtained by less reliable means like questionnaires. The exact

Alcohol use in adolescents is influenced by internal and external factors. In the first place, health interventions such as government campaigns for mass media as well as smaller programs attempt to decrease youth alcohol use. Some studies show effects on knowledge, attitude and behavior. However, the effect is uncertain and these health effects can

Secondly, the alcohol industry has a major influence via alcohol commercials and brand visibility. Advertisements attempt to make the customer feel positive about a specific product or brand. Not only adults, but adolescents as well are persuaded to adopt a positive attitude towards alcohol and even drink more alcohol (46). Policies concerning alcohol advertisement focus on specific high-risk groups. Restricting outdoor alcohol advertisements near schools, banning alcohol commercials from television early in the evening or on youth-oriented channels and specific advertisement related rules are laid

the 5-HTOL level in various body fluids will rise above normal values.

CDT testing is available in a regular hospital lab.

established (43;44)

**13. Prevention** 

down in the law.

disappear over time (45).

alcohol consumption and markers (43;44).

role of biomarkers should be clarified further.

Another factor that influences alcohol use is media portrayals. The ambience that movies and television series create in relation to alcohol increases alcohol consumption, partly through the 'modeling theory' In particular, the so-called 'product placements' which are hidden in television shows and movies are often located tactically. Direct relations have been described between alcohol use in movies and early-onset teen drinking, drinking without parental awareness and acute alcohol consumption (47).

External risk factors that should be considered when carrying out prevention measures are matters of social, economic, physical and legal availability, which are the most important predictors of adolescent alcohol consumption, drinking patterns and alcohol-related harm (48).

Social availability refers to the social context into which drinking is incorporated. As was mentioned before, teens and adolescents drink alcohol in the company of their peers. Another social factor related to higher alcohol use is parental alcohol consumption. Economic availability relates to, prices of alcohol and especially to special promotions which increase alcohol consumption. The most frequently used governmental tool to prevent alcohol use is increasing taxes on alcoholic beverages. Higher prices lead to lower consumption (49). A third factor that can be used in prevention is physical availability, which focuses on outlet density and opening hours. Higher outlet density is related to higher availability. Especially outlet density and location should be considered, for example by decreasing availability near educational institutions.

A very important factor is legal availability. Alcohol policies for various age groups differ around the world, but the increasing number of patients admitted with alcohol intoxication demonstrates the infectivity of these laws. All legislation concerning the purchase, sale, consumption and possession of alcohol should be critically arranged for underage citizens. One of the prime governmental tools to influence alcohol consumption is setting age limits, because binge drinking, drinking at school and drinking and driving are related especially to the sale of alcohol to underage persons. Research has shown that higher legal age limits are related to a decrease of alcohol-related car crashes and other injuries. However, despite legal age limits it is still possible for many underage adolescents to obtain alcohol in commercial places. Strikingly, compliance with age legislation in commercial establishment is not guaranteed; and alcohol can easily be obtained and consumed (50). Falsification of identification cards is another way to obtain alcohol.

Prevention of alcohol use among adolescents should be aimed at patients, parents and politics. A conjunct of medical, political and sociological awareness of the dangers of alcohol use can decrease alcohol use within modern societies.
