The legal age

The legal age limits in Europe Raising the minimum age limits for selling alcohol in ITALY

E. Scafato Director National Observatory on Alcohol (ONA) Director Population Health and Health determinants Director WHO Collaborating Centre for Health Promotion and Research on Alcohol and Alcohol-related problems National Centre for Epidemiology, Surveillance and Health Promotion (CNESPS) Istituto Superiore di Sanità (ISS), Rome, Italy President Società Italiana di Alcologi a - SIA

Amsterdam May 30th 2013 Eyes on Ages Conference Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre RESEARCH and HEALTH

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Alcohol and young people Alcohol and young people is a relatively recent Public Health problem in Italy.

The Mediterranean style of alcohol consumption usually referred in the household to drinking in moderation within meals and under the formal control of the family members included traditionally also the ban of drinking for minors and for all the young people not still allowed by the adults to drink alcoholic beverages, usually after the age of 16-18.

But something has changed The so called “new market� and the increase of the alcoholic beverages affordability and availability started in the beginning of the third millennium in contributing to a really fast and unexpected change in drinking models among the youngsters as witnessed by the experience reported across Europe at the end of the 90s.

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European Charter on Alcohol Paris, december 1994

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Istituto Superiore di Sanita’

From alcopops to Alcohol Policy: reacting to threats to health of young people in Europe.

Emanuele SCAFATO MD Laboratorio di Epidemiologia e Biostatistica ENLAPRE, OPORTO 22/ 11/ 1999

Istituto Superiore di SanitĂ

ALCOHOL and YOUNG PEOPLE

ALCOPOPS

Flavoured mixed alcoholic drinks with a suggestive style of packaging particularly appealing youth culture and taste

YOUNG PEOPLE & ALCOHOL European recalls PARIGI Dic. 1995

LUSSEMBURGO Giu. 2001

• Incrementare il grado di consapevolezza

Tutti i bambini e gli dei giovani nei confronti del consumo delle adolescenti hanno il bevande alcoliche diritto di crescere in un• Ridurre il rischio legato al consumo di ambiente protettoalcol dalle tra i giovani ed il suo impatto sociale e sanitario conseguenze negative • Sollecitare il mondo della produzione ad del consumo di alcol e, incrementare il livello di attenzione e la per quanto possibile, responsabilità sulle modalità di dalla pubblicità di confezionamento e di marketing dei bevande prodotti alcolici ribadendo alcoliche. l’inopportunità di utilizzare tecniche indirizzate al target e alla cultura giovanile

STOCCOLMA Febb. 2001

Entro l'anno 2006: 1) ridurre in maniera rilevante il numero dei giovani che iniziano a consumare alcol; 2) ritardare l'età in cui i giovani cominciano a consumare alcol; 3) incrementare il livello di coinvolgimento dei Giovani nella definizione delle politiche giovanili legate alla salute, in particolare per le questioni che riguardano l'alcol; 4) aumentare l'educazione dei giovani sull'alcol; 5) ridurre al minimo le pressioni esercitate sui giovani per incitarli al consumo, specialmente quelle derivanti dalle promozioni, distribuzioni gratuite, pubblicità, sponsorizzazioni e disponibilità relativi all’alcol, con particolare attenzione alle manifestazioni (sportive, musicali ecc)

Entro il 2015 il consumo di alcol al di sotto dei 15 anni deve essere ZERO litri.

Il 25 % dei decessi registrati tra i maschi di età 15-29 sono legati all’alcol.

55 000 giovani nella Reg. Eur. WHO sono morti nel 1999 per cause legate all’uso di

ALCOHOL & YOUNG PEOPLE Declaration 2001

Istituto Superiore di Sanita’

Protecting children and young people from commercial pressure to drink Italians start drinking on average at the age at 11-12, well under the European average of 14. The onset of alcohol drinking for underage has been for years traditionally strictly related with the family permission to do it in connection with the celebration of particular events and/or in some regional cultures with the “initiation� of young males to the adult world. Alcohol drinking, in the Mediterranean style was intended in moderation, within meals and always under the family or the social control.

But something has changed during the last fifteen years.

Once enabled, young people follows different attitudes and trends according to the nucleus of peers of reference and always far from the adult or social control.

The meeting places, more than family, are the favourite places where young people, even underage, are enabled to experiment or to experience alcohol effects on relaxation, socialization, disinhibition and the sense of belonging typical of the youth relationship based on homologation.

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Underaged and alcoholic beverages

Since many years the prevalence of drinkers among children and adolescents is far to be close to zero as expectable in terms of an effective Public Health perspective. Even with a slight decreasing trend experienced after the activation of specific strategies by the Ministry of Health and the Istituto Superiore di Sanità, 18,2 % of 11-16 years old youngsters drank alcoholic beverages in 2010, 20,8 % males, 18,2 % females.

Beer drinkers are the most relevant part of under-aged in both sex followed by the alcoholic aperitifs (RTDs, breezer), wine, spirits and bitter (the so called “amari” drinkers, 35 degree of alcoholic strength much more typical of the older consumption).

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Young people and alcoholic beverages

The increase in prevalence of very young drinkers when they grow-up to 17-18 years is more than relevant.

The prevalence of those who drank alcoholic beverages in 2010 was 60,3 %, 66,3 % males, 54 % females.

The evidence of this crucial shift identified thanks to the new national survey and monitoring standard represented a relevant starting point for the setting of new prevention strategies. The increase in prevalence of drinkers has been mainly supported by beer drinking and the alcoholic aperitifs drinking (RTDs, breezer) with an observed convergence in the prevalence between males and females supported mainly by the rise in females drinkers rate during the last three years for all the different alcoholic beverages probably due to a major appeal exerted by marketing on the teen-agers. For young males the trends was observed decreasing during the period 2003-2010.

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Underaged and risky behaviours

The Osservatorio Nazionale Alcol CNESPS estimates that the prevalence of young people drinking between meals and hazardous drinkers decreased during the last few years probably thanks to the national campaigns mostly active on the very recent younger generation.

The effects are not detected for binge drinkers.

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Young people and risky behaviours

The Osservatorio Nazionale Alcol CNESPS estimates that the prevalence of young people drinking between meals it is maximum among the 18-24 (48,5 % males, 35 % females) and well beyond the women national average of 14.2 % among the 16-17 years old female.

More than 450.000 adolescents aged 11-15 and more than 500.000 young people aged 16-20 are harmful consumers in Italy as reported in the last Report of the Ministry of Health to the Parliament. (Hazardous drinkers statistics are available only since 2008)

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Alcohol and young people raising the minimum age limits in Italy n

n

n

n

Setting and enforcing age limits for selling and serving of alcoholic beverages is among the most effective measures to curb alcohol use and harm among the young. The actions towards revising age restrictions for selling and serving alcoholic beverages upwards towards age 18 has been subject in Italy to several institutional discussions, project or proposal of laws.

The National Committee on Alcohol, acknowledging the statements of the first National Conference on Alcohol held in Rome in 2010 provided the competent Ministries with a number of advices formally published and submitted to the Parliament according to the law 125/2001 mandates. It should be noted that the article of the law (Code Rocco) banning the serving (and not the sale) to individuals below the age of 16 years is active since 1932 and no efforts have been made til 2010 to modify the age limit and to introduce the ban on sales (and not only on serving as it is) .

Italy was still one among the few countries (GR, IT, LU, MT, PT) implementing a lower limit of 16.

An essential component of age restrictions concerns the effectiveness of enforcement; the relevant number of young people receiving alcohol by adults in the on-premises, off-premises and in the family is a fair good indicator on how and why Italy was scored by the ECAS study as one of the lowest alcohol control and alcohol policy strictness Countries.

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Strictness of alcohol policies in the BtG countries in 2005 according to subgroups of alcohol control.

ITALY as a Low alcohol control countries ECAS list.

Slovenia Slovakia It aly P ort ugal Spain Romania Germany Bulgaria Aust ria Malt a Greece Czech Republic Cyprus Luxembourg 0

5

10

15

Control of p roduction and wholesale (2 p oints) Age limits (4 p oints)

Control of distribution (10 p oints) Control of marketing (3 p oints)

BAC limits (4 p oints) Alcohol taxation (16 p oints)

Public p olicy (1 p oint)

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ALCOHOL : the framework for action in ITALY NATIONAL HEALTH PLAN n LAWS and REGULATIONS n NATIONAL ALCOHOL AND HEALTH PLAN n NATIONAL COMMITTEE n

(Consulta Nazionale Alcol)

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The devolution of competencies on health The Regions After the introduction of the devolution of health matters to the Region’s authonomy, the National Health Plan, even if produced in form of a framework document, has started to represent a process and a matter of negotiation of priorities agreed between the Government and the Regions, recognising different possible ways of managing health problems in different social, economic, cultural and epidemiological contexts.

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The devolution of competencies on safety The Municipalities Anther devolution on safety and security matters to the Municipalities represented a new way to deal with problems related with alcohol in the community (violence prevention, crime prevention, road safety, public orders problems in the streets ) opening the possibilities for the Mayors of the cities to deal with authonomy in managing local problems in different social, economic, cultural operative modalities.

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WHO HEALTH 21 “Target 12” ?

16 September 1999 – Florence – Italy – WHO Regional Committee for Europe Resolution

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The Frame Law on Alcohol (nr 125/2001) RIGHTS not PRINCIPLES Art. 2 - Aims This law: n ensures all people’s rights, especially children and adolescents, to a family, community and working life protected from the consequences of alcoholic beverages abuse; n fosters access to health and social treatment services for heavy drinkers and their families; n promotes information and education on the negative consequences of alcohol consumption and abuse; n promotes research and ensures adequate standards of training and updating for professionals dealing with alcohol related problems; n supports non profit non-governmental and voluntary organisations which aim is to prevent or reduce alcoholrelated problems.

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Monitoring alcohol : basic for policy

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Targets on Alcohol The devolution process confirmed the overall approach for Health Planning leaving to the regional autonomies the implementation of strategies and programs oriented by the National Health Plan.

Two main targets were mostly considered at National, Regional and Municipality level : n

Underaged protection/age limits n

Drink driving

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A NEW WAY TO DEAL WITH ALCOHOL

The National Alcohol and Health Plan PNAS 2007-2009 According to the need to have a National Health Strategy on Alcohol the Ministry of Health is actually planning to implement a national alcohol strategy/action (National Alcohol and Health Plan - PNAS) implementing at the National level the WHO EAAP strategy and the recent Framework for Alcohol Policy.

The PNAS has been endorsed in April 2007 by the State- Regions Conference.

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The strategies of PNAS 2007-2009 and 2009-2012 Alcohol and minors

n

n

reduction of the limits of blood alcohol concentration for safe driving and more effective enforcement of regulations on limits to blood alcohol concentrations when driving; initiatives to promote a ban on the sale of alcoholic beverages to minors;

Osservatorio Nazionale Alcol - ISS-CNESPS - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS

Actions implemented in Italy ( 2007) n

n

n

Enforcement against serving intoxicated persons, new rules on sales of alcoholic beverages forbidden in discos after 2 a.m. (by law 3/10/2007) Mandatory BAC and drugs controls for public transport driver and for a long list of working activities considered at higher risk for community safety (by State-Region agreement 16/03/2007) Better enforcement of age limits for serving; proposal to complement current ban for serving with a new ban of sales to underaged and to increase from 16 to 18 the serving/sales limit Osservatorio Nazionale Alcol - ISS-CNESPS - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS

Out of meals alcohol consumption Tra 1998 e 2007: ü Crescita del consumo almeno una volta la settimana dal 5,1% al 7% per la popolazione di 14 anni e più ü Forte crescita del consumo di alcolici fuori pasto tra i ragazzi di 14-17 anni: dal 12,6% al 20,5% ü Crescita maggiore tra le ragazze: dal 9,7% al 17,9% Maschi

Fem m ine

Maschi e fem m ine

14-17enni 15,2

12,6

16,8 15,4 12,8

22,7 20,7 18,4

18,0

14,5

24,2

17,2 15,9

15,1

18,7

20,6

20,5

20,5

18,2 16,8

16,3

15,6 17,9

13,7 12,2

11,5

9,7

1998

1999

2000

2001

2002

2003

2005

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2007

More than 4 millions of binge drinkers Over the average 18-24 and 25-44 years old 390.000 below the legal age 30

Maschio

Femmine

25 20 15

23,3

10

18,8 10,3

5

1,6 1,5

13,4

12,4

9,7 5,1

3,6

2,7

6,5

1,2

3,3 1,1

3,5

0

11-15

16-17

18-24

25-44

45-64

65-74

75+

Classi di età

≥ 11 anni

Fonte: Dalla presentazione del Ministro della Salute della relazione al Parlamento 2011 Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for RESEARCH and HEALTH

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The trend of binge drinkers Osservatorio Nazionale Alcol CNESPS – ISS

WHO CC forWHO Research CC for andResearch Health and Promotion Health onPromotion Alcohol an don alcohol-relate Alcohol and alcohol-related d health problem problems s

IL “BERE” ESTREMO (extreme drinking) EYE BALLING BALCONING PUB’S CRAWL

DRUNKORRESSIA Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre RESEARCH and HEALTH

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Municipalities Efforts.

Barrage of New Rules Targets Italy's Drinkers

By ELISABETTA POVOLEDO

Published: August 4, 2009 ROME — In an effort to regulate the sale of alcoholic beverages and control potential abuse, lawmakers in Italy have recently concocted a series of measures that critics describe as a cocktail for confusion.

In Bologna, for example, commercial venues that sell alcohol (excluding restaurants and bars) must now close by 10 p.m.

In Florence, Mayor Matteo Renzi last week passed a special law to ensure that the city’s tripe vendors could continue to sell Chianti wine to wash down the local delicacy even after a national law went into effect banning itinerant merchants from selling liquor.

And Milan’s city hall has just passed a law that imposes fines on bars and restaurants serving alcohol to anyone under 16.

“We’re the first to do it in Italy, and we hope to be the first to see positive results,” Mayor Letizia Moratti of Milan said in a July 17 press release.

But serving alcohol to minors under 16 has been a criminal offense since 1929.

Selling alcohol to minors in supermarkets or stores, however, is not.

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NATIONAL DEBATE ABOUT LAWS ENFORCEMENT ON UNDERAGED PROTECTION Art. 689 Codice Penale (1929)

Strict control aimed at verifying : - minimum legal age of 16 - intoxication - mental health diseases - other cognitive impairment or diseases Furthermore VENDING HOURS respect Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre RESEARCH and HEALTH

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Only serving or SERVING AND SELLING?

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SELLING AND SERVING NO LEGAL DISTINCTION

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NO DIFFERENCES between SELLING AND SERVING MEANING : NO AVAILABILITY FOR MINORS

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Affordability change targeting young 1996-2006 (Rand Report)

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AVAILABILITY. Social alert and media campaignes on VENDING MACHINE infringement of laws «No control for minors»

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Social alert and media campaignes on VENDING MACHINE infringement of laws «No control for minors» Messaggero Cronaca di Roma , 2 giugno 2010

NO STOP ALCOHOL Movida: alcohol vending hours alcohol infringed

I distributori automatici di bevande alcoliche aperti 24 ore su 24, nei punti caldi della movida del centro storico, beffano l'ordinanza anti-pubs’crawl. Da Fontana di Trevi a piazza Santi Apostoli, fino a corso Rinascimento il tour della sbronza , lo si può fare tranquillamente. Da Fontana di Trevi a piazza Santi Apostoli, fino a corso Rinascimento il tour della sbronza , lo si può fare tranquillamente

Solo due mesi fa c'era un negozietto di souvenirs.

Ora al posto degli espositori con le cartoline ci sono quattro frigo carichi di alcolici.

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Municipalities respons to VENDING MACHINE laws infringement «No control for minors»

Milan, vending machines con1iscation

La polizia locale ha elevato una multa da 308 euro al titolare del bar sulla base del testo unico per il commercio della Regione Lombardia, che non consente la vendita di alcolici in distributori automatici. In attesa del pagamento della contravvenzione, l'apparecchiatura è stata sequestrata: dopo potrà essere riutilizzata, ma naturalmente senza l'offerta di birra o cocktail alcolici.

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MUNICIPALITIES REGULATION ENFORCEMENT

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NEW MUNICIPALITIES REGULATIONS

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New regulations on VENDING HOURS and stricter controls of Municipality Police

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Law 189/2012 Setting and enforcing new age limits The actions towards revising age restrictions for selling and serving alcoholic beverages upwards towards age 18 has been subject to several institutional discussions, project or proposal of laws and finalized by the Parliament in 2012.

The law 189/2012 acknowledges the National Committee on Alcohol opinions and the statements of the first National Conference on Alcohol held in Rome in 2010 providing the competent Ministries with specific NEW RULES n rising

from 16 to 18 the minimum legal age n introducing the ban for selling to underaged overcoming the historical “limit” of serving.

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Divieto di vendita alcolici ai minori di anni 18 G.U. n. 263 del 10 novembre 2012, legge 8 novembre 2012, n.189 La legge modifica il dL 13.09.2012, n.158 recante “Disposizioni urgenti per promuovere lo sviluppo del Paese mediante un più alto livello di tutela della salute”, (decreto salute Balduzzi) inserendo nell’art.7 importanti novità per la vendita di alcolici; in particolare: a. il comma 3-bis modifica la legge 30 marzo 2001, n.125, che reca la “Legge quadro in materia di alcol e di problemi alcol correlati”, introduce l’art.14-ter.

Art.14-ter. (Introduzione del divieto di vendita di bevande alcoliche a minori).

1. (IDENTITY CHECK) Chiunque vende bevande alcoliche ha l'obbligo di chiedere all'acquirente, all'atto dell'acquisto, l'esibizione di un documento di identità, tranne che nei casi in cui la maggiore età dell'acquirente sia manifesta.

2. (PENALTIES) Salvo che il fatto non costituisca reato, si applica la sanzione amministrativa pecuniaria da 250 a 1000 euro a chiunque vende bevande alcoliche ai minori di anni diciotto.

(Repeated infringement) Se il fatto è commesso più di una volta si applica la sanzione amministrativa pecuniaria da 500 a 2000 euro con la sospensione dell'attività per tre mesi".

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Divieto di vendita alcolici ai minori di anni 18 G.U. n. 263 del 10 novembre 2012, legge 8 novembre 2012, n.189 b. Art. 689 PENAL CODE modified with introduction of two new commas on VENDING MACHINE and new PENALTIES “1. L'esercente un'osteria o un altro pubblico spaccio di cibi o di bevande,

il quale somministra, in un luogo pubblico o aperto al pubblico, bevande alcooliche a un minore degli anni sedici, o a persona che appaia affetta da malattia di mente, o che si trovi in manifeste condizioni di deficienza psichica a causa di un'altra infermità, è punito con l'arresto fino a un anno.

1-bis La stessa pena di cui al primo comma si applica a chi pone in essere una delle condotte di cui al medesimo comma, attraverso distributori automatici che non consentano la rilevazione dei dati anagrafici dell'utilizzatore mediante sistemi di lettura ottica dei documenti. La pena di cui al periodo precedente non si applica qualora sia presente sul posto personale incaricato di effettuare il controllo dei dati.

1-ter Se il fatto di cui al primo comma e' commesso più di una volta si applica anche la sanzione amministrativa pecuniaria da 1000 a 25000 euro con la sospensione dell'attività per tre mesi.

2. Se dal fatto deriva l'ubriachezza, la pena è aumentata.

3. La condanna importa la sospensione dall'esercizio.

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FURTHER NEEDS FOR ACTION AGE LIMITS do not represent the only one solution to tackle the increased exposure to alcohol-related risk by underaged.

Drink driving and marketing regulation are the two most relevant threaths to health and safety that have requested attention and new laws succesfully introduced in Italy last year together with the call for setting renewed GUIDELINES for alcohol consumption.

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Osservatorio Nazionale Alcol CNESPS – ISS

WHO CC for Research and Health Promotion on Alcohol an d alcohol-relate d health problem s

Unità Alcoliche equivalenti (contenenti 12 g di alcol )

Tra 16 e

0-18 anni 18-20 & 65+ 0 Unità 1 Unità

Donne 1 Unità

Uomin 2 Unità

WHAT IS NEEDED for a successful ALCOHOL strategy Community leaders

Information by medical service providers

Peer information and partner information

Sport’s, culture’s, music’s leaders

Information by pharmacists

INFORMATION & EDUCATION • promote life skills • support environments • provide protection • reduce harm

The mass media: - radio - press - television

GPs and social councelling

Health education by schools, universities, etc.

Health education by parents, grandparents and relatives

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and ALCOHOL- RELATED

for

HEALTH PROBLEMS

Conclusions Science and research contribution is fundamental to serve policy in providing scientific evidence, in evaluating policies where evidence is lacking and can effectively guide policymaking in providing the information on which future policies may be based.

A reinforced supporting role for public health, the society, the families has to be provided to give to young people the ability to make changes or healthy choices, stressing and recognising the individual’s responsibility to decide if, how, when and why to use these opportunity.

The challenge for the present is to have policy-makers, society and institutions committed in overcoming a prevalent market-oriented decision-making process repositioning health as a more relevant value than a “no ordinary commodity�.

The challenge for the future is to reach a balance between social marketing and commercial marketing and alcohol communication hopefully giving them same opportunities, strictly ensuring that the promotion of new and old alcoholic beverages do not target children and adolescents.

The final goal is to support peoples right to be protected by misleading information on alcohol and always allowed to make informed choices and supported in adopting healthy lifestyles and model of consumption.

Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre RESEARCH and HEALTH

PROMOTION on

ALCOHOL

and ALCOHOL- RELATED

for

HEALTH PROBLEMS

Renewing the challenge for the Third Millennium.

INVESTING FOR HEALTH

Rome ISS 1999

Istituto Superiore di Sanità 2013 Roma 18 aprile

Grazie per l’attenzione

Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre RESEARCH and HEALTH

PROMOTION on

ALCOHOL

and ALCOHOL- RELATED

for

HEALTH PROBLEMS