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Am J Drug Alcohol Abuse. 2019 Aug 23:1-9. doi: 10.1080/00952990.2019.1653316. [Epub ahead of print]

Underage drinkers' first experience consuming a popular brand of supersized alcopop.

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Department of Global and Community Health, George Mason University , Fairfax , VA , USA.
Department of Sociology & Anthropology, Montana State University , Bozeman , MT , USA.
Department of Health Education & Behavior, University of Florida , Gainesville , FL , USA.
Department of Health and Kinesiology, Texas A&M University , College Station , TX , USA.
College of Social Work, University of Utah , Salt Lake City , UT , USA.
Alcohol Research Group , Emeryville , CA , USA.
Pacific Institute for Research and Evaluation , Santa Cruz , CA , USA.
School of Public Health, University of North Texas Health Science Center , Fort Worth , TX , USA.
Department of Health Law, Policy & Management, Boston University , Boston , MA , USA.


Background: Supersized alcopops are sugar sweetened beverages with high alcohol concentration; Four Loko is the most commonly consumed brand among underage drinkers. Objectives: The current study examined the prevalence and correlates of Four Loko consumption, as well as drinking location, beverage source, quantity consumed, and alcohol-related consequences among students who consumed the product before age 21. Methods: Undergraduate drinkers (n = 1,019; 53.5% female) attending public universities in Florida, Montana, and Virginia completed a classroom survey. Multivariable logistic regression models examined first-time Four Loko experiences among students under age 21 at the time of the drinking episode (n = 336). Results: Among drinkers, 46% had consumed Four Loko. The vast majority (93%) drank the product before age 21. During their first Four Loko drinking episode, 57% consumed at least one can and 10% drank two or more cans. Among underage drinkers, being male (AOR = 6.8), paying for the Four Loko (AOR = 3.1), and earlier age of alcohol initiation (AOR = 0.8) were associated with greater odds of drinking at least one can. Among underage drinkers who finished at least one can, 36% blacked out and 21% vomited. The odds of blacking out and vomiting were greater if the participant drank at least one can (AOR = 6.0, AOR = 4.0). Students in states that sold Four Loko with higher alcohol-by-volume were more likely to blackout (AOR = 2.0) and vomit (AOR = 2.5). Conclusions: Delaying the age of first alcohol use may have protective effects on supersized alcopop consumption. Increased enforcement of existing laws is needed to prevent underage access to Four Loko. Further, laws that reduce the alcohol content of Four Loko may reduce negative consequences associated with its consumption.


Supersized alcopops; alcohol sources; alcohol-related consequences; college students; drinking locations; flavored alcoholic beverages; ready-to-drink; underage drinking

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