The Delphi process sought to develop guidelines on reducing alcohol-related harm for young people in Europe. Experts agreed children under 16 should not drink, and 16-17 year olds should ideally avoid drinking but may need harm reduction advice. For ages 18-25, binge drinking should be addressed. Guidelines should be jointly developed and involve youth. While opinions varied on gender-specific guidelines, most agreed short-term consequences like accidents have the highest impact. Parents play a key role by communicating, being good role models, and ensuring safety.

1. Guidelines for reducing alcohol-
related harm for young people
Results of the Delphi process

2. Content
1. Scope and purpose
2. Preliminary work
3. Method & recruiting
4. Panel description
5. Results of the Delphi process
2Guidelines for reducing alcohol-related harm for young people

3. Scope and purpose
Guidelines for reducing alcohol-related harm for young people 3
Overall aim:
Development of a background paper about guidelines on
drinking by young people, targeted on young people,
parents, health or other professionals or policy makers.
Questions:
1. Which information should guidelines for young people
entail?
2. Which messages are effective?
3. How can young people be reached with guidelines?
 Overview about guidelines in Europe, attitudes and opinions
of European experts towards the topic (showing points of
convergence and disagreement) & scientific background

4. Preliminary work
Guidelines for reducing alcohol-related harm for young people 4
1. RARHAWP 5 survey in 2014, including 27 European countries
 Overview of existing guidelines, relevant scientific studies & brief
interventions
2. Expert meeting in December 2014 in Münster (DE) with 13
European experts
 to discuss the results of the survey and
 to plan the Delphi process

5. Method & recruiting
Guidelines for reducing alcohol-related harm for young people 5
Aim: 2 prevention experts & 2 researchers from all
member states plus IS, NO & CH
Nominated by CNAPA representatives: 94 from all
countries, except BG, SE & SK
Actual participation:
Round no. 1: 55
Round no. 2: 59*
*90% had participated in both rounds

6. Panel description
Guidelines for reducing alcohol-related harm for young people 6
37%
35%
27%
20%
33%
12%
35%
0% 5% 10% 15% 20% 25% 30% 35% 40%
Practical prevention
Research/Science
Other
Both
Round no.1
Round no.2
Professional background

7. Panel description
Guidelines for reducing alcohol-related harm for young people 7
8%
33%
59%
10%
31%
59%
0% 20% 40% 60% 80%
<10
11-20
>20
Round no. 1
Round no. 2
Years of experience
Can you relate to the topic also based on personal experiences, e.g. with your
own children?
Round no. 1: 78%
Round no. 2: 82%

8. SUMMARY
Delphi process on reducing alcohol-related harm for young people
Guidelines for reducing alcohol-related harm for young people 8

9. EU Alcohol Action Plan on Youth Drinking and
Heavy Episodic Drinking (Binge Drinking)
Guidelines for reducing alcohol-related harm for young people 9
Most important areas for action (expert opinion)
1. Reducing heavy episodic drinking (binge drinking)
2. Reducing exposure of youth to alcohol marketing and advertising
3. Reduce harm from alcohol during pregnancy
4. Reduce accessibility and availability of alcoholic beverages for youth
Target groups and priorities (expert opinion)
1. Protecting children from alcohol-related harm caused by others
2. Prevention of and minimizing the consumption of alcohol by adolescents until they
reach the drinking age limit
3. Protecting the unborn child and the baby
4. Prevention of harmful and hazardous drinking among youth over the legal drinking age
limit

10. Nature of guidelines for young people
Guidelines for reducing alcohol-related harm for young people 10
Provider: Joint development &publishing of official guidelines for young people by
governmental body, scientific society and medical associations
Participation of young people:
“At all levels youth should be involved at the early stage of development, review,
dissemination and implementation to get better informed policies and understanding of
the target group.”
“Once the consumption limits are defined by experts, young people can help design the best
messages […], as peers.”
“The danger is that adults put young people in a role where
they have to act as adult decision makers […] without having
the necessary knowledge.This is a form of child/youths abuse
commonly leading to absurd rules. As a workshop to learn
democracy and to argue – perfect – but not to base serious
decisions on.”

11. Age groups – Children under 16
Guidelines for reducing alcohol-related harm for young people 11
Statement Agreement in %
Children should not drink alcohol at all. 75.5
Children between 14 and 15 ideally should not drink at all, but if they do, e.g. in special situations like family
celebrations, they should only take a sip.
36.7
Arguments:
“The later the better”
“There is no evidence that some quantity of alcohol is safe.”
“It’s a pragmatic attitude! Normally, children under 16 must not drink,
but in reality there are many occasions to taste alcohol.We must
prevent that alcohol is being considered a “demonic” substance,
prohibited and therefore fascinating!”

12. Age groups – 16- to 17-year-olds
Guidelines for reducing alcohol-related harm for young people 12
Statement Agreement in %
Young people should not drink under the age of 18. 60.4
Young people between 16 and 17 should be careful when they drink and how much. 47.2
If consuming alcohol, they should do so infrequently and certainly not more than once a week. 30.2
If they drink alcohol, it should always be with guidance of a parent or career or in a supervised and safe
environment.
28.3
They should never exceed adult limits. 24.5
To drink a beer or a glass of wine from time to time is presumably not harmful for 16- to 17-year-olds in
general.
22.6
16- and 17-year-olds should not drink more than 1 beer or 1 glass of wine a day, no more than 2 times a
week.
11.3
Arguments:
“We need to provide guidance that takes into account the reality of young
people between 16 and 17 years for whom alcohol consumption is common
and unlikely to disappear soon. As a result guidance on consumption needs to
be provided for this group along with clear warnings about the alcohol-related
harms.”
“Alcohol is ubiquitous in our cultures, therefore learning how to deal with
alcohol sensibly is a developmental task young people need to complete.
Therefore, they need detailed knowledge rather than limiting guidelines.”

13. Age groups – Young people between 18 & 25
Guidelines for reducing alcohol-related harm for young people 13
• No qualitative advice for this age group has been reported in the RARHAWP 5 survey in
2014.
• 83% of the Delphi panel agreed that special advice is needed for this age group.
• Binge drinking and heavy episodic drinking should be a focus for this age group.

14. Gender differences
Guidelines for reducing alcohol-related harm for young people 14
Delphi round no. 1: 55% of the respondents voted for different guidelines for boys and girls.
Delphi round no. 2: After seeing the arguments of all respondents, 45% voted for different
guidelines.
Arguments pro different guidelines:
• Gender-specific consequences of alcohol consumption;
• Different drinking behaviour & motives;
• Physical differences;
• Differences in emotional maturation process;
• Higher probability for developing an alcohol addiction for men.
Arguments against different guidelines:
• Different guidelines for boys and girls could appear to give tacit permission for underage drinking;
• Alcohol consumption takes place in the peer group;
• Evidence increasingly suggests similar harms for young boys and girls under the age of 18.

15. Short- & long-term consequences
Guidelines for reducing alcohol-related harm for young people 15
The majority states that short-term consequences have the highest impact on young people‘s
actions!
Short-term consequences Agreement in %
Traffic accidents 94.3
Injuries 84.9
Reckless sexual behaviour 83.0
Fights & violence 81.1
Intoxication 79.3
Academic failure 64.1

16. Guidelines for reducing alcohol-related harm for young people 16
2,7
3,2
3,4
3,8
5,2
5,5
5,7
7,4
0,0 1,0 2,0 3,0 4,0 5,0 6,0 7,0 8,0
Harm for the immune system
Heart conditions
Cancer
Liver diseases
Mental illnesses/psychiatric problems
Alcohol dependency
Long-term social consequences
Disruption of brain development
But: 66% of the respondents think long-term consequences
should be communicated as well.
Short- & long-term consequences

17. Safety advice & risk reduction
Guidelines for reducing alcohol-related harm for young people 17
78% of the respondents agreed that the focus of guidelines for young people
should be on risk reduction
Statement Agreement in %
Advice for safe transport 86.5
Not to drink in particular situations, e.g. if sad, alone, sick etc. 78.6
Advice on how to say no 78.6
Advice for parties 76.9
Not to drink at particular times of day/week, e.g. in/before school, at/before work 67.3
Risk minimizing advice should be given:
• Already to 16- to 17-year-olds 60.4%
• Even to children younger than 16 25.5%
• Only over 18-year-olds 15.1%

18. Role of parents
Guidelines for reducing alcohol-related harm for young people 18
Most important aspects:
1. Communication
2. Parents‘ own drinking behaviour
3. Monitoring and rule enforcement
4. Parties and transport

19. Role of parents
Guidelines for reducing alcohol-related harm for young people 19
Points of agreement (more than 80%)
Statement Agreement in %
Parents need to talk to their children about:
- risks of alcohol consumption/reasons for not drinking alcohol at a young age
- short-term effects of alcohol
- not getting into a car with someone who has been drinking.
100.0
98.1
98.1
If parents are hosting a party, they should provide enough non-alcoholic drinks for their guests. 98.1
Parents should be good role models. 96.2
Parents need to talk to their children about alcohol if they have questions about it. 94.3
Parents should check their own alcohol consumption. 92.3
Parents should ensure a safe way home for their children if they go to a party. 90.4
Parents need to talk to their children about alcohol:
- if parents notice that their children’s friends consume alcohol.
- when recognizing regular alcohol consumption of their own children.
88.7
84.9
They should check how alcohol is treated in the children’s environment, e.g. in their group of friends, sport
and other clubs.
84.6
Parents should lay down clear rules together which children and determine consequences if rules get
broken.
82.7

20. Alcohol as a part of European culture
Guidelines for reducing alcohol-related harm for young people 20
Statement Agreement in %
Delay the onset of drinking 80.0
Role models and well-informed parents 72.0
Staying close to the actual reality of young people when communicating preventive messages 70.0
Avoiding binge drinking 68.0
Inclusion of peers, schools and youth workers/street workers 62.0
Combination of individual and structural prevention 62.0

21. Summary
Guidelines for reducing alcohol-related harm for young people 21
Points of disagreement:
- Zero tolerance vs. risk minimizing advice for young people underage
- Formulation of guidelines /terms to use and avoid
Points of convergence:
- Joint development by the governmental body, scientific society and medical
associations with participation of the target group;
- Children under the age of 16 should not drink at all;
- 16- to 17-year-olds should ideally not drink but risk minimizing advice is necessary;
- Focus should be on short-term consequences but long-term risks should also be
communicated;
- Parents are role models and should keep track of their own consumption;
- Communication between parents and children is essential;
- In order to reduce the accessibility of alcohol for young people, all relevant actors need
to work together and an integrated alcohol policy is necessary.

22. Name: Rebekka Steffens, Doris Sarrazin
Adress: Warendorfer Str. 27, 48145 Münster, Germany
Phone: +49 251 591 5382 | E-mail: rebekka.steffens@lwl.org; doris.sarrazin@lwl.org
Website: www.lwl-ks.de

23. This presentation was produced for a meeting organized within
Joint Action on Reducing Alcohol Related Harm (RARHA) which
has received funding from the European Union, in the framework
of the Health Programme (2008-2013).
The content of this presentation represents the views of the
author/s and it is their sole responsibility; it can in no way be
taken to reflect the views of the European Commission or of the
Consumers, Health, Agriculture and Food Executive Agency or
any other body of the European Union.The European
Commission and the ExecutiveAgency do not accept
responsibility for any use that may be made of the information it
contains.