LAUSR

Chhoa et al describe the early exposure to alcohol of secondary school students in Miri, Malaysia. They report that problematic alcohol consumption is prevalent among underaged young people in the province of Sarawak, with the median age of initiation into alcohol consumption being 12.9 years. Their study cohort is similar to other communities reporting high rates of adolescent exposure to alcohol. However, the authors identified an aspect of adolescent alcohol exposure that is typically overlooked: ethnicity and cultural values. Worldwide, medical advice recommends that initiation to alcohol consumption should be delayed until late adolescence. Earlier initiation to alcohol is implicated in unsafe sexual exploration, violence, and depression, among other social and health concerns. While there is no medical harm in delaying exposure to alcohol, as Chhoa et al highlight, there is the potential risk of the loss of cultural integration for young people if other cultural practices not involving alcohol are absent from those that are valued and upheld by families and the society. For young people, the cultural consequences of ostracization from the family and society appear to far outweigh the risks of early alcohol consumption. In public health research, under-age exposure to alcohol is viewed as the issue to be directly addressed. This can translate into efforts such as educational programs targeting adolescents with a focus on reducing alcohol consumption or reducing access to alcohol through age-restricted selling. Undoubtedly, these are reasonable approaches; however, based on the findings of Chhoa et al, working directly with the elders of the youth in their community and family may be a more impactful approach. Specifically, this approach involves developing public health programmes that create awareness among the elders of the risks of adolescent alcohol exposure. Through carefully crafted public health education targeting the adult community, longer-term advantages (e.g. reduced violence, reduced incidence of depression, reduced unsafe sexual exploration) could be experienced alongside the immediate benefits, such as facilitated social integration. Such campaigns would aim to disrupt normative attitudes toward alcohol consumption, challenge the role alcohol plays in family events and cultural festivities, and foster the development of alternative social integration opportunities for this “under-age” sector of society. Many interventions or therapies are either ineffective (e.g. psychoeducation) or expensive (e.g. rehabilitation). And unfortunately, many of these are implemented only after the problem of under-age exposure to alcohol. Taking a proactive approach, (ie. carefully managing the cultural integration of young people into the society without alcohol), is potentially an alternative approach that can mitigate the harm of problematic alcohol consumption at little cost. Opportunities to reduce harm at no to little cost are too rare not to be taken advantage of in public health.