Introduction
Young adults are vulnerable to alcohol-related harm and so drinks specifically marketed at them are of particular concern.1 For instance, up to 62% of 15–16-year-olds in Europe reported recently consuming alcopops, premixed spirit-based beverages that are highly sweetened and modelled on non-alcoholic or energy drinks.2

In terms of health outcomes, most injuries, suicides and drownings in young people are associated with alcohol intoxication.3–5 This is compounded by the adverse effects of alcohol on development and the fact that alcohol use in youth predicts problematic use in adulthood.6

Measures to reduce high-risk alcohol consumption have included minimum unit pricing,7 advertising bans and random breath testing.8 Whereas there is evidence that raising alcohol duty across the board can reduce alcohol-related harms,9 there is less for measures that target specific types of alcohol beverage in isolation. An example was the 70% increase in excise duty on ‘premixed’ alcoholic beverages (‘alcopops’) implemented in Australia on 27 April 2008. The rationale was that this targeted increase would reduce alcohol consumption among young people of both sexes10 given their preference for premixed spirits and spirits over other forms of alcohol.5

The effectiveness of this measure has been extensively debated.11 ,12 In particular, it is unclear whether young people reduced harmful consumption, absorbed the price increase or changed to other alcoholic drinks with no effect on alcohol-related harm. Alcohol sales data reported a substantial fall in the sales of ready-to-drink beverages in the 3 months following introduction of the tax, with a smaller shift to other beverages (beer and spirits) and a net reduction in overall sales.13 However, sales data can be contradictory with reports from Europe that increasing the tax on alcopops did not influence total alcohol consumption when the price of other beverages remained unchanged.2 Moreover, sales data reflect overall consumption, not the amount of risky drinking in certain population groups.14 ,15 Neither do they take into account changes in the alcohol content of drinks over time.16 Indicators of health outcomes, such as health service use, may therefore be more appropriate to assess the success of such policies.

Two further studies included a wider range of alcohol-related harms, including trauma and used interrupted time series to adjust for seasonal and secular trends.19 ,20 Both found no change in either ED presentations or hospital admissions.19 ,20 However, they also had limitations. One was confined to the Gold Coast, a popular tourist destination in Queensland for end-of-school celebrations, which may affect generalisability to elsewhere in Australia or overseas.19 The other used a more representative sample from wider Queensland, including all hospital admissions in the state, as identified by both hospital administrative data and the Queensland Trauma Registry, but only covered 29% of the jurisdiction's EDs.20 In addition, there were only data for 1 year following the tax increase and alcohol-related presentations were not compared to a control group. It is therefore possible that the results could have been confounded by changes in population or catchments of the emergency departments included in the study. We therefore undertook a study that included controls, covered more EDs and extended follow-up to 2 years following the increase in the tax. Our hypothesis was that the tax increase was not associated with any change in alcohol-related harms in spite of the documented fall in the sale of alcopops immediately following implementation.13

Two further studies included a wider range of alcohol-related harms, including trauma and used interrupted time series to adjust for seasonal and secular trends.19 ,20 Both found no change in either ED presentations or hospital admissions.19 ,20 However, they also had limitations. One was confined to the Gold Coast, a popular tourist destination in Queensland for end-of-school celebrations, which may affect generalisability to elsewhere in Australia or overseas.19 The other used a more representative sample from wider Queensland, including all hospital admissions in the state, as identified by both hospital administrative data and the Queensland Trauma Registry, but only covered 29% of the jurisdiction's EDs.20 In addition, there were only data for 1 year following the tax increase and alcohol-related presentations were not compared to a control group. It is therefore possible that the results could have been confounded by changes in population or catchments of the emergency departments included in the study. We therefore undertook a study that included controls, covered more EDs and extended follow-up to 2 years following the increase in the tax. Our hypothesis was that the tax increase was not associated with any change in alcohol-related harms in spite of the documented fall in the sale of alcopops immediately following implementation.13

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Two further studies included a wider range of alcohol-related harms, including trauma and used interrupted time series to adjust for seasonal and secular trends.19

One was confined to the Gold Coast, a popular tourist destination in Queensland for end-of-school celebrations, which may affect generalisability to elsewhere in Australia or overseas.

The other used a more representative sample from wider Queensland, including all hospital admissions in the state, as identified by both hospital administrative data and the Queensland Trauma Registry, but only covered 29% of the jurisdiction's EDs.

In addition, there were only data for 1 year following the tax increase and alcohol-related presentations were not compared to a control group.

It is therefore possible that the results could have been confounded by changes in population or catchments of the emergency departments included in the study.

We therefore undertook a study that included controls, covered more EDs and extended follow-up to 2 years following the increase in the tax. Our hypothesis was that the tax increase was not associated with any change in alcohol-related harms in spite of the documented fall in the sale of alcopops immediately following implementation.

Introduction
Young adults are vulnerable to alcohol-related harm and so drinks specifically marketed at them are of particular concern.1 For instance, up to 62% of 15–16-year-olds in Europe reported recently consuming alcopops, premixed spirit-based beverages that are highly sweetened and modelled on non-alcoholic or energy drinks.2

In terms of health outcomes, most injuries, suicides and drownings in young people are associated with alcohol intoxication.3–5 This is compounded by the adverse effects of alcohol on development and the fact that alcohol use in youth predicts problematic use in adulthood.6

Measures to reduce high-risk alcohol consumption have included minimum unit pricing,7 advertising bans and random breath testing.8

Measures to reduce high-risk alcohol consumption have included minimum unit pricing,7 advertising bans and random breath testing.8

Whereas there is evidence that raising alcohol duty across the board can reduce alcohol-related harms,9 there is less for measures that target specific types of alcohol beverage in isolation.

An example was the 70% increase in excise duty on ‘premixed’ alcoholic beverages (‘alcopops’) implemented in Australia on 27 April 2008.

The rationale was that this targeted increase would reduce alcohol consumption among young people of both sexes10 given their preference for premixed spirits and spirits over other forms of alcohol.5

The effectiveness of this measure has been extensively debated.11 ,12 In particular, it is unclear whether young people reduced harmful consumption, absorbed the price increase or changed to other alcoholic drinks with no effect on alcohol-related harm.

Alcohol sales data reported a substantial fall in the sales of ready-to-drink beverages in the 3 months following introduction of the tax, with a smaller shift to other beverages (beer and spirits) and a net reduction in overall sales.13

However, sales data can be contradictory with reports from Europe that increasing the tax on alcopops did not influence total alcohol consumption when the price of other beverages remained unchanged.

Moreover, sales data reflect overall consumption, not the amount of risky drinking in certain population groups.14 ,15 Neither do they take into account changes in the alcohol content of drinks over time.16

Indicators of health outcomes, such as health service use, may therefore be more appropriate to assess the success of such policies.

An initial study of hospital admissions and emergency department (ED) presentations in young people for alcohol-related incidents across Australia found no decrease in alcohol-related harms following the tax increase,17 while another restricted to New South Wales (NSW) reported a reduction.18

An initial study of hospital admissions and emergency department (ED) presentations in young people for alcohol-related incidents across Australia found no decrease in alcohol-related harms following the tax increase,17 while another restricted to New South Wales (NSW) reported a reduction.18

An initial study of hospital admissions and emergency department (ED) presentations in young people for alcohol-related incidents across Australia found no decrease in alcohol-related harms following the tax increase,17 while another restricted to New South Wales (NSW) reported a reduction.18

However, health outcomes in both studies were limited to blood alcohol levels, or to alcohol-attributable mental health conditions such as intoxication, dependence and abuse. These form the minority of alcohol-attributable conditions for which young people are admitted, unintentional and intentional injuries being the most common causes in both males (66%) and females (59%).