Skip to main content

The impact of an alcohol policy change on developmental trajectories of youth alcohol use: examination of a natural experiment in Canada



In 2015, the Liquor Control Board of Ontario (LCBO) authorized sale of alcohol in some Ontario grocery stores. This research evaluates the impact of the new policy on alcohol use patterns of youth in a quasi-experimental setting with two control groups.


The sample consists of 2267 grade 9 students attending 60 secondary schools across Ontario (n = 56) and Alberta (n = 4), who provided 4-year linked longitudinal data (2013–2014 to 2016–2017) in the COMPASS study. The study used the frequency of drinking and the frequency of binge drinking to characterize alcohol use behaviours.


Latent transition analysis found four statuses of alcohol use: abstainer, periodic drinker, low-risk drinker, and high-risk regular drinker. The new policy had no negative impact among periodic and low-risk drinkers, but the risk of transitioning from the abstainer (lowest risk status) to high-risk regular drinker (highest risk status) among the exposed cohort was 1.71 times greater post-policy than pre-policy change, compared with those of Ontario-unexposed (0.50) and Alberta-unexposed cohorts (1.00). The probability of sustaining high-risk drinking among the exposed cohort increased by a factor of 1.76, compared with 1.13-fold and 0.89-fold among the Ontario-unexposed and Alberta-unexposed cohorts, respectively.


Youth are more likely to transition from abstinence to high-risk regular drinking, and high-risk regular drinkers are more likely to maintain their behaviours in the jurisdictions exposed to the latest change in LCBO policy authorizing grocery stores to sell alcohol. When formulating policy interventions, youth access to alcohol should be considered in order to reduce their harmful alcohol consumption.



Depuis 2015, la Régie des alcools de l’Ontario (LCBO) autorise la vente d’alcool dans certaines épiceries de la province. Nous évaluons ici l’incidence de la nouvelle politique sur les habitudes de consommation d’alcool des jeunes dans un milieu quasi-expérimental avec deux groupes témoins.


Notre échantillon est constitué de 2 267 élèves de 9e année, fréquentant 60 écoles secondaires en Ontario (n = 56) et en Alberta (n = 4), qui ont fourni des données longitudinales couplées sur une période de quatre ans (2013-2014 à 2016-2017) dans le cadre de l’étude COMPASS. L’étude utilise la fréquence de consommation et la fréquence d’hyperalcoolisation rapide pour caractériser les comportements de consommation d’alcool.


Une analyse de transition latente a permis de répartir la consommation d’alcool en quatre catégories : non-consommation, consommation ponctuelle, consommation à faible risque et consommation régulière à haut risque. La nouvelle politique n’a pas eu d’effet nuisible chez les consommateurs ponctuels et à faible risque, mais le risque de passer de la catégorie de la non-consommation (risque minimal) à celle de la consommation régulière à haut risque (risque maximal) dans la cohorte exposée était 1,71 fois supérieur après l’instauration de la politique qu’avant le changement d’orientation, comparativement aux cohortes non exposées de l’Ontario (0,50) et de l’Alberta (1,00). La probabilité de maintenir une consommation d’alcool à haut risque dans la cohorte exposée a été de 1,76 fois supérieure, contre 1,13 fois et 0,89 fois dans les cohortes non exposées de l’Ontario et de l’Alberta, respectivement.


Dans les administrations exposées au changement récent de la politique de la LCBO, qui autorise les épiceries à vendre de l’alcool, les jeunes sont plus susceptibles de passer de l’abstinence à une consommation régulière à haut risque, et les consommateurs réguliers à haut risque sont plus susceptibles de maintenir leur comportement. Lors de l’élaboration de politiques, il faudrait tenir compte de l’accès des jeunes à l’alcool pour réduire la consommation nocive dans cette population.

This is a preview of subscription content, access via your institution.


  • Butt, P., Beirness, D., Gliksman, L., Paradis, C., & Stockwell, T. (2011). Alcohol and health in Canada: a summary of evidence and guidelines for low-risk drinking. Ottawa, ON: Canadian Centre on Substance Abuse.

    Google Scholar 

  • Campbell, C. A., Hahn, R. A., Elder, R., Brewer, R., Chattopadhyay, S., Fielding, J., et al. (2009). The effectiveness of limiting alcohol outlet density as a means of reducing excessive alcohol consumption and alcohol-related harms. American Journal of Preventive Medicine, 37(6), 556–569.

    Article  Google Scholar 

  • Canadian Student Tobacco, Alcohol and Drug Survey. (2017). CSTADT questionnaire: alcohol. Accessed 05 May 2019.

  • Chan, G. C., Kelly, A. B., Toumbourou, J. W., Hemphill, S. A., Young, R. M., Haynes, M. A., & Catalano, R. F. (2013). Predicting steep escalations in alcohol use over the teenage years: age-related variations in key social influences. Addiction, 108(11), 1924–1932.

    Article  PubMed  PubMed Central  Google Scholar 

  • Chung, T., Pedersen, S. L., Kim, K. H., Hipwell, A. E., & Stepp, S. D. (2014). Racial differences in type of alcoholic beverage consumed during adolescence in the Pittsburgh girls study. Alcoholism, Clinical and Experimental Research, 38(1), 285–293.

    Article  Google Scholar 

  • Collins, L. M., & Lanza, S. T. (2013). Latent class and latent transition analysis: with applications in the social, behavioral, and health sciences. Wiley.

  • Dawson, D. A., Grant, B. F., Stinson, F. S., & Zhou, Y. (2005). Effectiveness of the derived Alcohol Use Disorders Identification Test (AUDIT-C) in screening for alcohol use disorders and risk drinking in the US general population. Alcoholism, Clinical and Experimental Research, 29(5), 844–854.

    Article  PubMed  Google Scholar 

  • Forster, J. L., Murray, D. M., Wolfson, M., & Wagenaar, A. C. (1995). Commercial availability of alcohol to young people: results of alcohol purchase attempts. Preventive Medicine, 24(4), 342–347.

    CAS  Article  Google Scholar 

  • Gohari, M. R., Dubin, J. A., Cook, R. J., & Leatherdale, S. T. (2019). Identifying trajectories of alcohol use among a sample secondary-school students in Ontario and Alberta: longitudinal evidence from the COMPASS study. Health Promotion and Chronic Disease Prevention in Canada: Research, Policy and Practice, 39, 7.

    Article  Google Scholar 

  • Gohari, M. R., Cook, R. J., Dubin, J. A., & Leatherdale, S. T. (2020). Identifying patterns of alcohol use among secondary school students in Canada: a multilevel latent class analysis. Addictive Behaviors, 100, 106120.

    Article  Google Scholar 

  • Jackson, N., Denny, S., Sheridan, J., Fleming, T., Clark, T., Teevale, T., & Ameratunga, S. (2014). Predictors of drinking patterns in adolescence: a latent class analysis. Drug and Alcohol Dependence, 135, 133–139

  • Leatherdale, S. T. (2019). Natural experiment methodology for research: a review of how different methods can support real-world research. International Journal of Social Research Methodology, 22, 19–35.

    Article  Google Scholar 

  • Leatherdale, S. T., Brown, K. S., Carson, V., Childs, R. A., Dubin, J. A., Elliott, S. J., et al. (2014). The COMPASS study: a longitudinal hierarchical research platform for evaluating natural experiments related to changes in school-level programs, policies and built environment resources. BMC Public Health, 14(1), 331.

    Article  Google Scholar 

  • Little, R. J., & Rubin, D. B. (2014). Statistical analysis with missing data. Wiley.

  • Malone, P. S., Northrup, T. F., Masyn, K. E., Lamis, D. A., & Lamont, A. E. (2012). Initiation and persistence of alcohol use in United States Black, Hispanic, and White male and female youth. Addictive Behaviors, 37(3), 299–305.

    Article  Google Scholar 

  • McBride, O., Adamson, G., Cheng, H. G., & Slade, T. (2014). Changes in drinking patterns in the first years after onset: a latent transition analysis of National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) data. Psychology of Addictive Behaviors, 28(3), 696.

    Article  Google Scholar 

  • Miles, H., Winstock, A., & Strang, J. (2001). Identifying young people who drink too much: the clinical utility of the five-item Alcohol Use Disorders Identification Test (AUDIT). Drug and Alcohol Review, 20(1), 9–18.

    Article  Google Scholar 

  • Norström, T. (2004). Per capita alcohol consumption and all-cause mortality in Canada, 1950–98. Addiction, 99(10), 1274–1278.

    Article  Google Scholar 

  • Nylund, K. L., Asparouhov, T., & Muthén, B. O. (2007). Deciding on the number of classes in latent class analysis and growth mixture modeling: a Monte Carlo simulation study. Structural Equation Modeling, 14(4), 535–569.

    Article  Google Scholar 

  • Premier’s Advisory Council on Government Assets. (2015). Modernizing beer retailing and distribution. Retrieved from

  • Public Health Agency of Canada (2016) (The Chief Public Health Officer’s Report on the State of Public Health in Canada, 2015: Alcohol Consumption in Canada.).

  • Qian, W., Battista, K., Bredin, C., Stephen, B., & Leatherdale, S. (2015). Assessing longitudinal data linkage results in the COMPASS study. COMPASS system. Accessed 05 May 2019.

  • Reboussin, B. A., Ip, E. H., & Wolfson, M. (2008). Locally dependent latent class models with covariates: an application to under-age drinking in the USA. Journal of the Royal Statistical Society: Series A (Statistics in Society), 171(4), 877–897.

    Article  Google Scholar 

  • Rowland, B., Evans-Whipp, T., Hemphill, S., Leung, R., Livingston, M., & Toumbourou, J. (2016). The density of alcohol outlets and adolescent alcohol consumption: an Australian longitudinal analysis. Health & Place, 37, 43–49.

    CAS  Article  Google Scholar 

  • Schwarz, G. (1978). Estimating the dimension of a model. The Annals of Statistics, 6(2), 461–464.

    Article  Google Scholar 

  • Sherk, A., Stockwell, T., Chikritzhs, T., Andréasson, S., Angus, C., Gripenberg, J., et al. (2018). Alcohol consumption and the physical availability of take-away alcohol: systematic reviews and meta-analyses of the days and hours of sale and outlet density. Journal of Studies on Alcohol and Drugs, 79(1), 58–67.

    Article  Google Scholar 

  • Snowden, A. J. (2016). Neighborhood characteristics contribute to urban alcohol availability: accounting for race/ethnicity and social disorganization. Journal of Ethnicity in Substance Abuse, 15(4), 346–366.

    Article  Google Scholar 

  • Stockwell, T., Zhao, J., Macdonald, S., Pakula, B., Gruenewald, P., & Holder, H. (2009). Changes in per capita alcohol sales during the partial privatization of British Columbia’s retail alcohol monopoly 2003–2008: a multi-level local area analysis. Addiction, 104(11), 1827–1836.

    Article  Google Scholar 

  • Stockwell, T., Zhao, J., Macdonald, S., Vallance, K., Gruenewald, P., Ponicki, W., et al. (2011). Impact on alcohol-related mortality of a rapid rise in the density of private liquor outlets in British Columbia: a local area multi-level analysis. Addiction, 106(4), 768–776.

    Article  Google Scholar 

  • Sudhinaraset, M., Wigglesworth, C., & Takeuchi, D. T. (2016). Social and cultural contexts of alcohol use: influences in a social–ecological framework. Alcohol Research: Current Reviews, 38(1), 35–45.

    Google Scholar 

  • The Ontario Ministry of Finance. (2018). Beer, wins, and cider sales in grocery stores. Accessed 05 May 2019.

  • Thern, E., Munter, J., Hemmingsson, T., Davey Smith, G., Ramstedt, M., Tynelius, P., & Rasmussen, F. (2017). Effects of increased alcohol availability during adolescence on the risk of all-cause and cause-specific disability pension: a natural experiment. Addiction, 112(6), 1004–1012.

    Article  Google Scholar 

  • Trolldal, B. (2005). An investigation of the effect of privatization of retail sales of alcohol on consumption and traffic accidents in Alberta, Canada. Addiction, 100(5), 662–671.

    Article  Google Scholar 

  • University Park: The Methodology Center, Penn State. (2015). PROC LCA & PROC LTA [computer software].

  • Wagenaar, A. C., Toomey, T. L., Murray, D. M., Short, B. J., Wolfson, M., & Jones-Webb, R. (1996). Sources of alcohol for underage drinkers. Journal of Studies on Alcohol, 57(3), 325–333.

    CAS  Article  Google Scholar 

  • World Health Organization (2015) Alcohol, fact sheet. Accessed 05 May 2019.

  • Zalcman, R. F., & Mann, R. E. (2007). The effects of privatization of alcohol sales in Alberta on suicide mortality rates. Contemporary Drug Problems, 34(4), 589–609.

    Article  Google Scholar 

Download references


The COMPASS study was supported by a bridge grant from the Canadian Institutes of Health Research (CIHR) Institute of Nutrition, Metabolism and Diabetes (INMD) through the “Obesity – Interventions to Prevent or Treat” priority funding awards (OOP-110788; grant awarded to S. Leatherdale) and an operating grant from the Canadian Institutes of Health Research (CIHR) Institute of Population and Public Health (IPPH) (MOP-114875; grant awarded to S. Leatherdale), a CIHR Project Grant (PJT-148562; grant awarded to S. Leatherdale), a CIHR Project Grant (PJT-149092; grant awarded to K. Patte), and a research funding arrangement with Health Canada (#1617-HQ-000012; contract awarded to S. Leatherdale).

Author information

Authors and Affiliations


Corresponding author

Correspondence to Mahmood R. Gohari.

Ethics declarations

The authors declare that they have no conflicts of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material


(DOCX 56 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Gohari, M.R., Cook, R.J., Dubin, J.A. et al. The impact of an alcohol policy change on developmental trajectories of youth alcohol use: examination of a natural experiment in Canada. Can J Public Health 112, 210–218 (2021).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Adolescents
  • Developmental trajectory
  • Substance use
  • Latent transition analysis
  • Policy evaluation


  • Adolescents
  • trajectoire développementale
  • consommation de substances
  • analyse de transition latente
  • évaluation des politiques