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1 Journal of Preventive Medicine and Public Health July, Vol. 43, No. 4, doi:.396/jpmph Estimating the Socioeconomic Costs of Alcohol Drinking Among Adolescents in Korea Jaeyeun Kim, Woojin Chung,3, Sunmi Lee 3, Chongyon Park 3 Department of Public Health, Yonsei University Graduate School; Graduate School of Public Health, Yonsei University; 3 Health Insurance Policy Research Institute, National Health Insurance Corporation Objectives: The purpose of this study was to estimate the socioeconomic costs resulting from alcohol drinking among adolescents as of 6 from a societal perspective. Methods: The costs were classified into direct costs, indirect costs, and other costs. The direct costs consisted of direct medical costs and direct non-medical costs. The indirect costs were computed by future income losses from premature death, productivity losses from using medical services and reduction of productivity from drinking and hangover. The other costs consisted of property damage, public administrative expenses, and traffic accident compensation. Results: The socioeconomic costs of alcohol drinking among adolescents as of 6 were estimated to be billion won (.5% of GDP). In the case of the former, the amount included 48.5% for reduction of productivity from drinking and hangover, 39.38% for future income losses from premature death, and 6.7% for hangover costs. Conclusions: The results showed that the socioeconomic costs of alcohol drinking among adolescents in Korea were a serious as compared with that of the United States. Therefore, the active interventions such as a surveillance system and a prevention program to control adolescents drinking by government and preventive medicine specialist are needed. Key words: Alcohol drinking, Costs, Adolescent, Korea J Prev Med Public Health ;43(4):34-35

4 Table. The types of costs and sources Types of costs Direct costs Medical costs Health insurance / Medical aid Industrial accident compensation insurance Automobile insurance Non-medical costs Transportation Care giver Hangover Indirect costs Future income losses from premature death Reduction of productivity from hangover and productivity losses from sick leave Other costs Property damages Public administrative expenses Traffic accidents compensation Sources - 6 National Health Insurance Statistical Yearbook, National Health Insurance Corporation - 6 Yearbook of Labor Statistics, Ministry of Labor - Status for occurrence of traffic accidents caused by intoxication, Korean National Police Agency - Estimation and assessment the costs of road traffic accident in 6, Road Traffic Authority - The Third Korea National Health and Nutrition Examination Survey, Korea Institute for Health and Social Affairs - Annual report on the consumer price index, Korea National Statistical Office. - Medicare service, Korea Care Worker Education Center - The Third Korea National Health and Nutrition Examination Survey, Korea Institute for Health and Social Affairs - Annual report on the cause of death statistics, Korea National Statistical Office - Life table, Korea National Statistical Office - Annual report on the survey of economically active population, Korea National Statistical Office - Annual report on the consumer price index, Korea National Statistical Office - 6 Report on Wage Structure Survey, Ministry of Labor - Survey report on the Wages and Working Hours at Establishments, Ministry of Labor - 6 National Health Insurance Statistical Yearbook, National Health Insurance Corporation - The Third Korea National Health and Nutrition Examination Survey, Korea Institute for Health and Social Affairs - Population projection for Korea, Korea National Statistical Office - Annual report on the survey of economically active population, Korea National Statistical Office - 6 Report on Wage Structure Survey, Ministry of Labor - 6 Yearbook of disaster, National Emergency Management Agency - Estimating and assessment the costs of road traffic accident in 6, Road Traffic Authority - Estimating and assessment the costs of road traffic accident in 6, Road Traffic Authority - Estimating and assessment the costs of road traffic accident in 6, Road Traffic Authority

6 Table. Direct costs of health insurance and medical aid benefit related to underage drinking (unit: thousand won) Diseases Oropharyngeal cancer Oesophageal cancer Liver cancer Laryngeal cancer Female breast cancer Alcoholic psychosis Alcohol dependence Alcohol abuse Epilepsy Hypertension Supraventricular cardiac dysrhythmias Haemorrhagic stroke Ischaemic stroke Oesophageal varices Gastro-oesophageal haemorrhage Alcoholic gastritis Alcoholic liver cirrhosis Unspecified liver cirrosis Cholelithiasis Chronic pancreatitis Low birthweight Psoriasis Alcohol poisoning Health insurance benefits Male Female Medical aid benefits Male Female Health insurance benefits related to underage drinking Male Female Total Male Female Total Medical aid benefits related to underage drinking Total Table 3. Future income losses resulting from premature death related to underage drinking (unit: person, thousand won) Diseases Oropharyngeal cancer Oesophageal cancer Liver cancer Epilepsy Haemorrhagic stroke Ischaemic stroke Unspecified liver cirrhosis Acute pancreatitis Low birthweight Road traffic injuries: non-pedestrian Road traffic injuries: pedestrian Fall injuries Fire injuries Drowning Aspration Occupational/machine injuries Suicide Assault Male Deaths Female Deaths related to underage drinking Male Female Future income losses resulting from premature death Male Female Total Total

7 Table 4. Productivity losses resulting from sick leave related to underage drinking (unit: day, thousand won) Diseases Oropharyngeal cancer Oesophageal cancer Liver cancer Laryngeal cancer Female breast cancer Alcoholic psychosis Alcohol dependence Alcohol abuse Epilepsy Alcoholic polyneuropathy Hypertension Alcoholic cardiomyopathy Supraventricular cardiac dysrhythmias Haemorrhagic stroke Ischaemic stroke Oesophageal varices Gastro-oesophageal haemorrhage Alcoholic gastritis Alcoholic liver cirrhosis Unspecified liver cirrhosis Cholelithiasis Acute pancreatitis Chronic pancreatitis Low birthweight Psoriasis Alcohol poisoning Length of stay Male Female Outpatient days Male Female , Visit days related to underage drinking Male Female Costs of productivity loss resulting from sick leave Male Female Total Total

8 Table 5. The socioeconomic costs of underage drinking (unit : thousand won) Direct costs Medical costs Health insurance Benefits Cost not insured Medical aid Types of costs Total (%) Industrial accident compensation insurance Automobile insurance Non-medical costs Transportation Care giver Hangover Subtotal Indirect costs Future income losses from premature death Reduction of productivity from hangover Productivity losses from sick leave Subtotal Other costs Property damage Traffic accidents Fire Public administrative expenses Automobile insurance Police administration Traffic accidents compensation Automobile insurance Injuries Deaths Subtotal Total (.9) (6.7) (6.87) (7.77) (39.38) (48.5) (87.63) (.33) (3.77) (.36) (4.6) ()

9 Table 6. Sensitivity analysis (unit : thousand won) Future income losses resulting from premature death Reduction of productivity from hangover Industrial accident compensation insurance Discount rate (%) Rate of productivity reduction (%) Attributable rate of industrial accident compensation insurance (%) Attributable rate of binge drinker (%) Hangover costs from binge drinker Future income losses (%) Indirect costs (%) 6835 (5.64) (45.7) (39.38) (33.76) (8.9) Costs of productivity reduction (%) 7437 (35.87) (4.7) (48.5) (5.8) (56.6) Costs of industrial accident compensation insurance (%),44837 (.),59789 (.5),74786 (.9), (.3) 46 (.7) (9.34) (88.93) (87.63) (86.49) 8466 (85.5) Indirect costs (%) (84.68) (86.3) (87.63) (88.7) (89.63) Direct costs (%) (7.7) (7.73) (7.77) 3549 (7.8) (7.84) Costs of hangover (%) Direct costs (%) (6.7) (5.44) 5597 (4.3) (.8) (.4) (.) (7.77) 4984 (6.5) 9767 (5.3) (3.9) (.54) (.4) Socioeconomic costs of underage drinking Socioeconomic costs of underage drinking Socioeconomic costs of underage drinking Socioeconomic costs of underage drinking

10 . Hingson R, Kenkel D. Social, health and economic consequences of underage drinking. In National Research Council and Institute of Medicine, Reducing Underage Drinking: A Collective Responsibility. Washington, DC: National Academies Press 4: Hoaken PN, Stewart SH. Drugs of abuse and the elicitation of human aggressive behavior. Addict Behav 3; 8(9): Iciardi JA, Pottieger AE. Kids, crack, and crime. J Drug Issues 99; (): Schulenberg J, Wadsworth KN, O Malley PM, Bachman JG, Johnston LD. Adolescent risk factors for binge drinking during the transition to young adulthood: Variable-and pattern-centered approaches to change. Dev Psychol 996; 3(4): Cho JA, Chun SS. A study of drinking prevalence and drinking levels, related social and psychological factors among Korean middle school students. J Korean Alcohol Sci 8; 9(): (Korean) 6. Park NH. Gender differences in the association between psycho-social factors and smoking, drinking in adolescents. J Korean Soc Health Educ Promot 5; (4): (Korean) 7. Korea Institute for Health and Social Affairs. The First Korea National Health and Nutrition Examination Survey (KNHANES ). Seoul: Korea Institute for Health and Social Affair; 999. (Korean) 8. Korea Institute for Health and Social Affairs. The Third Korea National Health and Nutrition Examination Survey (KNHANES ). Seoul: Korea Institute for Health and Social Affair; 6. (Korean) 9. Lee CS, Kim SJ, Kweon YR. The effect of smoking and drinking prevention program on middle school students. J Korean Acad Psychiatr Ment Health Nurs 9; 8(): 5-5. (Korean). WHO. International Guide for Monitoring Alcohol Consumption and Related Harm Geneva: WHO;.. Noh IC, Suh MH, Kim YR. Socioeconomic Costs and Policy Priorities of Alcohol Drinking. Seoul: Korea Institute for Health and Social Affairs; 997. (Korean). Chung WJ, Chun HJ, Lee SM. Socioeconomic costs of alcohol drinking in Korea. J Prev Med Public Health 6; 39(): -9. (Korean) 3. Lee SM, Chung WJ, Kim IS, Kum HJ, Cho WH, Shin EC et al. Socioeconomic costs of alcohol drinking in Korea. J Korean Acad Fam Med 8; 9(3): -. (Korean) 4. Rice DP. Cost-of-illness studies: fact or fiction? Lancet 994; 344(8936): Byford S, Torgerson DJ, Raftery J. Economic note: cost of illness studies. BMJ ; 3(745): Ridolfo B, Stevenson C. The Quantification of Drugcaused Mortality and Morbidity in Australia, 998. Canberra: Australian Institute of Health and Welfare;. 7. National Health Insurance Corporation. 6 Natiional Health Insurance Statistical Yearbook. Seoul: National Health Insurance Corporation; 7. (Korean) 8. Ministry of Labor. 6 Yearbook of Labor Statistics. Seoul: Ministry of Laber; 7. (Korean) 9. Korean National Police Agency. Status for Occurrence of Traffic Accidents Caused by Intoxication; 7. (Korean). Chang YC, Park HH, Cho HE, Lee EY, Yoo CS, Hwang

11 JH, et al. Estimating and Assessment the Costs of Road Traffic Accident in 6. Seoul: Road Traffic Authority; 7. (Korean). Kim JH, Lee HY, Hwang RI, Chung HJ. 6 Research on the Actual Conditions of Co-payment. Seoul: National Health Insurance Corporation; 7. (Korean). Korea National Statistical Office. Annual Report on the Consumer Price Index. Seoul: Korea National Statistical Office; 7. (Korean) 3. Korea Care Worker Education Center. Medicare service. [cited 8 Oct 5]. Available from: URL: kcenet.com/?page=service/fee. 4. Korea National Statistical Office. Annual Report on the Cause of Death Statistics. Seoul: Korea National Statistical Office; 7. (Korean) 5. Korea National Statistical Office. Life Table. Seoul: Korea National Statistical Office; 7. (Korean) 6. Korea National Statistical Office. Annual Report on the Survey of Economically Active Population. Seoul: Korea National Statistical Office; 7. (Korean) 7. Ministry of Labor. 6 Report on Wage Structure Survey. Seoul: Ministry of Laber; 7. (Korean) 8. Ministry of Labor. Survey Report on the Wages and Working Hours at Establishments. Seoul: Ministry of Laber; 7. (Korean) 9. Korea National Statistical Office. Population Projections for Korea. Seoul: Korea National Statistical Office; 7. (Korean) 3. Devlin NJ, Scuffham PA, Bunt LJ. The social costs of alcohol abuse in New Zealand. Addiction 997; 9(): National Emergency Management Agency. 6 Yearbook of Disaster. Seoul: Natioanl Emergency Management Agency; 7. (Korean) 3. Kim KK. Drinking and safety of worker. Korea Occupational Safety and Health Agency; 6 (Korean) 33. Gold MR, Siegel JE, Russell LB, Weinstein MC. Cost Effectiveness in Health and Medicine. New York: Oxford University Press; 966. p Drummond MF, O Brien B, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes, nd ed. New York: Oxford University Press; 997. p Canadian Coordinating Office for Health Technology Assessment(CCOHTA). Guidelines for Economic Evaluation of Pharmaceuticals, nd ed. Ottawa: Canadian Coordinating Office for Health Technology Assessment (CCOHTA); Levy DT, Miller TR, Cox KC. Costs of Underage Drinking. U.S. Pacific Institute. Office of Juvenile Justice and Delinquency Prevention. Department of Justice; Miller TR, Levy DT, Spicer RS, Taylor DM. Societal Costs of Underage drinking. J Stud Alcohol 6; 67(4): Underage Drinking Enforcement Training Center. Underage Drinking Costs. Pacific Institute for Research and Evaluation Ministry for Health, Welfare and Family Affairs. The Symposium on National Health Investment and Chronic Disease Management. Seoul: Ministry for Health, Welfare and Family Affairs; 7. (Korean) 4. Choi EJ, Seo MK, Park SW, Lee YM, Park SJ. The Middle-Long Term Policy of Underage Drinking and Smoking. Seoul: Korea Institute for Health and Social Affairs, National Youth Commission; 7. (Korean)

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