Association between the initiation of strong chū-hai consumption and the incidence of hazardous and harmful alcohol use in Japan: An online survey-based cohort study

OBJECTIVE: To investigate the association between the initiation of strong chū-hai-an inexpensive Japanese ready-to-drink beverage with high-alcohol-content-consumption and the newly incident hazardous and harmful alcohol use among individuals who consume alcohol. METHODS: This cohort study is based on a three-year longitudinal internet survey conducted in Japan from 2022 to 2024. Respondents who completed all three annual surveys, did not drink strong chū-hai in 2022, and consumed alcohol without presenting hazardous or harmful alcohol use in both 2022 and 2023, were included. The outcome was defined as having newly developed hazardous and harmful alcohol use in 2024, defined as a score of ≥ 8 on the Alcohol Use Identification Test. We fitted a multivariable logistic regression model to examine confounder-adjusted association between initiating strong chū-hai consumption and the incidence of hazardous and harmful alcohol use. RESULTS: Of 5358 respondents from 33,000 surveyed in 2022, approximately 10 % (n = 533) initiated strong chū-hai consumption in 2023. In 2024, the prevalence of hazardous and harmful alcohol use was higher for those who initiated strong chū-hai consumption (7.7 %) than those who did not (3.1 %). Multivariable analysis revealed that initiating strong chū-hai consumption was associated with higher odds of hazardous and harmful alcohol use the year following (adjusted odds ratio 1.90, 95 % confidence interval 1.19-3.06, p = 0.008). CONCLUSIONS: The initiation of strong chū-hai consumption was associated with the incidence of hazardous and harmful alcohol use. Considering the global increase in sales of ready-to-drink alcoholic beverages, our findings serve as an important caution for policymakers worldwide.