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MILAN (Reuters) - Gone midnight on the last Saturday in summer and the young people in the square drinking cocktails and beer slur as they chant: "Happy birthday, son of a b---h..."
An unremarkable sight in northern European countries like Britain, it's becoming familiar in Milan as an Italian tradition of touching wine only at meals caves in to the power of binge-drinking.
In a country where proverbially "wine makes good blood" -- a popular belief that moderate alcohol intake makes people good-humored and can be healthy -- the authorities are grappling with a youth drinks culture modeled on the heavy-drinking north.
"We have not yet reached levels seen in the UK but in five years we'll be there. We are not that far off," Dr. Luca Bernardo, an expert in adolescent health at Milan's Fatebenefratelli hospital, told Reuters.
His hospital is in an area surrounded by bars and he said at least every two weeks its emergency room has to treat a young patient who is in an alcoholic coma or severely intoxicated.
It's no surprise to see children as young as 11 to 13 in the emergency room, Bernardo said.
Alcohol advertising, new products such as alcopops aimed at a younger public, boredom and psychological problems can spur youth drinking, doctors say.
In the Milan square near the San Lorenzo Columns, two hoardings overlook the scene: one is for Absolut vodka, the other for Nastro Azzurro beer.
At the bar on the corner where students in their twenties line up, the top drinks are cuba libre, vodka and lemon, gin and tonic, and various brands of beer.
Milan in July became Italy's first city to crack down on youth drinking. In a move applauded by Prime Minister Silvio Berlusconi, the business hub set 500-euro fines for the possession and consumption of alcohol by under-16s or those selling to them.
Alcohol's social and economic costs -- estimated by the World Health Organization in 2004 at 5 to 6 percent of gross domestic product -- include increased traffic fatalities.
Italian media regularly report on the "Saturday Night Massacre."
Drunk-driving kills about 2,800 young people every year, according to a proposal in March by center-right ruling party MPs to raise the legal drinking age to 18 and reduce blood alcohol content allowed in driving.
"Public opinion is quite sensitive to this," Senator Lucio Malan, one of the signatories, told Reuters.
A 2007 study from research firm ESPAD showed 38 percent of Italian students between 15 and 16 had reported binge drinking in the last month -- a rise of almost 23 percent from 1995.
The jump put Italy ahead of Sweden and Finland, which reported declines, but still well behind Britain's 54 percent.
Highlighting the shift toward the north European model, 2008 figures from national statistics office ISTAT show consumers of wine and beer are declining, while those choosing other drinks like spirits are on the rise.
The number of Italians overall who drink between meals has remained stable over the last 10 years at one in four, ISTAT numbers show. But among 14-17-year olds, at 20 percent, it has jumped nearly half in the last decade.
Dr. Emanuele Scafato, head of CNESPS' alcohol observatory, a Rome-based center collaborating with the World Health Organization, said unlike such countries as France and Germany, Italy's measures against drink-driving and the sale of drinks to teenagers were light.
He blamed heavy advertising and alcopops for the new excesses, saying about 169 million euros are spent every year in Italy on alcohol advertising.
Massimiliano Bruni, professor at Milan's business university Bocconi, said there was little chance of pressure building for the government to tighten up on alcohol advertising: softer initiatives to promote responsible drinking look more likely.
"I don't see risks of intervention on this," he said, noting that Italy was slower than other western countries to clamp down on cigarette smoking.
"There might be sensitizing initiatives and it cannot be ruled out that in the future some products will be required to carry a label warning that alcohol damages health," he said.
Young consumers may perceive alcopops as non-alcoholic and needed educating: "There has been no education that makes clear that these products must be drunk in a mindful matter."
Scafato said almost 70 percent of nightclubbers under 16 bought alcoholic drinks in clubs and bars, and alcohol consumption among young people is often associated with games favoring heavy drinking.
"In discotheques you often see people at private tables racing to consume bottles," said Luca Rizzi, who organises events and provides services for clubs around Milan.
"Every time a bottle is delivered at one table this is accompanied by fruit and fireworks. Automatically a nearby table orders another bottle because the contest has started." he said.
"A lot of money is spent ... there are tables worth 5,000 euros" Rizzi said, referring to how much a group of friends spends in one night for drinks and entertainment.
Back at the San Lorenzo Columns, a policemen on patrol turns a blind eye to the wafts of cannabis smoke from the circles of young people. "Our presence here makes sure things don't get worse," he says, adding the under-16s don't come.
"They know we are here and they go somewhere else."
Editing by Sara Ledwith