Our team investigated trends in adolescent alcohol-related harms in high-income countries around the world. The results indicated that although harms have been declining in some countries, they usually have not kept up with declines in consumption.
We know that younger generations have been drinking less in recent years. For example, Vashishtha and colleagues showed that for adolescents, drinking has declined in high-income countries since the 2000s – starting in North America, with teenagers in Europe and Australasia catching up pretty quickly. While it is clear alcohol consumption has been declining for adolescents, we didn’t know if alcohol-related harms have also decreased. As well, we wanted to explore any differences in these harm trends according to sex. Some consumption research reports that drinking is declining more for teenage boys than girls, but again, there had not yet been any large-scale attempts to explore differences in harm trends according to sex.
The systematic review
Our study systematically reviewed the literature regarding alcohol-related harms for adolescents in high-income countries from 2000 to 2019. We focused on adolescents aged 10-19 in high-income countries that had at least a 30% reduction in adolescent consumption, with this threshold decided by the team to signify a meaningful decline in drinking. We defined alcohol-related harms as health-systems based measures – for example, emergency department presentations, mortality rates, or assessments by clinicians.
46 records were included in the final article, with results split based on the following geographic regions:
- Anglosphere countries – 15 records (United Kingdom, Australia, Ireland, New Zealand)
- North America – 15 records (Canada and United States)
- Mainland Europe – 16 records (Netherlands, Belgium, Switzerland, Sweden, Austria, Germany, Lithuania, Spain, Estonia, Finland, Iceland, Norway, Portugal).
Changes in harms over time were identified as a basic percentage change. A difference of 10% or more from baseline indicated change, while a difference of less than 10% was marked as stability.
What did we find?
Anglosphere countries
- The region with the most consistent evidence for declines in adolescent alcohol-related harms, with many records reporting sizeable decreases in harms.
- 69% of results reported either decreasing or stable trends.
- For example, England reported a 56% decrease in rates of hospital admissions wholly attributable to alcohol for under-18-year-olds from 2006/07 to 2018/19.
- Only one record in this region, from Ireland, found increases in harms in the form of alcohol-related cases of chronic liver disease and cirrhosis. However, the only other record from Ireland indicated substantial decreases in harms measured by hospital discharges wholly attributable to alcohol.
- There were some conflicting sex-based differences in harm trends. While many records found harms decreased for males and females, a few reported decreases for males but stable trends for females.
North America
- The second-most amount of evidence indicating declines in adolescent alcohol-related harms.
- 64% of results indicated either decreasing or stable trends.
- Although conflicting, there is some evidence for increases in harms for females, while harms for males were consistently either decreasing or stable. A study focused on college populations also found increases in harms for this population.
Mainland Europe
- The largest mix of findings, including the most records indicating increases in adolescent alcohol-related harms.
- 38% of records found decreasing or stable trends.
- However, there was very little evidence for sex-based differences in harm trends. A study focused on a university city found increases in harms for this population.
What do these findings mean?
Our review brought together a variety of literature, including many types of alcohol-related harms, many ways to measure these harms, many time periods, and many portions of adolescent age groups. Pulling these results together indicated that adolescent alcohol-related harms have decreased to a certain extent – mostly in Anglosphere countries and to a lesser degree in North America, with mixed findings for Europe.
The declining trends in consumption reported in previous studies seem to be more dramatic than the trends we’re seeing in harms. This could be because survey sampling methods tend to ‘miss’ some subpopulations, such as those who choose not to respond to surveys, with these groups more likely to be heavier drinkers. A strength of our study is that we defined alcohol-related harms using objective measures (e.g., hospital admissions), which are less likely to ‘miss’ specific populations compared to survey sampling methods.
Regardless, our results indicate a potential decrease in the disease burden attributable to alcohol use for adolescents. Further research in this space would be valuable to understand why we found some contradictory sex-based findings in the Anglosphere and North America regions, and to investigate potential increases in alcohol-related harms for college and university populations.
Adolescent alcohol-related harms – the key takeaway
Alcohol-related harms have been declining for adolescents, particularly in Anglosphere countries. Since the decline in adolescent consumption from the 2000s, alcohol-related harms have been declining most strongly in the United Kingdom, Australia, New Zealand and Ireland, followed by North America.
To find more out about the research being conducted by NDRI’s Alcohol Policy and Strategies team, click here.
Written by Emma Vieira, Research Officer and PhD Candidate, National Drug Research Institute, Curtin University.
All IAS Blogposts are published with the permission of the author. The views expressed are solely the author’s own and do not necessarily represent the views of the Institute of Alcohol Studies.