Global Trends in the Prevalence of Alcohol Consumption Among School-Going Adolescents Aged 12–15 Years
Original article
Abstract
Purpose
Adolescent alcohol consumption is detrimental to multiple facets of health. However, there is a scarcity of data available on time trends in adolescents’ alcohol consumption particularly from non-Western countries and low- and middle-income countries.
Thus, the researchers examined the temporal trend of alcohol use in a large representative sample of school-going adolescents aged 12–15 years from 22 countries in Africa, Asia, and the Americas.
Methods
Data from the Global School-based Student Health Survey were analyzed.
Alcohol consumption referred to consuming alcohol on at least one day in the past 30 days.
Crude linear trends of past 30-day alcohol consumption by country were assessed by linear regression models.
Results
Data on 135,426 adolescents aged 12–15 years were analyzed.
The overall mean prevalence of past 30-day alcohol consumption was 14.1%.
Of the 22 countries included in the study, increasing, decreasing, and stable trends were observed in 3, 8, and 11 countries, respectively.
Specifically, significant increases were observed in Benin between 2009 (16.1%) and 2016 (38.6%), Myanmar between 2007 (0.9%) and 2016 (3.6%), and Vanuatu between 2011 (7.6%) and 2016 (12.2%).
The most drastic decrease was observed in Samoa between 2011 (34.5%) and 2017 (9.8%), but the rate of decrease was modest in most countries.
Discussion
Among school-going adolescents, decreasing trends in alcohol consumption were more common than increasing trends, but the rate of decrease was limited in most countries, suggesting that more global action is required to curb adolescent alcohol consumption.
Implications and Contribution
Alcohol consumption was analyzed in 135,426 adolescents (52.0% females) from 22 countries. Overall mean prevalence of past 30-day alcohol consumption was 14.1%.
Decreasing trends in alcohol consumption were more common than increasing trends, but the rate of decrease was limited in most countries, suggesting that more global action is required.
Alcohol harm in youth
Alcohol use in adolescents is a global health concern due to its high prevalence and the fact that consuming alcohol is particularly deleterious for adolescents. Specifically, the prevalence of weekly alcohol use and inebriation, defined as having been alcohol inebriated on two or more occasions, is very low at age 11 but increases significantly by age 15 for boys and girls in almost all countries and regions.
Indeed, one large multi-country study showed that just 2% and 1% of 11-year-old boys and girls reported having been alcohol inebriated at least twice, respectively, whereas 24% of boys and 20% of girls aged 15 years reported being so.
Furthermore, alcohol consumption in adolescence is associated with a plethora of adverse outcomes, including, for example:
- psychological distress,
- poorer academic performance,
- risky sexual behavior,
- suicidal behavior,
- smoking,
- appetite changes,
- weight loss,
- eczema,
- headaches,
- liver damage, and
- sleep disturbance.
Importantly, alcohol consumption in adolescence has a detrimental impact on brain development. For instance, heavy alcohol use impacts the neuropsychological performance (e.g., memory functions) of young people and likely impairs growth and integrity of certain brain structures.
In addition, adolescent alcohol use can have long-term health effects that can persist into adulthood such as:
- adult alcohol dependency and addiction,
- diminished work capacity,
- diabetes,
- mental health complications, and
- premature death.
Study background
Despite the known deleterious effects of alcohol consumption among adolescents, little is known about its recent temporal trends, especially in low- and middle-income countries (LMICs). This information is vital to establish effective policies or interventions that aim to reduce adolescent alcohol consumption in such settings.
Targeting adolescents is crucial given that habits shaped in adolescence (e.g., alcohol consumption) often track into adulthood.
The previous studies on temporal trends on alcohol consumption among adolescents have mainly focused on high-income countries (HICs) and have often shown declining trends but some have shown increasing trends.
Results
A total of 135,426 school-going adolescents aged 12–15 years from 22 countries were included in the analytical sample. The mean age was 13.8 years and 52.0% were females.
The overall mean prevalence of past 30-day alcohol consumption was 14.1% (boys 16.6%, girls 11.8%) but ranged widely across countries. Specifically, the lowest and highest prevalence were observed in Myanmar in 2007 (0.9%) and Seychelles in 2007 (57.1%), respectively.
The trends in the prevalence of alcohol consumption
Among the 22 countries included in the study, based on the overall sample, significant increasing and decreasing trends were observed in three and eight countries, respectively.
No significant decreasing or increasing trends were observed in the remaining 11 countries.
Specifically, significant increases were observed in
- Benin between 2009 (16.1%) and 2016 (38.6%),
- Myanmar between 2007 (0.9%) and 2016 (3.6%), and
- Vanuatu between 2011 (7.6%) and 2016 (12.2%).
On the contrary, significant decreases were observed in
- Namibia between 2004 (32.6%) and 2013 (23.0%),
- Seychelles between 2007 (57.1%) and 2015 (45.4%),
- Anguilla between 2009 (41.9%) and 2016 (29.7%),
- Jamaica between 2010 (52.4%) and 2017 (45.2%),
- Trinidad & Tobago between 2007 (38.1%) and 2017 (26.5%),
- Uruguay between 2006 (55.2%) and 2012 (45.2%),
- Samoa between 2011 (34.5%) and 2017 (9.8%), and
- Tonga between 2010 (16.2%) and 2017 (10.4%).
Furthermore, significant interaction in terms of trends by sex was found in eight countries. For example, in Guyana and Thailand, a significant increasing trend was only found among girls, while in Myanmar, this was only found among boys. Furthermore, in Tonga, a decreasing trend was only found among girls.
Discussion of the main findings
The present study included a large representative sample of in-school adolescents aged 12–15 years from 22 countries across multiple continents.
The study found significant increasing and decreasing trends in alcohol consumption in three and eight countries, respectively.
Specifically, significant increases were observed in Benin between 2009 (16.1%) and 2016 (38.6%), Myanmar between 2007 (0.9%) and 2016 (3.6%), and Vanuatu between 2011 (7.6%) and 2016 (12.2%).
The most pronounced decreasing trend was observed in Samoa between 2011 (34.5%) and 2017 (9.8%), but in other countries with decreasing trends, the rate of decrease was modest. No significant decreasing or increasing trends were observed in the remaining countries.
Finally, several distinct patterns in terms of sex differences were observed in eight countries.
This is the first study on alcohol consumption trends with such a large number of countries for which trends were previously unknown.
Meaning and implications
It is encouraging that more than a third of the countries (8/22) included in the study had significant decreasing trends in alcohol consumption and that a significant increasing trend was only observed in a few countries (n = 3). However, it is worrying that in countries such as Benin the prevalence of alcohol consumption more than doubled between 2009 (16.1%) and 2016 (38.6%), and quadrupled in Myanmar between 2007 (0.9%) and 2016 (3.6%), although it should be noted that in Myanmar, alcohol consumption at baseline was exceptionally low and thus highly unlikely to decrease overtime.
While the reasons for this increase cannot be stated with certainty, it is worth noting that although Benin has a national alcohol policy, there is no policy to limit access to alcoholic beverages to minors (e.g., ‘national legal minimum age for off- and on-premise sales of alcoholic beverages’).
This is also true for Vanuatu, which also observed an increasing trend in adolescent alcohol use.
Benin also does not have any limits in relation to alcohol advertising.
It is indeed plausible that a lack of law and regulation around alcohol consumption and sales is driving an increase in alcohol consumption among adolescents in Benin.
Moreover, alcohol consumption is rising among the adult population in Benin, which may be owing to hunger and distress resulting from persistent food insecurity. Importantly, literature has suggested that adolescents with parents who consume alcohol are much more likely to consume alcohol themselves.
Finally, alcohol consumption quadrupled in Myanmar between 2007 and 2016 and this may be owing to civil unrest which is an ongoing issue in Myanmar. It is plausible that adolescents turn to alcohol with the perception that consumption will aid in coping with external chaotic influences.
Next, decreasing trends in alcohol consumption were observed in eight countries with Samoa experiencing the most striking decline.
In 2011, Samoa introduced the national legal minimum age of 21 years for off- and on-premise sales of alcoholic beverages.
Selling or serving alcohol to a person under the age of 21 years is punishable with a three hundred dollar fine, imprisonment for nine months, or both. Moreover, during the study period, the Ministry of Police and Prisons carried out educational awareness programs for children in schools on preventing alcohol consumption.
It is thus likely that the introduction of age limit to purchase alcohol in Samoa coupled with educational awareness programs collectively reduced alcohol consumption among Samoan adolescents.
Interestingly, in Jamaica, which also showed a significant declining trend between 2010 and 2017 in our study, the underage alcohol consumption campaign was launched in 2013. The campaign included several components including public service announcements on radio and television targeting the high school championship and carnival periods, presentations on alcohol awareness in schools, and monitoring the enforcement of sale of alcohol to minors by auditing of popular events, as well as distributing various other alcohol awareness materials (e.g., posters). However, it should be noted that the present hypotheses to explain decreasing trends in alcohol consumption in such settings are indeed speculative, and it is not possible to truly know or elucidate on the underlying reasons.
It should be noted that in eight countries, trends in alcohol use varied by sex.
For example, in Thailand, a significant increasing trend was only found among girls, while in Myanmar, this was only found among boys.
Policy implications
Although it is positive that alcohol consumption is declining among adolescents in some countries, the data suggest that further global action is required to curb adolescent alcohol consumption.
Findings from the present study suggest that alcohol consumption among adolescents is a global concern. While some level of improvement was observed, further global efforts are required to curb alcohol consumption among adolescents.
It does seem that the implementation of laws introducing a minimum age of at least 18 to purchase alcohol may have a positive effect in reducing levels of alcohol consumption among adolescents.
In addition to the introduction of a minimum age to purchase alcohol, the World Health Organization recommends the following:
- regulation of the marketing of alcoholic beverages (in particular to younger people),
- demand reduction via taxation and pricing mechanisms,
- raising awareness of the health and social problems for individuals and society at large caused by alcohol,
- ensuring support for effective alcohol policies,
- providing accessible and affordable treatment for people with alcohol-use disorders, and
- implementing screening and brief intervention programs in health services for people with heavy alcohol use, and alcohol use disorder and addiction.
Moreover, a range of school-based interventions have been developed to prevent or delay the onset of alcohol use, most of which are targeted to middle-school students. To be most effective, interventions should be theory driven, address social norms around alcohol use, build personal and social skills helping students resist pressure to use alcohol, involve interactive teaching approaches, use peer leaders, integrate other segments of the population into the program, focus on sustainability (e.g., incorporate behavior change techniques), provide training and support to facilitators, and be culturally and developmentally appropriate.
