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Alcohol and Youth Trends: Implications for Public Health

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I. Introduction

Alcohol use and misuse during adolescence is a significant public health concern in Canada, and specifically to this report, in Ontario. To identify the prominent issues involved in alcohol use during adolescence an environmental scan of recently published literature was conducted.   

This article looks at patterns in alcohol use during adolescence, the motivations of alcohol use, and the consequences of hazardous and harmful drinking. Unless otherwise stated, the article focuses on individuals between the ages of 12 and 18. The term hazardous drinking is defined as an established pattern of drinking that increases the likelihood of future medical and physical problems as defined by Adlaf and Paglia-Boak (1) and the term binge drinking refers to the consumption of five standard alcoholic drinks in one sitting or event.

With alcohol use being the fifth leading risk factor for premature death worldwide according to the World Health Organization (2), and the third leading risk factor contributing to the burden of disease in high-income countries, it is an issue that causes significant health problems, and serious concerns. Alcohol is now being compared to tobacco and in fact research has shown that the affect of tobacco is actually less than that of alcohol in adolescence, and while it is not always the direct cause of injury and/or death, it is a significant co-factor in other leading causes of death among this age group (i.e., motor vehicle collisions).

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II Methodology

This report outlines the key findings generated from a systematic literature review and key informant interviews about current issues surrounding alcohol use during adolescence.

The search for relevant literature included print, electronic, public and unpublished materials found by searching library databases, the Internet, and leading organizations within the field. A variety of keywords were used during this search and the search strategy included only articles published in English from 1999 onwards.

A list of key informants from Ontario were contacted based on their expertise and professional experience with alcohol use issues pertaining specifically to youth.

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III Results

Based on the literature review and key informant interviews, three major themes were identified on the topic of youth and alcohol:

  • patterns of usage,
  • reasons and motivation for use, and
  • consequences of use.

Trends of Youth Alcohol Use in Canada

In Canada a significant portion of youth aged 15 and over are drinking excessively. (1) Hazardous or harmful use tends to increase with increasing grade level and the heaviest drinkers report to be in grade 11 and 12. (3,4) In Canada, by late adolescence (18-24 years), 90% of youth (2.7 million people) have consumed alcohol. (5)

In Ontario, approximately 62% of students have been drinking in the past year, or to put it differently, over 500,000 underage youth in Ontario have consumed alcohol.(5) Student reports of alcohol use have increased from 1993-2003. Research has also found that hazardous/harmful drinking is reported in Ontario by approximately 16% of students.

Early Age of Onset

The earlier a youth starts drinking the more likely he or she will experience alcohol-related harm later in life. An Ontario-wide study (6) found that individuals who begin using alcohol in the pre- and early adolescent years (11-14) are most vulnerable to the risk of developing alcohol disorders later in life. This study suggests that the initiation of alcohol during the ages of 11-14 tends to escalate toward heavier and more frequent alcohol consumption later in adolescence and adulthood.

According to a US study, youth who report early onset of drinking (before the age 12) have very similar personality characteristics. These personality characteristics include: ongoing disruption, hyperactivity, aggression (i.e., conduct problems or being antisocial), depression, withdrawn, and/or anxiousness.(7) The authors suggest that these characteristics combined with early drinking in children increases the risk for alcohol problems later in adolescence and early adulthood. Additionally, children who experience adversity are more likely to initiate drinking during early adolescence.

Why Some Youth Drink and Some Don't

Youths' experiences, role models, and environment have already formed many of their ideas and expectations regarding alcohol by the age of 15.(8)  Some influences that help to explain why some youth choose to drink are as follows.        

1. Advertising and Promotion: A recent trend in alcohol advertising research is focusing on the connection between exposure to advertising and adolescent consumption of alcohol in the attempt to determine if there is a causal relationship.

Current American research has observed that youth who are exposed to more alcohol advertising are more likely to view alcohol and alcohol use as positive. This in turn is likely to influence their likelihood of consuming alcohol in the future. (9) Exposure to alcohol advertising during the early stages of adolescence has also been shown to predict beer drinking and drinking intentions one year later. (10)

Targeted advertising has not been systematically studied in Canada. However, in Ontario, the Association to Reduce Alcohol Promotion (ARAPO) was established out of an advocacy group working in resistance to large amounts of alcohol promotion observed in a low-income neighbourhood in Toronto (http://www.apolnet.ca/arapo, 2007).

2. Community Influence: There are a number of community factors that influence why youth choose or do not choose to drink alcohol. These community factors include

  • cultural/ethnic beliefs and religious practices,
  • geographical location, and
  • socio-economic status (SES).

Canadian culture currently holds the norm that alcohol use (and excessive use) is permissible during adolescence. Perhaps not surprisingly, immigrant youth from other cultures tend to drink less than Canadian-born youth, as they often hold different norms around alcohol (i.e., abstain or drink less for cultural reasons). These youth, however, tend to give up their alcohol abstaining practices, once they identify more with Canada and the pro-alcohol norms held by their Canadian peers.(11) It was also found that schools in Ontario with greater cultural and religious diversity produced a climate less supportive of underage drinking. As a result, these schools reported less hazardous and harmful drinking among the student population. Where there was less diversity (i.e., more youth who have English as their first language), the overall school climate was more pro-alcohol which had a greater negative influence on individual choices to drink.

Geographical location can also affect how young people view their health status. Youth who dwell in smaller towns or rural regions are more likely to identify themselves as current heavy drinkers. (12) Additionally, it has been observed that those who live in Canadian rural regions have higher rates of drinking and driving, and riding with a drunk driver. (13)

Social-economic differences and alcohol use among youth is a new and emerging area of study; as a result, the current evidence is limited and contradictory. Some research suggests that the higher the income, the more disposable income, the more likely youth will drink excessively. Other studies suggest that drinking is less likely as income increases.  

Specifically in Canada, Breslin and Adlaf (14,1) found that the greater number of hours youth worked per week the more likely they were to binge drink. (4) This was still the result even after controlling for a variety of variables, e.g., age and gender. The authors suspect that working longer hours corresponded with increases in disposable income and a decrease in parental supervision that makes it possible to binge drink. However, this depended on the purpose for employment. While many youth worked for the ability to purchase luxury items and entertainment, some youth, specifically those from families living with low socio-economic status, may be using their income for more essential living expenses (e.g., shelter, nutritious food).  As a result, lower-income youth who worked longer hours tended not to engage in binge drinking.

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IV Discussion

This report has indicated that alcohol use among youth in Canada, and specifically Ontario, is a significant issue, with many serious intentional and unintentional consequences. Early onset of drinking and excessive drinking was found to be especially harmful to young people. Practitioners should consider the following when addressing many of the major influences on adolescent drinking and binge drinking:

  • counteracting the influence of alcohol promotion;
  • addressing alcohol accessibility;
  • counteracting pro-alcohol norms found in the community, school, and family environment;
  • addressing the link between alcohol use and other drugs;
  • preventing, detecting, and treating depression and alcohol misuse; and
  • targeting interventions to address personality risk factors.

Some recommendations that follow from these categories include

  • Pressure policy makers to ban and monitor alcohol promotion
  • Maintain the current minimum drinking age, support zero BAC limit for all drivers under 21
  • Pressure policy makers and producers to increase the price of alcohol
  • Educate parents on reducing alcohol accessibility
  • Provide alternative transportation options for youth living in rural settings
  • Combine alcohol prevention programs with job searching programs
  • Create relevant health promotion interventions with First Nations youth.
  • Improve school climate by supporting youth connectedness to school activities and career enhancing goals
  • Use peer-to-peer components in prevention initiatives
  • Use harm reduction strategies
  • Offer skill training opportunities for parents with teenagers
  • Improve outreach and effectiveness of mental health programs

As illustrated throughout this paper, alcohol use during adolescence is a significant public health issue, with main concerns revolving around increased rates in alcohol use among youth, earlier age of onset of drinking, and increased youth-targeted alcohol product promotion. Public health professionals can use these findings as a reference point to refine current interventions and support future innovative actions to address the problems associated with underage drinking.

For a more in-depth look at this report and its findings please visit http://www.apolnet.ca/resources/pubs/rpt_AlcoholYouth-5Nov07.pdf.

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V References

1. Adlaf, E.M., & Paglia-Boak, A. (2005). Drug use among Ontario students No. 16.  Toronto, Ontario, Canada: centre for Addiction and Mental Health.

2. World Health Organization. (2002). The world health report 2002 - reducing risks, promoting healthy life. Geneva: World Health Organization. Retrieved May 2007, from http://www/who.int/whr/2002/en/

3. Feldman, L., Harvey, B., Holowaty, P., & Shortt, L. (1999). Alcohol use beliefs and behaviors among high school students. Journal of Adolescent Health, 24(1), 48-58.

4. Poulin, C. (2006). Harm reduction policies and programs for youth. Ottawa, Ontario: Canadian Centre on Substance Abuse.

5. Statistics Canada. (2007). Age Groups (14) and Sex (3) for the Population of Canada, Provinces, Territories, Census Divisions and Census Subdivisions, 2006 Census - 100% Data. Retrieved September 2007, from http://www12.statcan.ca/english/census/index.cfm

6. DeWit, D. J., Adlaf, E. M., Offord, D. R., & Ogborne, A. C. (2000). Age at first alcohol use: A risk factor for the development of alcohol disorders. American Journal of Psychiatry, 157(5), 745-750. Alcohol and Youth Trends 32.

7. U.S. Department of Health and Human Services, national Institutes if Health. (2006).  Alcohol alert: Underage drinking: Why do adolescents drink, what are the risks, and how can underage drinking be prevented? No. 67. U.S.: National Institutes of Health, National Institutes on Alcohol Abuse and Alcoholism.

8. National Alcohol Strategy Working Group. (2007). Reducing alcohol-related harm in Canada: Toward a culture of moderation on proposed reforms to the Liquor License Act.  Toronto, ON. Retrieved September, 2007 from http://www.nationalframework-cadrenaional.ca/detail_e.php?id_sub=1&id_top_sub=2.

9. Austin E.W. Chen, M., & Grube, J.W. (2006). How does alcohol advertising influence underage drinking? The role of desirability, identification and skepticism. Journal of Adolescent Health, 38(4), 376-384.

10. Collins, R.L. Ellickson, P.L., McCaffrey, and Hambarsoomians, D. (2007). Early adolescent exposure to alcohol advertising and its relationship to underage drinking.  Journal of Adolescent Health, 40 (6), 527-534.

11. Kairouz, S., & Adlaf, E. M. (2003). Schools, students and heavy drinking: A multilevel anaylsis. Addiction Research and Theory, 11(6), 427-439.

12. Mitura, V. & Bollman, R. (2004). Health Status and Behaviours of Canada's Youth: A Rural-Urban Comparison No. 3. Ottawa, Ontario, Canada: Minister of Industry. Statistics Canada.

13. Drixler, C., Krahn, H., & Wood, R. T. (2001). Teenage drinking and driving in rural Alberta. Journal of Youth Studies, 4(1), 63-81.  

14. Breslin, F. C., & Adlaf, E. M. (2005). Part-time work and adolescent heavy episodic drinking: The influence of family and community context. Journal of Studies on Alcohol, 66(6), 784-794.