Normalisation of non‐drinking? 15–16‐year‐olds' accounts of refraining from alcohol

Trend analyses and comparison of characteristics of current-, former- and never-drinkers among young adults in France from 2000 to 2021

BACKGROUND

An overall decrease in alcohol consumption has recently been observed among a growing segment of the youth population in Western countries. Our study aimed to assess evolving trends in the rates of current-, former- and never- alcohol drinkers among 18-30-year-old French individuals between 2000 and 2021, and to compare their socio-economic characteristics, psychoactive substance use, and health-related parameters.

METHODS

We used cross-sectional survey data from the 2000, 2005, 2010, 2014, 2017 and 2021 editions of the French Health Barometer, and tested the existence of a linear trend in current-, former- and never-drinking among young adults aged 18 to 30 over time. We compared the characteristics of the three groups by conducting a multivariable logistic regression.

RESULTS

In total, 26,622 participants were included in our analyses. We found no significant changes in the trends of current-, former- and never-drinkers from 2000 to 2021. Post-hoc analyses found no significant changes in the trend of at-risk drinkers during the same period. Compared to current-drinkers, former- and never- drinkers were less likely to be male (OR: 0.75 [0.66; 0.85]); OR: 0.48 [0.43; 0.54]), and were more likely to have incomplete high school education (OR: 1.70 [1.47; 1.97]; OR: 1.72 [1.51; 1.96]), to be unemployed (OR: 1.58 [1.33; 1.89]; OR: 1.34 [1.15; 1.56]), to have a low income (OR: 1.88 [1.62; 2.19]; OR: 1.28 [1.13; 1.45]), to have a higher level of physical activity (OR: 2.57 [2.25; 2.95]; OR: 1.38 [1.24; 1.55]), and to practice a religion (OR: 17.16, 95CI [15.08; 19.53]; OR: 5.43 [4.88; 6.05]). Never-drinkers were less likely to have experimented with tobacco and cannabis, as well as other illicit drugs, while former-drinkers were less likely to report current tobacco use or past-year cannabis use.

CONCLUSIONS

In contrast to other countries, we found no clear trend indicating a shift in the patterns of alcohol use among young adults aged 18-30 in France from 2000 to 2021. Groups of current-, former- and never-drinkers differed in socio-economic, socio-demographic, health-related parameters and substance use characteristics.

Understanding youth drinking decline: Similarity and change in the function and social meaning of alcohol use (and non-use) in adolescent cohorts 20 years apart

INTRODUCTION

Qualitative research aimed at understanding the decline in youth drinking has so far been hampered by a lack of baseline data for comparison. This New Zealand study overcomes this limitation by comparing archival qualitative data collected at the height of youth drinking (1999-2001) with contemporary data collected for this study (June-October 2022). The aim is to explore changes in the function and social meaning of alcohol use (and non-use) for two cohorts about 20 years apart.

METHODS

Both archival and contemporary data were collected from 14 to 17 year old secondary school students (years 10-12) through individual and small-group/pair interviews in matched suburban co-ed schools. Interviews explored friendships, lifestyles, romantic relationships and experiences and perceptions of substance use and non-use.

RESULTS AND DISCUSSION

Comparative analysis highlighted changes that may help to explain the decline in youth drinking, including an increased value placed on personal choice and acceptance of diversity; decreased face-to-face socialising and the emergence of social media as a central feature of adolescent social life, perhaps displacing key functions of drinking and partying; increased pervasiveness of risk discourses and increased awareness of health and social risks of alcohol; and increased framing of alcohol use as a coping mechanism by both drinkers and non-drinkers.

CONCLUSIONS

Collectively, these changes appear to have shifted the social position of drinking from an almost compulsory component of adolescent social life in 1999-2001, to an optional activity that many contemporary adolescents perceive to have high risks and few benefits.

Ambivalence in Adolescents’ Alcohol Expectancies: A Longitudinal Mixed Methods Study Among 12-to-18-Year-Olds

Drawing on the framework of alcohol expectancies and their importance for drinking behaviors, this longitudinal mixed-methods study examined changes and continuities in development of alcohol expectancies during adolescence. Quantitative and qualitative data were prospectively collected at four time points between 2015 and 2020 from nationwide, socio-economic, and gender-balanced samples of Norwegian adolescents aged 12–18. Quantitative data ( n = 3425) were analyzed using linear mixed-effects models, and qualitative data ( nT1 = 118) using thematic analysis. Quantitative and qualitative results were juxtaposed in the discussion. Quantitative results indicated an increase in social facilitation and tension reduction expectancies from age 13 to 18, and a simultaneous decrease in negative emotional expectancies. This development could partly be explained by experience with alcohol use in adolescence. Similarly, qualitative findings showed adolescents’ expectancies of alcohol evolving with age; from one-sided negative expectancies of aggression and harm to increased positive expectancies of fun, sociability, and relaxation. Both analyses showed that negative expectances remained high throughout the study period, but by late adolescence, many participants held positive and negative expectations simultaneously. The qualitative data illustrated how adolescents’ alcohol expectancies became increasingly ambivalent and complex with age, as alcohol use became more common. Prevention strategies aiming to reduce underage alcohol use should acknowledge this complexity.

The great decline in adolescent risk behaviours: Unitary trend, separate trends, or cascade?

In many high-income countries, the proportion of adolescents who smoke, drink, or engage in other risk behaviours has declined markedly over the past 25 years. We illustrate this behavioural shift by collating and presenting previously published data (1990-2019) on smoking, alcohol use, cannabis use, early sexual initiation and juvenile crime in Australia, England, the Netherlands, New Zealand, and the USA, also providing European averages where comparable data are available. Then we explore empirical evidence for and against hypothesised causes of these declines. Specifically, we explore whether the declines across risk behaviours can be considered 1) a 'unitary trend' caused by common underlying drivers; 2) separate trends with behaviour-specific causes; or 3) the result of a 'cascade' effect, with declines in one risk behaviour causing declines in others. We find the unitary trend hypothesis has theoretical and empirical support, and there is international evidence that decreasing unstructured face-to-face time with friends is a common underlying driver. Additionally, evidence suggests that behaviour-specific factors have played a role in the decline of tobacco smoking (e.g. decreasing adolescent approval of smoking, increasing strength of tobacco control policies) and drinking (e.g. more restrictive parental rules and attitudes toward adolescent drinking, decreasing ease of access to alcohol). Finally, declining tobacco and alcohol use may have suppressed adolescent cannabis use (and perhaps other risk behaviours), but evidence for such a cascade is equivocal. We conclude that the causal factors behind the great decline in adolescent risk behaviours are multiple. While broad contextual changes appear to have reduced the opportunities for risk behaviours in general, behaviour-specific factors have also played an important role in smoking and drinking declines, and 'knock-on' effect from these behavioural domains to others are possible. Many hypothesised explanations remain to be tested empirically.

The Declining Trend in Adolescent Drinking: Do Volume and Drinking Pattern Go Hand in Hand?

Traditionally, adolescent drinking cultures differed between Nordic and Mediterranean countries; the former being characterised by low volume and relatively frequent heavy episodic drinking (HED). Across these drinking cultures, we examined the associations between alcohol volume and HED with respect to (i) secular trends at the country level and (ii) individual-level associations over time. The data stem from the European School Survey Project on Alcohol and Other Drugs (ESPAD) conducted among 15–16-year-olds in Finland, Iceland, Norway, Sweden, France and Italy, employing six cross-sectional surveys from 1999 to 2019 (n = 126,126). Both consumption volume and HED frequency decreased in all Nordic countries and displayed a curvilinear trend in France and Italy. In all countries, consumption volume and HED correlated highly over time at the country level. At the individual level, the correlation was positive but with a varying magnitude over time and between countries. In 1999/2003, the alcohol volume–HED correlation was significantly higher in the Nordic compared to the Mediterranean countries but became significantly weaker in Finland, Norway and Sweden and remained stable in France, Iceland and Italy during the period. In conclusion, while trends in consumption volume and drinking patterns went hand in hand at the aggregate level, the association at the individual level weakened over time in several Nordic countries, along with the substantial decline in adolescent drinking since 2000.

Declining Trend in Adolescent Alcohol Use: Does It Have Any Significance for Drinking Behaviour in Young Adulthood?

Since 2000, adolescent alcohol use has declined substantially in many high-income countries, particularly in Northern Europe. This study examined whether birth cohorts in Norway who experienced different levels of alcohol consumption in mid-adolescence differed in drinking behaviour when they reached young adulthood. We analysed data from annual population surveys in Norway (2012–2021). The analytic sample comprised data from respondents aged 20–29 years (N = 5266), and we applied four birth cohorts (i.e., 1983–1987, 1988–1992, 1993–1996 and 1997–2001). We applied age categories with two- and five-year intervals and tested whether drinking frequency, heavy episodic drinking (HED) and usual number of drinks per drinking occasion during the past 12 months differed by birth cohort in age-specific strata. Possible cohort differences within age groups were tested using Pearson’s Chi square. There were no statistically significant differences between cohorts with respect to drinking frequency or HED frequency. However, the youngest cohort had fewer drinks per occasion when in their early 20s compared to older cohorts. This study showed that birth cohorts who differed substantially in levels of alcohol consumption in mid-adolescence, only to a little extent differed in drinking behaviour in young adulthood.

Declining drinking among adolescents: Are we seeing a denormalisation of drinking and a normalisation of non-drinking?

BACKGROUND

In the early 2000s, alcohol use among young people began to decline in many western countries, especially among adolescents (ages between 12-17 years old). These declines have continued steadily over the past two decades, against the backdrop of much smaller declines among the general population.

ARGUMENT

Hypotheses examining individual factors fail adequately to provide the necessary 'big picture' thinking needed to understand declines in adolescent drinking. We use the normalisation thesis to argue that there is strong international evidence for both processes of denormalisation of drinking and normalisation of non-drinking occurring for adolescents in many western countries.

CONCLUSIONS

Research on declining adolescent drinking provides evidence of both denormalisation of alcohol consumption and normalisation of non-drinking. This has implications for enabling policy environments more amenable to regulation and increasing the acceptability of non-drinking in social contexts. Normalisation theory (and its various interpretations) provides a useful multi-dimensional tool for understanding declines in adolescent drinking.

Long-term trends in adolescent alcohol, tobacco and cannabis use and emerging substance use issues in Aotearoa New Zealand

This narrative review summarises the latest evidence on the causes and consequences of substance use in adolescence and describes long-term trends in adolescent alcohol, tobacco and cannabis use in Aotearoa. Adolescence is a time of rapid brain development when young people are uniquely vulnerable to the risks of substance use. It is a major cause of health and social harm in this age group and can affect adult outcomes and the health of the next generation. Therefore, substance use trends are central to understanding the current and future state of child and youth wellbeing in Aotearoa. Adolescent use of alcohol, tobacco and cannabis peaked in the late 1990s/early 2000s, then declined rapidly, and prevalence is now much lower than 20 years ago. However, levels of adolescent binge drinking remain high by international standards and disparities in tobacco and cannabis use by ethnicity and socioeconomic status are wide. Evidence suggests we may again be at a turning point, with-long term declines stalling or reversing in the past 2-5 years, and vaping emerging as a new risk. Greater investment in primary prevention is indicated, including restrictions on alcohol marketing and availability, and alleviation of poverty, racism and marginalisation.

17 Is the New 15: Changing Alcohol Consumption among Swedish Youth

To examine and compare trends in drinking prevalence in nationally representative samples of Swedish 9th and 11th grade students between 2000 and 2018. A further aim is to compare drinking behaviours in the two age groups during years with similar drinking prevalence. Data were drawn from annual surveys of a nationally representative sample of students in year 9 (15-16 years old) and year 11 (17-18 years old). The data covered 19 years for year 9 and 16 years for year 11. Two reference years where the prevalence of drinking was similar were extracted for further comparison, 2018 for year 11 (n = 4878) and 2005 for year 9 (n = 5423). The reference years were compared with regard to the volume of drinking, heavy episodic drinking, having had an accident and quarrelling while drunk. The prevalence of drinking declined in both age groups during the study period. The rate of decline was somewhat higher among year 9 students. In 2018, the prevalence of drinking was the same for year 11 students as it was for year 9 students in 2005. The volume of drinking was lower among year 11 students in 2018 than year 9 students in 2005. No differences were observed for heavy episodic drinking. The decline in drinking has caused a displacement of consumption so that today's 17-18-year-olds have a similar drinking behaviour to what 15-16-year-olds had in 2005.

Normalization of Non-Drinking? Health, School Situation and Social Relations among Swedish Ninth Graders That Drink and Do Not Drink Alcohol

Alcohol consumption is a major contributor to the disease burden among adolescents. The adolescent alcohol abstainer is still often depicted as problematic in the research literature and in prominent theoretical frameworks. However, over the past two decades, there has been a marked trend of declining youth drinking in Sweden. The declining trend has led to a shift in the majority behaviour of youth, from drinking to non-drinking. It is plausible that this trend has also shifted the position of non-drinkers. This paper examines the position of non-drinkers in a nationally representative sample of Swedish adolescents. A survey was carried out in 2017 in 500 randomly selected schools. A total of 5549 respondents (15-16-year-olds) agreed to participate and answered the questionnaire. A minority (42.8%) had consumed alcohol during their lifetime. The results show that non-drinkers had better health and school performance when compared to drinkers. The results also showed that there were no differences in the social position between non-drinkers and drinkers. These findings are new and indicate a changed position of non-drinkers among Swedish adolescents. With non-drinking being the majority behaviour among Swedish adolescents this seems to have shifted the position of non-drinkers. There is a need for research on the long-term importance of not drinking during adolescence.

"No one associates alcohol with being in good health": Health and wellbeing as imperatives to manage alcohol use for young people

Young people's drinking has declined markedly in Australia over the past 15 years, and this may be linked to changing norms and values around health. We take the view that healthism-a discourse that privileges good health and renders people personally responsible for managing health-has become pervasive, creating new pressures influencing young people's alcohol practices. Through interviews with 50 young light drinkers and abstainers, we explored these notions of health and alcohol. Although health was not the only reason that participants abstained or drank lightly, many avoided drinking to minimise health risks and to pursue healthy lifestyles. Their understanding of health came from multiple sources such as the media, schools, parents-and often reinforced public health messages, and healthist discourse. This discourse influenced how participants perceived health norms, engaged with health in everyday life and managed their alcohol consumption. Because the need to be healthy incorporated bodily health, mental health and social wellbeing, it also created tensions around how young people could drink while maintaining their health. This highlights the importance of health as a key consideration in the alcohol practices of light drinking and abstaining young Australians, which could help explain broader declines in youth drinking.