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Underage Drinking

 | 
Philippe De Witte
, 
Mack C. Mitchell Jr.

Chapter 1. Underage Drinking in Europe and North America

Franca Beccaria et Helene R. White

Texte intégral

1This chapter presents epidemiological data on underage drinking in European countries, the United States (U.S.), and Canada with an emphasis on ages 11-16 years. It is not meant to be a comprehensive report of all the existing epidemiological data. Rather, we provide a summary of key findings regarding drinking patterns from a few major European and North American reports. First, we summarize data from students in two European surveys. Next we present data collected in one annual, national survey of students in the U.S. and provincial data collected from students in Canada, which were recently summarized in a national report. Finally, we compare certain aspects of drinking patterns across Europe and North America. Because of differences in legal ages for drinking across countries and within Canada, underage drinking has different meanings. Further, there are many differences across the surveys in study design, questionnaire administration, and measures included, which makes accurate comparisons difficult. Nevertheless, we attempt to paint a picture of how many youth drink, how much and how often they drink, and what they drink.

KEY FINDINGS

2• Although rates of underage drinking have decreased in Europe recently and in the United States for more than a decade, underage drinking is still quite prevalent in Europe and North America. Prevalence rates are generally higher in Europe than in Canada and even more so than in the United States.

3• Average rates for Europe mask large differences across individual countries in terms of frequency, quantity, and intoxication, with countries showing varied patterns of consumption. Young drinkers who consume large quantities of alcohol per drinking day can be found both in countries with high as well as low frequencies of consumption and vice versa.

4• For the most part, the prevalence of drinking is relatively similar for adolescent boys and girls in both Europe and North America, even if significant differences still remain in many countries in the extent of frequent and heavy drinking. High rates of heavy episodic drinking among younger girls in Europe and North America warrant greater attention.

5• Patterns of drinking of youth across European countries are relatively consistent with the patterns of adult drinking within the same country, although for some countries they match better than for others.

UNDERAGE DRINKING IN EUROPE

6The best way to create a detailed representation of the current situation of young people drinking in Europe is to examine findings from two large-scale, cross-national surveys. These two surveys are the European School Survey Project on Alcohol and Other Drugs (ESPAD; Hibell, Guttormsson, Ahlström, Balakireva, Bjarnason, Kokkevi, & Kraus, 2012) and the Health Behaviour in School-Aged Children (HBSC; Currie, Zanotti, Morgan, Currie, de Looze, Roberts, Samdal, Smith, & Barnekow, 2012) studies, which include almost all the European countries. The ESPAD was initiated in the mid-1980s by a group of researchers working with the Pompidou Group, along with the Swedish Council for Information on Alcohol and Other Drugs, as the first European investigation on alcohol, drugs, and risk behaviours among young people. In the same period, the most comprehensive research on health among school-aged young people was launched as a World Health Organization collaborative cross-national study, the HBSC survey. Although the two studies have used, in many regards, different methodologies, they offer a comprehensive picture of risky behaviour among European young people. The differences in the questionnaires, including wording differences, the slightly different sampling methods, the dissimilarity of participating countries, and the not completely overlapping age of the samples make results not always comparable (Charrier & Cavallo, 2010). Keeping in mind these limitations, the main findings emerging from these two international resources will be summarized and where possible compared.

The Surveys’ Aims, Methods, and Samples

  • 5 Albania, Belgium (Flanders), Bosnia-Herzegovina, Bulgaria, Croatia, Cyprus, the Czech Republic, De (...)

7ESPAD. The aim of the ESPAD is to collect comparable data on substance use among 15-to 16-year-old European students in order to monitor national trends and to compare tendencies among European countries (Hibell et al., 2012). The investigation has been planned to be repeated every four years so as to observe the changes that have taken place within each country and any variations in drug and alcohol consumption and abuse on a European scale. Thus far, five investigations have been carried out in the following years: 1995, 1999, 2003, 2007, and 2011. The same questionnaire has been used in all the participating countries in order to collect comparable data. In the last wave, more than 100,000 students, born in 1995 (mean age 15.8 years), completed self-administered questionnaires, which were administered in the classroom by teachers or research assistants. Whereas only 26 countries participated in the first wave, 36 countries5 participated in 2011. In each country, with a few exceptions, the final sampling unit in the multi-stage stratified sampling process was the classroom, defined using random samples including schools and classes, with a sample size of at least 2,400. Only the smallest European countries (e.g., Cyprus, Iceland) used a total sample. Researchers in most countries drew a nationally representative sample, but not in Germany where the study was done in 5 out of 16 federal states, Belgium where data collection was limited to Flanders, the Dutch speaking part, and the Russian Federation where data was limited to Moscow. Besides these countries, the report includes also some selected results from two non-ESPAD countries, Spain and U.S. For the United Kingdom (U.K.), the net sample was too small and cannot be considered representative, so those data are not fully comparable to the data from the other countries.

  • 6 Armenia, Austria, Belgium (Flemish and French), Canada, Croatia, the Czech Republic, Denmark, Engl (...)

8HBSC. The initial aim of the HBSC was to provide a wide picture of health-related behaviours and the social context of young people’s health in industrialized countries. In later studies, these behaviours also included smoking, alcohol consumption, and cannabis use (Currie et al., 2012). The HBSC used self-administered, structured questionnaires. The number of countries involved in the HBSC cross-national study grew from the five European Nordic countries in 1983-84 to 41 countries6 from Europe and North America in the last survey in 2009-10. The HBSC study focuses on children and adolescents aged 11, 13, and 15 years old, with achieved mean ages of 11.6, 13.5, and 15.5, respectively. This is an age period that represents early to middle adolescence and the challenge of physical and emotional changes. The nationally representative samples were stratified by region or school type, in accordance with the structure of the national school system, but the primary sampling unit was the school classroom. With the exception of the smallest countries, where a census survey was more appropriate, the sample size in each country was approximately 1,500 students for each age group. It was decided that a number of regions would be covered in Germany and the Russian Federation, instead of the national territories.

Prevalence of Drinking

9Lifetime and last 12 months use of alcohol. An average of about 90% of the 15-16 year-old students across all the ESPAD countries has drunk any alcohol at least once in their lifetime. The rate is quite varied among countries, with the highest percentages in the Czech Republic, Estonia, and Latvia (95% or more), and the lowest ones in Iceland, Montenegro, Norway, Portugal, Romania, and Sweden (below 80%). Annual prevalence data for boys and girls in each country are shown in Figure 1. Most of the students have used alcohol during the last 12 months. In fact, about 90% of the students in the Czech Republic, Denmark, Germany, Greece, and Monaco consumed alcohol in the past year, whereas the lowest rates of yearly consumption are reported in Iceland (43%). Thus, alcohol consumption is a common behaviour among European 15- to 16-year-old students. For those countries that participated in all five waves, at the aggregate level the percentages of students reporting lifetime and last 12 months alcohol use has remained relatively unchanged from 1995 to 2011 (not shown).

10Last month use of alcohol. Figure 2 shows past month prevalence data from the ESPAD. There is great variability across countries in the percentage of students reporting alcohol use in the last month. The ESPAD average across countries is 57%, but in some countries such as Cyprus, the Czech Republic, Denmark, Germany, and Greece the vast majority of students (70% or more) report use in the last month. In contrast, in Nordic countries – the Faroe Islands (44%), Iceland (17%), Finland (48%), Norway (35%), and Sweden (38%) – and in Balkan countries – Albania (32%), Bosnia-Herzegovina (47%), and Montenegro (38%), less than half of the students report alcohol use in the last month. Low monthly prevalence is also found in Romania (49%) and the Russian Federation (37%). The patterns for lifetime and monthly drinking are consistent across countries; in those countries where a greater number of students have tried alcohol in their life, there is also a higher percentage that have drunk in the last month. Comparing the different waves from 1995 (not shown), there has been an increase at the aggregate level of alcohol use during the last month between 1995 and 2003, followed by a slight decrease in the last two surveys, so that the average of students who have drunk any alcoholic beverage in 2011 in the last month is the same as 1995 (57%). The most prominent recent decrease has been found in Iceland and Ireland, among both boys and girls.

11Sex differences in prevalence. For lifetime and past year alcohol use, the sex differences are quite small, and where there are any, they seem to be culturally specific. Regarding last month alcohol use, on average more boys than girls report drinking (59% vs. 54%), with large differences among countries. In the Balkan countries, Albania, Bosnia-Herzegovina, Montenegro, and Serbia, as well Cyprus and Italy, the gap between boys and girls is quite high, while in the Nordic and Baltic countries of Estonia, Finland, Iceland, Latvia, Lithuania, Norway, and Sweden, a higher percentage of girls than boys have drunk in the last month (see Figures 1 and 2).

12Weekly drinking. In the HBSC study, students were asked how often they drink any alcoholic beverage. Figure 3 shows the rates of weekly drinking across European countries for boys and girls at ages 11 (Figure 3a), 13 (Figure 3b), and 15 (Figure 3c). While there are large variations among countries in weekly consumption, the number of consumers increases greatly from ages 11 to 15 years, especially between 13 and 15 years old. At age 11 the average prevalence of weekly drinking across countries is 4%, with a wide range from less than 1% in Portugal, Germany, Iceland, and Norway to more than 15% in Romania and Armenia. Higher rates among boys are found in Ukraine, the Czech Republic, Italy, and Croatia. At age 13, on average 8% of the students report weekly drinking. Iceland and Portugal maintain the lowest rates and the Czech Republic and Ukraine the highest, but at the two extreme positions we can also find Finland, Sweden, and Macedonia on the bottom, and Romania, Croatia, Wales, Armenia, and Greece on the top level. At age 15 the average is 21% but the rank ordering among countries is more or less the same as at age 13, with remarkable differences between countries.

Types of Beverages Consumed

13The HBSC study provides information on consumption of different alcoholic beverages (not shown). It is interesting to note that at age 11 years there are no differences among types of beverages, whereas at age 13 years and even more so at age 15 years, students prefer beer, followed by alcopops and spirits at about the same level, and then wine. Almost the same preferences emerge from the ESPAD study (not shown). There is clearly a preference for beer among 15- to 16-year-olds in the ESPAD, which is consumed by 47% of the students in the last month, followed by spirits and wine (37%-38%), alcopops (32%), and cider (27%). Higher beer preference is reported in Belgium, Bulgaria, the Czech Republic, and Germany compared to other countries, whereas a higher amount of cider is consumed in Denmark, Estonia, Latvia, and Lithuania, compared to the other countries. Alcopops are most common in Cyprus, Denmark, Germany, and Italy. Wine drinking is not particularly high among 15- to 16-year-olds, even if some countries show a figure of 50% or more in the last month (i.e., Croatia, France, Greece, Hungary, Malta, Moldova, and Monaco). As expected, wine drinking is relatively rare among students in the Nordic countries (6-19%). There are also considerable differences in the rates of spirit use, ranging from 50% or more in the last month in Croatia, the Czech Republic, Denmark, France, Greece, Malta, Monaco, and the Slovak Republic to 20% or less in Albania, Iceland, Moldova, and Norway.

Quantity

14In the ESPAD study, the quantity of consumption can be estimated by responses to a question asking youth about the quantity of alcoholic beverages consumed on their most recent alcohol-drinking day. Within the whole sample, students drink on average 2-3 drinks of spirits, 40 centiliters of wine, or one litre of beer, but there is great variation among countries (not shown). The quantity of alcohol consumed is almost twice the average in Denmark and three other Nordic countries show a high level of consumption (Finland, Norway, and Sweden), followed by Croatia, Ireland, and the U.K. The lowest quantity levels are reported by students in Albania, Moldova, and Romania, although the amount of alcohol consumed is also quite low in Bosnia-Herzegovina, Montenegro, and the Russian Federation. The results clearly show that students with lower alcohol consumption on their last drinking day live in the Balkan area, in Eastern Europe, and in the Mediterranean region rather than in the other parts of Europe.

15The patterns of consumption do not show any statistical correlation between frequency of consumption and the amount of alcohol consumed across countries. This means that those students who consume a large quantity of alcohol per drinking day can be found both in countries with high as well as low frequencies of consumption and vice versa. For example, in Albania, the Russian Federation, and Montenegro students report both low frequency of alcohol consumption and low amounts consumed, unlike Norway and Sweden where prevalence of drinking during the last month is low but the average consumption during the latest drinking day is one of the highest. The same complex picture occurs if we compare those countries with highest drinking frequencies in the last month, such as Denmark, Greece, and Cyprus. Danish students report the highest quantity of consumption on their most recent drinking day, whereas students in Greece and Cyprus have drunk small quantities on their most recent drinking day (not shown).

Alcohol Intoxication

16Students in the ESPAD were asked how drunk they got on their most recent drinking day using a 10-point scale ranging from “not drunk at all” to “heavily intoxicated.” Students from Denmark, the Faroe Islands, and the U.K. report the highest average intoxication scores (4-4.6), while the lowest scores (2-2.4) are reported by students living in Albania, Bosnia-Herzegovina, Cyprus, Greece, Moldova, Montenegro, and Portugal (not shown). The data show a strong association at the country level between the amount of alcohol consumed on the most recent drinking day and the perceived level of intoxication.

17In the ESPAD questionnaire students were also asked to indicate the number of times that they had been intoxicated due to alcohol during their lifetime, in the past year, and in the past month. As intoxication is a subjective perception, the researchers gave the students some examples of what being “intoxicated” means, such as staggering when walking, slurred speech, or vomiting. Drunkenness is a quite common experience among ESPAD students, as on average almost half of them (47%) has already been intoxicated at least once in their life, 37% in the last year, and 17% in the last month. Past year data for each country are presented in Figure 4 (lifetime and past month data are not shown).

18Great differences occur among countries in drunkenness. Lifetime intoxication is highest in Denmark (71%), followed by the Czech Republic, Hungary, Latvia, Lithuania, and Slovakia (more than 60%), whereas the lowest percentages are reported in Albania, Cyprus, Greece, Iceland, Italy, Montenegro, Norway, Portugal, Romania, Serbia, and Sweden (below 40%). In terms of sex differences, more boys than girls report drunkenness experiences in a vast majority of countries, even though these differences are not that large.

19Moving to data on being drunk during the last year (see Figure 4), the figure shows little variation from the lifetime figures. Even though more boys than girls report past year drunkenness in most countries, in some countries, such as Estonia, Finland, Iceland, Ireland, Norway, Sweden, and the U.K., the percentage for girls is higher than that for boys; in particular, in Monaco the difference is more than 10 percentage points higher for girls than boys. Last month intoxication is strongly correlated with lifetime and last year intoxication on the aggregate country level, so that the order of the countries is more or less the same across all three measures and the patterns across countries remain almost the same, which also holds for students who have been drunk more than twice in the last month.

20In the HBSC study students were asked whether and how often they have ever been “really drunk”. The reported experience of drunkenness at least twice increases significantly with age, from an average of 2% among 11-year-olds, to 9% among 13-year-olds, and 32% among 15-year-olds (see Figure 5). The value for 15-year-olds is similar to that found among 15- to 16-years-olds in the ESPAD study for last year drunkenness (37%). Generally boys report higher rates than girls. Perhaps the greater sex differences found in the HBSC, compared to the ESPAD, can be attributed to the former’s question which focuses on “really” drunk.

21As expected, at age 11 years (Figure 5a), having been drunk on two or more occasions is very rare in most countries. However, rates are alarming in Armenia, Latvia, Romania, the Russian Federation, and Ukraine. Data at age 13 years (Figure 5b) show great variation ranging from the lowest percent in Iceland (1% of girls and 4% of boys) to the highest in Latvia (12% of girls and 25% of boys). High levels of drunkenness are also found in Estonia, Greenland, Lithuania, and Wales. Similarly, at age 15 years (Figure 5c), the differences among countries are large, with the lowest rates in Macedonia (8% of girls and 19% of boys) and Italy (14% of girls and 19% of boys), and the highest in Denmark (56% of girls and 55% of boys).

Heavy Episodic (or Binge) Drinking

22As perception of drunkenness is a relatively subjective measure, in the ESPAD study a more objective question was introduced, which asked students about the number of times during the last month they had consumed five or more drinks on one occasion. This measure is often used to operationalize “heavy episodic drinking” (HED), although some studies of youth refer to this behaviour as “binge drinking” (Wechsler, Davenport, Dowdall, Moeykens, & Castillo, 1994). It should be noted, however, that adolescent girls, compared to boys, are generally smaller and weigh less. Therefore, at the same number of drinks, girls will achieve much higher blood alcohol concentration (BAC) levels than boys. Even at equal weight, females achieve higher BACs than males (Lieber, 1997). Thus, some studies (although not included in this report) differentiate this measure for boys (5+ drinks per occasion) and girls (4+ drinks per occasion) (e.g., Wechsler et al., 2002). This sex-based measure (5+/4+) results in more sex parity for estimates of HED, compared to the sex non-specific measure (5+).

23Figure 6 shows rates of HED in the last month by sex from the ESPAD study. On average, 39% of the ESPAD students have had five or more drinks on one occasion during the last month, and for 14% this has happened at least three times during this period (not shown). Nevertheless, it is worth highlighting that the range between the highest countries and lowest countries is smaller than the comparison reported above for intoxication. Denmark and Malta (56%) are at the top followed by Croatia, the Czech Republic, Estonia, Slovenia, the U.K., and Slovakia (50-54%). The lowest levels of HED are reported by students in Iceland (13%), Albania (21%), and Portugal (22%). The aggregate country correlation between “having been intoxicated during the last 30 days” and “having engaged in heavy episodic drinking” in the same period is high and statistically significant.

24Nevertheless, the minor difference among countries in rates of HED, compared to rates of drunkenness, raises a question that could be related to methodological issues, as the first measure can be considered as more objective than the second one. On the other hand, according to Room (2010), it may reflect cultural differences in the quantity of alcohol consumed. That is, there is a large possible range beyond five drinks. It may be that southern European teenagers may stop at only five drinks, whereas those young people in the rest of Europe who drink five or more units on one occasion may actually drink a lot more than five drinks. Alternatively, Room suggests that the greater expectancies of disinhibition for a given amount of drinking in the north of Europe may push youth to act in accordance with them, and thus report higher rates of drunkenness. A third plausible explanation he offers is that for southern European teenagers the definition of drunkenness could be more extreme and/or deviant than for their contemporaries in other parts of Europe. None of these hypotheses has been adequately tested and results are inconclusive (Room & Bullock, 2002; Room, 2007).

25At the aggregate level, the percentage of boys who report HED during the last month is higher than of girls (43% vs. 35%). Nevertheless, as discussed above, by using the same level (5+) for boys and girls, the results might be biased against girls. At the aggregate level, HED during the last month increased from 1995 to 1999 and from 2003 to 2007 but it is slightly lower in 2011 (see Figure 20). Whereas the increase between 2003 and 2007 is due to an increase for girls, the decrease between 2007 and 2011 occurs for both sexes. Bulgaria, Croatia, the Czech Republic, Greece, Hungary, Malta, and Slovakia are the countries that have shown a constant upward trend in HED across all five data collections (not shown).

Age of Onset of Alcohol Consumption and Drunkenness

26Age of onset of consumption. In the ESPAD study, students were asked the age at which they had their first glass of each type of alcoholic beverage (not shown). In the majority of the countries, almost half of all students (including non-drinkers) report having their first drink at age 13 years or younger. Beer is the most common alcoholic beverage consumed by age 13 years (44%), followed by wine (38%), cider (34%), alcopops (27%), and spirits (20%). Age of onset is quite spread out across European youth.

27A similar trend in terms of age of onset by age 13 years emerges from HBSC data. In fact, among 15-year-olds, 39% report first drinking by age 13 years or younger with great variation among countries: from 11% in Iceland to 62% in Estonia. Both countries were in similar positions in the ESPAD scale. HBSC students in Finland, Italy, Norway, Romania, the Russian Federation, and Sweden also report low rates of early-onset drinking (less than 30% first consume alcohol by age 13 years), whereas in Croatia, the Czech Republic, Latvia, and Lithuania at least 50% of 15-year-olds report first drinking by age 13 (not shown).

28Age of onset of drunkenness. In the ESPAD survey about one fifth of students in Estonia, Latvia, the Russian Federation, and Slovakia report having experienced their first intoxication by age 13 years or younger (not shown). In other countries, the percentage is substantially lower with an overall average of 12%. At the bottom of the scale are Iceland and Italy with about 5% reporting first being drunk by age 13 years.

29The HBSC study shows almost the same average with 14% of the 15-year-olds reporting having been drunk by age 13 years. As seen in Figure 7, young people from southern European countries (Italy, Greece, and Portugal) generally have a lower prevalence of early drunkenness compared to northern European countries (Estonia, Latvia, and Lithuania). On the other hand, some Nordic countries, such as Iceland and Norway also have low rates.

Availability of Alcoholic Beverages

30In the ESPAD study students were asked to report on whether they had bought any alcoholic beverages in a store over the last month for their own consumption (not shown). On average, 25% of students (ages 15-16 years) report that they bought beer, the most common type of alcoholic beverage in the majority of the countries. The variation among countries is wide, although in almost every country in Europe the minimum legal age for off-premise purchase (i.e., buying alcohol to take out and drink some place else) is 16 or 18 years (see Table 1). Whereas about six in ten students have bought alcohol to take out in Bulgaria, Malta, and Ukraine, only 4% have done so in Iceland and 11-17% in Finland, Norway, and Sweden (not shown).

31According to national regulations, on-premise alcohol consumption should be even more difficult than off-premise purchase. Nevertheless, on average, one in three 15- to 16-year-olds reports having consumed beer in a public establishment during the last month (not shown). Further, in the past month, one fourth has drunk spirits and one fifth has consumed alcopops in a public establishment. Again the variation across countries is large, considering that high proportions of on-premise alcohol consumption are found in Greece, Cyprus, and Malta, while in Iceland, Finland, Norway, and Sweden rates are relatively low (about 10%). (See Hibell et al., 2012 for greater detail).

32Students in the ESPAD survey were also asked how easy it would be to get beer, wine, and spirits if they wanted to (not shown). Nearly three-fourths (73%; range 44-92%) report that it would be “fairly easy” or “very easy” to get beer. Rates were slightly lower for wine (66%; range 42-83%) and much lower for spirits (53%; range 24-74%). Overall, 81% (range 55-96%) report that it would be fairly or very easy to get an alcoholic beverage.

Summary

33The ESPAD and HBSC surveys have used similar but, in many regards, importantly different methodologies to study adolescent alcohol use behaviours in Europe. Thus, they can be thought to provide complementary information on student drinking across European countries. Besides differences in the actual questionnaire items gathering information on alcohol use, these two surveys differ in their sampling methods, participating countries, sample sizes, and the age groups that were targeted. Comparisons between the two surveys are possible only with regards to the oldest age group in the HBSC study (age 15 years), which has a similar mean age as students in the ESPAD study. While acknowledging the important differences and the resulting difficulties in forming a coherent synthesis of the findings, some similar patterns emerge suggesting a strong overlap in findings (Hibell et al., 2012).

34In both surveys, teenagers in the Nordic countries report the least frequent drinking, although Denmark is clearly an exception, having a high proportion of students reporting recent alcohol use in the ESPAD survey. In contrast, adolescents living in some central European countries report frequent drinking; examples include the Czech Republic and Germany. In addition, southern European countries, such as Greece, score high in frequent drinking in both surveys.

35There is better consistency between the two surveys vis-à-vis drunkenness. In both surveys, Danish adolescents report the highest prevalence of drunkenness. The Czech Republic, the U.K., Hungary, Finland, and the Baltic countries are also consistently high in drunkenness. In contrast, southern European countries, such as Italy, Portugal, and Greece, are in the lower position of drunkenness prevalence in both surveys. The Balkan countries also show low rates of drunkenness in the ESPAD survey; but only two Balkan countries participated in the HBSC study making comparisons more difficult. The prevalence of drinking and drunkenness reported by adolescents in a certain country in the two surveys are often quite similar, although relatively large differences between surveys are also evident for some countries.

36In examining the ESPAD and HBSC surveys, two main themes related to underage drinking in Europe seem to emerge. The first point is that alcohol use behaviour is common among European adolescents, and this situation has remained relatively stable at least since the mid-1990s. Over the entire 16-year period of the ESPAD study, the lifetime prevalence of alcohol use has remained unchanged in most of the countries, and on average is only slightly lower in the latest, compared to the first, survey (89% in 1995 vs. 87% in 2011). Last year alcohol consumption shows the same trend, and last month prevalence has not changed at all. Furthermore, heavy episodic drinking reached its peak between 2003 and 2007, but it is slightly lower in 2011.

37Secondly, there are great variations among European countries in underage drinking behaviours, and although some general patterns can explain this variation, these differences are not easily classifiable into clear-cut and obvious categories. Overall, the data indicate that:

  • most European adolescents find it easy to get various alcoholic beverages;
  • close to 90% of 15- to 16-year-olds have drunk alcohol at least once;
  • beer is the dominant alcoholic beverage among European adolescents; and
  • drunkenness is a common experience among European adolescents, with almost half of the 15- to 16-year-old students having been intoxicated at least once during their lifetime.

38Some of the differences across countries can potentially be explained by the traditional drinking cultures that characterize European countries. Previous surveys generally indicated that in those countries where students drank more frequently, the total amount of alcohol consumed during the last drinking day was usually lower than in those countries in which drinking was less frequent. In the last wave of these surveys, however, it is possible to find large quantity consumption in countries both with low and high frequencies of consumption, and vice versa. For example, among those countries with high drinking prevalence in the last month, such as Denmark, Greece, and Cyprus, students from Greece and Cyprus have drunk small quantities on their most recent drinking day, whereas the Danish students consume large quantities. Nevertheless, some patterns seem to remain constant across time, such as in Norway and Sweden, where the prevalence of drinking during the last month is low, but the quantity of last day consumption is high.

39In summary, it seems that across Europe, even among teenagers, some countries show drinking patterns more oriented towards intoxication, while youth in other countries are more oriented towards moderate drinking patterns. Similar to adults, young people living in Nordic and north-western European countries and some central European countries drink heavily more frequently, compared to those living in southern Europe and in the Balkan region. These geographical differences are particularly strong among girls.

40Nevertheless, the traditional classification into “dry” and “wet” drinking cultures (Allamani et al., 2011; Room & Mäkelä, 2000; Room & Mitchel, 1972) does not fit well for contemporary young people (Beccaria, 2011; Järvinen & Room, 2007; Room, 2010). Nordic countries have always been considered the best representation of “dry” cultures, characterized by a low level of per-capita consumption and a high prevalence and level of intoxication. These dry countries also typically have a high level of formal regulation on alcohol consumption and distribution, and high prevalence of public health problems due to acute intoxication. On the contrary, in “wet” cultures, drinking occurs mainly during meals and in social gatherings; alcohol per capita consumption is high, but with a low level of intoxication; the main control on alcohol consumption and distribution is informal; and chronic health problems are more important than problems occurring from acute intoxication. The two cultures also differ with regard to the type of alcoholic beverage consumed, where spirits and beer are more prevalent in dry cultures and wine more prevalent in wet cultures.

41However, nowadays it has become increasingly problematic to apply this classification to young people’s drinking cultures because of many factors, one of them being the converging alcohol consumption levels in Europe with per-capita consumption among the general population, falling in southern and rising in northern Europe (Allamani & Beccaria, 2007; Beccaria, 2010; Järvinen & Room, 2007; Room, 2010; WHO, 2011). According to Room (2011, p. 235), the two European surveys of adolescents summarized in this chapter show that “the clearer distinction to be made between European youth drinking cultures may be in terms of how intoxication is defined and the extent to which it is valued or disvalued.” Thus, youthful drinking cultures can be divided into “intoxication cultures” and “non-intoxication cultures” (Järvinen & Room, 2007). The measure that distinguishes these cultures the most is self-reported drunkenness, which is “also the variable that best predicts the level of alcohol-related problems in a country” (Jarvinen & Room, 2007, p. 162). Prime examples of youth non-intoxication cultures have for several years been Italy, Portugal, France, and Greece. Youth intoxication cultures, on the other hand, have been best represented by Denmark, the Czech Republic, the U.K., and the Baltic countries with Finland and Sweden following closely behind. Based on the most recent European surveys summarized above, some central European countries seem to have joined the group of youth intoxication cultures, whereas most of the Balkan countries should be added to the youth non-intoxication cultures. These patterns of adolescent drinking seem to correspond well with both historical and more recent statistics on alcohol use behaviours in the general population in different parts of Europe. These statistics have generally shown that frequent but moderate drinking is common in southern European cultures, whereas drinking less frequently but in larger amounts often resulting in intoxication is more typical of northern, northwestern, Baltic, and central-eastern European countries (European Commission, 2010; Kuntsche, Rehm & Gmel, 2004; Leifman, 2002; Nazareth et al., 2011; Simpura & Karlsson, 2001; WHO, 2011). This correspondence implies that adolescent drinking has to be viewed in the context of the more general drinking culture. This perspective has important implications for policies aimed at reducing the risks linked to underage drinking. Below we examine drinking in North America and how it relates to these various European drinking cultures.

UNDERAGE DRINKING IN NORTH AMERICA

42This section describes underage drinking in the United States (U.S.) and Canada focusing primarily on approximate ages 12 through 18 years. The data for the U.S. come from the Monitoring the Future (MTF) study (Johnston, O’Malley, Bachman, & Schulenberg, 2012), which involves annual data collection throughout the U.S. (except Alaska and Hawaii) from 8th, 10th, and 12th graders. The MTF began in 1975 as annual cross-sectional studies of 12th graders. In 1991, it was expanded to include 8th and 10th graders. The study uses a multistage random sampling procedure each year, first selecting particular geographic areas and then selecting public and private schools within those areas. Finally, students are randomly chosen from within the selected schools. The sampling plan is designed to create a representative sample of all U.S. students. A passive consent procedure is used. Each year, approximately 17,000 8th graders (from approximately 150 schools), 15,000 10th graders (from approximately 130 schools), and 15,000-18,000 12th graders (from 120-146 schools) are surveyed. Data are weighted to account for differential probabilities of selection. The MTF excludes high school dropouts (about 12-15% of students nationally) and students who are absent from school on the day of data collection. Thus, estimates may be somewhat lower than those for all youth because dropouts and absent students are more likely to be alcohol and drug users than youth who remain in/attend school. (For greater detail on sampling and response rates, see Johnston et al., 2012.)

43The data on underage drinking in Canada come from the first Cross-Canada Report on Student Alcohol and Drug Use (Young et al., 2011). These data were compiled from provincial school surveys and include data from: British Columbia, Alberta, Manitoba, Ontario, Québec, New Brunswick, Prince Edward Island, Nova Scotia, and Newfoundland. The Canadian provincial studies differed in a number of design characteristics that could affect estimates, including: sample selection procedures and exclusion criteria, stratification procedures, use of clustering, response rates, weighting and post-stratification adjustments applied to the data, missing data imputation, the type of questionnaire administration (e.g., anonymous, paper and pencil), how questionnaires were administered and by whom, when the data were collected, and use of passive versus active parental consent (for greater detail see Young et al., 2011).

44Data were presented separately by province in the Cross-Canada Report. Due to the differential number of students surveyed in each study and the differential distribution of adolescents across provinces, it would be inaccurate to average across provinces to determine a national average. We, therefore, weighted the data, taking into account the percentages of youth in each province. Specifically, using data from the Statistics Canada (2007), we derived the percentage of the total population of Canada for 10- to 14-year-olds and 15- to 19-year-olds for each province. We then multiplied that percentage by the estimates for each province, summed those figures, and divided by 100%. Because Québec was not included in the 12th grade estimates (they included 11th graders in the estimates for sex) and Québec made up 23% of the 10- to 19-year-olds in Canada, when we computed estimates for 12th graders we summed across the eight other provinces and divided by 77. For the 7th and 9th grade calculations we used the percentage of 10- to 14-year-olds; for the 10th and 12th graders we used the percentage of 15- to 19-year-olds; and for the sex estimates we took the average percentage for the two age groups. Readers should evaluate these data as very rough estimates given the weighting procedure and the other issues described above regarding survey differences.

45Below we will first present data on patterns of underage drinking in the U.S. from the most recent MTF. Then we discuss patterns in Canada. We will then make comparisons across both countries by using data from the MTF in 2007, the same year in which most of the Canadian data were collected. At the end of the chapter we tie these results to those presented earlier in this chapter on drinking patterns among European adolescents.

Underage Drinking in the U.S.

46Patterns. In Figure 8 we present data on lifetime, last year, and last month prevalence by grade for the total sample. In the U.S., 8th graders are approximately 13-14 years old, 10th graders are approximately 15-16 years old, and 12th graders are approximately 17-18 years old. Therefore, the 10th graders in the U.S. are relatively the same age as the 15- to 16-year-olds in the ESPAD study described above. As shown here, all three indicators increase with grade level. About one-third of the 8th graders have ever tried alcohol, which increases to 56% of the 10th graders and 70% of the 12th graders. Rates of annual prevalence (use in the last year) are slightly less but show the same pattern. Prevalence rates for use in the last month are 13% for the 8th graders, 27% for the 10th graders, and 40% for the 12th graders.

47Figure 9 shows indicators of heavy and frequent drinking by grade, including the prevalence of daily drinking, getting drunk in the last year, and heavy episodic drinking (HED, also referred to as binge drinking), which is defined in the MTF as drinking five or more drinks in a row in the last 2 weeks. As shown here, very few youths report daily drinking ranging from 0.4% of the 8th graders to about 2% of the 12th graders. In contrast, 11% of the 8th graders, 29% of the 10th graders, and 42% of the 12th graders report having been drunk in the past year. Furthermore, 6% of the 8th graders, 15% of the 10th graders, and 22% of the 12th graders report at least one occasion of HED in the past 2 weeks.

48Subgroup differences. In terms of annual prevalence, rates are remarkably similar for boys and girls, although at grade 8, females are slightly higher than males and at grade 12, females are slightly lower than males (not shown). Figure 10 presents sex differences in daily drinking and prevalence of HED in the last 2 weeks. Note that nondrinkers are included in these calculations; however, as described above, sex differences in prevalence of drinking in the last year are relatively small. As shown here, although prevalence rates are relatively similar for both sexes, boys drink more frequently than girls, especially with advancing age. More than twice as many 12th grade boys (2.9%) than girls (1.2%) report daily alcohol use. Boys, compared to girls, are less likely to report HED in the last 2 weeks in grade 8, slightly more likely in grade 10, and much more likely by grade 12. As pointed out earlier in this chapter, the use of a sex-nonspecific measure of HED biases the results against females.

49We also examined the prevalence of last year drinking and past 2 week HED separately for Whites, Blacks, and Hispanics in the 8th, 10th, and 12th, grades (Figure 11). Blacks consistently report the lowest prevalence of last year drinking. In the 8th grade Hispanics, compared to Whites, report a higher prevalence of last year drinking. In the 10th grade the former report a slightly higher rate than the latter. However, by the 12th grade, Whites report a slightly higher annual prevalence rate than Hispanics. Race/ethnic differences in rates of HED follow a similar pattern.

50In addition, there are differences in drinking patterns among adolescents in the U.S. depending on where they live in the country, especially with advancing age. Figure 12 shows regional differences in the prevalence of last year drinking and HED in the past 2 weeks. In the 8th grade, Southern youth are most likely to drink followed by youth living in the West. In the 10th grade youths living in the West and Midwest are less likely to drink than youth living in the other two regions, whereas in the 12th grade, youth living in the Northeast and Midwest report higher prevalence rates than those living in the South and West. A relatively similar pattern is seen for HED in the past 2 weeks. Thus, these data indicate that there are subcultural differences in patterns of underage drinking within the U.S. depending on race/ethnicity and region of the country analogous to the cultural differences reported above across Europe, but the nature of these differences varies depending on the age of the youth. Data from the MTF also indicate that there are differences in underage drinking patterns by parent education levels and college plans. In general, higher parental education levels are associated with lower prevalence of drinking, especially in the younger grades. In addition, those students who plan to go to college, compared to those who do not, are less likely to drink while in high school (see Johnston et al., 2012 for greater detail).

51Trends in underage drinking, beverage preference, and perceived availability over time. A major advantage of the MTF is that it has been following high school seniors for the past 36 years and 8th and 10th graders for the past 20 years. Therefore, it is possible to examine historical trends in underage drinking over a long period of time.

52Figure 13 shows trends in annual prevalence of alcohol use for 8th graders and 10th graders from 1991 through 2011 and for 12th graders from 1975 through 2011. These data show a large decline from 1991 to 2011, especially among 8th graders. As shown in Figure 14, HED also decreased from 1991 to 2011 for both boys and girls with the percentage decline increasing from the 8th to 12th grade. Looking back to the 1970s, there has been a general decline in drinking and HED among U.S. 12th graders since the peak drinking years in the late 70s, although there have been cyclical changes. These cyclical changes in drinking patterns among 12th graders have been in concert with trends in student perceptions of harmfulness of and disapproval of drinking (Johnston, 2003).

53In addition, as drinking has decreased over time, so has perceived availability. For example, in 1999, 72% of 8th graders, 88% of 10th graders, and 95% of 12th graders reported that it would be fairly easy or very easy to get alcohol if they wanted it. In contrast, in 2011 the rates are 59%, 78%, and 89%, respectively (not shown).

54Trends in alcoholic beverage preference are shown in Figure 15, which presents 30-day prevalence rates separately for beer, spirits, wine, and alcopops (designated as flavored alcoholic beverages in the questionnaire) among 12th graders. Although beer was by far the most used beverage from the 1970s through the 1990s, in recent years, use of spirits has caught up. Beer remains the most used beverage by boys, but more girls currently drink spirits than beer (not shown). Alcopops were quite popular, especially for girls, in the late 80s but their popularity has diminished (for more details on sex differences in use of various beverages see Johnston et al., 2012).

Underage Drinking Patterns in Canada

55Figure 16 presents weighted data on drinking from the Cross-Canada Report for grades 7, 9, 10, and 12. Seventh graders are generally ages 1213 years old, 9th graders 14-15 years old, 10th graders 15-16 years old, and 12th graders 17-18 years old. Therefore, youth in each grade in Canada are comparable in age to youth in same grade in the U.S. and 10th graders in Canada are similar in age to the 15- to 16-year-olds in the ESPAD study. We show rates of lifetime alcohol use prevalence, last year prevalence, and heavy episodic drinking. Lifetime prevalence increases from 28% of 7th graders to 81% of 12th graders. The biggest jump occurs between the 7th and 9th grades. A similar pattern is observed for annual prevalence, which is slightly lower than lifetime prevalence. For the Cross-Canada Report, HED was defined as drinking five or more drinks on one occasion within the last month. There is a large increase in HED from the 10th to the 12th grade; almost half (45%) of the 12th graders report HED, compared to 29% of 10th graders. Although 18% of the 9th graders also report HED, only 3% of the 7th graders do.

56Figure 17 shows sex differences in these same three indicators of drinking. There are virtually no differences between males and females in lifetime prevalence, past year prevalence, or HED. The findings for HED are particularly noteworthy given that the same number of drinks (5+) was used to define HED for both boys and girls.

57As stated earlier, data were presented in the Cross-Canada Report separately by province. The highest rates of annual prevalence by Canadian students are in Ontario (62%) and Québec (60%), whereas the lowest rates are in Prince Edward Island (46%) and Alberta (49%) (not shown). Although there is variation across provinces, there is only a 16 percentage point difference from the lowest to the highest province. Furthermore, it is unclear whether these differences reflect real differences among students in the different provinces or whether they reflect differences in the survey methods (Young et al., 2011). In addition, we examined differences by province in the rate of HED in the last month. For seven of the eight provinces for which the data were reported, rates were between 24% and 28% indicating very little variation across provinces except for Alberta (19%). For the most part, differences between boys and girls within provinces were negligible (not shown).

Comparisons of the U.S. and Canada

58For this section, we compare U.S. and Canadian youth by examining 10th graders (approximately 15-16 years old) and 12th graders (approximately 17-18 years old) in both countries. We use data from the MTF survey in 2007 to make them more comparable to the data from Canada, which were mostly collected in 2007, although some provinces were surveyed in 2008 (and one collected some data in the last two months of 2006). The Canadian data are weighted as above.

59Figure 18 shows last year prevalence and HED for the two countries. Annual prevalence rates are about 10 percentage points higher in Canada than in the U.S. for both grades. In fact, last year prevalence rates for Canadian 10th graders are comparable to U.S. 12th graders. When comparing HED, it should be kept in mind that Canadian youth reported on the prevalence of drinking five or more drinks on one occasion in the last month, whereas American youth reported on drinking five or more drinks in a row in the past 2 weeks. These differences in time frame could account for the substantially higher rates in Canada compared to the U.S., especially in the 12th grade. Nevertheless, it appears that youth in Canada are more likely to drink than youth in the U.S. at the same grade level. Whether differences in legal drinking age (ages 18 or 19 in Canada and 21 in the U.S.) account for these differences remains to be studied. We next compare some of the data on patterns of drinking for the U.S. and Canada with those reported for Europe.

COMPARISONS BETWEEN EUROPE AND NORTH AMERICA

60The 2009/2010 HBSC study also collected data from students in the U.S. and Canada (Currie at al., 2012). Thus, it is possible to compare drinking patterns among countries in Europe and these two North American countries using the same questions. In terms of prevalence and frequency, the U.S. and Canada fall toward the low end of rankings compared with the European countries. For example, among 13-year-olds in the U.S., 4% of girls and 5% of boys drink weekly and for Canada these rates are also 4% and 5%, respectively. These rates are lower than the HBSC average of 6% for girls and 10% for boys. Among 15-year-olds, rates are 9% and 11%, respectively, for the U.S. and 13% and 17%, respectively, for Canada, again lower, especially for boys, than the HBSC average of 17% and 25%, respectively (see Figure 3 for rates in specific European countries to compare the U.S. and Canadian rates presented here). In terms of early drunkenness, 7% of the 15-year-old girls and 10% of the 15-year-old boys in the U.S. report having been drunk by age 13. In Canada 16% of 15-year-old boys and girls report early drunkenness. The U.S. rates are lower than the HBSC survey average for early drunkenness, which is 12% for girls and 16% for boys, while the rate for Canadian girls is higher than the HBSC average for girls (not shown).

61An examination of youth who have been drunk at least twice from the HBSC study shows that the U.S. is clearly towards the bottom for all three age groups, generally even lower than France and close to Italy (not shown). For example, 4% of U.S. 13-year-old girls report having been drunk two or more times in their lives compared to 4% of French 13-year-old girls and 2% of Italian 13-year-old girls. For 13-year-old boys, the rate is 4% in the U.S., 5% in France, and 4% in Italy. Similarly, for 15-year-olds the rates in the U.S. are 13% for girls and 15% for boys, compared to 14% and 19% for girls and boys, respectively, in Italy, and 17% and 26%, respectively, in France. In contrast, Canadian students are relatively high in the rankings for frequent drunkenness; 10% of the 13-year-old girls and 8% of the 13-year-old boys report being drunk at least twice in their lives, which is about in the middle of all HBSC countries (average: 8% for girls and 11% for boys). Rates for 15-year-olds in Canada are 35% for girls and 33% for boys, which are again near the middle of the survey (HBSC average: 29% for girls and 34% for boys). Thus, these data seem to suggest that drinking patterns among U.S. youth are comparable to those of European youth in non-intoxication cultures, whereas patterns for Canadian youth are more closely aligned with intoxication cultures. However, it should be noted that frequency of drinking is relatively low among U.S. adolescents. Therefore, these youth do not neatly fit the European typology, which defines non-intoxication cultures as those with high frequency and less drunkenness (Järvinen & Room, 2007). The latest surveys in Europe also show that this distinction is not always clear. That is, low levels of intoxication are related to both high and low frequency of drinking across European countries.

62Findings from the ESPAD, which assesses on average 15- to 16-year-old students, can be compared to those for American and Canadian 10th graders, who generally average 15-16 years of age. Figure 19 compares lifetime, last year, and last month prevalence of drinking for the European average from the 2007 ESPAD (Hibell et al., 2009), the MTF in 2007 (Johnston et al., 2012), and the Cross-Canada Report, which collected data in 2007/2008 (Young et al., 2011). As seen here, average prevalence rates are highest in Europe and lowest in the U.S. with Canada in the middle.

63Figure 20 shows rates of last year drinking for European students and U.S. students at the five time periods at which the ESPAD survey was conducted (1995, 1999, 2003, 2007, and 2011). As seen here and discussed above, annual prevalence rates are higher in Europe than the U.S. Furthermore, in the U.S. there has been a decline in annual prevalence since 1999, whereas rates in Europe have remained relatively steady, although the latest survey shows a slight decline since 2003. Whether differences in legal regulations, prevention efforts, or social norms account for these variations in rates and trends across the U.S. and Europe should be investigated.

64Figure 20 also shows rates of HED in Europe and the U.S. during these same time periods. When comparing these rates, it should be kept in mind that the U.S. measure of HED is based on the past 2 weeks and the European measure is based on the past month. Therefore, since rates were relatively comparable for Europe and the U.S. in 1995, it probably suggests greater heavy drinking in the U.S. at that time. However, rates have declined in the U.S. over this 16-year period, whereas rates have increased in Europe through 2007 and show a slight decline in the latest survey. Whether these declines will continue remains to be seen. The finding that almost four in ten European 15- or 16-year-olds have consumed five or more drinks at least once in the last month still indicates a potentially serious problem in Europe.

65It does not appear that these differences in drinking in the U.S. and Europe can be accounted for by easier availability of alcohol in Europe than in the U.S. In 2011, 81% of the European 15- to 16-year-olds, on average, reported that it would be very easy or fairly easy to get an alcoholic beverage if they wanted it. In that same year 78% of the 10th graders in the U.S. said that it would be very easy or fairly easy to get alcohol too. Note, however, that perceptions of availability vary greatly across Europe ranging from 55-96% of the 15- to 16-year olds reporting that it would be easy or fairly easy to get an alcoholic beverage. Obviously, more cross-national research is needed to examine the associations between drinking regulations and drinking patterns among youth.

66There are large cultural differences in beverage preference; however, the most frequently used beverages among students in Europe and the U.S. are beer and spirits. In both Europe and the U.S., boys generally prefer beer and girls generally prefer spirits, although drink preferences of European girls are spread out across the various beverages depending on their country of residence. The recent upward trend in preference for spirits could signal more problems in the future given the generally higher peak BACs achieved from one standard drink of spirits compared to one standard-sized beer (Mitchell, personal communication, July 12, 2012). Although the amount of absolute alcohol is the same in one standard drink of both beverages, beer is absorbed more slowly, which results in a lower peak BAC.

SUMMARY AND CONCLUSIONS

67The findings clearly show that underage drinking is a normative behaviour in Europe and North America. Lifetime and annual prevalence rates, however, are on average much higher in Europe than in the U.S. and Canada. In 2007, nearly 90% of European 15- or 16-year-olds had tried alcohol at least once in their lives, compared to 62% of U.S. 10th graders and 70% of Canadian 10th graders. In addition, prevalence rates for drunkenness are somewhat lower in the U.S. compared to Europe. In 2011, 47% of the European 15- or 16-year-olds report having been drunk at least once in their lives, 37% in the last year, and 17% in the last month, compared to 36%, 29%, and 14% respectively, of 10th graders in the U.S.

68Nevertheless, there are several factors that complicate these comparisons. First of all, examining average rates across Europe masks large differences across individual countries in terms of frequency, quantity, and intoxication levels. Some countries show a drinking culture which is geared more toward intoxication, while the drinking culture of other countries is characterized by drinking more frequently but also more moderately (Järvinen & Room, 2007). Until a few years ago, these patterns appeared to be related to the European geography: on average, young people in northern and northwestern Europe had relatively high rates of drunkenness, including early initiation of drunkenness, and those in southern Europe had relatively low rates. In recent years, regional distinctions have become somewhat blurred. Nevertheless, even though there are exceptions and the picture is complex, higher-risk drinking patterns can be found among youth in Baltic, northwestern, and central European countries and lower-risk drinking patterns among youth in Balkan and southern European countries. Nordic countries, which traditionally have been considered as characterized by high levels of intoxication, show a complex drinking pattern; Danish youth are towards the top in most of the comparisons and Icelandic youth are in the bottom, while youth living in Finland, Norway, and Sweden are somewhere in between. These geographic differences seem to be stronger for girls than boys.

69Patterns of HED and drunkenness in the U.S. are more consistent with those in non-intoxication cultures like Mediterranean and Balkan countries. On the other hand, patterns of HED in Canada more closely match those of intoxication cultures like Central European countries. However, there are clearly some signs of cultural and gender convergence in adolescent drunkenness within European and North American countries (Kuntsche et al., 2011). For example, although HED is higher in some European countries, such as Denmark, Croatia, the Czech Republic, Estonia, Slovenia, and the U.K. than in others, such as Iceland, Albania, and Portugal, in recent years HED has been converging and slightly lowering. Thus, it will be necessary to keep an eye on trends in HED and drunkenness across European countries and to conduct more studies focused on understanding the motives that in some countries orient young people to getting drunk, while in other countries protect against frequent drunkenness. To complicate matters even further, one must consider within-country heterogeneity in drinking norms and behaviours. For example, it is clear from the MTF data that there are subcultural differences in the U.S. based on race/ethnicity, with greater proportions of White adolescents drinking and drinking heavily than Black adolescents. The European studies discussed above did not present data separately within countries based on ethnic background. However, there is some evidence to suggest that minority ethnic groups generally have lower prevalence rates of drinking compared to the White population (Hurcombe, Bayley, & Goodman, 2010).

70Just as there are regional differences in adolescent drinking patterns in Europe, there are also differences in drinking patterns in the U.S. depending on the region of the country. In general, Southern and Western youth exhibit the highest rates of annual prevalence and HED in early adolescence and Northeastern youth exhibit the highest rates in late adolescence. In contrast, there is little provincial variation in drinking prevalence and HED among adolescents living in Canada.

71For the most part, prevalence of drinking is relatively similar for boys and girls in both Europe and North America. The narrowing of the gender gap and even higher rates of drunkenness among females than males in several European countries is a recent phenomenon, which is probably occurring in concert within the convergence between the sexes with respect to other lifestyle factors. This gender parity seems to be especially apparent at younger ages and could reflect a generation change. For example, in the U.S. 8th grade girls, compared to boys, are more likely to drink and drink heavily. This difference could simply reflect the fact that these girls have acquired drinking styles typical of an older age as they often have older male friends with whom they drink. Nonetheless, by the 12th grade, boys in the U.S. drink more often and engage more often in HED than girls, suggesting that traditional sex differences may emerge with advancing age. Similarly, data from European adults also suggests that, for the most part, adult men drink more often and in greater quantities than adult women (Eurobarometer, 2010; WHO, 2010). It is clear, however, that the relatively high rates of HED among younger girls in Europe and North America require greater attention. Furthermore, a recent study found that there has been an increase in risk for alcohol-related traffic accidents among underage (ages 16-20 years) females in the U.S. (Voas, Torres, Romano, & Lacey, 2012) adding greater concern about increases in drinking by female adolescents.

72In conclusion, the studies reviewed above have shown relatively high rates of drinking, drunkenness, and HED among adolescents in Europe and North America. Although rates may be higher for the most part in Europe than North America, this does not mean that problems experienced by youth are different. More research is needed to determine if lower prevalence rates of drinking in the U.S. and Canada, compared to Europe, result in less damage, and what other factors determine which youth experience negative consequences from use. In the next chapter we examine risk and protective factors that influence drinking among adolescents and whether these factors may contribute to our understanding of cross-cultural differences in drinking patterns and related problems.

Table 1. Age limits for purchasing alcoholic beverages, on- and off-premise, by country in Europe (European Union, Norway and Switzerland) and North America

Table 1. Age limits for purchasing alcoholic beverages, on- and off-premise, by country in Europe (European Union, Norway and Switzerland) and North America

Sources:
http://www.ccsa.ca/​eng/​topics/​legislation/​LegalDrinkingAge/​Pages/​default.aspx; U.S. Department of Health & Human Services (2011); WHO (2012).
* New limits introduced in October 2012

Figure 1. Last year prevalence of drinking by sex in the ESPAD 2011 study (percentages)

Figure 1. Last year prevalence of drinking by sex in the ESPAD 2011 study (percentages)

Figure 2. Last month prevalence of drinking in the ESPAD 2011 study (percentages)

Figure 2. Last month prevalence of drinking in the ESPAD 2011 study (percentages)

Figure 3a. Weekly drinking at age 11 by sex in the HBSC 2009/10 study (percentages)

Figure 3a. Weekly drinking at age 11 by sex in the HBSC 2009/10 study (percentages)

Figure 3b. Weekly drinking at age 13 by sex in the HBSC 2009/10 study (percentages)

Figure 3b. Weekly drinking at age 13 by sex in the HBSC 2009/10 study (percentages)

Figure 3c. Weekly drinking at age 15 by sex in the HBSC 2009/10 study (percentages)

Figure 3c. Weekly drinking at age 15 by sex in the HBSC 2009/10 study (percentages)

Figure 4. Having been drunk during the last year by sex in the ESPAD 2011 study (percentages)

Figure 4. Having been drunk during the last year by sex in the ESPAD 2011 study (percentages)

Figure 5a. Proportion of 11-year-olds who report having been drunk on two or more occasions, by sex, in the HBSC 2009/10 study (percentages)

Figure 5a. Proportion of 11-year-olds who report having been drunk on two or more occasions, by sex, in the HBSC 2009/10 study (percentages)

Figure 5b. Proportion of 13-year-olds who report having been drunk on two or more occasions, by sex, in the HBSC 2009/10 study (percentages)

Figure 5b. Proportion of 13-year-olds who report having been drunk on two or more occasions, by sex, in the HBSC 2009/10 study (percentages)

Figure 5c. Proportion of 15-year-olds who report having been drunk on two or more occasions, by sex, in the HBSC 2009/10 study (percentages)

Figure 5c. Proportion of 15-year-olds who report having been drunk on two or more occasions, by sex, in the HBSC 2009/10 study (percentages)

Figure 6. Drinking 5+ drinks on at least one occasion during the last month, by sex, in the ESPAD 2011 study (percentages)

Figure 6. Drinking 5+ drinks on at least one occasion during the last month, by sex, in the ESPAD 2011 study (percentages)

Figure 7. Proportion of 15-year-olds who report first drunkenness at age 13 or younger by sex in the HBSC 2009/10 study (percentages)

Figure 7. Proportion of 15-year-olds who report first drunkenness at age 13 or younger by sex in the HBSC 2009/10 study (percentages)

Figure 8. Lifetime, last year, and last month prevalence of drinking in the U.S. 2011 by grade (percentages)

Figure 8. Lifetime, last year, and last month prevalence of drinking in the U.S. 2011 by grade (percentages)

Figure 9. Daily drinking, drunk in the last year, and drinking 5+ drinks in a row (HED) in the last 2 weeks in the U.S. 2011 by grade (percentages)

Figure 9. Daily drinking, drunk in the last year, and drinking 5+ drinks in a row (HED) in the last 2 weeks in the U.S. 2011 by grade (percentages)

Figure 10. Last month prevalence of daily drinking and drinking 5+ drinks in a row (HED) in the last 2 weeks in the U.S. 2011 by grade and sex (percentages)

Figure 10. Last month prevalence of daily drinking and drinking 5+ drinks in a row (HED) in the last 2 weeks in the U.S. 2011 by grade and sex (percentages)

Figure 11: Last year prevalence of drinking and drinking 5+ drinks in a row (HED) in the last 2 weeks in the U.S. 2011 by grade and race/ethnicity (percentages)

Figure 11: Last year prevalence of drinking and drinking 5+ drinks in a row (HED) in the last 2 weeks in the U.S. 2011 by grade and race/ethnicity (percentages)

Figure 12: Last year prevalence of drinking and drinking 5+ drinks in a row (HED) in the last 2 weeks in the U.S. 2011 by grade and region of residence (percentages)

Figure 12: Last year prevalence of drinking and drinking 5+ drinks in a row (HED) in the last 2 weeks in the U.S. 2011 by grade and region of residence (percentages)

Figure 13. Trends in last year prevalence of drinking U.S. 1975-2011 by grade (percentages)

Figure 13. Trends in last year prevalence of drinking U.S. 1975-2011 by grade (percentages)

Figure 14. Trends in drinking 5+ drinks in a row in the last 2 weeks U.S. 1975-2011 by grade and sex (percentages)

Figure 14. Trends in drinking 5+ drinks in a row in the last 2 weeks U.S. 1975-2011 by grade and sex (percentages)

Figure 15. Trends in 30-day prevalence of different beverages among U.S. 12th graders 1975-2011 (percentages)

Figure 15. Trends in 30-day prevalence of different beverages among U.S. 12th graders 1975-2011 (percentages)

Figure 16. Prevalence of lifetime drinking, last year drinking, and drinking 5+ drinks on one occasion in the last month (HED) in Canada 2007-2008 by grade (percentages)

Figure 16. Prevalence of lifetime drinking, last year drinking, and drinking 5+ drinks on one occasion in the last month (HED) in Canada 2007-2008 by grade (percentages)

Figure 17. Prevalence of lifetime drinking, last year drinking, and drinking 5+ drinks on one occasion in the last month (HED) in Canada 2007-2008 by sex (percentages)

Figure 17. Prevalence of lifetime drinking, last year drinking, and drinking 5+ drinks on one occasion in the last month (HED) in Canada 2007-2008 by sex (percentages)

Figure 18. Comparison of annual prevalence and heavy episodic drinking between the U.S. (2007) and Canada (2007-2008) by grade (percentages)

Figure 18. Comparison of annual prevalence and heavy episodic drinking between the U.S. (2007) and Canada (2007-2008) by grade (percentages)

Figure 19: Prevalence of lifetime, last year, and last month drinking in European 15- to 16-year-olds (2007), U.S. 10th graders (2007), and Canadian 10th graders (2007-2008) (percentages)

Figure 19: Prevalence of lifetime, last year, and last month drinking in European 15- to 16-year-olds (2007), U.S. 10th graders (2007), and Canadian 10th graders (2007-2008) (percentages)

Figure 20. Trends in annual prevalence and heavy episodic drinking (HED)* among European (EU) 15- to 16-year-olds and the U.S. 10th graders 1995-2011 (percentages)

Figure 20. Trends in annual prevalence and heavy episodic drinking (HED)* among European (EU) 15- to 16-year-olds and the U.S. 10th graders 1995-2011 (percentages)

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Notes

5 Albania, Belgium (Flanders), Bosnia-Herzegovina, Bulgaria, Croatia, Cyprus, the Czech Republic, Denmark, Estonia, the Faroe Islands, Finland, France, Germany (5 out of 16 federal states), Greece, Hungary, Iceland, Ireland, Italy, Latvia, Liechtenstein, Lithuania, Malta, Monaco, Moldova, Montenegro, Norway, Poland, Portugal, Romania, the Russian Federation (Moscow), Serbia, Slovakia, Slovenia, Sweden, Ukraine and the United Kingdom.

6 Armenia, Austria, Belgium (Flemish and French), Canada, Croatia, the Czech Republic, Denmark, England, Estonia, Finland, France, Germany, Greece, Greenland, Hungary, Iceland, Ireland, Israel, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Romania, Russian Federation, Scotland, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey, the former Yugoslav Republic of Macedonia (MKD), Ukraine, United States and Wales.

Table des illustrations

Titre Table 1. Age limits for purchasing alcoholic beverages, on- and off-premise, by country in Europe (European Union, Norway and Switzerland) and North America
Légende Sources:http://www.ccsa.ca/​eng/​topics/​legislation/​LegalDrinkingAge/​Pages/​default.aspx; U.S. Department of Health & Human Services (2011); WHO (2012).* New limits introduced in October 2012
URL http://books.openedition.org/pucl/docannexe/image/3274/img-1.jpg
Fichier image/jpeg, 251k
Titre Figure 1. Last year prevalence of drinking by sex in the ESPAD 2011 study (percentages)
URL http://books.openedition.org/pucl/docannexe/image/3274/img-2.jpg
Fichier image/jpeg, 252k
Titre Figure 2. Last month prevalence of drinking in the ESPAD 2011 study (percentages)
URL http://books.openedition.org/pucl/docannexe/image/3274/img-3.jpg
Fichier image/jpeg, 253k
Titre Figure 3a. Weekly drinking at age 11 by sex in the HBSC 2009/10 study (percentages)
URL http://books.openedition.org/pucl/docannexe/image/3274/img-4.jpg
Fichier image/jpeg, 150k
Titre Figure 3b. Weekly drinking at age 13 by sex in the HBSC 2009/10 study (percentages)
URL http://books.openedition.org/pucl/docannexe/image/3274/img-5.jpg
Fichier image/jpeg, 183k
Titre Figure 3c. Weekly drinking at age 15 by sex in the HBSC 2009/10 study (percentages)
URL http://books.openedition.org/pucl/docannexe/image/3274/img-6.jpg
Fichier image/jpeg, 213k
Titre Figure 4. Having been drunk during the last year by sex in the ESPAD 2011 study (percentages)
URL http://books.openedition.org/pucl/docannexe/image/3274/img-7.jpg
Fichier image/jpeg, 180k
Titre Figure 5a. Proportion of 11-year-olds who report having been drunk on two or more occasions, by sex, in the HBSC 2009/10 study (percentages)
URL http://books.openedition.org/pucl/docannexe/image/3274/img-8.jpg
Fichier image/jpeg, 142k
Titre Figure 5b. Proportion of 13-year-olds who report having been drunk on two or more occasions, by sex, in the HBSC 2009/10 study (percentages)
URL http://books.openedition.org/pucl/docannexe/image/3274/img-9.jpg
Fichier image/jpeg, 192k
Titre Figure 5c. Proportion of 15-year-olds who report having been drunk on two or more occasions, by sex, in the HBSC 2009/10 study (percentages)
URL http://books.openedition.org/pucl/docannexe/image/3274/img-10.jpg
Fichier image/jpeg, 229k
Titre Figure 6. Drinking 5+ drinks on at least one occasion during the last month, by sex, in the ESPAD 2011 study (percentages)
URL http://books.openedition.org/pucl/docannexe/image/3274/img-11.jpg
Fichier image/jpeg, 204k
Titre Figure 7. Proportion of 15-year-olds who report first drunkenness at age 13 or younger by sex in the HBSC 2009/10 study (percentages)
URL http://books.openedition.org/pucl/docannexe/image/3274/img-12.jpg
Fichier image/jpeg, 183k
Titre Figure 8. Lifetime, last year, and last month prevalence of drinking in the U.S. 2011 by grade (percentages)
URL http://books.openedition.org/pucl/docannexe/image/3274/img-13.jpg
Fichier image/jpeg, 113k
Titre Figure 9. Daily drinking, drunk in the last year, and drinking 5+ drinks in a row (HED) in the last 2 weeks in the U.S. 2011 by grade (percentages)
URL http://books.openedition.org/pucl/docannexe/image/3274/img-14.jpg
Fichier image/jpeg, 105k
Titre Figure 10. Last month prevalence of daily drinking and drinking 5+ drinks in a row (HED) in the last 2 weeks in the U.S. 2011 by grade and sex (percentages)
URL http://books.openedition.org/pucl/docannexe/image/3274/img-15.jpg
Fichier image/jpeg, 104k
Titre Figure 11: Last year prevalence of drinking and drinking 5+ drinks in a row (HED) in the last 2 weeks in the U.S. 2011 by grade and race/ethnicity (percentages)
URL http://books.openedition.org/pucl/docannexe/image/3274/img-16.jpg
Fichier image/jpeg, 136k
Titre Figure 12: Last year prevalence of drinking and drinking 5+ drinks in a row (HED) in the last 2 weeks in the U.S. 2011 by grade and region of residence (percentages)
URL http://books.openedition.org/pucl/docannexe/image/3274/img-17.jpg
Fichier image/jpeg, 140k
Titre Figure 13. Trends in last year prevalence of drinking U.S. 1975-2011 by grade (percentages)
URL http://books.openedition.org/pucl/docannexe/image/3274/img-18.jpg
Fichier image/jpeg, 146k
Titre Figure 14. Trends in drinking 5+ drinks in a row in the last 2 weeks U.S. 1975-2011 by grade and sex (percentages)
URL http://books.openedition.org/pucl/docannexe/image/3274/img-19.jpg
Fichier image/jpeg, 157k
Titre Figure 15. Trends in 30-day prevalence of different beverages among U.S. 12th graders 1975-2011 (percentages)
URL http://books.openedition.org/pucl/docannexe/image/3274/img-20.jpg
Fichier image/jpeg, 171k
Titre Figure 16. Prevalence of lifetime drinking, last year drinking, and drinking 5+ drinks on one occasion in the last month (HED) in Canada 2007-2008 by grade (percentages)
URL http://books.openedition.org/pucl/docannexe/image/3274/img-21.jpg
Fichier image/jpeg, 143k
Titre Figure 17. Prevalence of lifetime drinking, last year drinking, and drinking 5+ drinks on one occasion in the last month (HED) in Canada 2007-2008 by sex (percentages)
URL http://books.openedition.org/pucl/docannexe/image/3274/img-22.jpg
Fichier image/jpeg, 113k
Titre Figure 18. Comparison of annual prevalence and heavy episodic drinking between the U.S. (2007) and Canada (2007-2008) by grade (percentages)
URL http://books.openedition.org/pucl/docannexe/image/3274/img-23.jpg
Fichier image/jpeg, 124k
Titre Figure 19: Prevalence of lifetime, last year, and last month drinking in European 15- to 16-year-olds (2007), U.S. 10th graders (2007), and Canadian 10th graders (2007-2008) (percentages)
URL http://books.openedition.org/pucl/docannexe/image/3274/img-24.jpg
Fichier image/jpeg, 132k
Titre Figure 20. Trends in annual prevalence and heavy episodic drinking (HED)* among European (EU) 15- to 16-year-olds and the U.S. 10th graders 1995-2011 (percentages)
URL http://books.openedition.org/pucl/docannexe/image/3274/img-25.jpg
Fichier image/jpeg, 138k

Auteurs

Ph.D.
Eclectica
Institute for Training and Research
via Silvio Pellico 1
IT – 10125 Torino
beccaria@eclectica.it

Ph.D., Professor II
Center of Alcohol Studies
Rutgers University
607 Allison Road, Piscataway
USA – New Jersey 08854-8001
hewhite@rci.rutgers.edu

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