Trends in early alcohol and drunkenness initiation, by gender and subregion

55 CHAPTER TRENDS IN EARLY ALCOHOL AND DRUNKENNESS INITIATION, BY GENDER AND SUBREGION SUMMARY • In 2014, around one in four adolescents in the Region first consumed alcohol at age 13 or younger, and just under one in 10 were first drunk at this early age. • Gender differences are not present in all countries and regions, but when present, boys are more likely to report early alcohol initiation and early drunkenness. • Early alcohol initiation has declined in most countries and regions. On average, early alcohol initiation across all countries and regions declined from 46% in 2002 to 28% in 2014. Similarly, early drunkenness more than halved, from 17% to 8%, over this period. • A significant increase in alcohol use at age 13 or younger was reported in Slovenia among both boys and girls and in Greece among girls only. • The biggest changes in early initiation of alcohol and drunkenness were seen in the Nordic and Ireland/Great Britain subregions, which had the highest prevalence in 2002. Less change was seen in the southern Europe/ Mediterranean subregion. ADOLESCENT ALCOHOL-RELATED BEHAVIOURS: TRENDS AND INEQUALITIES IN THE WHO EUROPEAN REGION, 2002–2014 24 INTRODUCTION Regular or excessive alcohol use during early adolescence raises concerns. Early initiation of alcohol is linked to an increase in alcohol-related harms in adolescence and adulthood, including an increased risk of alcohol-use disorders in adulthood (1). The adolescent brain is going through structural and developmental changes during this period (2,3), and early onset of alcohol use increases the risk of alcohol-related neurocognitive vulnerabilities as well as being a risk factor for poorer subsequent neuropsychological functioning (4). The brain may also be more vulnerable to the addictive effects of alcohol and other drugs during this period of intense neurodevelopment (5,6). This chapter focuses on early age of alcohol use, presenting trends in prevalence of early alcohol initiation (alcohol use at age 13 or before) and early drunkenness (being drunk at age 13 or before). PREVALENCE IN 2014 Across all 36 countries and regions in 2014, more than one in four 15-year-olds (28%) reported that they had first started consuming alcohol at age 13 years or younger (25% of girls and 31% of boys). Prevalence was over 30% in under half of countries and regions for both genders (11 among girls and 17 for boys). The highest prevalence of early alcohol initiation was reported among boys in Estonia (50%), Greece (47%), and Croatia and Hungary (46%); among girls, it was Estonia (47%), Lithuania (41%) and Greece (38%). Lowest prevalence among girls was in Israel (4%), Iceland (5%), Italy (12%) and Sweden (13%), and among boys in Iceland (6%), Sweden (15%) and Norway (16%). Boys were more likely to report early alcohol initiation in most countries and regions, with the difference being significant in half (18). The largest gender differences were seen in Romania (20 percentage points), and Croatia and Italy (14 percentage points). Fewer than one in 10 (8%) of 15-year-olds across all countries and regions reported being first drunk before the age of 13 (7% of girls and 9% of boys). The range of prevalence across countries and regions for early drunkenness is smaller than for early age at initiation, as would be expected. Prevalence was over 10% in a minority of countries and regions for girls (five) and in less than half for boys (13). The highest prevalence was found in Lithuania and Estonia for both boys (25% and 21%) and girls (15% and 17%). Lowest prevalence among girls was in Israel (1%), and Iceland, Italy and the former Yugoslav Republic of Macedonia (2%), and among boys in Iceland and Norway (3%), and the Netherlands (4%). Gender differences were less pronounced than for early drinking. In 12 out of 36 countries and regions, the prevalence of early drunkenness initiation was higher among boys than girls, with no difference in the others. The largest gender differences were seen in Romania, Lithuania and Croatia (Fig. 5.1 and 5.2). TRENDS OVER TIME Generally, early alcohol initiation declined substantially in most countries and regions, from 46% in 2002 to 28% in 2014. The greatest reductions between 2002 and 2014 were seen in Czechia (from 71% to 22% among girls, and 76% to 28% for boys) and Wales (65% to 25% among girls, 69% to 25% boys). These had the highest prevalence of early drinking in 2002. Fig. 5.3 shows the change in prevalence of early alcohol initiation between 2002 and 2014 for boys and girls. TRENDS IN EARLY ALCOHOL AND DRUNKENNESS INITIATION, BY GENDER AND SUBREGION 25 5 Alcohol Drunkeness 0202060 40 40 60 Estonia Lithuania Greece Austria Portugal Hungary Germany Slovenia Croatia Poland Denmark Latvia England Scotland Spain Luxembourg Ukraine MKDª Wales France Netherlands Switzerland Czechia Slovakia Belgium (Flemish) Romania Finland Belgium (French) Malta Ireland Russian Federation Norway Sweden Italy Iceland Israel HBSC average Fifteen-year-olds only. a The former Yugoslav Republic of Macedonia (MKD is an abbreviation of the ISO). Fig. 5.1. Prevalence of early alcohol initiation and early drunkenness, 2014, girls (%) Alcohol Drunkeness 0202060 40 40 60 Estonia Greece Croatia Hungary Lithuania Slovenia Austria Romania Portugal France Germany Ukraine Denmark Luxembourg Poland England Malta Netherlands Scotland Switzerland Belgium (Flemish) Slovakia Latvia Czechia Italy Wales Belgium (French) Spain MKDª Finland Ireland Russian Federation Israel Norway Sweden Iceland HBSC average Fifteen-year-olds only. a The former Yugoslav Republic of Macedonia (MKD is an abbreviation of the ISO). Fig. 5.2. Prevalence of early alcohol initiation and early drunkenness, 2014, boys (%) ADOLESCENT ALCOHOL-RELATED BEHAVIOURS: TRENDS AND INEQUALITIES IN THE WHO EUROPEAN REGION, 2002–2014 26 Several other countries and regions had declines greater than 30 percentage points (Belgium (French) and Belgium (Flemish) in both genders, and Finland, Austria and Scotland for girls only). By contrast, a significant increase in alcohol use at age 13 or younger was reported in Slovenia among both boys and girls, and in Greece among girls only. The downward trend was similar in magnitude for boys and girls in most countries and regions, but in a few (such as Finland, Latvia, Lithuania and Poland), gender differences that were apparent in 2002 were absent in 2014 following a greater decline in prevalence of early alcohol initiation in one gender than another. Prevalence of early alcohol initiation higher than 50% was reported in 15 countries and regions for boys and 11 for girls in 2002. Those with the highest prevalence were Czechia (76%), and Austria and Wales (69%) among boys, and Austria (72%), Czechia (71%), Wales (65%) and Scotland (60%) for girls. Only a few countries and regions reported prevalence of early initiation of alcohol below 30% (two for boys and six for girls) in 2002. By contrast, more than half reported prevalence less than 30% in 2014, and none reported prevalence greater than 50%. Prevalence in Iceland consistently has been among the lowest in all age groups in each year since 2006. The prevalence of drunkenness at age 13 or earlier across all 36 countries and regions more than halved between 2002 and 2014 (17% to 8%). Fig. 5.4 shows the change in prevalence of early drunkenness initiation between 2002 and 2014 for boys and girls. Finland, Wales, England and Denmark reported the largest decreases: Finland decreased from 41% in 2002 to 12% in 2014 among girls and from 35% to 14% among boys, and Wales from 30% to 10% among girls and from 35% to 10% for boys. No countries or regions showed a significant increase in early drunkenness. Generally, prevalence decreased in both girls and boys, and this was significant in 24 countries and regions for girls and 28 for boys. In most, however, the decline in prevalence has been greater among boys. Gender differences in prevalence of early drunkenness reduced between 2002, when 22 countries and regions had a significantly higher prevalence in boys than girls, and 2014, when only 12 still showed a significant gender difference. Prevalence in 2002 ranged from 2–41% among girls and from 7–35% among boys. The countries and regions with the highest prevalence among girls were Finland (41%), Scotland (32%), and Denmark, England and Wales (all 30%); among boys, countries and regions with the highest prevalence were similar to those in 2014, with Wales and Finland (both 35%) and Lithuania (34%) highest. Prevalence of greater than 10% in 2002 was seen in most countries and regions for boys (26) and in around half (18) for girls. In 2014, however, only a minority had prevalence of early drunkenness greater than 10% (13 for boys and five for girls) (Fig 5.4). GEOGRAPHICAL DIFFERENCES Prevalence of early alcohol initiation in the Nordic countries in 2014 was 14% among girls and 16% for boys, substantially lower than that in the other subregions, which ranged from 23–29% among girls and 27–37% for boys. Nordic countries have had the lowest prevalence since 2006. Large declines in prevalence of early alcohol initiation were seen between 2002 and 2014 in most geographic subregions. The highest prevalence of early initiation of alcohol use in 2002 was found in the Ireland/Great Britain subregion (54% for girls and 58% for boys). This and the Nordic subregion had the largest change, of over 30% in both genders, between 2002 and 2014. The smallest change over this time was in southern Europe/Mediterranean, which had the lowest prevalence in 2002 (39% among males and 26% among females). Prevalence among boys in this TRENDS IN EARLY ALCOHOL AND DRUNKENNESS INITIATION, BY GENDER AND SUBREGION 27 5 010 20 30 40 50 807060 Iceland Israel Italy Slovenia Russian Federation MKDª Spain Norway Malta Sweden Ukraine Latvia Switzerland Finland Portugal France Ireland Romania Luxembourg Germany Croatia Greece Slovakia England Netherlands Scotland Estonia Poland Belgium (French) Hungary Denmark Belgium (Flemish) Lithuania Austria Wales Czechia HBSC average Girls Boys 20142002 Fifteen-year-olds only. No data for 2002 were received for Iceland, Luxembourg, Romania and Slovakia. Data for Iceland, Romania, Luxembourg and Slovakia describe the difference from 2006 to 2014. Statistically significant change in prevalence is indicated in the corresponding table in Annex 1. a The former Yugoslav Republic of Macedonia (MKD is an abbreviation of the ISO). Fig. 5.3. Change in prevalence of early alcohol initiation, 2002–2014, by gender (%) 010 20 30 40 50 Malta Italy Israel Spain MKDa Iceland Portugal Greece France Switzerland Luxembourg Netherlands Hungary Belgium (Flemish) Germany Norway Slovenia Russian Federation Ukraine Latvia Poland Ireland Belgium (French) Sweden Romania Slovakia Croatia Czechia Austria Scotland England Estonia Denmark Lithuania Finland Wales HBSC average Girls Boys 20142002 Fifteen-year-olds only. No data for 2002 were received for Iceland, Luxembourg, Romania and Slovakia. Data for Iceland, Romania, Luxembourg and Slovakia describe the difference from 2006 to 2014. Statistically significant change in prevalence is indicated in the corresponding table in Annex 1. a The former Yugoslav Republic of Macedonia (MKD is an abbreviation of the ISO). Fig. 5.4. Change in prevalence of early drunkenness initiation, 2002–2014, by gender (%) ADOLESCENT ALCOHOL-RELATED BEHAVIOURS: TRENDS AND INEQUALITIES IN THE WHO EUROPEAN REGION, 2002–2014 28 subregion stayed stable until 2010 and has declined by 9% since then; among girls, prevalence increased before falling back to roughly the same level as in 2002. Fig. 5.5 and 5.6 show trends in early alcohol and early drunkenness initiation, respectively, between 2002 and 2014, by subregion and gender. Gender differences are relatively small in all subregions, with boys having a higher prevalence of early alcohol initiation than girls; in 2014, gender differences ranged between 2% in the Nordic subregion and 8% in central–eastern Europe. Gender differences were consistently smallest in all years in the Nordic and Ireland/Great Britain subregions. Prevalence of first drunkenness at age 13 or younger in 2014 was highest among boys in central– eastern Europe (15%), with all other subregion gender combinations ranging between 4% in girls in southern Europe/Mediterranean and 10% in boys in Ireland/Great Britain. Nordic countries and Ireland/Great Britain had the highest prevalence of early drunkenness in 2002, and it is in these subregions where the greatest decline in prevalence has been seen (around 20 percentage points between 2002 and 2014). The prevalence in the southern Europe/Mediterranean subregion remained the lowest of all study years from 2002 to 2014. Gender differences at subregional level have generally remained fairly stable over time. Nordic and Ireland/Great Britain show consistently negligible gender differences in prevalence of early drunkenness over time. In contrast, the other subregions have fairly consistent gender differences, with more boys reporting early drunkenness than girls. The largest gender differences are seen consistently in the central–eastern Europe subregion, although the differences have declined over time (Fig. 5.5 and 5.6). 0 25 20 15 10 5 30 35 40 50 45 60 55 2002 2006 2010 2014 Prevalence (%) GIRLS Central–eastern Europe Southern/ Mediterranean Central–western Europe BOYS NordicIreland/ Great Britain Fifteen-year-olds only. No data for 2002 were received for Iceland, Luxembourg, Romania and Slovakia. Data for Iceland, Romania, Luxembourg and Slovakia describe the difference from 2006 to 2014. No data for 2006 were received for Spain. No data for 2010 were received for Malta. See Chapter 1 for list of countries in each subregion. Fig. 5.5. Trends in early alcohol initiation, 2002–2014, by subregion and gender (%) 0 25 20 15 10 5 30 35 40 50 45 60 55 2002 2006 2010 2014 Prevalence (%) GIRLS Central–eastern Europe Southern/ Mediterranean Central–western Europe BOYS NordicIreland/ Great Britain Fifteen-year-olds only. No data for 2002 were received for Iceland, Luxembourg, Romania and Slovakia. Data for Iceland, Romania, Luxembourg and Slovakia describe the difference from 2006 to 2014. No data for 2006 were received for Spain. No data for 2010 were received for Malta. See Chapter 1 for list of countries in each subregion. Fig. 5.6. Trends in early drunkenness initiation, 2002–2014, by subregion and gender (%) TRENDS IN EARLY ALCOHOL AND DRUNKENNESS INITIATION, BY GENDER AND SUBREGION 29 5 REFERENCES 1. Grant BF, Dawson DA. Age of onset of alcohol use and its association with DSM-IV alcohol abuse and dependence: results from the National Longitudinal Alcohol Epidemiologic Survey. J Subst Abuse 1997;9:103–10. 2. Mulder J, de Greeff J. Eyes on age: a research on alcohol age limit policies in European Member States. Legislation, enforcement and research. Utrecht: Dutch Institute for Alcohol Policy; 2013 (http://ec.europa.eu/health/sites/health/ files/alcohol/docs/eyes_on_ages_report_en.pdf). 3. 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