Youth Drinking in Decline: Implications for Public Health, Public Policy, and Public Debate
Youth Drinking in Decline: Implications for Public Health, Public Policy, and Public Debate
This commentary explores the decline in youth drinking, its future trajectory, public health consequences, and impact on alcohol policy and debate.
Introduction: The Phenomenon of Declining Youth Drinking
Widespread Decline: Youth drinking has significantly decreased across most high-income countries since the mid-2000s.
Young people are less likely to consume alcohol.
They initiate drinking at older ages.
They drink less frequently and in smaller quantities.
They are less prone to getting drunk.
Survey Evidence: These trends are consistently observed in major international surveys:
Health Behaviours in School-aged Children (HBSC) study.
European Schools Project on Alcohol and other Drugs (ESPAD).
Public Perception: Contemporary youth are dubbed 'generation sensible' or 'the new puritans', a stark contrast to the 'new culture of intoxication' discourse of the 1990s and 2000s.
Gap in Discussion: While the nature and drivers of this decline have been explored, its profound implications for public health and policy-making have received less attention.
Leading Risk Factor: Alcohol consumption is the primary global risk factor for mortality and morbidity among year-olds, associated with:
Road traffic accidents, violence, poor educational performance.
Mental health problems, alcohol poisoning, and dependence.
Long-term Health Impact: Early initiation and young adult drinking patterns can influence future alcohol consumption and chronic disease in later life.
Policy Relevance: Drinking trends impact public debate, judgments on policy appropriateness, feasibility, and design.
COVID-19 Context: The pandemic introduces uncertainty due to reported changes in consumption patterns, making it unclear how the decline might be affected post-pandemic.
How Will Youth Drinking Trends Develop in Future?
Stabilisation, Not Reversal: Evidence suggests the downturn will stabilise rather than reverse in the short term, despite uncertainty from the COVID-19 pandemic.
The steepest decline occurred in the mid-2000s, with a broader group of Western European and Australian countries joining the trend that started earlier in the US and Northern Europe.
Recent data from 2018-2019 indicates a slowing of the decline, with trends stabilising in some countries, but no widespread reversal.
Root Causes: The international, long-term, and consistent nature of the trend points to large-scale, structural, and cultural shifts:
Increased economic insecurity among young people.
Influence of new internet-based technologies.
Shifts in parent-child relationships.
Immigration from cultures with more abstemious drinking habits.
Emergence of new health practices tied to wellness and healthism.
Concurrent shifts in a wide range of adolescent behaviors (e.g., less socialising without parents, delayed adult responsibilities like learning to drive or having paid jobs, as noted by Twenge).
Delay vs. Rejection Debate: Significant debate exists on whether youth are delaying alcohol initiation or rejecting it entirely.
Delay Theory: Some researchers posit it's a delay, aligning with broader changes in young people's approach to adult responsibilities, focusing on 'cultivating the individual self'. Cultural position of drinking as a rite of passage has shifted.
Persistence Theory: However, drivers of adult drinking (high availability, affordability, pervasive marketing, gender norms, life stressors, social pleasures) might eventually lead to increased consumption.
US Precedent: Women born in the late 1970s and early 1980s drank less as adolescents but more as adults than preceding/succeeding generations.
Current Evidence on Adult Persistence: Mixed findings across countries.
England: Proportion of year-olds drinking in the last week fell from 67 ext{%} in to 41 ext{%} in , making them the lightest drinking adult age group.
Australia: Differences in drinking between recent birth cohorts narrow but don't disappear in early adulthood.
Finland: Differences disappeared by age .
Long-term Threats: Despite optimism, complacency from policy actors and concerted efforts by alcohol producers could reverse trends.
Policy Complacency: Erosion of alcohol taxes, relaxation of advertising restrictions, reduced social responsibility efforts, less public discussion of harm.
Industry Action: Shift from prioritising high-priced products to increasing sales volumes through:
Developing new products (e.g., no- and low-alcohol drinks that may 'recruit' young people).
Marketing linking alcohol to new leisure practices (e.g., fitness).
Sophisticated social media strategies emphasising authenticity and 'experiences'.
What Does the Decline in Youth Drinking Mean for Public Health?
Substantial Public Health Benefits: A sustained reduction in youth drinking, persisting into adulthood, is expected to yield significant benefits.
Short-term: Decreased rates of road traffic accidents, violence, alcohol poisonings, and alcohol dependence among young people.
Long-term: Reductions in alcohol-attributable chronic diseases.
Latency Period: Chronic disease mortality and morbidity peak between ages and , so the largest health benefits may take years to appear.
Obscured Data: Population-level data may initially obscure these benefits. Overall alcohol-related harm in some countries might worsen before improving, as heavier drinking cohorts from the 1990s/2000s move through peak risk ages, leading to increased harm in older age groups.
Contingency of Benefits: The extent of benefits relies on lower drinking levels persisting into adulthood and the decline not reversing.
Limited Evidence on Harm Impact (To Date):
England: Hospital admissions for alcohol-specific conditions among under-$18$s dropped by 58 ext{%} (from to per ) between and .
England: Alcohol-specific mortality rate among year-olds decreased by 22 ext{%} between and (data for under not publicly available).
Australia: Hospitalisation rates among year-olds for wholly alcohol-attributable conditions were broadly stable from to , indicating more equivocal trends.
Additional Considerations for Public Health Impact:
Other Health Risk Factors: The impact depends on trends in co-occurring risk factors (e.g., smoking and illicit drug use are declining; obesity and mental health problems are increasing). Interactions can magnify or dampen benefits.
Sociodemographic Characteristics: Risks are greater for women and disadvantaged groups. Studies suggest the drinking downturn may be smaller among girls, those of lower socioeconomic position, and heavy drinkers (though evidence is mixed for the latter two).
Age Distribution of Harm: A decline in harm concentrated in lighter-drinking generations would rebalance harm away from younger people, further concentrating it among middle- and older-aged individuals. This has implications for public debate and policy priorities.
What Will the Decline in Youth Drinking Mean for Public Debate and Policy?
Complex Policy System: Policy and debate are influenced by a complex interplay of actors, politics, power, evidence, institutional structures, and economic/technological trends, not simple cause-and-effect.
Two Illustrative Model Scenarios:
The Reinforcement Scenario
Virtuous Circle: Envisions a positive feedback loop:
Lighter drinking generations entering adulthood increase adult abstinence/moderate drinking.
Future generations drink less due to alternative health practices, less targeted marketing, and closer parent-child relationships.
This shifts power in alcohol policy debate towards control advocates, as the public, media, and policy actors become less opposed to alcohol control.
Significant reductions in consumption and harm frame alcohol as a 'tractable problem', offering 'political rewards' for effective action.
Public health priorities align better with political incentives.
Government partnerships shift from industry to public health actors, leading to stronger, evidence-based alcohol control policies.
Policy Transfer: International nature of the decline could create external pressures for policy transfer (e.g., supra-national organization mandates or increased pressure from multiple governments implementing similar policies).
Analogy to Tobacco Experience: This model partially mirrors tobacco control, where reduced use, negative public attitudes, effective policies, and increased advocate influence created an accelerating trend towards stricter control.
Key Differences and Challenges from Tobacco:
Policy Causality: Little evidence suggests policy changes precipitated or sustained the youth drinking decline; some implicated policies (e.g., Challenge 25) were industry-backed.
Individual Health Impetus: Concerns about smokers' health drove tobacco trends. For alcohol, individual risk is generally not comparable to smoking, even if population-level harm is present.
Framing: Smoking is often framed as a binary 'yes/no' behavior, allowing a clear consensus 'against' it. Alcohol consumption is a continuum, limiting the scope for a clear 'against drinking' consensus.
Challenges for Reinforcement Model: Lack of public health-driven policy successes, weak individual-level health impetus, and unclear dividing lines mean calls for new interventions may not resonate, alcohol policy may remain a low political priority, and only incremental rather than radical changes may occur.
The Withdrawal Scenario (More Plausible)
Apathetic Public: An increasingly abstemious public becomes apathetic towards alcohol-related problems, especially as they are unlikely to experience them themselves or only in the distant future.
Industry Adaptability: The alcohol industry effectively harnesses or neutralises drivers of the decline (e.g., sophisticated social media marketing).
Reduced Policy Motivation: Policy-makers have fewer motivations to address alcohol-related harm, potentially shifting focus to other pressing issues.
Increased concerns about economic and cultural consequences of interventions, particularly for traditional venues (pubs/bars) and the nightlife economy (exacerbated by COVID-19).
Erosion of Controls: Public health advocates struggle to gain government attention.
Industry-government partnerships persist, leading to the removal or dilution of restrictive policies under the argument that they are no longer needed or are harming economic/cultural assets.
Even in countries with strong alcohol control traditions (e.g., Sweden, Finland, Scotland), commercial arguments could gain influence as the justification for restrictive measures declines.
Potential Consequences:
Relaxation of formal and informal controls on alcohol use.
Increased risk of perpetuating Skog’s 'long waves' of alcohol consumption, characterized by multi-decade rises and falls.
Global corporations lobbying for partnership arrangements in new jurisdictions, citing 'success' in reducing youth drinking.
Public health actors may pivot to focusing on issues in low- and middle-income countries, where multinational corporations are expanding markets.
Alternatively, public health actors may focus on smaller-scale, more 'tractable' problems in high-income countries, with high profiles but narrow scopes (e.g., 'children of alcoholics' campaigns, leading to minor policy shifts) or campaigns with uncertain benefits but less contention than WHO 'best buys' (e.g., Dry January, calorie labelling, no-/low-alcohol drinks).
This reflects a shift towards incremental change rather than radical change.
Conclusions and Recommendations
Established Decline: The decline in youth drinking is well-established and unlikely to reverse significantly.
Persistence into Adulthood: Young people appear to be carrying lighter consumption into adulthood in some regions.
Public Health Benefits: Likely to deliver substantial short-term and long-term public health benefits, though population-level data may initially obscure the latter due to harms from older, heavier drinking cohorts.
Uncertain Policy Impact: The effect on public policy and debate is less clear, with the withdrawal model deemed more plausible than the reinforcement model.
Limitations: The analysis is speculative and influenced by UK and Australian policy contexts, and focuses on high-income countries, contrasting with rising youth drinking in many low- and middle-income countries, which might counteract global health gains.
Four Tentative Suggestions for Public Health Actors:
Understand Decline Drivers: Continue efforts to understand why youth drinking is declining. This helps determine persistence into adulthood and identify policy measures to reinforce.
Understand Youth Attitudes and Public Debate: Research children's, young people's, and emerging adults' attitudes towards alcohol and policy, and the changing potency of ideas in public debate (e.g., 'vulnerable young person' vs. 'unruly youth'). This informs advocacy and intervention strategies.
Address Policy Weaknesses and Adjust Messages: Continue advocating for governments to address systemic alcohol policy weaknesses (e.g., poorly structured tax systems, dysfunctional industry self-regulation, inadequate treatment services).
Adjust Messaging: Potentially adjust messages, such as the claim of a robust causal relationship between average consumption and harm. For example, in the UK, a decline in youth drinking reduced average consumption, but rising harm among older age groups disproved a direct proportional link globally, as shown by .
Rigorously Consider Policy Goals: Unlike tobacco control (with its clear goal of a tobacco-free world), the ultimate aims of alcohol policy are less defined. Declining harms may necessitate a reappraisal of alcohol policy's end goals by public health actors in future decades.
Funding and Declarations
Funding: Supported by the Wellcome Trust ( ) and an ARC Discovery Early Career Research Award to AP ( ).
Ethics: No ethics approval was required as no animal or human participation was involved.
Interests: Authors declare no known competing financial interests or personal relationships.
Open Access: Authors applied a CC BY public copyright licence to any Author Accepted Manuscript.