Youth drinking in decline: What are the implications for public health, public policy and public debate?

John Holmes,Hannah Fairbrother,Amy Pennay,Victoria Whitaker,Melissa Oldham,Petra Sylvia Meier,Michael Livingston

doi:10.1016/j.drugpo.2022.103606

Abstract

Youth drinking has declined across most high-income countries in the last 20 years. Although researchers and commentators have explored the nature and drivers of decline, they have paid less attention to its implications. This matters because of the potential impact on contemporary and future public health, as well as on alcohol policy-making. This commentary therefore considers how youth drinking trends may develop in future, what this would mean for public health, and what it might mean for alcohol policy and debate. We argue that the decline in youth drinking is well-established and unlikely to reverse, despite smaller declines and stabilising trends in recent years. Young people also appear to be carrying their lighter drinking into adulthood in at least some countries. This suggests we should expect large short- and long-term public health benefits. The latter may however be obscured in population-level data by increased harm arising from earlier, heavier drinking generations moving through the highest risk points in the life course. The likely impact of the decline in youth drinking on public and policy debate is less clear. We explore the possibilities using two model scenarios, the reinforcement and withdrawal models. In the reinforcement model, a 'virtuous' circle of falling alcohol consumption, increasing public support for alcohol control policies and apparent policy successes facilitates progressive strengthening of policy, akin to that seen in the tobacco experience. In the withdrawal model, policy-makers turn their attention to other problems, public health advocates struggle to justify proposed interventions and existing policies erode over time as industry actors reassert and strengthen their partnerships with government around alcohol policy. We argue that disconnects between the tobacco experience and the reinforcement model make the withdrawal model a more plausible scenario. We conclude by suggesting some tentative ways forward for public health actors working in this space.

Highlights

Youth drinking has declined markedly across most high-income countries from the mid-2000s onwards
The trends vary in scale and timing across countries (Vashishtha, Pennay, et al, 2020), but appear in both of the main international surveys detailing youth alcohol use; the Health Behaviours in School-aged Children study (HBSC, 2018, Fig. 1) and the European Schools Project on Alcohol and other Drugs (ESPAD) (Inchley et al, 2018; The ESPAD Group, 2020)
The alcohol problems public health actors focus on instead may include those with a high profile but narrow scope, such as recent UK campaigns on ‘children of alcoholics’, which were driven by the personal experiences of a small group of parliamentarians and prompted only minor policy shifts (BBC News, 2018a), albeit relating to high-risk and vulnerable groups

Summary

Introduction

Youth drinking has declined markedly across most high-income countries from the mid-2000s onwards. There is little evidence on changes in drinking among young people and it is unclear whether understandings of the decline in youth drinking may shift as a ‘new normal’ and post-pandemic trends in alcohol consumption emerge.

Results

Conclusion