Emerging Trends in Underage Drinking

Epi Corner 

Emerging Trends in Underage Drinking 


A recent report from the National Institute on Alcohol Abuse and Alcoholism identified an overall downward trend in the prevalence of alcohol consumption in the past 30 days by youth and young adults (12–20-year-olds) from 1991-2019. The rate of decline in consumption was greater in males than in females, with the prevalence among females (20.2%) exceeding that of males (17.2%) in 2019. The highest rates of underage drinking were in non-Hispanic whites followed by Hispanics and non-Hispanic Blacks.1  Binge drinking in this age group also trended down from a high of 18.6% in 2001 to 10.6 in 2019. However even though binge drinking patterns show a decline, the decline in extreme, high-intensity drinking (10-15+ drinks in a row) has been slower than rates for those drinking 5+ drinks in a rowData for the report was compiled from three nationally representative surveys, the National Survey on Drug Use and Health (NSDUH, the Monitoring the Future (MTF) and the Youth Risk Behavior Survey (YRBS).  


While these findings are encouraging to prevention researchers and practitioners, the data also suggest several areas of concernData collected during the COVID-19 Pandemic have shown a disturbing increase in addiction-related behaviors including underage drinking.2  Trend analyses at the state or local level can be helpful in proactively identifying changes in consumption patterns as well as risk factors to inform annual prevention targets.  


Risk factors for underage drinking should also be understood in the context of changing norms and behaviors in the larger social environmentA recent systematic review and meta-analysis of studies from 7 countries including the United States that examined the association between internet addiction disorder (IAD) and health risk behaviors among adolescents and young adults found that IAD was positively correlated with alcohol consumption, smoking, and increased risk for suicidal behavior among adolescents.3  A systematic review of energy drink (ED) consumption in European children found that consumption of EDs was associated with polysubstance use, violent and other risky behaviors (including bullying and being bullied).  Adolescents who mixed EDs with alcohol drank significantly more alcohol than others. The stimulant effects of EDs were often used to counteract the depressive effects of alcohol leading to an underestimation of intoxication and increasing the likelihood of hazardous drinking behaviorsThe authors of this review suggest that ED consumption may be a flag for other hazardous behaviors in adolescents.4 


The body of research on risk factors for alcohol and other drug use in adolescents suggests that risky or unhealthy behaviors tend to cluster within individualsIdentifying associated unhealthy or risky behaviors can also inform prevention planning.   A systematic review by Domingues et al. (2022) that examined the relationship between a “sense of coherence” (SOC)5 and health related behaviors in 13- to 18-year-olds, found a relationship between the SOC and eight health-related behaviors: alcohol use, illicit drug use, physical activity, tobacco use, eating habits, rest/sleep, oral health, and internet use. The authors concluded that understanding SOC may inform the development of adolescent and youth health promotion programs and policies.6  




Azmawati MN, Rozmi I, Fauziah I, Hassan MR,Manaf MRA, Amt N, Norhayti I, Saraurdin NS (2021). Risk and Protective Factors of Drug Abuse Among Adolescents: A Systematic ReviewBMC Public Health, 21, pg. 2088https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8590764/pdf/12889_2021_Article_11906.pdf 

Chen, C. M., & Yoon, Y. H. (2021). Surveillance Report# 116: Trends in Underage Drinking in the United States, 1991–2019. https://pubs.niaaa.nih.gov/publications/surveillance116/SR116_Underage_Drinking.pdf 

Da-Silva-Domingues H, del-Pino-Casado R, Palomio-Moral PA, Martinez CL, Moreno-Camera S, Frias-Osuna A (2022). Relationship Between Sense of Coherence and Health Related Behaviors in Adolescents and Young Adults: A Systematic ReviewBMC Public Health 22, pg. 477PMCID: PMC8915532 

U.S. Department of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA; 2020). State Reports – Underage Drinking Prevention and Enforcement: Region 6. Rockville, MD: SAMHSA. https://store.samhsa.gov/sites/pttc/files/SAMHSA_Digital_Download/PEP21-03-11-008.pdf  

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