Alcohol consumption is a leading risk factor for the global burden of disease through its association with injuries and chronic diseases such as cancer.1-2Alcohol consumption is a known human carcinogen associated with cancers of the upper aerodigestive tract (oral cavity, pharynx, larynx, and oesophagus) and cancers of the colon, rectum, liver, and female breast,3-5 and showing dose-response relationships.6,7 In addition, the joint effect of alcohol consumption and behavioural risk factors such as smoking and poor dietary practices can further increase cancer risk.4,7,8 Alcohol is the most commonly used drug in Australia, where it is consumed in a wide range of social circumstances.9-10
In 2018, alcohol consumption was the 5th leading risk factor contributing to the disease burden in accounting for 4.5% of the total burden. Alcohol use was attributed to 40% of the liver cancer burden in DALYs, 37.9% of that for nasopharyngeal cancer, and 37.5% for other oral cavity and pharynx cancers. Alcohol consumption contributed to the burden of 30 diseases and injuries, including alcohol use disorders, 8 types of cancer, chronic liver disease, and 12 types of injury – predominantly road traffic injuries and suicide & other self-inflicted injuries.11
Those who begin drinking before age 15 years appear to be at greater risk of serious life-long problems and more likely to develop alcohol dependence than those who begin drinking at older ages.12
About this measure
The 2020 National Health and Medical Research Council (NHMRC) Australian Guidelines 13 contribute to Australia’s National Alcohol Strategy 2019–202814, aiming to prevent and minimise alcohol-related harms by improving awareness and understanding of those harms.
These guidelines advise that children and people under 18 years of age should not drink alcohol (NHMRC 2020).13-14 Drinking alcohol in adolescence can be harmful to young people’s physical and psychosocial development.
This analysis focuses on the proportion of young people aged 12-17 years reporting no alcohol consumption in the previous 12 months.
Data used in this analysis were sourced from the three-yearly Australian Secondary Schools Alcohol and Drug (ASSAD) surveys, published between 1984 and 2022-2023.15
Current status
In 2022-23:15
- More than 1 in 2 secondary school students aged 12 to 17 years (56.3%) reported not consuming alcohol in the previous 12 months.
- The proportion of adolescents reported consuming no alcohol in the previous 12 months was significantly higher in adolescents aged 12-15 years compared with ages of 16-17 years (65.0% vs 36.2%).
- The proportion of adolescents aged 12-17 years who did not consume alcohol in the previous 12 months was higher in males (59.5%) than females (53.2%) although this did not achieve statistical significance. Similarly, in the AIHW – National Drug Strategy Household Survey 2022-23 report,16 higher proportion of females aged 14 to 17 years have reported consuming alcohol in the previous 12 months than males (35% vs 27%, respectively).
Trends
From 1996 to 2022-23, the proportion of secondary school students who reported consuming no alcohol in the last 12 months generally increased, with a sharp increase from 2002 to 2014 (from 32.9% to 54.9%). The proportion was marginally higher again at 56.3% in 2022-23.15
Among students aged 16-17 years, there was an increase from 2005 to 2017 (from 12.5% to 28.3% respectively) and then an increase from 28.3% in 2017 to 36.2% in 2022-23. In younger students aged 12-15 years, a sharp increase was reported from 2002-2017 (from 32.2% to 65.5% respectively) which then stabilized at about 65.0% in 2023.15
These increases in proportions of adolescents having no alcohol consumption in the past year may have been influenced by initiatives leading from the National Drug Strategy and associated campaigns, as well as from other initiatives by state and territory governments. Caution should be taken when interpreting trends over time. (See “About the Data”)
This trend was also reported by the AIHW – National Drug Strategy Household Survey 2022-23 report16, indicating that the proportion of people aged 14–17 who reported not having alcohol in the previous 12 months increased significantly in both females and males from 2007 to 2016 (from 36% and 39% to 71% and 73% respectively). This proportion in females decreased from 2019 to 22-23 (from 72% to 65% respectively) after being relatively stable from 2016-2019. By comparison, the proportion in males reached 73% in 2022-23 after a marginal decrease from 73% to 68% between 2016 and 2019.
About the data
This measure comprises the proportion of those aged 12-17 years who reported consuming no alcohol in the previous 12 months.
Data are sourced from Australian School Students Alcohol and Drug Surveys. The proportion of secondary school children who reported consuming no alcohol in the previous 12 months was determined by subtracting those who did report consuming alcohol in the previous 12 months from the total population.
The Australian School Students Alcohol and Drug Survey (ASSAD) survey is a triennial national survey since 1984. This is the largest national survey of adolescent substance use in Australia. It is administered on school premises without parental involvement, which has been shown to result in more accurate estimates of smoking and vaping compared to other survey methods.19 The ASSAD survey sampled secondary school students aged 12 to 17 years with representation across all Australian states and territories (including metropolitan and regional areas). Students were asked if they have ever had even part of an alcoholic drink (‘lifetime (ever) drinking’), had an alcoholic drink in the last twelve months (‘past year drinking’), had an alcoholic drink in the last four weeks (‘past month drinking’), and the number of alcoholic drinks they had on each of the last seven days (‘past week drinking’ if they had an alcoholic drink on any of these days).15
Caution should be taken when interpreting trends over time due to:15
(i) Changes in the national survey methodology for 2022/2023 (e.g., a shift from pen-and-paper to online survey mode, and providing schools with the option of having classroom teachers administer the survey in place of research staff in some jurisdictions).
(ii) The additional time lag between the COVID-delayed 2022/2023 survey round and the previous ASSAD survey round in 2017 (i.e., about five years instead of three years).
(iii) Data collection being spread across two academic school years for the most recent survey round (compared with a single academic school year for all previous survey rounds).
(iv) The smaller number of schools and students included in the final sample for 2022/2023. This would have reduced the precision of the prevalence estimates (i.e., the confidence intervals around each estimate would be larger).
Data sources
Australian data: Cancer Council Victoria, Tobacco and alcohol use among Australian secondary school students (ASSAD), 1984-2017. https://www.cancervic.org.au/research/behavioural/major-topics-projects/tobacco/australian-secondary-student-smoking-behaviours.html
The ASSAD data for surveys in 1984, 1987, 1990, 1993, 1996, 1999, 2002, 2005, 2008, 2011, 2014, 2017 and 2022-2023 were reported separately. Examples are as follows:
- Hill D, Willcox S, Gardner G, and Houston J. Tobacco and alcohol use among Australian secondary schoolchildren. Medical Journal of Australia, 1987; 146(3):125–30. Available from: http://www.ncbi.nlm.nih.gov/pubmed/3494905
- Hill D, White V, Pain M, and Gardner G. Tobacco and alcohol use among Australian secondary school students in 1987. Medical Journal of Australia, 1990; 152(3):124–30. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2300011
- Hill D, White V, Williams R, and Gardner G. Tobacco and alcohol use among Australian secondary school students in 1990. Medical Journal of Australia, 1993; 158(4):228–34. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8426543
- Hill D, White V, and Segan C. Prevalence of cigarette smoking among Australian secondary school students in 1993. Australian Journal of Public Health, 1995; 19(5):445–9. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1753-6405.1995.tb00408.x/full
- Hill D, White V, and Letcher T. Tobacco use among Australian secondary students in 1996. Australian and New Zealand Journal of Public Health, 1999; 23(3):252–9. Available from: http://www3.interscience.wiley.com/journal/120141556/abstract
- Hill D, White V, and Effendi Y. Changes in the use of tobacco among Australian secondary students: results of the 1999 prevalence study and comparisons with earlier years. Aust NZ J Public Health, 2002; 26:156–63. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1467-842X.2002.tb00910.x/abstract
- White V and Hayman J. Smoking behaviours of Australian secondary school students in 2002. National Drug Strategy monograph series no. 54, Canberra: Australian Government Department of Health and Ageing, 2004. Available from: http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/content/mono54
- White V and Hayman J. Smoking behaviours of Australian secondary students in 2005. National Drug Strategy Monograph series no. 59, Canberra: Drug Strategy Branch, Australian Government Department of Health and Ageing, 2006. Available from: http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/mono59
- White V and Smith G. Tobacco use among Australian secondary students (PDF 87 KB) in Australian secondary school students’ use of tobacco, alcohol, and over-the-counter and illicit substances in 2008. Canberra: Drug Strategy Branch Australian Government Department of Health and Ageing; 2009. Available from: http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/Publishing.nsf/content/school08
- White V and Bariola E. Tobacco use among Australian secondary students in 2011, in Australian secondary school students’ use of tobacco, alcohol, and over-the-counter and illicit substances in 2011. Canberra: Drug Strategy Branch Australian Government Department of Health and Ageing; 2012. Available from: http://darta.net.au/wordpress-content/uploads/2017/01/ASSAD-2011.pdf
- White V and Williams T, Australian secondary school students’ use of tobacco in 2014. Centre for Behavioural Research in Cancer, Cancer Council Victoria; 2015. Available from: http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/Publishing.nsf/content/BCBF6B2C638E1202CA257ACD0020E35C/File/Tobacco%20Report%202014.PDF
- Guerin N and White V. Statistics & Trends: Australian Secondary Students’ Use of Tobacco, Alcohol, Over-the-counter Drugs, and Illicit Substances, Second edition. Cancer Council Victoria, 2020. Available from: https://www.health.gov.au/resources/publications/trends-in-substance-use-among-australian-secondary-school-students-1996-2017
- Scully M, Bain E, Koh I, Wakefield M, and Durkin S. Centre for Behavioural Research in Cancer. Cancer Council Victoria. Prepared for Australian Government Department of Health and Aged Care. ASSAD 2022–2023: Australian secondary school students’ use of tobacco and e-cigarettes. Available from: https://www.health.gov.au/sites/default/files/2023-11/secondary-school-students-use-of-tobacco-and-e-cigarettes-2022-2023.pdf
References
Data:
Centre for Behavioural Research in Cancer. Cancer Council Victoria. Prepared for Australian Government Department of Health and Aged Care. Australian secondary school student alcohol use. Since 1984 https://www.cancervic.org.au/research/behavioural/major-topics-projects/alcohol/australian-secondary-school-student-alcohol-use.html
Policy:
National Health and Medical Research Council (NHMRC). Australian guidelines to reduce health risks from drinking alcohol. Canberra: NHMRC; 2020; Available at: https://www.nhmrc.gov.au/about-us/publications/australian-guidelines-reduce-health-risks-drinking-alcohol#block-views-block-file-attachments-content-block-1
National Alcohol Strategy 2019-2028. Available at https://www.health.gov.au/resources/publications/national-alcohol-strategy-2019-2028?language=en
References:
- Rehm J, Gmel GE Sr, Gmel G, et al. The relationship between different dimensions of alcohol use and the burden of disease-an update. Addiction. 2017 Jun;112(6):968-1001.
- Murray CJL, Aravkin AY, Zheng P et al. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020; 396: 1223-1249.
- Rumgay H, Shield K, Charvat H, et al. Global burden of cancer in 2020 attributable to alcohol consumption: a population-based study. Lancet Oncol. 2021 Aug;22(8):1071-1080.
- Cancer Australia 2015. Lifestyle risk factors and the primary prevention of cancer. Sydney: Cancer Australia. Accessed Apr 2023; http://canceraustralia.gov.au/publications-and-resources/position-statements/lifestyle-risk-factors-and-primary-prevention-cancer
- Pandeya, N., Wilson, L. F., Webb, P. M., et al. Cancers in Australia in 2010 attributable to the consumption of alcohol. Aust N Z J Public Health. 2015;39(5):408-13.
- Bagnardi, V., Rota, M., Botteri, E., et al. Alcohol consumption and site-specific cancer risk: a comprehensive dose-response meta-analysis. Br J Cancer. 2015;112(3):580-93.
- Loomba R., Yang H.-I., Su J., et al. Synergism between obesity and alcohol in increasing the risk of hepatocellular carcinoma: a prospective cohort study. Am J Epidemiol 2013; 177: 333–342.
- Schutze, M., Boeing, H., Pischon, T., et al. Alcohol attributable burden of incidence of cancer in eight European countries based on results from prospective cohort study. BMJ. 2011;342d1584.
- Australian Institute of Health and Welfare 2020. National Drug Strategy Household Survey 2019. Drug Statistics series no. 32. PHE 270. Canberra AIHW. Accessed Apr 2023; https://www.aihw.gov.au/reports/illicit-use-of-drugs/national-drug-strategy-household-survey-2019/contents/summary
- Australian Institute of Health and Welfare 2022. Alcohol, tobacco & other drugs in Australia. Accessed Apr 2023; https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia/contents/drug-types/alcohol
- Australian Institute of Health and Welfare 2021. Australian Burden of Disease Study 2018: Interactive data on risk factor burden. Accessed Apr 2023; https://www.aihw.gov.au/reports/burden-of-disease/abds-2018-interactive-data-risk-factors/contents/alcohol-use
- National Research Council (US) and Institute of Medicine (US) Committee on Developing a Strategy to Reduce and Prevent Underage Drinking; Bonnie RJ, O'Connell ME, editors. Reducing Underage Drinking: A Collective Responsibility. Washington (DC): National Academies Press (US); 2004. 3, Consequences of Underage Drinking. Accessed May 2024: https://www.ncbi.nlm.nih.gov/books/NBK37591/
- National Health and Medical Research Council. Australian Guidelines to Reduce Health Risks from Drinking Alcohol. Commonwealth of Australia, Canberra. Accessed May 2024; https://www.nhmrc.gov.au/about-us/publications/australian-guidelines-reduce-health-risks-drinking-alcohol
- Commonwealth of Australia as represented by the Department of Health. The National Alcohol Strategy 2019–2028. 2019. Accessed May 2024; https://www.health.gov.au/sites/default/files/documents/2020/11/national-alcohol-strategy-2019-2028.pdf
- Centre for Behavioural Research in Cancer. Cancer Council Victoria. Prepared for Australian Government Department of Health and Aged Care. ASSAD 2022–2023: Australian secondary school students’ use of alcohol and other substances. Accessed May 2024; https://www.health.gov.au/sites/default/files/2024-02/secondary-school-students-use-of-alcohol-and-other-substances-2022-2023_0.pdf
- AIHW (Australian Institute of Health and Welfare). National Drug Strategy Household Survey 2022–2023: Young people’s consumption of alcohol. Accessed May 2024; https://www.aihw.gov.au/reports/alcohol/young-people-alcohol