Research focus

Research staff:

This project was led by the National Drug Research Institute (Curtin University) in collaboration with the National Drug and Alcohol Research Centre (UNSW); Turning Point (Monash University); and St John of God Hospital (Bunbury, WA), and was funded by the Australian National Preventative Health Agency.

Tina Lam, National Drug Research Institute
Simon Lenton, National Drug Research Institute
Lucinda Burns, National Drug and Alcohol Research Centre
Alexandra Aiken, National Drug and Alcohol Research Centre
Rowan Ogeil, Turning Point
William Gilmore, National Drug Research Institute
Tanya Chikritzhs, National Drug Research Institute
Belinda Lloyd, Turning Point
Daniel Lubman, Turning Point
Richard Mattick, National Drug and Alcohol Research Centre
Steve Allsop, National Drug Research Institute

Why did we undertake this research?

Increasing evidence suggests that young Australians’ alcohol use is diverging into two trends. On one hand, more young people are choosing to abstain, and on the other, those who are drinking seem to be doing so at more risky levels (1-3). This latter group of risky drinkers is overrepresented in harm statistics such as hospitalisations (6), while being underrepresented in national health surveys that examine the Australian population as a whole. These young people may not be selected to participate in mainstream surveys due to the recruitment method (e.g. by only surveying in schools, or households with a landline), or not identified as very high risk drinkers due to the nature of the instruments (e.g. by excluding quantities of >20 drinks from the dataset)(1, 2). As these young people are particularly vulnerable to risk, a richer understanding of their contexts of use and the harms they experience, which can often go unreported in official statistics, is ­­­­­­required.

The first research objective was to describe the contexts of consumption, harms experienced and other alcohol-related issues amongst 16-19 year olds who drink in a risky manner. The ages of 16-19 were selected as key points when patterns of drinking can change dramatically. The second objective was to pilot a method to investigate trends in adolescent alcohol use over time and thus, if and when the project receives further funding, to detect developing patterns of problematic alcohol use and associated harms as successive years of data accrue. This model would serve as an early warning system, similar to that used with illicit drugs through the Illicit Drug Reporting System and the Ecstasy and Related Drugs Reporting System (4, 5).

What did we do?

Nine-hundred and fifty-eight (958) risky drinking young Australians aged 16-19 participated in this project. These young people were recruited as being within the heaviest drinking 20-25% of their age-bracket. Thus, female participants aged 16-19 and males aged 16-17 had to have been consuming 7 or more standard drinks per drinking session at least twice a month. The males aged 18-19 had to have been drinking 11 or more standard drinks at least twice a month. Whilst this sample is not representative of all 16-19 year old risky drinkers, respondents reported similar rates of high risk drinking to matched samples of risky young drinkers recruited using random sampling techniques surveys (3, 6) (7).

A mixture of face to face (F2F; n=351) and online (n=607) surveys were conducted in four jurisdictions – Perth, Melbourne, Sydney and the regional Western Australian city of Bunbury. The most popular recruitment method was through social media. Of the 958 participants, 52% were female, 20% were aged 16 years old, 34% aged 17, 21% aged 18 and 24% aged 19. Most were in full time study (36% in school, 32% in university, 8% in technical and vocational education), 9% were unemployed, 6% full time employed, 3% were trade apprentices, 3% otherwise occupied, and most and lived with their parents (80%).

A key section of the surveys centred on the ‘last risky drinking session’ – the most recent time the participant drank seven or more standard drinks in a single occasion. In addition to this last session, the survey also included information about ‘usual’ drinking patterns, outcomes of alcohol use, influences that were protective against risky drinking/alcohol related outcomes, venue access, promotions, labelling and policy support and demographic variables such as disposable income and living arrangements.

Seventy of the quantitative face-to-face interviewees also took part in a qualitative 30-minute interview. These respondents were engaged in open-ended discussions around the themes of: big nights (what they are understood to be, what happened at the last one, their first big night), parental engagement in drinking, ‘drinking careers’, pre-drinking, bringing your own alcohol to events, and use of stimulants with alcohol.

What did we find out?

There is widespread agreement in the existing research literature that managing the physical and economic availability of alcohol is paramount in efforts to minimise alcohol related harm (7-11). This section outlines some of the policy based findings from the project – firstly in terms of how the participants experienced regulations, and secondly to gauge their support for proposed policy measures. These findings are described in greater detail elsewhere (7).

Alcohol policies are regulations and practices designed to reduce alcohol related harms within society (12). For example, Australian licensees and their staff are obliged to not sell alcohol to anyone under the age of 18, and to not serve an intoxicated individual (13). However, it appeared that many of the age based restrictions on alcohol were commonly circumvented by this study’s 16-17 year old participants (‘the under 18s’; n=460).

• Half of the underage participants said it was 'easy' or 'very easy' in general for under 18s to purchase alcohol from the bottle store
• Half of the under 18s said it was ‘easy’ or ‘very easy’ the last time they tried to purchase from the bottle store. Excluding those who had never tried to purchase alcohol from a bottle store, three-quarters of the under 18s said their most recent attempt was ‘easy’ or ‘very easy’.
• Around forty percent of the 16-17 year olds said it was ‘easy’ or ‘very easy’ in general as well as in their own experience, to get into a licensed venue as someone under the age of 18
• Over half of the under 18s had previously attempted to enter a licensed venue. Of these young people, the majority did not have their ID checked the last time they went into a licensed venue.
• A fifth of the under 18s found it easy in their own experience to enter a licensed venue while intoxicated.

The face-to-face interviewees were asked to rank their degree of support for eight measures intended to reduce the problems associated with alcohol use (16-19 years old, n=351). Even amongst this heavy drinking group of young people, the following proposed policies held majority support (four other proposals did not receive majority support):

• Most supported increasing the price of a standard drink by 20¢ if the extra 20¢ was used to support prevention and treatment of alcohol problems (there was significantly less support for a 20¢ increase when prevention/ treatment was not included in the question)
• Most supported limiting advertising for alcohol on TV until after 9.30pm.
• Most supported requiring information on national drinking guidelines on all alcohol containers.
• Most supported limiting advertising for alcohol where the majority of the audience is likely to be under 18.

What does it mean?

The Young Australians Alcohol Reporting System (YAARS) achieved its dual aims of providing rich contextual detail about risky drinking practices, and showing the method was viable for reaching sentinel samples of young drinkers consuming alcohol at risky levels.

As an example of the first aim, it was found that participants commonly bypassed age-based restrictions on alcohol access and a large majority of underage respondents found it ‘easy’ or ‘very easy’ to make such a purchase the last time they tried. This is consistent with the literature (15), and supports the imperative that the discussion around risky consumption must also include policies addressing packaged liquor.

There is a consistent evidence base that price-based policies influence consumption and harm including among young people and heavy drinkers (8). However, there is some contention, especially amongst younger and riskier drinkers, about the implementation of price based strategies (1, 9). This study found support for an increase in price even among one of the populations at greatest risk of alcohol related harm. Similarly modest taxes have previously been found to reduce alcohol related mortality (10). Young Australians appear to support price-based alcohol taxation measures so long as the extra funds were earmarked for prevention and treatment of alcohol related problems.

Lastly, this pilot project demonstrated substantial utility in accessing the heaviest drinking 20-25% of Australian teenagers that are often underrepresented in other surveys, for example as they are no longer attending school at the time of survey. The characterisation of their last risky drinking session provided important detail on the context of their alcohol consumption and identified potential levers to reduce this harm.

Where to next?

The research team recommends continuing this project on an annual basis and across all Australian jurisdictions, thus creating an early warning system for changing patterns of use and harm, and the capacity to interrogate key issues of interest to governments and service providers (e.g. risky alcohol consumption among young rural Australians; alcohol related harm among young Aboriginal people; contexts of alcohol related violence and injury among young Australians; impact of policy change and strategies to prevent and reduce harm).

To date, Dr Tina Lam, Research Fellow at the National Drug Research Institute has received funding through Healthway (the Western Australian Health Promotion Foundation) to continue this research with young risky drinkers in metropolitan and regional areas of Western Australia.

Much of the material presented in this article is based on: Lam, T., Lenton, S. R., Burns, L., Aiken, A., Ogeil, R., Gilmore, W. T., Chikritzhs, T. N., Lloyd, B., Lubman, D. I., Mattick, R. and Allsop, S. J. (2015), Alcohol policy impact on young risky drinkers and their support for proposed measures. Australian and New Zealand Journal of Public Health, 39, (2), pp. 129-134.