title: Adolescent alcohol use: a reflection of national drinking patterns and policy?
abstract: OBJECTIVE
  To analyse how adolescent drunkenness and frequency of drinking were associated with adult drinking patterns and alcohol control policies.
  
  
  METHODS
  Cross-sectional survey data on 13- and 15-year-olds in 37 countries who participated in the Health Behaviour in School-Aged Children (HBSC) Study in 2010 (n = 144 788) were linked to national-level indicators on alcohol control policies and adult drinking patterns.
  
  
  METHODS
  Outcome measures were self-reported weekly drinking and life-time drunkenness (drunk once or more). Data were analysed using multi-level logistic regression models.
  
  
  RESULTS
  In the mutually adjusted models, adolescent drunkenness was associated significantly with high adult alcohol consumption [odds ratio (OR) = 3.15 among boys, 95% confidence interval (CI) = 2.13-4.64, OR girls = 2.44, CI = 1.57-3.80] and risky drinking patterns in the adult population (OR boys = 2.02, CI = 1.33-3.05, OR girls = 1.61, CI = 1.18-2.18). The level of abstainers in the adult population was also associated significantly with girls' drunkenness; a 10% increase in the number of abstainers in a country reduced the odds of drunkenness with 21% (OR = 0.79, CI = 0.68-0.90). Weekly drinking was associated significantly with weak restrictions on availability (OR boys = 2.82, CI = 1.74-4.54, OR girls = 2.00, CI = 1.15-3.46) and advertising (OR boys = 1.56, CI = 1.02-2.40, OR girls = 1.79, CI = 1.10-2.94).
  
  
  CONCLUSIONS
  Comparing data cross-nationally, high levels of adult alcohol consumption and limited alcohol control policies are associated with high levels of alcohol use among adolescents.
authors.affiliation: National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
authors.forename: Pernille
authors.initials: P
authors.lastname: Bendtsen
authors.forename: Mogens Trab
authors.initials: MT
authors.lastname: Damsgaard
authors.forename: Taisia
authors.initials: T
authors.lastname: Huckle
authors.forename: Sally
authors.initials: S
authors.lastname: Casswell
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Kuntsche
authors.forename: Petra
authors.initials: P
authors.lastname: Arnold
authors.forename: Margreet E
authors.initials: ME
authors.lastname: de Looze
authors.forename: Felix
authors.initials: F
authors.lastname: Hofmann
authors.forename: Anne
authors.initials: A
authors.lastname: Hublet
authors.forename: Bruce
authors.initials: B
authors.lastname: Simons-Morton
authors.forename: Tom
authors.initials: T
authors.lastname: ter Bogt
authors.forename: Bjørn E
authors.initials: BE
authors.lastname: Holstein
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology / Q000523:psychology*; D000435:Alcoholic Intoxication / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D011640:Public Policy
keywords: Adolescents; alcohol control policies; alcohol use; country-level predictors; cross-national studies; minimum purchasing age