Drunkenness among Young People: A Cross-National Comparison* HOLGER SCHMID, PH.D.,' TOM TER BOGT, PH.D., t EMMANUELLE GODEAU, M.D.,* ANNE HUBLET, M.A.,' SONIA FERREIRA DIAS, M.A.,' AND ANASTASIOS FOTIOU, M.A. t Research Department, Swiss Institute for the Prevention ofAlcohol and Drug Problems, P.O. Box 870, CH-I 00I Lausanne, Switzerland ABSTRACT. Objective: International studies show a rise in drunken- ness among young people in recent years. In this study the number of drunkenness occasions among 15-vear old students in 22 countries is reported. The cross-national association between drunkenness, on the one hand, and the frequency of alcohol intake and the preference for distilled spirits, on the other, is described. Variation between countries is examined on the basis of national characteristics, including national prevention policies. Method: Data on alcohol use were taken from the 1998 World Health Organization (WHO) collaborative, cross-national survey on Health Behaviour of School-Aged Children. The multinational representative sample consisted of 10,951 male and 11,451 female (drinling) students. Country characteristics were derived from the WHO Global Alcohol Database. Hierarchical Generalized Linear Model was used to analyze the effects of country characteristics on individual drunk- enness. Results: The lifetime prevalence of drunkenness was 57. 1% for males and 50.4% for females. The number of drunkenness occasions showed a significant variation in the 22 countries. The correlation be- tween drunkenness and preference for distilled spirits was positive in 21 countries and strong (Spearman's p > 0.40) in some eastern coun- tries. Geographic location turned out to be an important country-level association with drunkenness and its predictors. Southern European countries showed moderate associations, whereas strong associations were found in Scandinavia, the Baltic countries and Russia. Conclusions: Cultural differences in alcohol use exist, and frequency of alcohol in- take and use of spirits influence drunkenness. Despite the potential in- fluence of preventive policy measures on drunkenness, no preventive effect of the measures included in this study was found. (J Stud Alco- hol 64: 650-661, 2003) THE THREE MOST FREQUENT forms of mortality among adolescents, accidental death, homicide and sui- cide, are associated with alcohol use (Edwards et al., 1994; Sells and Blum, 1996; World Health Organization [WHO], Received: December 13, 2002. Revision: April 10, 2003. *Health Behavior in School-Aged Children (HBSC) is a World Health OrganizationIEURO collaborative study. International coordinator of the 1997/98 study: Candace Currie, University of Edinburgh, Edinburgh, Scot- land; data bank manager: Bente Wold, University of Bergen, Bergen, Nor- way. This publication on the 1997/98 HBSC reports on data from the follow- ing countries (principal investigator[s] at that time): Austria (Wolfgang Dur); Belgium (Flanders) (Lea Maes); Canada (Will Boyce, Alan King); Czech Republic (Ladislav Csemy); Densark (Pernille Due, Bjorn E. Holstein); Estonia (Mai Maser); Finland (JormaTynjfla); France (Christiane Dressen); Germany (Klaus Hurrelnann); Greece (Anna Kokkevi); Greenland (Michael Pedersen); Hungary (Anna Aszmann); Latvia (leva Ranka); Lithuania (Apolinaras Zaborskis); Norway (Bente Wold); Poland (Barbara Woynarowska); Republic of Ireland (Saoirse Nic Gabhainn); Russia (Alexander Komkov); Slovak Republic (Miro Bronis); Sweden (Ulla Marklund); Switzerland (Beatrice Janin Jacquat); United States (Mary Overpeck). tCorrespondence regarding this article may be sent to Holger Sclimid, Ph.D., at the above address, or via email at: hschmidCa,sfa-ispa.ch. Tom ter Bogt is with the Department of Child and Adolescent Studies, Universiteit Utrecht, The Netherlands; Emmanuelle Godeau is with Service Medical du Rectorat de Toulouse, Toulouse, France; Anne Hublet is with the Depart- ment of Public Health, Ghent University, Ghent, Belgium; S6nia Ferreira Dias is with CMDT/lnstituto Higiene e Medicina Tropical, Univetidade Nova de Lisboa, Lisbon, Portugal; and Anastasios Fotiou is with the University Mental Health Research Institute, Athens, Greece. 2000; Zador et al., 2000). Nearly 9 out of 10 teenage auto- mobile accidents, for example, point to the use of alcohol (Windle et al., 1996). When the purpose of alcohol con- sumption is to achieve intoxication, strong health effects can be expected for young people. Intoxication implies a loss of motor control, judgment ability and reduced inhibi- tion that can easily occur in young adolescents with the intake of even a relatively small amount of alcohol (Midanik, 1999; Windle et al., 1996). Epidemiological data describing trends in the prevalence of drunkenness show a considerable rise in drunkenness and a high prevalence of drunkenness in general. The Moni- toring the Future Study reports that over 50% of high school seniors have been drunk at least once in the past year, 31 % have recently engaged in heavy episodic drinking and nearly 4% drink daily (Johnston et al., 1998). The Health Behav- ior in School-Aged Children (HBSC) study allows an in- temational comparison. When the surveys of 1993/1994 and 1997/1998 are compared, 9 out of 12 participating coun- tries show an increase in the proportion of 15 year olds having been drunk two or more times (Nic Gabhainn and Francois, 2000). The European School Survey Project on Alcohol and Other Drugs (ESPAD) reports that in the large majority of the 30 included countries, more than half of the 15-year-old students have been drunk at least once in their life (Hibell et al., 2000). Moreover, when looking at changes between the survey years 1995 and 1999, in none of the included countries have figures decreased, and in about one 650