Contents lists available at ScienceDirect Drug and Alcohol Dependence journal homepage: www.elsevier.com/locate/drugalcdep Leisure activities and alcohol consumption among adolescents from Peru and El Salvador Benjamín Prieto-Damm a,b , Pedro A. de la Rosa a,c , Cristina Lopez-del Burgo a,c,d , Maria Calatrava a,d , Alfonso Osorio a,d,e, ⁎ , Aranzazu Albertos a,d,e , Jokin de Irala a,c,d a Institute for Culture and Society, Universidad de Navarra, Campus Universitario, 31080, Pamplona, Spain b Tabancura School, Las Hualtatas 10500, Vitacura, Región Metropolitana, Chile c Preventive Medicine and Public Health, School of Medicine, Universidad de Navarra, Campus Universitario, 31080, Pamplona, Spain d IdiSNA, Navarra Institute for Health Research, Calle Irunlarrea 3, 31008, Pamplona, Navarra, Spain e School of Education and Psychology, Universidad de Navarra, Campus Universitario, 31080, Pamplona, Spain ARTICLE INFO Keywords: Adolescents Alcohol Underage drinking Structured leisure Unstructured leisure ABSTRACT Introduction: Structured and unstructured leisure are known protective and risk factors, respectively, for alcohol consumption during adolescence. However, little is known about the interaction between the two leisure types and alcohol consumption. Method: A cross-sectional study was performed among high-school students in El Salvador and Peru. Schooled adolescents, aged 13–18 (N = 5640), completed a self-administered questionnaire about risk behaviors, in- cluding their leisure activities and whether they had consumed alcoholic beverages. They were classified into tertiles of the amount of time of both structured and unstructured activities. A non-conditional multivariate logistic regression was conducted to evaluate the association of both types of leisure with alcohol consumption. We also used a likelihood ratio test to assess the potential interaction of structured and unstructured leisure time in alcohol consumption. Results: alcohol consumption was much more frequent among adolescents in the highest tertile of unstructured leisure time compared to the lowest one (Adjusted OR: 5.52; 95% CI: 4.49–6.78), and less frequent among those from the highest tertile of structured leisure time compared to the lowest one (Adjusted OR: 0.66; 95% CI: 0.55–0.80). We did not find an interaction effect between structured and unstructured leisure time with regard to initiation of alcohol consumption. Discussion: The study suggests that structured leisure is not enough to compensate for the possible harmful effect of unstructured leisure. Parents, educators and policy makers might be advised to discourage unstructured leisure among adolescents, and not simply to encourage structured leisure. 1. Introduction Alcohol consumption is common among adolescents (World Health Organization, 2014). Results from multiple surveys show that 13.4% of adolescents from the United Kingdom have consumed alcohol before 5 th grade (age 10–11) (Maggs et al., 2015). In South America, more than 50% of students aged 13–15 years of age had their first drink before age 14 (Pan American Health Organization, 2015). Among U.S. 12 th grade students (age 17), more than 40% have consumed alcohol at least once during the previous 30 days, and more than 20% have experienced binge drinking during that same period (Kann et al., 2018, supp. tables 98, 102). Alcohol consumption during adolescence may disturb normal brain development, causing behavioral and neurological disorders in adult- hood such as altered adult synapses and reduced adult neurogenesis (Crews et al., 2016). Adults who were alcohol drinkers during adoles- cence are at higher risk of health problems such as depression, suicide, chronic alcoholism (Cheng et al., 2016; Marshall, 2014), and lower academic competence (Koutra et al., 2012) compared to nondrinkers. Moreover, alcohol use contributes to the risk of injury, violence, risky sex, suicide attempts and illicit substance use in adolescents (Pan American Health Organization, 2015). Because of these consequences, underage drinking has been con- sidered a risky behavior (Centers for Disease Control and Prevention, 2018). Fortunately, some progress in reducing teenage alcohol intake and related problems has been made in recent years (de Looze et al., https://doi.org/10.1016/j.drugalcdep.2019.03.002 Received 18 December 2018; Received in revised form 6 March 2019; Accepted 9 March 2019 ⁎ Corresponding author at: Universidad de Navarra, Campus Universitario 31080, Pamplona, Spain. E-mail address: aosorio@unav.es (A. Osorio). Drug and Alcohol Dependence 199 (2019) 27–34 Available online 06 April 2019 0376-8716/ © 2019 Elsevier B.V. All rights reserved. T