Individual and community correlates of young people's high-risk drinking in Victoria, Australia
Introduction
Large numbers of young people have been hospitalised, injured in road crashes, assaulted and affected by domestic violence in Australia because of their short-term risky1 drinking (Laslett et al., 2006). Australian survey data show that short-term risky drinking patterns typically increase with age, peaking at around 18–25 years (AIHW, 2005). A range of studies have examined the correlates of heavy drinking amongst young people (using a range of definitions—generally drinking above specified levels), finding significant individual-level (see Hawkins et al., 1992) and community-level (e.g. Beyers et al., 2004, Wechsler, 2000) effects. Increasingly, researchers are focussing on models that incorporate both of these levels, providing a richer understanding of a range of outcomes (Diez-Roux, 2000).
The individual-level correlates of drinking among young people have been summarised in previous reviews (Hawkins et al., 1992, Loxley et al., 2004). Briefly, these studies have shown that heavy episodic drinking is related to a variety of individual, familial, school, peer and cultural factors (Hawkins et al., 1992). Typically, individuals poorly integrated with their school, peers and family, living in poor social environments engage in socially negative behaviours such as risky drinking at a young age. Such findings are not surprising given the social determinants of broader health behaviours and evidence in the literature on adult drinking behaviours. However, the majority of studies conducted on youth drinking have focused on any drinking or risky or high-risk drinking defined typically as around 5 or more drinks on any one occasion (Bond et al., 2005, Casswell et al., 2002). The place of alcohol in Australian culture means that these behaviours are commonplace, with such drinking often regarded as a “rite of passage” (Patton et al., 2004). Therefore it is important to examine riskier drinking patterns (e.g. 10 or more drinks on an occasion) and whether the patterns of correlates and predictors of risky drinking patterns flow through to the very high-risk drinking patterns examined in our study.
Community-level effects on drinking and drinking-related harms have been investigated in studies in Australia and overseas, generally on adult populations (Blomgren et al., 2004, Dietze et al., 2000, Makela, 1999, Scribner et al., 1995). Alcohol outlet density was related to estimated per capita consumption at a local area level in Australia, with higher rates of density and consumption related to higher rates of harm (Dietze et al., 2000). Studies in the USA have linked alcohol outlet density to alcohol consumption and harms for young drinkers (Treno et al., 2003, Weitzman et al., 2003). While studies directly examining the link between neighbourhood socio-economic status and adult alcohol consumption have found mixed results (Jonas et al., 1999, Karvonen and Rimpela, 1997, Pollack et al., 2005), more poverty is generally associated with more harm (Jonas et al., 1999). Australia is highly urbanised and there are marked variations in Australian consumption according to level of urbanisation with regional and rural locations associated with higher rates of drinking and harm than metropolitan areas (Chikritzhs et al., 2003, JonesWebb et al., 1997).
We analysed the Victorian Youth Alcohol and Drug Surveys (VYADS) – surveys commissioned by the Premier's Drug Prevention Council (PDPC) – an advisory body to the Victorian Premier – that provide patterns and trends in alcohol and other drug use among young Victorians (see Premier's Drug Prevention Council, 2005). Previous analyses highlighted the prevalence of risky and high-risk drinking, defined by National Health and Medical Research Council (NH&MRC) guidelines (2001). Further, regular very high-risk drinking patterns (males >20 Australian standard drinks2 and females >11 Australian standard drinks per occasion at least 12 times in the last 12 months) were reported by 18% of all respondents. These findings are cause for considerable concern. We analysed the surveys to determine key individual-level correlates of very high-risk drinking. We also examined whether community-level factors were related to young people's very high-risk drinking over and above these individual-level correlates through multi-level modelling.
Section snippets
Survey methods
The data in this study come from the 2003 and 2004 VYAD Surveys conducted by a market research provider for the PDPC. Computer Assisted Telephone Interviews were conducted with households selected at random from landline telephone numbers listed in the Electronic White Pages (EWP) for the Australian state of Victoria. This method excludes residents with unlisted numbers, as well as homeless or institutionalised people. Around 20% of Australian households have unlisted phone numbers (Grande et
Results
Around 20% (2167) of the sample reported monthly very high-risk drinking. An initial exploration of the association between gender, age and very high-risk drinking showed a non-linear relationship. Male and female rates of very high-risk drinking were similar for the younger respondents, but while the rate for females decreased as age increased from 19 to 24, the male rate remained stable (Table 1). Therefore, we analysed age as a categorical variable and its interaction with gender was
Discussion
The criteria we used for defining very high-risk drinking, 20 standard drinks for males and 11 standard drinks for females is conservative in comparison to most studies, probably closely resembling the lay concept of what constitutes “binge” drinking. A substantial proportion of this sample of young people reported monthly or more frequent very high-risk drinking.
The pattern of effects of the individual-level correlates we examined was largely consistent across all of the analyses and was also
Conclusions
Our analysis of the correlates of this drinking pattern have replicated previous work and show that individual-level social, cultural and economic factors are important predictors of very high-risk drinking, with particularly strong effects for recreational income. In addition to individual-level factors we identified two community-level contextual variables, remoteness and packaged liquor outlet density that were also associated with rates of very high-risk drinking among young people.
Role of funding source
The work was funded by the Alcohol Education and Rehabilitation Foundation and PD is the recipient of a Career Development Award from the National Health and Medical Research Council; neither of these funding bodies had any further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.
Contributors
All authors designed the study and contributed to the analysis strategy. Laslett and Dietze managed the literature searches and summaries of previous related work. Livingston undertook the statistical analysis, and Laslett and Livingston wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript.
Conflict of interest
None.
Acknowledgements
This research utilises data from The Victorian Youth Alcohol and Drug Surveys undertaken in 2003 and 2004 for the Premier's Drug Prevention Council. We would like to thank the Council for facilitating access to these data. The work was funded by the Alcohol Education and Rehabilitation Foundation and PD is the recipient of a Career Development Award from the NH&MRC.
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