
==== Front
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10.1080/09687637.2024.2335989
Article
Have declines in the prevalence of young adult drinking in English-speaking high-income countries followed declines in youth drinking? A systematic review
Dunphy Jessica a
Vieira Emma b
Stevely Abigail K. a
Livingston Michael bcd
Vashishtha Rakhi ce
Rivelin Kirsten a
Holmes John a
a Sheffield Addictions Research Group, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
b National Drug Research Institute, Curtin University, Perth, Australia
c Centre For Alcohol Policy Research, La Trobe University, Melbourne, Australia
d Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
e Health Services and Systems Research, Duke-NUS Medical School, Singapore
Emma Vieira emma.vieira@curtin.edu.au, National Drug Research Institute, Curtin University, Perth, Australia
22 5 2024
23 5 2024
20 9 2024
114
https://creativecommons.org/licenses/by/4.0/ This work is licensed under a BY 4.0 International license.

Background

Alcohol use in early adulthood is a significant public health concern. The prevalence of adolescent alcohol consumption has been declining in high-income English-speaking countries since the early 2000s. This review aims to examine whether this trend continues in young adulthood.

Methods

We systematically searched Medline, PsycInfo and CINAHL and the grey literature. Eligible records reported the prevalence of alcohol consumption amongst 18–25-year-olds over a minimum three-year time frame in the United States (US), Canada, the United Kingdom, the Republic of Ireland, Australia and New Zealand. Results were described using narrative synthesis. Quality assessment was undertaken using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies.

Results and conclusion

Thirty-two records from 22 different surveys were included. The prevalence of consumption amongst young adults fell in Australia, Ireland, and the United Kingdom and was stable in New Zealand and Canada. In the US, there was evidence of a decline in the prevalence of drinking among under-21s, but results for adults over the minimum purchase age were mixed. The prevalence of alcohol consumption in young adults appears to be broadly declining. This could lead to reduced rates of alcohol-related harms in the future. Further high-quality multinational surveys may help to confirm this trend.

Alcohol drinking
underage drinking
young people
adults
trends
==== Body
pmcIntroduction

Adolescent and young adult alcohol use is a significant public health concern (Marshall, 2014; WHO, 2018). Initiation of alcohol use generally occurs during adolescence (Marshall, 2014; WHO, 2018) and peaks during young adulthood (Leggat et al., 2022; Patrick et al., 2016). Early initiation of alcohol is associated with alcohol use disorders in adulthood, which cause a significant burden of morbidity and mortality worldwide (Degenhardt et al., 2018; Rehm et al., 2009; WHO, 2018). In addition, adolescent alcohol use clusters with other issues in emerging adulthood such as academic problems, tobacco and illicit drug use, and risky sexual behavior (Meader et al., 2016; Whitaker et al., 2021).

Recent data from the United States (US), Canada, Australia, and many European countries, however, shows that the proportion of the adolescent population who consume any alcohol has declined, including a reduction in how often they are drinking and how many drinks they consume per session (Kraus et al., 2018; Oldham et al., 2018; Pape et al., 2018; Vashishtha et al., 2021). The extent and timing of this decline varies between countries, with the earliest and largest declines seen in English-speaking countries and northern Europe (Kraus et al., 2018; Vashishtha et al., 2021). Despite a growing body of research, the reasons for this decline are not yet clear, with various factors suggested to have played a role (De Looze et al., 2019; Vashishtha et al., 2020, 2021). As adolescents mature into young adults and often look to move out of the parental home and start a career, their attitudes, preferences, activities and relationships are likely to change. Additionally, young adults are most likely to drink socially in public places (Hardie et al., 2023), making them significant and easily accessible targets for public health efforts. Consequently, it is important to continue to track trends in adolescent drinking into young adulthood to understand whether and why the decline in drinking within this generation persists.

Should the decline in adolescent drinking continue into young adulthood and beyond, it would be expected that alcohol-related harms would reduce significantly in the future (Aiken et al., 2018; Livingston & Vashishtha, 2019). Some researchers also suggest that even a shift towards later initiation of alcohol consumption may reduce alcohol-related harms in later life, though evidence for this is weak due to a paucity of studies able to make strong causal claims regarding the long-term effects of early initiation and the attenuation of any effects after adjustment for confounding factors within the existing studies (Enstad et al., 2019; Kim et al., 2017; Maimaris & McCambridge, 2014).

The decline in adolescent drinking, initially noted in the US, has been documented since the early 2000s (Pape et al., 2018; Vashishtha et al., 2021), thus the earliest cohorts who drove the decline have now progressed through young adult-hood (considered here to be 18–25 years). While there are several studies that have examined trends in adolescent drinking and provided explanations to declining trends among adolescents, there has not been equivalent research amongst the young adult population (Kraus et al., 2018; Vashishtha et al., 2021). Previously, Livingston and Vashishtha (2019) examined consumption trends in young adults and found mostly mixed evidence for a decline in alcohol consumption among young adults. However, this research was not entirely systematic, comparing different age groups and consumption measures, and was based solely on literature which was readily accessible in the public domain (Livingston & Vashishtha, 2019). There has not yet been an attempt to systematically review the literature on trends in young adult drinking.

This is the first systematic review to comprehensively examine the trends in the prevalence of young adult alcohol consumption over time. The primary aim of the review was to determine whether the proportion of young adults aged 18–25 years who consume alcohol has changed over time since 2000 in selected high-income countries which have seen a decline in adolescent drinking. Prevalence of alcohol consumption was chosen as the outcome of interest as it has fallen substantially among adolescents, is commonly measured, and is related to overall population risk (Rossow & Romelsjö, 2006; Sobell & Sobell, 2004). Whether there was a difference between males and females in how prevalence changed over time was considered as a secondary outcome.

Materials and methods

This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline (Page et al., 2021). The protocol for the review is available in Supplementary Material 1 and was not pre-registered.

Eligibility criteria

As this review involves prevalence data, we used the condition-context-population (CoCoPop) framework to focus the research question (Munn et al., 2015). Full eligibility criteria are shown in Table 1.

Condition (variable of interest)

Studies were eligible if they reported the total, male or female prevalence of alcohol consumption or abstention in a country of interest. This must have been reported over a given time period (e.g. past week). Figures reported in papers as abstention were converted to consumption by calculating (100%-proportion of abstainers). Initial plans were to include heavy/binge drinking measures however resource constraints meant that this was not possible after searches were completed (see protocol changes in Supplementary Material 1).

Context

The time period of interest was 2000 or later to ensure data was captured from the period after the initial adolescent drinking decline had been noted (Pape et al., 2018; Vashishtha et al., 2021). The included surveys needed to report 2 data points over a minimum 3-year time span to ensure some potential for medium-term change. Surveys with multiple cross-sectional reports across the study period were eligible for inclusion.

The countries of interest were English-speaking, high-income countries which have seen a decline in adolescent drinking (Kraus et al., 2018; Oldham et al., 2018; Pape et al., 2018; Vashishtha et al., 2021). High-income countries were defined in line with the World Bank categorization (The World Bank, n.d.). English-speaking countries were chosen for two key reasons. Firstly, many of the countries which have seen some of the earliest and steepest declines in adolescent drinking are English-speaking nations (Vashishtha et al., 2021). Choosing countries which have had early, steep declines in adolescent drinking ensures a longer time period to assess any concomitant changes in young adult drinking and a greater likelihood of such changes occurring. Additionally, scoping searches identified that a high proportion of records would come from grey literature, which is usually published in a country’s national language. English-speaking countries were chosen as time and resource constraints precluded translation of records from other languages into English.

Given these geographical and technical constraints, records from a total of six countries were eligible for inclusion: Australia, Canada, Ireland, New Zealand, the United Kingdom (UK), and the United States (US). The United Kingdom has four constituent nations: England, Northern Ireland, Scotland, and Wales (UK Parliament, 2016). Each country has its own surveys with relatively few UK-wide surveys on alcohol consumption. Consequently, trends in these constituent nations were considered separately where appropriate.

Population

There was no clear a priori definition of ‘young adulthood’; the core age range of 18–25 was chosen as this has precedent in other related literature (Drazdowski, 2016; Kinouani et al., 2020; Petker et al., 2019; Scott et al., 2018). For reports to be eligible, all recorded ages within the survey or the particular survey age group band had to be between 16 and 34, including at least one year in the core 18–25 range. For example, an age group of 25–34 years would be included as it included one year (25 years) in the core range, whereas an age group of 26–34 years would not have been included. The exception to this was where the highest age within the sample was 18 years (for example, 16–18-year-olds); these results were not included as they were felt to reflect adolescent, rather than young adult, age groups.

General population and higher education (college) student populations, which have a separate acknowledged drinking culture but comprise a significant proportion of the available estimates in some countries (National Institute on Alcohol Abuse and Alcoholism, 2014), were included in this review. College populations were included only where results were available from national or regional studies rather than single institutions, to ensure that the population was more representative of the college population of the country. Other narrowly defined populations, such as those with a long-standing medical condition, were excluded.

Search strategy

Electronic database searching was conducted in Medline, PsycInfo, and CINAHL from January 2000 to April 2021, using terms and synonyms for four concepts: alcohol consumption, young adults, trends over time, and the countries of interest. Search terms were combined to identify records which contained at least one term from each concept and additional search terms were used to exclude commonly identified irrelevant topics. Search strategies can be found in Supplementary Material 2.

Where it appeared that prevalence data had been collected as part of the study process but was not reported in the record, we first determined whether that information was available from another source such as a survey report. On the single occasion where information was not available from an alternative source, the corresponding author was contacted via email. When multiple articles used the same survey source, the author of the most recent report was contacted. Where no reply was received or data was not available, this record was excluded from the review.

Full reference list screening was conducted for included records and forward searches of the first 50 citations for each article on Google Scholar were completed to determine if any further articles were eligible for inclusion. A list of potential grey literature sources was compiled using an initial scoping search of ‘[country] +young adult + alcohol + survey’ on Google. Additional sources were identified through informal discussion with international researchers and other stakeholders within the authors’ network. A final version of this list is available in Supplementary Material 3.

Screening and data extraction

One reviewer conducted most of the screening and data extraction (JD). A second reviewer (KR) independently assessed 15 randomly selected papers from the three database searches against the documented eligibility criteria at the ‘title and abstract’ stage, with full agreement between the two reviewers. Data were extracted using a standardized form which was developed a priori. Data extracted included record identifying information, funding sources and conflict of interest, country, study design, population, survey used, sample size, time measure and prevalence of alcohol consumption and/or abstention. Where data were missing or unclear, no attempts were made to contact authors due to the time constraints of this review. Instead, this missing or unclear data is commented upon throughout the document.

We used the Joanna Briggs Institute Checklist for Prevalence Studies (The Joanna Briggs Institute, 2017) to assess the risk of bias in included records. This carried the advantage of allowing the assessment of multiple types of study design with the same tool. The risk of bias for each record was assessed at the outcome-level by a single reviewer (JD). This tool includes nine domains. The overall quality of each outcome was assessed qualitatively rather than arriving at an overall score. Where multiple surveys were included in the same record, each survey was assessed separately. Similarly, where multiple waves of surveys were included, quality assessment was undertaken on each wave separately. When considering response rates, an overall survey response rate of 50% or above was generally considered to be sufficient. Some judgement was used with this figure, however, given that relatively low response rates can be justified if the sample remains representative of the population being studied (Bethlehem et al., 2009; Hendra & Hill, 2019; Wright, 2015). Coverage of the population, another domain on the checklist, was used as a marker of quality. It was assessed by comparing the proportion of survey respondents in the young adult age band(s) to the estimated proportion of the population who fall into those age bands. Young adults tend to be under-represented in general population surveys, therefore a coverage rate of approximately 5% below the proportion of that age group in the general population was considered acceptable.

Synthesis of results

Meta-analysis was precluded at the scoping stage by the considerable heterogeneity in survey methods, population, age groups and time measure for the primary outcome, which was assessed qualitatively. As such, results are presented narratively at the survey-level, being divided into five population groups following data extraction: 18–25 years (US), 18–25 years (other countries), 18–35, 16–24 and college (higher level educational institutions). We chose these groupings based on a mix of frequency of use in survey reports and to separate out the US from other countries in the 18–25 group given the higher legal purchase age of 21 in the US. The results focus on the surveys with a minimum 10-year time span to ensure sufficient and robust trend data are available. The remaining surveys with time spans between 3- and 10-years are presented in Supplementary Material 4 and are discussed briefly throughout.

The primary outcome is presented as a change in the prevalence of alcohol consumption (% of total survey population) between the survey start year (first cross-sectional study available from 2000 onwards) and end year (last cross-sectional study available). To avoid overstating small changes, we chose to describe changes in prevalence of >5% as increases or decreases over time and changes of ≤5% as a stable prevalence over time. A secondary outcome comparing the difference in changes in alcohol consumption between sexes (male and female) was also considered.

Any reporting on the statistical significance of trends is reported at record-level (Supplementary Material 5). Most records use a p-value of ≤.05 for statistical significance, with the exception of White et al. (2015) who use a cut off of ≤0.01. The commentary also includes consideration of whether participants were of the legal minimum purchase age (MPA) for alcohol for the countries included (Table 2). Whilst this is not the same as the minimum legal age for alcohol consumption, many countries do not have an age limit on consumption per se, particularly outside licensed premises.

Results

Description of included studies

In total, 4400 records were identified from initial database searches conducted in April 2021, as can be seen in the PRISMA diagram (Figure 1). Additional grey literature and bibliography/citation searches identified a further 194 records, bringing the total to 4594 records identified. Of these, 41 records were included in the review. The main reasons for screening out records were a lack of inclusion of the primary outcome or failing to meet eligibility criteria regarding age categories, population, or required time periods (Table 3).

We included data from 22 surveys. For seven of these, we included data from two or more reports on a single wave or year. We treated these reports as a single record for synthesis purposes but as separate records for quality assessment. The 22 surveys therefore provided 32 records for synthesis and 41 for quality assessment. Record-level data is available in Supplementary Material 5 and further information about each survey – including the population, time period, measure, survey mode, and response rates – is available in Supplementary Material 6.

Of the 32 records used for synthesis, 31 included general population data. Two of these also included a subset of data from the 18–22-year-old US college population. The remaining record reported on the US college population only. Twenty-three (72%) records reported on alcohol consumption, mostly over the past year (n = 13, 41%), or the past month (n = 8, 20%). Fourteen (44%) records reported alcohol abstention figures, mostly over the past-year (n = 7, 22%) or lifetime abstention (n = 6, 19%). Forty-one percent of records (n = 13) were from the US. The remaining records included eight records (25%) from the UK, five records (16%) from Australia, two records (6%) from New Zealand, two records (6%) from Ireland and two records (6%) from Canada.

The two Canadian surveys included are closely related as, although there are some methodological differences, the key questions regarding the prevalence of alcohol consumption remain consistent over time (Canadian Centre on Substance Use and Addiction, 2017; Student Drug Use Surveys Working Group, 2013). This allowed for some tentative comparisons between the surveys, in line with the Canadian government reporting of this data (Government of Canada, 2020). Therefore, comparisons across both surveys are discussed in the text where relevant, with the results of both surveys reported in Supplementary Material 4 (as both surveys are under 10 years in length).

Study time periods ranged from 3 to 19 years. Ten records had relatively short durations of under 10 years. The results of these shorter duration surveys can be found in Supplementary Material 4. The results of the remaining 22 records are discussed below.

Risk of bias assessment

The quality of included records varied by domain of the checklist (Supplementary Material 7). All records used appropriate sampling frames and techniques, had an adequate sample size, and were assessed as reliably conducted using valid methods. Many studies, however, had important limitations. Firstly, many records did not adequately describe the population of interest in sufficient detail (29/41, 71%), considered here to be a sex breakdown for the age group in question. This made it difficult to determine how comparable populations were to each other, either between different surveys or for the same survey at different time points. Additionally, as is explored below, some surveys found differing trends for males and females. The relative proportions of males and females within the age group may therefore have impacted on the total population trend. While we can generally assume that there is likely to be an approximately equal proportion of males and females (50:50) in a well-sampled general population survey, where this was not reported we could confirm this.

Most records (31/41, 76%) reported adequate overall response rates, with the remainder not having response rates available in the public domain. The majority (31/41, 76%), however, did not include response rate or coverage by age, increasing uncertainty regarding whether the sample were representative of the young adult age group. Secondly, 80% of records (33/41) did not clearly report the numerator and denominator for prevalence data. This made it difficult to check the data, determine an accurate annual young adult sample size for whole population surveys and to calculate the non-response rate to alcohol-specific survey questions.

Trends in drinking prevalence

18–25 Years

Thirteen surveys reported on prevalence of alcohol consumption amongst 18–25-year-olds. Of the four American surveys (Table 4), the two which reported on 18–20-year-olds (under MPA in the US) found a decrease in total prevalence of consumption over time. For example, the prevalence of past-month consumption amongst 19–20-year-olds in one survey fell from 59.1% to 45.6% between 2000 and 2019 (Schulenberg et al., 2020). By contrast, results for US surveys where some or all adults were of MPA were more mixed with increases, decreases, and stability noted across different time measurements (Figure 2(a)). When considering males and females, most survey results indicate the same direction of trends for both sexes, except in the Monitoring the Future (MtF) results which indicated a decrease in prevalence for males but stability for females (Schulenberg et al., 2020).

When considering other countries (Table 5 and Figure 2(b)), survey results from the UK and Australia with time spans over 10 years indicated a mostly downward trend in total prevalence of alcohol consumption. The exception to this was the lifetime prevalence trends in the Australian National Health Survey (ANHS), which indicated stability (Australian Bureau of Statistics, 2002, 2017–18). These stable results were also mirrored in the New Zealand Health Survey’s past year prevalence trends (Ministry of Health, n.d.).

For survey results from studies with a less than 10-year timespan in this age group, the findings were also mostly stable. The only exceptions were an increase in female ‘nowadays’ consumption in the UK and a decrease in males past-year consumption in New Zealand.

18–35 Years

The seven US surveys that reported on older age groups showed mixed results (Table 6). Four surveys found no change, or mostly no change, in the prevalence of consumption over time. Two surveys found an increase in consumption over time. The final survey, Monitoring the Future, had stable results for lifetime and past year measures, but increased prevalence for overall past month and female past month measures. Two survey results show an increase in the prevalence of female consumption on a background of stable male consumption. For example, between 2006 and 2018, the prevalence of past-year consumption amongst 18–29-year-old females rose by 9% points from 61% to 70%, whilst the prevalence of male past-year consumption remained stable (McKetta & Keyes, 2019).

The six surveys from the UK, Ireland, Australia, and New Zealand generally found declines or stability in total prevalence of young adult alcohol consumption (Table 6). In contrast to data from the US, when male and female consumption patterns differed, female consumption generally followed a downward trend while male consumption remained stable. This was most notable in the ANHS where the prevalence of female past-year consumption fell by 11.4% points between 2001 and 2017/8, while the prevalence of male consumption fell just 1.7% points, remaining stable (Australian Bureau of Statistics, 2002, 2017–18). Examination of the full trend for all data points (data available on request), however, found that this increasing difference in prevalence between sexes is only consistent in the ANHS.

Surveys in New Zealand, Ireland, and some in the UK (England and Wales) with a time span under 10 years generally reported stability in the prevalence of consumption. The Adult Drinking Patterns in Northern Ireland survey noted a decrease in past week measures, and stability for males but a decrease for females in past year prevalence of consumption (Central Survey Unit, 2006, 2008; Information Analysis Directorate, 2014).

16–24 Years

Three surveys from the UK reported on 16–24-year-olds with a time span over 10 years, most of which found a decrease in prevalence of alcohol consumption over time, with two ‘nowadays’ measures resulting in stable findings (Table 7). Generally, the decline in prevalence of consumption was relatively similar between males and females, with the notable exception of the Opinion and Lifestyle Survey. Here, the prevalence of past week consumption amongst British males fell by 16% points from 64% to 48% between 2005 and 2017, double the 8% point decrease seen amongst females and resulting in equal prevalence between sexes at survey end point (Office for National Statistics, 2018). Both surveys from the UK with a time span under 10 years also found decreases in prevalence of alcohol consumption over time.

College (18–22 years)

Two US surveys reported on the college population, both of which found a decrease in the prevalence of alcohol consumption over time (Table 8). For example, NSDUH found an 8 percentage point fall in the prevalence of past-year consumption from 80.0% to 72.0% between 2002 and 2018 (McCabe et al., 2021).

Discussion

Principal findings

This is the first systematic review to comprehensively examine trends in the prevalence of young adult alcohol consumption over time. Outside of the US, studies generally showed clear declines (such as in Australia and Ireland), or a mix of stable and declining trends (in the UK), while New Zealand showed stable trends. Steep declines were especially evident within England compared to the rest of the UK, and in the 18–25 population within Australia. Studies under a 10-year time span generally showed stable trends across all countries.

Evidence from North America was more mixed, finding a decrease in prevalence of consumption among adults below MPA and among college-specific populations, but mixed trends for adults above the MPA. Of the seven surveys based in the US for adults above the MPA, three reported stable findings, two reported increases in prevalence, and two reported mixed findings based on survey measures and age ranges.

Some surveys, mainly from the US, found a convergence in the prevalence of consumption between sexes, but findings on this were not consistent. The included surveys were, however, heterogenous and the quality of many was limited by a lack of clear reporting on the size, response rate, and/or representativeness of the age-specific population.

We found that trends in young adult drinking in Great Britain, Ireland, and Australia generally mirrored adolescent drinking trends, which appears to suggest a sustained decline in alcohol consumption into young adulthood. Studies in Australia and Sweden have explicitly examined cohort consumption patterns and shown that declines in adolescent drinking continue into young adulthood but that cohort differences shrink, suggesting partial ‘catching up’ (Kraus et al., 2023; Livingston et al., 2021). If high-quality longitudinal surveys confirm this finding, this may have potential benefits going forward for both health and wider societal well-being (Oldham et al., 2018; WHO, 2018). It is important to note, however, that alcohol consumption remained high, with the majority of young adults of MPA in all surveys reporting consumption of alcohol within the past month.

The variable trends seen in the US are more difficult to interpret, as are the reasons why these trends diverged from the pattern seen in other countries included in this review. To some extent, this may be related to methodological differences between surveys. Additionally, demographic, political and cultural differences between and within countries could be important (Beard et al., 2017; Livingston, 2015; Pennay et al., 2019; Sudhinaraset et al., 2016). Taken with the decline in adolescent consumption, any increase in consumption amongst young adults may represent a shift towards later attainment of milestones, including initiation of alcohol consumption, as part of a ‘delayed adulthood’ (Hayford & Furstenberg, 2008; Twenge & Park, 2019).

Furthermore, the US has historically had lower levels of alcohol consumption, particularly among women, than the other countries in this review. Therefore, longer-term shifts towards increased alcohol consumption may be overlapping with the more recent shifts in youth drinking to produce trends that are distinct to the US. This divergence in trends between the US and other included countries appeared to result in a convergence towards a more similar prevalence of consumption between countries. This may actually suggest a homogenization of drinking cultures between countries, which has already been noted to some extent across the European Union (Bentzen et al., 2001; Smith & Mitry, 2007; Smith & Solgaard, 2000).

The differences in alcohol consumption by sex are also interesting. The more mixed picture in the US appeared to be driven by stable male consumption and increasing female consumption. Reasons for this are unclear. Again, the methodological weaknesses within the surveys may have a role. Additionally, gendered societal norms, both around drinking culture and wider social roles could have played a part (Keyes et al., 2008, 2019; Slade et al., 2016). The longer-term consequences of this converging trend between sexes could have potential practice-related implications with a need to raise awareness amongst health and social care practitioners of this changing demographic trend, along with careful monitoring of consumption and harm trends to inform future service planning.

Strengths and limitations

This is the first review to systematically synthesize findings on trends in the prevalence of young adult alcohol consumption and abstention. Literature searches identified over 4000 records, with over 30 included in the review. Records included data from large national surveys with rigorous sampling methodologies, so the trends identified are likely to be representative for the target population within each country. The lack of reported annual sample sizes and response rates for the age-specific survey populations do, however, make it difficult to determine whether certain demographic groups were under-represented (Meiklejohn et al., 2012; Nolen-Hoeksema, 2004).

Furthermore, the considerable methodological heterogeneity between surveys makes it difficult to directly compare results (Boniface & Shelton, 2013; Nugawela et al., 2016). The introduction of a large multinational study examining trends in alcohol consumption, similar to the adolescent European School Survey Project on Alcohol and Other Drugs (ESPAD), could help to address some of the methodological heterogeneity between surveys and may also allow comparison with additional non-English speaking countries which were excluded from this review, but would have significant logistical challenges (ESPAD Group, 2020).

Also, we chose to compare only data from the start and end year of each survey. There is also a risk that the data points used may not accurately represent the overall trend, however, since the data sources used were primarily large national surveys, the risk of high point-to-point variability is low.

Additionally, the self-reported nature of surveys increases the risk of social desirability and non-response biases, which could over- or under-estimate prevalence. There is evidence to support high non-response rates in both frequent drinkers and abstainers, so the impact of non-response on both individual survey responses and changes over time is difficult to assess (Boniface & Shelton, 2013; McCabe & West, 2016; Nugawela et al., 2016).

Also, this review focuses solely on one aspect of alcohol consumption: overall prevalence. Overall prevalence was chosen as it has fallen substantially among adolescents, is commonly measured, and is related to overall population risk. Further exploration and synthesis of literature on wider drinking habits would provide additional insights particularly with regard to the long-term health implications of these trends, especially as some studies point to differences in trends for heavy episodic drinking compared to any drinking (Kraus et al., 2023).

Finally, none of the included studies contained data from 2020 onwards. The COVID-19 pandemic has already had a short-term effect on drinking patterns in the young adult population. It would be valuable to examine the impact the pandemic has had on longer-term trends in consumption, although these are unlikely to be understood for several years.

Conclusions

Overall, we found evidence that young adult drinking is generally declining in countries outside of the US (i.e. UK, Ireland, Australia), but that trends are more mixed in North America. These findings suggest that previously identified declines in adolescent drinking are being maintained into young adult-hood and should lead to reduced rates of alcohol-related health and social harms in the future. There remain some key gaps in the evidence (e.g. for young adults in the UK) and reporting practices vary substantially between jurisdictions and surveys. High-quality, multinational surveys for these populations, similar to those conducted for adolescents (ESPAD Group, 2020; WHO, 2018) or based on the Standard EU Alcohol Survey (DEEP SEAS, n.d.), may help to improve the quality of this evidence.

Supplementary Material

Supplementary material

Acknowledgements

For the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. This study is supported by the National Institute for Health and Care Research (NIHR) School for Public Health Research (SPHR) (Grant Reference Number NIHR 204000) The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

Funding

AKS and JH were funded in whole, or in part, by the Wellcome Trust [208090/Z/17/Z]. ML was supported by the Australian Research Council (FT210100656). The funding sources had no role in the 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.

Figure 1 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram.

aSeven surveys included data from two or more reports on a single wave or year (Australian Bureau of Statistics, 2002, 2017–18; Bromley et al., 2008; Central Statistics Office, 2016, 2020; Central Survey Unit, 2006, 2008; Government of Canada, 2016, 2021; Ministry of Health, n.d.; Information Analysis Directorate, 2014; Schoenborn et al., 2004, 2013; Scottish Health Survey, 2020; The Scottish Government, 2009). We treated these reports as a single record for synthesis purposes but as separate records for quality assessment.

Figure 2 (a) The prevalence of alcohol consumption amongst 18–25-year-olds in the United States by consumption measure, 2000–2019 (Chen & Yoon, 2021; Dawson et al., 2015; Hasin et al., 2019; White et al., 2015; Schoenborn et al., 2004, 2013; Schulenberg et al., 2020; Slater et al., 2015; Substance Abuse and Mental Health Services Administration, 2020). (b) The prevalence of alcohol consumption amongst 18–25-year-olds in Australia, New Zealand and the United Kingdom, by country and consumption measure, 2000–2019/20 (Australian Bureau of Statistics, 2002, 2017–18; Australian Institute of Health and Welfare, 2021; Livingston, 2015; Ministry of Health, n.d.; Ng Fat et al., 2018). Orange lines represent an increase in prevalence of consumption of > 5% over the survey time frame; blue lines represent a decrease in prevalence of consumption of > 5% over the survey time frame; and green lines represent a stable prevalence of consumption of (change of ≤5%) over the survey time frame. (a) MTF: Monitoring the Future; NESARC: National Epidemiological Survey on Alcohol and Related Conditions; NHIS: National Health Interview Survey; NSDUH: National Survey on Drug Use and Health. (b): ANHS: Australian National Health Survey; HSE: Health Survey for England; NDSHS: National Drug Strategy Household Survey; NZHS: New Zealand Health Survey.

Table 1 Condition-Context-Population framework.

Element	Description	Key Concept for this Systematic Review	Inclusion Criteria	Exclusion Criteria	
Condition	Variable of interest	Proportion of the population who consume alcohol.
(Search terms were also used to search for the inverse – proportion of the population who do not consume alcohol)	Includes primary outcome (% of the population who do (not) consume alcohol)

	–	
Context	Context or specific setting such as geographical and time parameters	Geography: English-speaking high-income countries in Europe, North America and Australasia which have seen a decline in adolescent drinking
   Europe: Ireland and UK
   North America: Canada and US
   Australasia: Australia and New Zealand
Time: Minimum 3-year time span, with the two data points from 2000 or later	Includes national data from a country or countries of interest

Europe: Ireland and UK (England, Northern Ireland, Scotland or Wales)

North America: Canada and US

Australasia: Australia and New Zealand

Minimum 3-year time span, with the two data points from 2000 or later

	Subnational data (e.g. individual state-level survey)

	
Population	Appropriate population	Young adults (core age 18–25 years, range 16–34 years) from a general or student population	General population or school/university student population

Age range: must include an age in the range 18–25 years (minimum age in group used for data extraction 16 years, maximum age 34 years)

	Not general or student population – examples include populations comprised of individuals with specific medical conditions

	
Other	–	–	Repeated cross-sectional survey

Journal article, dissertation, survey report or online survey data from the survey’s author (for example, using a data explorer)

English language

	Cohort survey

Any other type of information source such as book chapters and other systematic reviews

	

Table 2 Minimum age (years) to purchase alcohol by country (International Alliance for Responsible Drinking, 2022).

Country	Minimum Purchase Age (Years) for Alcohol	
Australia	18	
Canada – Alberta, Manitoba, and Quebec	18	
Canada – British Columbia, Newfoundland
   and Labrador, New Brunswick, Nova
   Scotia, Northwest Territories, Nunavut,
  Ontario, Prince Edward Island,
   Saskatchewan and Yukon	19	
Ireland	18	
New Zealand	18 (reduced from 20 in
December 1999,
Gruenewald et al., 2015)	
United Kingdom	18	
United States	21 (for all states since
1984, APIS, n.d.)	

Table 3 Characteristics for each record and survey.

Study characteristic	Number of
included records
(% of all 32
included
records)a,b	Number of
included surveys
(% of all 22
included
surveys)a	
Age Group	18–25	19 (59)	13 (59)	
16–24	5 (15)	5 (23)	
18–35	18 (56)	17 (77)	
College (18–22)	3 (9)	2 (9)	
Measure	Consumption	23 (72)	18 (82)	
   Past-year	13 (41)	14 (64)	
   Past-month	8 (25)	4 (18)	
   Past-week	4 (13)	4 (18)	
   Lifetime	2 (6)	2 (9)	
   “Nowadays”	2 (6)	1 (5)	
Abstention	14 (44)	8 (36)	
   Past-year	7 (22)	6 (27)	
   Past-week	2 (6)	1 (5)	
   Lifetime	6 (19)	5 (23)	
   “Nowadays”	2 (9)	2 (9)	
Country	United States	13 (41)	7 (32)	
United Kingdom	8 (25)	7 (32)	
Australia	5 (16)	2 (9)	
New Zealand	2 (6)	2 (9)	
Ireland	2 (6)	2 (9)	
Canada	2 (6)	2 (9)	
Duration of
  Change Period	3–5 years	6 (19)		
6–10 years	8 (25)		
11–15 years	12 (38)		
16–20 years	10 (32)		
Source	Journal article	11 (34)		
Data sheet/explorer	11 (34)		
Report	10 (32)		
a Numbers may not sum due to rounding or because records/surveys include multiple populations, time periods and/or measures.

b Seven surveys included data from two or more reports on a single wave or year (Australian Bureau of Statistics, 2002, 2017-18; Bromley et al., 2008; Central Statistics Office, 2016, 2020; Central Survey Unit, 2006, 2008; Government of Canada, 2016, 2021; Ministry of Health, n.d.; Information Analysis Directorate, 2014; Schoenborn et al., 2004, 2013; Scottish Health Survey, 2020; The Scottish Government, 2009). We treated these reports as a single record for synthesis purposes but as separate records for quality assessment. Data from the more recent record considered here for ‘source’ purposes.

Table 4 Prevalence of consumption amongst US 18–25 year olds.

US 18-25	
				18–20					
Survey		Age Range
(Years)		Years	Measure	Prevalence (%)	% Change	Trend	
Monitoring the Future (Schulenberg et al. 2020)		19–20a		2000–2019	Past month	T: 59.1-45.6	−13.5	↘	
					Past year	T:79.7-64.3	−15.4		
National Survey on Drug Use and Health		18–20		2000–2019 (Chen & Yoon, 2021; Hasin et al., 2019; Slater et al., 2015; White et al., 2015)	Past month	T: 49.0-35.9	−13.1	↘	
						M: 52.4–33.8	−18.6		
						F: 45.4–38.2	−7.2		
				2002–2013	Lifetimeb	M: 82.4–74.2	−8.2		
				(White et al., 2015)		F: 81.0–74.6	−6.4		
				21-25					
Monitoring the Future (Schulenberg et al., 2020)		21–22		2000–2019	Past month	T: 70.5–68.4	−2.1	↔	
					Past year	T: 86.2–82.0	−4.2		
		23–24			Past month	T: 71.5–73.8	+2.3		
					Past year	T: 87.2–86.7	−0.5		
National Survey on Drug Use and Health (White et al., 2015)		21–25		2002–2012	Past month	M: 72.6–72.8	+0.2	↔	
						F: 60.6–65.4	+4.8		
					Lifetimeb	M: 91.6–90.9	−0.7		
						F: 88.4–90.1	+1.7		
				18-25					
Monitoring the Future (Schulenberg et al., 2020)		19–22		2000–2019	Past month	M: 67.8–56.4	−11.4	M: ↘	
						F: 62.2–58.2	−4.0	F: ↔	
National Epidemiological Survey on Alcohol and Related Conditions (Dawson et al., 2015)		18–24		2001/2–2012/13	Past year	T: 70.8–78.0	+7.7	↗	
National Health Interview Survey (Schoenborn et al., 2004, 2013)		18–24		1999–2001–2008–2010	Past year	T: 61.8–62.4	+0.6	↔	
						M: 67.1–65.9	−1.2		
						F: 56.6–58.9	+2.3		
					Lifetime	T: 66.5–66.6	+0.1	↔	
						M: 70.7–69.5	−1.2		
						F: 62.4–63.8	+1.3		
National Survey on Drug Use and Health		18–25		2002–2019 (SAMHSA, 2020)	Past month	T: 60.5–54.3	−6.2	↘	
				2002–2012 (White et al., 2015)	Past month	M: 65.2–62.6	−2.6	↔	
						F: 55.7–57.9	+2.2		
					Lifetimeb	M: 87.8–84.4	−3.4	↔	
						F: 85.5–84.4	−1.1		
Key: ↗: Increase of >5.0% between the start and end point provided. ↘: Decrease of >5.0% between the start and end point provided. ↔: Stable – any value with an increase or decrease of ≤5% between the start and end point provided. T: total; M: male; F: female.

a Monitoring the Future consists of a cross-sectional survey in 12th grade, with participants then selected to continue in a “panel” survey. This therefore has both cross-sectional and cohort elements.

b Reported in record as abstention data.

Table 5 Prevalence of consumption amongst 18–25 year old from Canada, United Kingdom, Australia and New Zealand.

Other Countries 18-25	
Country	Survey	Age Range (Years)	Years	Measure	Prevalence (%)	% Change	Trend	
UK (England)	Health Survey for England	18–24	2005–2015	“Nowadays”a	T: 85–76	−9.0	↘	
	(Ng Fat et al., 2018)							
Australia	Australian National Health Survey
(Australian Bureau of Statistics, 2002), 2017–18)	18–24	2001–2017/8	Past weekb	T: 63.3–48.4	−14.9	↘	
					M: 68.3–52.6	−15.4		
					F: 58.1–44.0	−14.1		
				Past yearb	T: 90.7–83.8	−6.9	↘	
					M: 91.6–84.4	−7.2		
					F: 90.0–83.3	−6.7		
				Lifetimeb	T: 93.3–88.6	−4.7	↔	
					M: 93.5–89.4	−4.1		
					F: 93.0–88.0	−5.0		
	National Drug Strategy Household Survey	18–24	2001–2019 (AIHW, 2021)	Past year	T: 90.3–79.2	−11.1	↘	
			2001–2013 (Livingston, 2015)	Lifetimea	T: 92.5–86.3	−6.2		
New Zealand	New Zealand Health Survey	18–24	2006/7–2018/19 (Ministry of Health, n.d.)	Past year	T: 89.1–85.6	−3.7	↔	
Key: ↗: increase of >5.0% between the start and end point provided; ↘: Decrease of >5.0% between the start and end point provided; ↔: Stable – any value with an increase or decrease of ≤5% between the start and end point provided. UK: United Kingdom; T: total; M: male; F: female.

a Author-calculated value based on data available in the original record.

b Reported in record as abstention data.

Table 6 Prevalence of consumption amongst 18–35-year-olds.

18–35 Years	
Country	Survey	Age Range (Years)	Years	Measure	Prevalence (%)	% Change	Trend	
US	Behavioral Risk Factor Surveillance System (Grucza et al., 2018)	18–29	2002–2013	Past month	T: 60.5–56.1	−4.4	↔	
Monitoring the Futurea	19–30	2000–2015 (Twenge & Park, 2019)	Lifetimeb	T: 89.5–86	−3.5	↔	
23–26	2000–2019 (Schulenberg et al., 2020)	Past month	M: 76.2–74.9	−1.3	M: ↔	
	F: 65.8–74.1	+8.3	F: ↗	
25–26	Past month	T: 68.7–75.0	+6.3	↗	
Past year	T: 84.2–87.8	+3.6	↔	
National Alcohol Survey (Grucza et al., 2018)	18–29	2000–2010c	Past yeard	T: 69.3–75.3	+6.0	↗	
National Epidemiological Survey on Alcohol and Related Conditions (Grant et al., 2017; Grucza et al., 2018)	18–29	2001/2–2012/3	Past month	T: 73.1–80.1	+7.0	↗	
National Health and Nutrition Examination Survey (Grucza et al., 2018)	18–29	2001/2–2013/4	Past yeard	T: 75.7–80.1	+4.4	↔	
National Health Interview Survey	18–29	2002–2013 (Grucza et al., 2018) 	Past year	T: 65.1d–68.3d	+3.2	↔	
2006–2018 (McKetta & Keyes, 2019)		M: 73–72	−1.0	M: ↔	
	F: 61–70	+9.0	F: ↗	
National Survey on Drug Use and Health	18–29 (Grucza et al., 2018)	2002–2012	Past year	T: 78.2–78.7	+0.5	↔	
					
					
UK (England)	Health Survey for England (NHS Digital, 2020)	25–34	2000–2019	Past weeke	T: 72–51	−21.0	↘	
		M: 77–57	−20.0		
		F: 67–45	−21.0		
UK (Scotland)	Scottish Health Survey**	25–34	2008–2019	Past year	T: 90–88	−2.0	T: ↔	
(Scottish Health Survey, 2020; The Scottish Government, 2009)				M: ↔	
			F: ↘	
2003-2019 (Bromley et al., 2008; Scottish Health Survey, 2020)		M: 93 to 92	−1.0		
	F: 90 to 84	−6.0		
Ireland	Irish National Drug and Alcohol Survey (Mongan et al., 2021)	25–34	2002/3–2019/20	Past year	T: 91.0–81.3	−9.7	↘	
Australia	Australian National Health Survey (Australian Bureau of Statistics, 2002, 2017–18)	25–34	2001–2017/18	Past weekf	T: 63.2–52.1	−11.1	↘	
	M: 73.0–61.3	−11.7		
	F: 53.7–43.5	−10.2		
Past yearf	T: 87.3–80.4	−6.9	T: ↘	
	M: 90.0–88.3	−1.7	M: ↔	
	F: 84.7–73.3	−11.4	F: N	
Lifetimee,f	T: 92.5–88.4	−4.1	T: ↔	
	M: 93.9–92.6	−1.3	M: ↔	
	F: 91.2–83.8	−7.4	F: ↘	
National Drug Strategy
Household Survey	18–29	2001–2013 (Callinan et al., 2017)	Lifetime	T: 87.0–79.0	−8.0	↘	
20–29	2001–2019	Past year	T: 91.1–78.0 (AIHW, 2020)	−12.1		
25–29		T: 91.2–76.4 (AIHW, 2021)	−14.8		
2001–2013 (Livingston, 2015)	Lifetime	T: 95.9–89.2	−6.7		
New Zealand	New Zealand Health Survey	25–34	2006/7–2018/19 (Ministry of Health, n.d.)	Past year	T: 86.7–82.3	−4.8	↔	
Key: ↗: Increase of >5.0% between the start and end point provided. ↘: Decrease of >5.0% between the start and end point provided. ↔: Stable – any value with an increase or decrease of ≤5% between the start and end point provided. US: United States; UK: United Kingdom; T: total; M: male; F: female.

a Monitoring the Future consists of a cross-sectional survey in 12th grade, with participants then selected to continue in a “panel” survey. This therefore has both cross-sectional and cohort elements.

b Figure obtained from a graph.

c Estimates are based on the fitted trend line for each survey, using all years of available data. These results were used to calculate the predicted average prevalence for each survey and each subgroup for the years 2002 and 2013.

d Note that the National Alcohol Survey takes place approximately every 5 years (2000, 2005, 2009/10, etc) and so did not have surveys in 2002 and 2013. The data here is based on a fitted trend line using all years of available data.

e Reported in record as abstention data.

f Author-calculated value based on data available in the original record.

Table 7 Prevalence of consumption amongst 16-24-year-olds.

16-24 Years	
Country	Survey	Age Range (Years)	Years	Measure	Prevalence (%)	% Point Change	Trend	
UK (England)	Health Survey for
England	16–24	2000–2019
(NHS Digital, 2020)	Past weeka	T: 63–40	−23	↘	
M: 67–43	−24	
F: 59–37	−22	
2005–2015
(Ng Fat et al., 2018)	Lifetimea	T: 91–83	−8	
UK (Great Britain)	Opinion and
Lifestyle Survey
(Office for National Statistics, 2018)	16–24	2005–2017	Past week	T: 60–48	−12	↘	
M: 64-48	−16	
F: 56–48	−8	
“Nowadays”a	T: 81–77	−4	↔	
M: 83–78	−5	
F: 80–76	−4	
UK (England)	Past week	T: 60–50	−10	↘	
M: 64–51	−13	
F: 56–49	−7	
“Nowadays”a	T: 81–77	−4	↔	
M: 83–78	−5	
F: 79–76	−3	
UK (Scotland)	Scottish Health
Survey	16–24	2008-2019
(Scottish Health Survey, 2020;
The Scottish Government, 2009) 2003-2019	Past yeara	T: 93–83	−10	↘	
M: 89–83	−6	
(Bromley et al., 2008; Scottish Health Survey, 2020)	F: 90–83	−7	
Key: ↗: Increase of >5.0% between the start and end point provided; ↘: Decrease of >5.0% between the start and end point provided.↔: Stable – any value with an increase or decrease of ≤5% between the start and end point provided. UK: United Kingdom; T: total; M: male; F: female.

a Reported in record as abstention data.

Table 8 Prevalence of consumption amongst in the college population.

College Population	
Country	Age Range (Years)	Survey	Years	Measure	Prevalence (%)	Percentage Change	Trend	
US	18–22 (1–4 years
after high
school)	Monitoring the Futurea	2000–2019	Past month (Schulenberg et al., 2020)	T: 67.4–62.2	−5.2	↘	
Past year	T: 83.2–77.6	−5.6		
(Schulenberg et al., 2020) Lifetime	T: 86.6–79.2	−7.4		
(Twenge & Park, 2019)				
18–22	National Survey on
Drug Use and Health (McCabe et al., 2021)	2002–2018	Past year	T: 80.0b–72.0b	−8.0	↘	
Key: ↗: Increase of >5.0% between the start and end point provided; ↘: Decrease of >5.0% between the start and end point provided; ↔: Stable – any value with an increase or decrease of ≤5% between the start and end point provided. UK: United Kingdom; T: total; M: male,; F: female.

a Monitoring the Future consists of a cross-sectional survey in 12th grade, with participants then selected to continue in a “panel” survey. This therefore has both cross-sectional and cohort elements.

b Reported in record as abstention data.

Disclosure statement

The authors report that there are no competing interests to declare. Each author certifies that their contribution to this work meets the standards of the International Committee of Medical Journal Editors.
==== Refs
Aiken A Clare PJ Wadolowski M Hutchinson D Najman JM Slade T Bruno R McBride N Kypri K Mattick RP Age of alcohol initiation and progression to binge drinking in adolescence: a prospective cohort study Alcoholism, Clinical and Experimental Research 2018 42 1 100 110 10.1111/acer.13525 29160941
Alcohol Policy Information System The 1984 National minimum drinking age act National Institute on Alcohol Abuse and Alcoholism (n.d.) https://alcoholpolicy.niaaa.nih.gov/the-1984-national-minimum-drinking-age-act
Australian Bureau of Statistics National health survey: Summary of results (Report No. 4363.0) Australian Bureau of Statistics 2002 https://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/90A3222FAD5E3563CA256C5D0001FD9D/$File/43640_2001.pdf
Australian Bureau of Statistics National health survey: First results ABS 2017–18 https://www.abs.gov.au/statistics/health/health-conditions-and-risks/national-health-survey/latest-release#data-downloads
Australian Institute of Health and Welfare National drug strategy household survey 2019 AIHW 2020 https://www.aihw.gov.au/reports/illicit-use-of-drugs/national-drug-strategy-household-survey-2019/contents/summary
Australian Institute of Health and Welfare National Drug Strategy Household Survey 2019. Data tables: National Drug Strategy Household Survey 2019 - 3 Alcohol supplementary tables [Data set] AIHW 2021 https://www.aihw.gov.au/reports/illicit-use-of-drugs/national-drug-strategy-household-survey-2019/data
Beard E Brown J Kaner E West R Michie S Predictors of and reasons for attempts to reduce alcohol intake: A population survey of adults in England PLOS One 2017 12 3 e0173458 10.1371/journal.pone.0173458 28278218
Bentzen J Eriksson T Smith V Alcohol consumption in European countries: Time series based tests of convergence Cahiers D’Economie et de Sociologie Rurales 2001 60-61 59 74 10.22004/ag.econ.206125
Bethlehem J Cobben F Schouten B Indicators for the representativeness of survey response Proceedings of Statistics Canada Symposium 2008 Statistics Canada 2009 https://www150.statcan.gc.ca/n1/en/pub/11-522-x/2008000/article/10976-eng.pdf?st=ar5ONhws
Boniface S Shelton N How is alcohol consumption affected if we account for under-reporting? A hypothetical scenario European Journal of Public Health 2013 23 6 1076 1081 10.1093/eurpub/ckt016 23444427
Bromley C Corbett J Erens B Moody A Scottish Health Survey: revised alcohol consumption estimates 2003 Scottish government 2008 https://webarchive.nrscotland.gov.uk/3000/https://www.gov.scot/Publications/2008/06/25104309/0
Callinan S Pennay A Livingston M Decreasing prevalence of social drinkers in Australia Addictive Behaviors 2017 67 20 25 10.1016/j.addbeh.2016.12.002 27984810
Canadian Centre on Substance Use and Addiction Canadian drug summary: Cannabis 2017 https://wwwcphaca/sites/default/files/uploads/resources/cannabis/ccsa-canadian-drug-summary-cannabis-2017-enpdf
Central Statistics Office Irish health survey 2015 Cork, Central Statistics Office 2016 https://www.cso.ie/en/releasesandpublications/ep/p-ihs/irishhealthsurvey2015/ct/
Central Statistics Office Irish health survey 2019 – main results Cork, Central Statistics Office 2020 https://www.cso.ie/en/releasesandpublications/ep/p-ihsmr/irishhealthsurvey2019-mainresults/
Central Survey Unit Adult drinking patterns in Northern Ireland 2005 Department of Health, Social Services and Public Safety 2006 https://www.health-ni.gov.uk/sites/default/files/publications/dhssps/adps-2005.pdf
Central Survey Unit Adult drinking patterns in Northern Ireland 2008 Department of Health, Social Services and Public Safety 2008 https://www.health-ni.gov.uk/sites/default/files/publications/dhssps/adps-2008.pdf
Chen CM Yoon YH Surveillance report #116: Trends in underage drinking in the United States, 1991-2019 National Institute on Alcohol Abuse and Alcoholism 2021 https://pubs.niaaa.nih.gov/publications/surveillance116/SR116_Underage_Drinking.pdf
Dawson DA goldstein RB Saha TD grant BF Changes in alcohol consumption: United States, 2001-2 to 2012-13 Drug and Alcohol Dependence 2015 148 56 61 10.1016/j.drugalcdep.2014.12.016 25620731
DEEP SEAS. (n.d.) The Standard European Alcohol Survey – Wave 2 Developing and Extending Evidence and Practice from the Standard European Alcohol Survey https://www.deep-seas.eu/standard-eu-alcohol-survey/
Degenhardt L Charlson F Ferrari A Santomauro D Erskine H Mantilla-Herrara A Whiteford H Leung J Naghavi M griswold M Rehm J The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990-2016: a systematic analysis for the global Burden of Disease Study 2016 The Lancet Psychiatry 2018 5 12 987 1012 10.1016/S2215-0366(18)30337-7 30392731
De Looze M van Dorsselaer S Stevens GWJM Boniel-Nissim M Vieno A Van den Eijnden RJJM The decline in adolescent substance use across Europe and North America in the early twenty-first century: A result of the digital revolution? International Journal of Public Health 2019 64 2 229 240 10.1007/s00038-018-1182-7 30560293
Drazdowski TK A systematic review of the motivations for the non-medical use of prescription drugs in young adults Drug and Alcohol Dependence 2016 162 3 25 10.1016/j.drugalcdep.2016.01.011 26851986
Enstad F Evans-Whipp T Kjeldsen A Toumbourou JW von Soest T Predicting hazardous drinking in late adolescence/young adulthood from early and excessive adolescent drinking – A longitudinal cross-national study of Norwegian and Australian adolescents BMC Public Health 2019 19 1 790 10.1186/s12889-019-7099-0 31226962
ESPAD group ESPAD Report 2019: Results from the European School Survey Project on Alcohol and Other Drugs EMCDDA Joint Publications, Publications Office of the European Union+ 2020 http://espad.org/sites/espad.org/files/2020.3878_EN_04.pdf
Government of Canada Canadian tobacco, alcohol and drugs survey (CTADS) 2013: Supplementary tables 2016 https://www.canada.ca/en/health-canada/services/canadian-alcohol-drugs-survey/2013-supplementary-tables.html
Government of Canada Alcohol use among Canadians 2020 https://health-infobase.canada.ca/alcohol/ctads/
Government of Canada Canadian tobacco, alcohol and drugs (CTADS) survey: 2017 detailed tables 2021 https://www.canada.ca/en/health-canada/services/canadian-alcohol-drugs-survey/2017-summary/2017-detailed-tables.html
Grant BF Chou SP Saha TD Pickering RP Kerridge BT Ruan WJ Huang B Jung J Zhang H Fan A Hasin DS Prevalence of 12-month alcohol use, high-risk drinking, and DSM-IV alcohol use disorder in the United States, 2001-2002 to 2012-2013: Results from the National Epidemiologic Survey on Alcohol and Related Conditions JAMA Psychiatry 2017 74 9 911 923 10.1001/jamapsychiatry.2017.2161 28793133
Grucza RA Sher KJ Kerr WC Krauss MJ Lui CK McDowell YE Hartz S Virdi g Bierut LJ Trends in adult alcohol use and binge drinking in the early 21st-century United States: A meta-analysis of 6 national survey series Alcoholism, Clinical and Experimental Research 2018 42 10 1939 1950 10.1111/acer.13859 30080258
Gruenewald PJ Treno AJ Ponicki WR Huckle T Yeh LC Casswell S Impacts of New Zealand’s lowered minimum purchase age on context-specific drinking and related risks Addiction (Abingdon, England) 2015 110 11 1757 1766 10.1111/add.13034 26119584
Hardie I Sasso A Holmes J Meier P Understanding changes in the locations of drinking occasions in great Britain: An age-period-cohort analysis of repeat cross-sectional market research data, 2001-2019 Drug and Alcohol Review 2023 42 1 105 118 10.1111/dar.13562 36222548
Hasin DS Shmulewitz D Keyes K Alcohol use and binge drinking among U.S. men, pregnant and non-pregnant women ages 18-44: 2002-2017 Drug and Alcohol Dependence 2019 205 107590 10.1016/j.drugalcdep.2019.107590 31600616
Hayford SR Furstenberg FF Delayed adulthood, delayed desistance? Trends in the age distribution of problem behaviors Journal of Research on Adolescence 2008 18 2 285 304 10.1111/j.1532-7795.2008.00561.x 19633730
Hendra R Hill A Rethinking response rates: New evidence of little relationship between survey response rates and nonresponse bias Evaluation Review 2019 43 5 307 330 10.1177/0193841X18807719 30580577
Information Analysis Directorate Adult drinking patterns in Northern Ireland 2013 Department of Health, Social Services and Public Safety 2014 https://www.health-ni.gov.uk/sites/default/files/publications/dhssps/adps-2013.pdf
International Alliance for Responsible Drinking Minimum legal age limits 2022 http://iardwebprod.azurewebs.net/science-resources/detail/Minimum-Legal-Age-Limits
Keyes KM grant BF Hasin DS Evidence for a closing gender gap in alcohol use, abuse, and dependence in the United States population Drug and Alcohol Dependence 2008 93 1-2 21 29 10.1016/j.drugalcdep.2007.08.017 17980512
Keyes KM Jager J Mal-Sarkar T Patrick ME Rutherford C Hasin D Is there a recent epidemic of women’s drinking? A critical review of national studies Alcoholism, Clinical and Experimental Research 2019 43 7 1344 1359 10.1111/acer.14082 31074877
Kim MJ Mason WA Herrenkohl TI Catalano RF Toumbourou JW Hemphill SA Influence of early onset of alcohol use on the development of adolescent alcohol problems: A longitudinal binational study Prevention Science 2017 18 1 1 11 10.1007/s11121-016-0710-z 27699620
Kinouani S Leflot C Vanderkam P Auriacombe M Langlois E Tzourio C Motivations for using electronic cigarettes in young adults: A systematic review Substance Abuse 2020 41 3 315 322 10.1080/08897077.2019.1671937 31638872
Kraus L Loy JK Olderbak S Trolldal B Ramstedt M Svensson J Törrönen J Does the decline in Swedish adolescent drinking persist into early adulthood? Addiction 2023 119 2 259 267 10.1111/add.16342 37726931
Kraus L Seitz N-N Piontek D Molinaro S Siciliano V guttormsson U Arpa S Monshouwer K Leifman H Vicente J griffiths P Are the times A-changin? Trends in adolescent substance use in Europe Addiction (Abingdon, England) 2018 113 7 1317 1332 10.1111/add.14201 29484751
Leggat G Livingston M Kuntsche S Callinan S Alcohol consumption trajectories over the Australian life course Addiction 2022 117 7 1931 1939 10.1111/add.15849 35188297
Livingston M Understanding recent trends in Australian alcohol consumption Foundation for Alcohol Research and Education 2015 https://fare.org.au/wp-content/uploads/Understanding-recent-trends-in-Australian-alcohol-consumption.pdf
Livingston M Callinan S Vashishtha R Yuen WS Dietze P Tracking the decline in Australian adolescent drinking into adulthood Addiction 2021 117 5 1273 1281 10.1111/add.15720 34697846
Livingston M Vashishtha R Conroy D Measham F Have recent declines in adolescent drinking continued into young adulthood? Young adult drinking styles: current perspectives on research, policy and practice Palgrave Macmillan 2019 21 46
Maimaris W McCambridge J Age of first drinking and adult alcohol problems: systematic review of prospective cohort studies Journal of Epidemiology and Community Health 2014 68 3 268 274 10.1136/jech-2013-203402 24249000
Marshall EJ Adolescent alcohol use: risks and consequences Alcohol and Alcoholism 2014 49 2 160 164 10.1093/alcalc/agt180 24402246
McCabe SE Arterberry BJ Dickinson K Evans-Polce RJ Ford JA Ryan JE Schepis TS Assessment of changes in alcohol and marijuana abstinence, co-use, and use disorders among US young adults from 2002 to 2018 JAMA Pediatrics 2021 175 1 64 72 10.1001/jamapediatrics.2020.3352 33044552
McCabe SE West BT Selective nonresponse bias in population-based survey estimates of drug use behaviors in the United States Social Psychiatry and Psychiatric Epidemiology 2016 51 1 141 153 10.1007/s00127-015-1122-2 26373776
McKetta S Keyes KM Heavy and binge alcohol drinking and parenting status in the United States from 2006 to 2018: An analysis of nationally representative cross-sectional surveys PLOS Medicine 2019 16 11 e1002954 10.1371/journal.pmed.1002954 31770389
Meader N King K Moe-Byrne T Wright K graham H Petticrew M Power C White M Sowden AJ A systematic review on the clustering and co-occurrence of multiple risk behaviours BMC Public Health 2016 16 1 657 10.1186/s12889-016-3373-6 27473458
Meiklejohn J Connor J Kypri K The effect of low survey response rates on estimates of alcohol consumption in a general population survey PLOS One 2012 7 4 e35527 10.1371/journal.pone.0035527 22532858
Ministry of Health Indicator: Past-year drinkers (had alcoholic drink in the past 12 months) (n.d.) https://minhealthnz.shinyapps.io/nz-health-survey-2018-19-annual-data-explorer/_w_4f57c795/#!/explore-indicators
Mongan D Millar SR galvin B The 2019–20 Irish National Drug and Alcohol Survey: Main findings Health Research Board National Drugs Library 2021 https://www.drugsandalcohol.ie/34287
Munn Z Moola S Lisy K Riitano D Tufanaru C Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data International Journal of Evidence-Based Healthcare 2015 13 3 147 153 10.1097/XEB.0000000000000054 26317388
National Institute on Alcohol Abuse and Alcoholism Alcohol alert number 87: Measuring the burden of alcohol National Institute on Alcohol Abuse and Alcoholism 2014 https://pubs.niaaa.nih.gov/publications/aa87/aa87.htm
Ng Fat L Shelton N Cable N Investigating the growing trend of non-drinking among young people; analysis of repeated cross-sectional surveys in England 2005–2015 BMC Public Health 2018 18 1 1090 10.1186/s12889-018-5995-3 30301472
NHS Digital Health Survey for England, 2019: Data tables 2020 https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-for-england/2019/health-survey-for-england-2019-data-tables
Nolen-Hoeksema S gender differences in risk factors and consequences for alcohol use and problems Clinical Psychology Review 2004 24 8 981 1010 10.1016/j.cpr.2004.08.003 15533281
Nugawela MD Langley T Szatkowski L Lewis S Measuring alcohol consumption in population surveys: a review of international guidelines and comparison with surveys in England Alcohol and Alcoholism 2016 51 1 84 92 10.1093/alcalc/agv073 26115987
Office for National Statistics All data related to adult drinking habits in great Britain: 2017 2018 https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/drugusealcoholandsmoking/bulletins/opinionsandlifestylesurveyadultdrinkinghabitsingreatbritain/2017/relateddata
Oldham M Holmes J Whitaker V Fairbrother H Curtis P Youth drinking in decline University of Sheffield, School of Health and Related Research 2018 https://www.sheffield.ac.uk/news/polopoly_fs/1.806889!/file/Oldham_Holmes_Youth_drinking_in_decline_FINAL.pdf
Page MJ McKenzie JE Bossuyt PM Boutron I Hoffmann TC Mulrow CD Shamseer L Tetzlaff JM Akl EA Brennan SE Chou R The PRISMA 2020 statement: an updated guideline for reporting systematic reviews BMJ 2021 372 n71 10.1136/bmj.n71 33782057
Pape H Rossow I Brunborg GS Adolescents drink less: How, who and why? A review of the recent research literature Drug and Alcohol Review 2018 37 S1 S98 S114 10.1111/dar.12695 29573020
Patrick ME Terry-McElrath YM Kloska DD Schulenberg JE High-intensity drinking among young adults in the United States: Prevalence, frequency, and developmental change Alcoholism, Clinical and Experimental Research 2016 40 9 1905 1912 10.1111/acer.13164 27488575
Pennay A Callinan S Livingston M Lubman D Holmes J MacLean S Herring R Dietze P Patterns in reduction or cessation of drinking in Australia (2001–2013) and motivation for change Alcohol and Alcoholism 2019 54 1 79 86 10.1093/alcalc/agy072 30346513
Petker TD Halladay J Vedelago L Ferro MA Tucker J goldman MS Murphy JG MacKillop J Predictors of aging out of heavy episodic drinking in emerging adults: A systematic review protocol Systematic Reviews 2019 8 1 230 10.1186/s13643-019-1139-9 31484558
Rehm J Mathers C Popova S Thavorncharoensap M Teerawattananon Y Patra J global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders Lancet 2009 373 9682 2223 2233 10.1016/S0140-6736(09)60746-7 19560604
Rossow I Romelsjö A The extent of the ‘prevention paradox’ in alcohol problems as a function of population drinking patterns Addiction 2006 101 1 84 90 10.1111/j.1360-0443.2005.01294.x 16393194
Schoenborn CA Adams PF Barnes PM Vickerie JL Schiller JS Health behaviors of adults: United States, 1999-2001 Vital and Health Statistics 2004 10 219 1 79 https://stacks.cdc.gov/view/cdc/7007/cdc_7007_DS1.pdf
Schoenborn CA Adams PF Peregoy JA Health behaviors of adults: United States, 2008-2010 Vital and Health Statistics 2013 10 257 1 184 https://www.cdc.gov/nchs/data/series/sr_10/sr10_257.pdf
Schulenberg JE Johnston LD O’Malley PM Bachman JG Miech RA Patrick ME Monitoring the Future national survey results on drug use, 1975-2019: Volume II, College students and adults ages Institute for Social Research, The University of Michigan 2020 19 60 https://files.eric.ed.gov/fulltext/ED608266.pdf
Scott S Beyer F Parkinson K Muir C graye A Kaner E Stead M Power C Fitzgerald N Bradley J Wrieden W Non-pharmacological interventions to reduce unhealthy eating and risky drinking in young adults aged 18–25 years: A systematic review and meta-analysis Nutrients 2018 10 10 1538 10.3390/nu10101538 30340361
Scottish Health Survey Welcome to the Scottish health survey National Statistics 2020 https://scotland.shinyapps.io/sg-scottish-health-survey/
Slade T Chapman C Swift W Keyes K Tonks Z Teesson M Birth cohort trends in the global epidemiology of alcohol use and alcohol-related harms in men and women: systematic review and metaregression BMJ Open 2016 6 10 e011827 10.1136/bmjopen-2016-011827
Slater M Haughwout S Castle I Surveillance report #103: trends in substance use among reproductive-age females in the United States, 2002-2013 National Institute on Alcohol Abuse and Alcoholism 2015 https://pubs.niaaa.nih.gov/publications/surveillance103/SUBST01.pdf
Smith DE Mitry DJ Cultural convergence: consumer behavioral changes in the European wine market Journal of Wine Research 2007 18 2 107 112 10.1080/09571260701660870
Smith DE Solgaard HS The dynamics of shifts in European alcohol drinks consumption Journal of International Consumer Marketing 2000 12 3 85 109 10.1300/J046v12n03_06
Sobell LC Sobell MB Alcohol consumption measures National Institute on Alcohol Abuse and Alcoholism 2004 https://pubs.niaaa.nih.gov/publications/assessingalcohol/measures.htm
Student Drug Use Surveys Working group The value of student alcohol and drug use surveys: the influence of student survey data on policies, programs and practice across Canada Canadian Centre on Substance Abuse 2013 http://www.mcs.bc.ca/pdf/Value_of_SDUS.pdf
Substance Abuse and Mental Health Services Administration Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health Center for Behavioural Health Statistics and Quality, Substance Abuse and Mental Health Services Administration 2020 https://www.samhsa.gov/data/sites/default/files/reports/rpt29393/2019NSDUHFFRPDFWHTML/2019NSDUHFFR090120.htm
Sudhinaraset M Wigglesworth C Takeuchi DT Social and cultural contexts of alcohol use: influences in a social-ecological framework Alcohol Research: current Reviews 2016 38 1 35 45 27159810
The Joanna Briggs Institute The Joanna Briggs institute critical appraisal tools for use in JBI systematic reviews: Checklist for prevalence studies The Joanna Briggs Institute 2017 https://jbi.global/sites/default/files/2019-05/JBI_Critical_Appraisal-Checklist_for_Prevalence_Studies2017_0.pdf
The Scottish government Supplementary web tables 2008 2009 https://webarchive.nrscotland.gov.uk/3000/https://www.gov.scot/Topics/Statistics/Browse/Health/scottish-health-survey/Supplementary2008
The World Bank World Bank country and lending groups The World Bank group (n.d.) https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups
Twenge JM Park H The decline in adult activities among U.S. adolescents, 1976-2016 Child Development 2019 90 2 638 654 10.1111/cdev.12930 28925063
Parliament UK Chapter 2: What is the union? The Union and devolution 2016 https://publications.parliament.uk/pa/ld201516/ldselect/ldconst/149/14905.htm
Vashishtha R Livingston M Pennay A Dietze P MacLean S Holmes J Herring R Caluzzi G Lubman D Why is adolescent drinking declining? A systematic review and narrative synthesis Addiction Research & Theory 2020 28 4 275 288 10.1080/16066359.2019.1663831
Vashishtha R Pennay A Dietze P Melvin Barrientos M Room R Livingston M Trends in adolescent drinking across 39 high-income countries: Exploring the timing and magnitude of decline European Journal of Public Health 2021 31 2 424 431 10.1093/eurpub/ckaa193 33188681
Whitaker V Oldham M Boyd J Fairbrother H Curtis P Meier P Holmes J Clustering of health-related behaviours within children aged 11-16: A systematic review BMC Public Health 2021 21 1 137 10.1186/s12889-020-10140-6 33446174
White A Castle IJP Chen CM Shirley M Roach D Hingson R Converging patterns of alcohol use and related outcomes among females and males in the United States, 2002 to 2012 Alcoholism, Clinical and Experimental Research 2015 39 9 1712 1726 10.1111/acer.12815 26331879
WHO Adolescent alcohol-related behaviors: trends and inequalities in the WHO European Region, 2002-2014. Observations from the Health Behaviour in School-aged Children (HBSC) WHO collaborative cross-national study World Health Organization, Regional Office for Europe 2018 https://iris.who.int/handle/10665/342239
Wright G An empirical examination of the relationship between nonresponse rate and nonresponse bias Statistical Journal of the IAOS 2015 31 2 305 315 10.3233/sji-140844
