Trajectories of alcohol-related harm among young people

In many high-income countries such as Australia, alcohol use has declined in young people since the early 2000s but there is conflicting evidence around reductions in alcohol-related harm. A key issue around quantifying alcohol-related harm is that different data sources can show vastly different patterns due to varying sample characteristics or methods of measurement. The studies comprising this thesis aimed to address these gaps by using a variety of data sources to examine: 1) trends in self-reported harms across age, period, and birth cohort using national surveys (n=121,281); 2) developmental patterns of blackouts, a very common harm, and predictors of high-risk patterns in a recent birth cohort (n=1,821); 3) developmental transitions between different types of alcohol-related harm and predictor of high-risk patterns in a recent birth cohort (n=1,828); and 4) risk factors for experiencing clinical alcohol-related harm for the first time at a younger age and compare rates of subsequent harm by age at first experience of clinical harm in a linked cohort (n=10,300). Several notable findings were identified. National data indicate that alcohol-related risky behaviours are much less common in recent birth cohorts, though they continue to be most prevalent in young people. Males generally had twice the prevalence of risky behaviours compared to females, but with reduced effect among more recent birth cohorts. Longitudinal cohort data indicated that escalating experience of harms, particularly blackouts and psychosocial harms (e.g., getting into fights) increased risk of early adulthood alcohol use disorder symptoms. Females were at higher risk of experiencing physiological harms such as blackouts earlier in life compared to males. Finally, analyses of linked hospital service data indicated that females were at higher risk of accessing hospital services for an alcohol-related problem for the first time at a younger age. Younger people were more likely to have subsequent injury-related ED presentations but less likely to be hospitalised. Past year hospital service access rates in this cohort were much higher than the same-aged general population. This thesis highlights important developments in young peoples’ experience of alcohol-related harm. The identification of a closing male-female gap in harms and of female status as a risk factor for early harm warrants future research and shifts to the approach of harm reduction and prevention among young people