3 questions to… Laure Com-Ruelle, following the publication of Issues in Health Economics n° 265, January 2022: "Alcohol Consumption in Young Adults: a Higher Overall Risk of Excessive Alcohol Consumption in Men and an Increasing Risk of Heavy Episodic Drinking in Women", written with Marie Choquet
In terms of prevention of risky behaviours, adolescence is a vulnerable period which is important to observe in order to understand the circumstances of the first experiments with alcohol for young people, and their drinking patterns. This is why specific surveys of adolescents have been conducted for a long time. However, over time, the transition period to adulthood has become longer, due to several sociological phenomena affecting the last generations; that's why it is necessary to study this period in particular.
First of all, the period between 18 and 30 years is a period of biological vulnerability because the brain becomes physically mature, in particular the prefrontal cortex, an area that carries out responsible decision-making and the ability to plan and control one's impulses. Moreover, at the dawn of the 21st century, young people are in a context of change and great uncertainty, of lengthening training years. Thus, young adults aged 18-30 are particularly vulnerable to unemployment, poverty, and the uncertainty of tomorrow. They postpone starting a family, live longer with their parents and have a diversity of situations and life paths. Alcohol consumption, which is strongly linked to the socio-cultural, family and relational environment, undergoes transformations during this period, that are crucial to understand.
Some specific surveys have extended the observation of adolescents beyond the age of 17, such as the one we published in 2011 on alcohol and young people aged 13-24 (Choquet et al., 2011), which raise many questions about alcohol consumption. More often, however, data on this pivotal period between adolescence and mature adulthood are derived from generalist health surveys that include few questions on the topic. This is the case for the 2014 Health, Health Care and Insurance Survey-European Health Interview Survey (ESPS-EHIS). There are enough young people aged18-30 to be studied specifically, as we have data on alcohol consumption via a validated test, and also data on the socio-economic characteristics of individuals.
The ESPS-EHIS 2014 data allowed us to construct alcohol consumption profiles based on the responses to the AUDIT-C test validated in French. Amongst young people aged 18-30, the following four graduated risk profiles were identified: non-consumers of alcohol (NC), safe consumers (SC), at episodic risk consumers (ERC), and at chronic risk or alcohol-dependent consumers (CRC). As these terms suggest, the last two categories represent populations at risk of problematic drinking with distinct patterns: the former only exposed themselves to risks occasionally, but, sometimes, in a significant way (alcoholic coma, accidents, unprotected sex, fights, etc.), and even frequently; the latter exposed themselves to risks to their health and, above all, to their future health, in an almost permanent and detrimental way, on both a mental and somatic level (cardiovascular diseases, hepatic cirrhosis, cancer, psychosis, etc.).
During the life cycle, it is between the age of 18 and 30 that these two cumulative risks peak, this is why it is necessary to act preventively upstream or in the face of proven damage. Young women are half as concerned as young men. They moderate their drinking earlier, between the age of 25-30 (at 18-24: 28% at episodic risk + 2% at chronic risk; 25-30: 24% at episodic risk + 2% at chronic risk). On the contrary, young men increase the risk up to age 30 (at age 18-24: 42% at episodic risk + 12% at chronic risk; 25-30: 50% at episodic risk + 10% at chronic risk). It is important to distinguish between gender and age because men and women do not behave in the same way.
Over the years, between 2002 and 2014, if risky consumption is globally stable among the 18-30 years old, we observed however a slight convergence between men and women: for the former, the risk tended to decrease due to a lower risk of chronic alcohol consumption, while for the latter, it tended to increase due to a risk of episodic alcohol consumption.
This study provides new descriptive results which, as such, are useful indicators for health professionals; this may alert them to patients for whom they know the socio-economic characteristics. However, health risk behaviours are not limited to alcohol; they are numerous and not independent of each other, so it is important to study how they combine. EHIS also collects data on tobacco use, nutrition (fruit and vegetable consumption) and physical activity (PSA), which are known to influence current and future health status.
Our next step will therefore be to construct these combined risk profiles and to study their determinants, vulnerability factors and protective factors, in order to be able to propose effective prevention and health promotion actions targeting this young adult population.