Alcohol use is associated with the leading causes of death among youth [1]. Despite the risks, evidence suggests alcohol use is very common and more prevalent than other forms of substance use among Canadian youth [2]. In order to develop and appropriately target prevention interventions, it is important to understand the factors associated with high-risk alcohol use. For instance, research has demonstrated that youth are more likely to binge drink if they are male or older [2], if they are aboriginal [3], if they are a smoker or marijuana user [4], if they are overweight or obese [5], if they are physical active [6], or if they have more disposable income [4]. Recent evidence also suggests that bullying behaviour is also associated with binge drinking among youth [7]. As such, the present brief examines how these factors, when considered concurrently, are associated with current alcohol use and binge drinking among a large sample of underage youth.

This cross-sectional study used self-reported data collected from grade 9 to 12 students attending 43 purposefully sampled Ontario secondary schools as part of the Year 1 sample for the COMPASS study (2012-2013) [8]. The data were collected using the COMPASS Student Questionnaire (Cq) and active-information passive consent procedures. All procedures were approved by the University of Waterloo Office of Research Ethics and participating School Boards. Additional details on the COMPASS study design, recruitment procedures, and measures are available in print [8] and online (www.compass.uwaterloo.ca).

A total of 30,147 eligible grade 9 to 12 students were enrolled in the 43 COMPASS schools in Year 1. Overall, 80.2% (n=24,173) of eligible students completed the Cq. Missing respondents resulted from scheduled spares or absenteeism at the time of the survey (18.8%), student refusal (0.1%), and parental refusal (0.9%).

Current alcohol use was measured by asking respondents: “In the last 12 months, how often did you have a drink of alcohol that was more than just a sip?” Respondents who reported consuming alcohol ‘once a month or more’ or ‘daily’ were classified as current drinkers. Current binge drinking was assessed by asking respondents: “In the last 12 months, how often did you have 5 drinks of alcohol or more on one occasion?” Respondents who reported consuming 5 or more drinks of alcohol in one occasion at a frequency of ‘once a month or more’ or ‘daily’ were classified as current binge drinkers, respondents who reported consuming 5 or more drinks of alcohol in one occasion at a frequency of ‘less than once a month’ or ‘I did not have 5 or more drinks on one occasion in the last 12 months’ were considered noncurrent binge drinkers, and respondents who reported ‘I have never done this’ were considered never binge drinkers.

Consistent with previous research [2,3], respondents also reported their current grade (9, 10, 11, 12), gender (male, female), ethnicity (white, off-reserve Aboriginal, other), weekly spending money ($0, $1-$20, $21-$100, more than $100, or I don’t know), as well as their smoking status, marijuana use, physical activity, bullying behaviour in the past month, and weight status. Smoking status was assessed by asking respondents, “Have you ever smoked 100 or more whole cigarettes in your life?” and “On how many of the last 30 days did you smoke one or more cigarettes?”. Students who reported ever smoking 100 cigarettes and any smoking in the previous 30 days were classified as current smokers, students who reported ever smoking 100 cigarettes but no smoking in the previous 30 days were classified as former smokers, and student who had not smoked 100 cigarettes in their lifetime were non-smokers. Marijuana use was assessed by asking respondents, “In the last 12 months, how often did you use marijuana or cannabis? (a joint, pot, weed, hash…)”. Those who reported marijuana use once a month or more were classified as current marijuana users, those who reported marijuana use less than once a month or not in the last year were classified as non-current users, respondents who reported never using marijuana were classified as never users. Physical activity was measured by asking respondents how many minutes of moderate and hard physical activity they engaged in on each of the last seven days. Consistent with the Canadian physical activity guidelines for youth (www.csep.ca), respondents who did not report performing at least 60 minutes of moderate- to vigorous-intensity physical activity daily and hard PA a day for at least three out of the last seven days were classified as not meeting the guideline. Being a victim of bullying was measured by asking respondents to report how often they have been physically, verbally or cyberbullied in the last 30 days. Bullying others was measured by asking respondents to report how often they have physically, verbally or cyberbullied other students in the last 30 days. Using previously validated measures of self-reported height and weight [9], Body Mass Index (BMI) was calculated for each student using the measures of weight (kg) and height (m) (BMI=kg/m²). Weight status was then determined using the BMI classification system of the World Health Organization [10] based on age and sex adjusted BMI cut-points (underweight, healthy weight, overweight, obese).

Complete data were available for 17,497 students. Descriptive analyses of alcohol use and the correlates of alcohol use were examined by gender. Two logistic regression analyses were performed to examine how the correlates were associated with current alcohol use and current binge drinking. Each model included the proc genmod command with school as a class statement to control for the clustering within schools.

Overall, 38.4% of students were considered current alcohol users and 25.5% were current binge drinkers. As shown in Table 1, more males than females were current alcohol users and more males than females were current binge drinkers. Males were more apt than females to be current smokers, current marijuana users, to meet the Canadian physical activity guidelines, to have bullied someone else in the past month, and be overweight or obese. Conversely, females were more apt than males to have been a bulling victim in the past month.

Table 1: Descriptive statistics for the sample of grade 9 to 12 students in the Year 1 COMPASS sample (2012-2013)

Factors associated with current alcohol use

As shown in Model 1 of Table 2, students were more likely to be current alcohol users if they were current smokers, if they were current or non-current marijuana users, if they met the Canadian physical activity guideline, if they had bullied someone else in the past month, if they were in a higher grade, or if they had more weekly spending money. Conversely, students were less likely to be current alcohol users if there were of non-white ethnicity or if they were underweight. Gender and being a victim of bullying in the past month were not associated with the likelihood of being a current drinker.

Table 2: Logistic regression analyses examining characteristics associated with alcohol use and binge drinking for the sample of grade 9 to 12 students in the Year 1 COMPASS sample (2012-2013)

Factors associated with current binge drinking

As shown in Model 2 of Table 2, students were more likely to be current binge drinkers if they were current smokers, if they were current or non-current marijuana users, if they met the Canadian physical activity guideline, if they had bullied someone else in the past month, if they were in a higher grade, or if they had more weekly spending money. Conversely, students were less likely to be current alcohol users if there were of non-white ethnicity. Gender, being a victim of bullying in the past month, and weight status were not associated with the likelihood of being a current binge drinker.

Alcohol use was common among this large sample of underage youth and that the factors associated with current alcohol use were generally the same as those associated with binge drinking. Consistent with previous research [11], we found that students who smoke cigarettes or use marijuana were more likely to be current drinkers. Given that current marijuana use was a stronger predictor of alcohol consumption relative to cigarette smoking, and the prevalence of marijuana smoking among youth is larger than cigarette smoking [2,11], it may be advantageous to explore developing and evaluating interventions that focus on preventing alcohol use via co-occurrence with marijuana use within the school context.

Consistent with previous literature [7], students who bullied other students were more likely to be high-risk drinkers whereas victims of bullying were not at increased risk. Recent evidence has identified that not only do bullying victims often become perpetrators of peer aggression themselves, but that students who are bullies are at increased risk for harmful alcohol use [12]. This suggests that research should further consider evaluating the impact that school-based intervention related to bullying prevention has on youth drinking.

Active students were at increased risk for binge drinking compared to those who are less active. While counterintuitive, this is consistent with previous research [6]. It may be prudent for schools to consider having student athletes agree to follow policies designed to prevent (or limit) alcohol consumption during the school-based sports season. Future research should examine the link between physical activity and alcohol use, especially given the increasing attention in public health practice toward promoting youth physical activity.

Due to the cross-sectional nature of the data, we are not able to make causal inferences about the factors associated with current alcohol use and binge drinking. The data also relies on self-report measures which may lead to underreporting of alcohol use. The degree of underreporting is likely to have been minimized, however, by the use of an anonymous pencil and paper survey in a school setting and by ensuring confidentiality of the responses.

We found that alcohol use was common, and that youth were consuming alcohol frequently and in volumes that are hazardous to their health. Considering that numerous risk factors were identified, future research should evaluate the impact of tailoring interventions to change the modifiable factors associated with high-risk drinking or targeting interventions to at-risk youth.

This work was supported by a bridge grant from the Canadian Institutes of Health Research (CIHR) Institute of Nutrition, Metabolism and Diabetes (INMD) through the “Obesity – Interventions to Prevent or Treat” priority funding awards (OOP-110788; grant awarded to S. Leatherdale) and an operating grant from the Canadian Institutes of Health Research (CIHR) Institute of Population and Public Health (IPPH) (MOP-114875; grant awarded to S. Leatherdale).