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Are changes in attitudes towards school associated with declining youth drinking? A multi-level analysis of 37 countries

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posted on 2022-07-01, 01:52 authored by Abigail K Stevely, Rakhi VashishthaRakhi Vashishtha, Hannah Fairbrother, Laura Fenton, Madeleine Henney, Michael LivingstonMichael Livingston, John Holmes
BACKGROUND: Changes in adolescents' attitudes towards school are a potential explanation for recent declines in young people's alcohol consumption. However, this has not been tested using multi-national survey data, which would permit stronger causal inferences by ruling out other country-specific explanations. This study, therefore, uses an international survey of schoolchildren to examine the associations between changing attitudes towards school and adolescent alcohol consumption. METHODS: We used data from 247 325 15-year-olds across 37 countries participating in four waves of the Health Behaviour in School-aged Children study (2001/02-2013/14). Attitudes towards school were assessed using two measures-self-reported pressure from schoolwork and whether respondents like school. Outcome measures were weekly alcohol consumption and having been drunk twice in one's lifetime. We used whole population and gender-specific hierarchical linear probability models to assess the relationship between attitudes and alcohol outcomes within countries over time. RESULTS: Country-level changes over time in liking school were not associated with changes in alcohol consumption. However, a 10% increase in feeling pressured by schoolwork was associated with a 1.8% decline in drunkenness [95% confidence interval (CI): -3.2% to -0.3%] and weakly associated with a 1.7% decline in weekly drinking (95% CI: -3.6% to 0.2%). Among girls only, increases in feeling pressured by schoolwork were associated with a 2.1% decline in weekly drinking (95% CI: -3.7% to -0.6%) and a 2.4% decline in drunkenness (95% CI: -3.8% to -1.1%). CONCLUSION: Changes in attitudes towards school may have played a minor role in the decline in alcohol consumption among adolescent girls only.


This research was funded in whole, or in part, by the Wellcome Trust (208090/Z/17/Z). 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 work was supported by the Australian Research Council (DP160101380).


Publication Date



European Journal of Public Health








Oxford University Press



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© The Author(s) 2022. Published by Oxford University Press on behalf of the European Public Health Association. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.