Heavy episodic drinking among French adolescents between 2005 and 2022: decreasing prevalence rates and increased risks.

Objective: To study the prevalence of alcohol use among French adolescents over time and factors associated with heavy episodic drinking (HED) among drinkers.

Method: Our analysis relies on six waves of a standardized cross, sectional survey conducted in mainland France between 2005 and 2022. The overall sample size comprises 179905 adolescents aged 17 (90166 males and 89739 females). Two outcomes were considered: declaring past month HED (at least one) and repeated HED (at least three) in the past month between 2005 and 2022. Relative risks and probabilities according to years of survey, gender and frequency of alcohol use (past 30 days) were estimated using modified Poisson regressions controlling for grade retention, schooling, living out of parental household, socioeconomic status, and other substance (tobacco, cannabis, other illicit substances) use.

Results: Despite a steady decline in alcohol use among French adolescents over the past two decades, the prevalence of HED still concerned one, third of 17-year-olds in 2022. The reduction in alcohol use conceals an increased likelihood of HED among occasional drinkers (<10 times a month). Moreover, the probability of HED among females is similar to that of males, or even higher depending on the frequency of use.

Conclusions: HED is becoming an increasingly common behavior among adolescent drinkers. The decline in prevalence conceals a homogenization of behavior between genders. Our results also question underage access to alcohol, despite increasing legal restrictions. These results support general prevention in early adolescence aimed at all drinkers, and not only at the most frequent or "at-risk" drinkers.