Substance Use by Canadian Youth - A National Survey of Canadians' Use of Alcohol and Other Drugs - Canadian Addiction Survey (CAS)

Chapter 3: Alcohol Use and Harms

Highlights

• Alcohol is the psychoactive substance most commonly used by Canadian youth, with 90.8% of youth having used alcohol in their lifetime and 82.9% having used alcohol in the past 12 months
• The mean age at which youth started drinking alcohol was 15.6 years.
• Of the 82.9% of youth who consumed alcohol over the past year, over one third (36.9%) reported doing so at least once a week, and 33.7% reported consuming 5 or more drinks per typical drinking occasion.
• The most common drinking pattern among youth is light/infrequent (38.7%).
• Among youth, 13.8% of past-year drinkers reported heavy drinking at least once a week, and 46.0% reported doing so at least once monthly.
• Youth had higher rates than the general population of reported lifetime harms (33.7% versus 24.2%) and harms in the past year (21.8% versus 8.8%) as a result of their own drinking.

Introduction

The focus of this chapter is on the use of alcohol among youth aged 15 to 24 and problems they experience as a result of their alcohol use. In addition, whether or not youth have a higher prevalence of use, higher frequency of use, higher quantity consumed per occasion, or more problems associated with their use than adults will be examined.

This chapter will report on five measures of alcohol use, including drinking status, drinking frequency, usual consumption, frequency of heavy drinking and compliance with low-risk drinking guidelines.

Drinking status was derived from two questions: "During the past 12 months, have you had a drink of beer, wine, liquor or any alcoholic beverage?" Those who answered "No" were then asked if they had ever had a drink. Three types of drinkers were defined: "past-year drinkers", those who consumed alcohol in the 12 months prior to completion of the survey; "former drinkers", those who had not consumed alcohol in the 12 months prior to the survey, but who had consumed in their lifetime; and "abstainers", those who never had an alcoholic beverage in their lifetime.

Because age of alcohol initiation has been linked to an increased risk for the development of alcohol disorders and other problems later in life, the mean age of alcohol initiation was examined (DeWit, Adlaf, Offord and Ogborne, 2000). The mean age at which youth started drinking alcohol was examined by asking respondents: "Not counting small sips, how old were you when you started drinking alcoholic beverages?"

Drinking frequency was derived from the question: "How often did you drink alcoholic beverages during the past 12 months?" The answers were grouped into four categories: less than once a month, one to three times a month, one to three times a week, and four times or more a week.

Usual consumption of alcohol referred to the usual number of drinks the respondent had on the days he or she consumed alcohol. Usual consumption was measured from the question: "During the past 12 months, on those days when you drank, how many drinks did you usually have?" The answers were recorded in three categories: one or two drinks, three or four drinks, five drinks or more.

Heavy drinking is defined as five or more drinks in a single sitting for males and four drinks or more for females. The frequency of heavy drinking over the past year was assessed in six categories: never; less than once a month; once a month; two to three times a month; once a week; more than once a week. Two variables were derived from the frequency of heavy drinking: monthly heavy drinking and weekly heavy drinking, which correspond to those who drink heavily at least monthly (including weekly) and at least weekly (respectively) over the past 12 months.

Low-risk drinking guidelines were disseminated in 1994 following an international conference on health benefits and risks (Ashley, et al., 1994). In 1997, revised guidelines were released by the former Addiction Research Foundation, now Centre for Addiction and Mental Health (CAMH), and the Canadian Centre on Substance Abuse (CCSA) and have been endorsed by various provincial governments and non-government agencies. These guidelines recommend that men and women limit weekly alcohol intake to no more than 14 and 9 standard drinks, respectively, and that alcohol intake on any one day should generally be limited to 2 standard drinks. These guidelines were intended to represent the low risk of the most important forms of harms associated with drinking alcohol. Compliance with the low-risk drinking guidelines is derived from the respondents' self-reported consumption of standard drinks over the past seven days, measured daily. Respondents are considered to have exceeded the guidelines if they report a total weekly consumption of 15 drinks or more for males or 10 drinks or more for females, or for both a daily consumption exceeding 2 drinks at least once over the past week.

Related to self-reported heavy drinking and low-risk drinking guidelines, harms associated with such use were also measured. The Alcohol Use Disorders Identification Test (AUDIT) was one test used to examine harmful and hazardous patterns of alcohol use, as well as harmful consequences of that use and indications of dependency. The development of the AUDIT was supported by the World Health Organization and consists of a 10-item questionnaire. The AUDIT was primarily used to screen for alcohol problems in clinical settings; however, it can be used in research to assess the prevalence of high-risk alcohol use in large groups. According to Babor, Higgins-Biddle, Saunders, and Monteiro (2001, p. 19), an AUDIT score of 8 or more indicates harmful use or possibly alcohol dependence. Since the present analysis of the scores is of a sample of respondents representing the Canadian population--as opposed to a clinical sample--the results should be interpreted with caution and scores of 8 or more should not be viewed as "alcoholism" but rather as an indicator of "high-risk drinking".

In addition to the AUDIT, questions that examine the prevalence of harms associated with respondents' own alcohol use will be examined, as well as those about harms to respondents aged 18 years or over due to someone else's alcohol use.

Results

Proportion of Youth Who Drink

Among youth, like adults, alcohol is the psychoactive substance most commonly used. In the 12 months before the survey, 82.9% of Canadian youth had consumed alcohol, 7.9% were former drinkers and 9.2% had never consumed alcohol in their lifetime (Table 3.1). Furthermore, a higher proportion of adults were former drinkers than youth (14.6% versus 7.9%), and a higher proportion of youth than adults were current drinkers (82.9% versus 78.8%).

There were no differences between males and females in the prevalence of current (83.5% versus 82.3%, respectively) or lifetime (90.8% versus 90.9%, respectively) alcohol use. In addition, there were no sex differences in prevalence of lifetime or current use among youth aged 15 to 17, 18 to 19, or 20 to 24. This is different from adults--males are more likely than females to report current alcohol use (81.8% versus 76.1%, respectively) and lifetime alcohol use (94.9% versus 92.1%, respectively). This seems to indicate that the differences in the rate of alcohol use between males and females appear later rather than earlier in life.

Table 3.1 also shows the relationship between drinking and each of the demographic characteristics when all the characteristics are taken into account at the same time. Among youth, there were no differences between males and females in the rate of past-year drinking. Youth 18 to 19 years old were more likely than those 15 to 17 years old to report past-year drinking (90.8% versus 62.3%); no differences were observed between those 18 to 19 and 20 to 24 years of age (90.8% versus 89.5%). Although a main effect of region was not significant when all factors were controlled for, youth from Quebec were more likely than those from the rest of Canada to report consuming alcohol in the past year (89.8%). In addition, while past-year drinking increased according to income adequacy in the general population, no differences in rates were observed for youth.

Mean Age of Drinking Initiation

Age of alcohol initiation has been linked to later alcohol-related problems and patterns (Gruber, DiClemente, Anderson and Lodico, 1996; DeWit et al., 2000; Kraus, Bloomfield, Augustin and Reese, 2000; Pitkanen, Lyyra and Pulkkinen, 2005). In addition, it has been found that about 40% of those who start drinking at age 14 or under develop alcohol dependence at some point in their lives, whereas for those who start drinking at age 21 years or older, only 10% develop dependence (Kosterman, et al., 2000).

The mean reported age of first alcohol use among youth was 15.6 years. There were no differences between the mean age reported by males (15.7 years) and that reported by females (15.4 years).

There were regional differences, however, in the mean age of alcohol initiation; youth from Quebec had a significantly younger mean age of initiation than those from the rest of Canada (15 years), and those from the Atlantic and Ontario regions had later ages (16 years).

Frequency of Drinking

In addition to prevalence of use, the CAS provided information on how often and how much individuals drink (Tables 3.2 and 3.3, respectively). Of the 82.9% of Canadian youth who reported having consumed alcohol over the past year, over one third (36.9%) reported doing so at least once a week. More specifically, 42.3% of Canadian youth consumed alcohol approximately 1 to 3 times a month, 33.8% did so 1 to 3 times a week, 20.8% did so less than once a month, and 3.1% consumed alcohol 4 or more times a week (Table 3.2). Youth consumed alcohol less frequently than adults; a higher proportion of youth reported drinking 1 to 3 times a month (42.3% versus 31.3%), whereas a lower proportion of youth reported doing so 4 or more times a week (3.1% versus 11.5%).

As with the general population, the frequency of drinking among youth varied according to gender, age and region. Males were more likely than females to consume alcohol 1 to 3 times a week and 4 or more times a week over the past year, while females were more likely than males to report consuming less than once a month or 1 to 3 times a month. Older youth were more likely to report a consumption pattern of 1 to 3 times a week, whereas the younger age groups of youth were more likely to report a consumption pattern of less than once a week. In addition, youth from the Atlantic (31.0%) and British Columbia (27.2%) regions were more likely to report consuming alcohol less than once a month, and those from the British Columbia region were less likely than those from the rest of Canada to report consuming 1 to 3 times a week. Youth who started drinking at a younger age were more likely to consume alcohol 4 or more times a week when compared with those who started drinking at a later age (Table 3.2).

Usual Quantity Consumed

While the CAS detailed report revealed that most Canadians overall tend to drink in moderation (Adlaf et al., 2005), this was not the case with youth. Instead, there was a fairly consistent distribution across the drinking patterns of 1 to 2 drinks (37.3%), 3 to 4 drinks (29.0%) and 5 or more drinks (33.7%) per typical drinking day for youth (Table 3.3). While Table 3.2 revealed that youth tend to drink less frequently than adults, Table 3.3 reveals that when they do drink, they drink much more. More specifically, youth were more likely than adults to consume 3 to 4 drinks (29.0% versus 18.6%) and 5 or more drinks (33.7% versus 12.6%) on a typical drinking day and, as a corollary, less likely to report consuming 1 to 2 drinks (37.3% versus 68.8%).

Among youth, as with the general population, moderate drinking (1 to 2 drinks) was more common among females than males (47.1% versus 28.2%). Youth from the Atlantic region were less likely (26.2%) and those from the Quebec region were more likely (43.9%) to drink moderately than the rest of Canada. In addition, youth who had started drinking at a later age were more likely to drink moderately per typical drinking day than those who started drinking younger.

Approximately one in three youth (33.7%) reported that they usually drank 5 or more drinks per typical drinking day. This level of consumption is more likely to be associated with an increased risk of alcohol-related problems. This pattern of drinking was more common among males, approximately 2 times more likely than females (42.7% versus 24.0%), and although a main effect of age was not significant when controlling for other factors, youth 18 to 19 years of age were more likely than those aged 15 to 17 (42.5% versus 28.8%) to drink 5 or more per typical drinking day. In terms of region, youth from the Atlantic region were more likely (48.8%) than those from the rest of Canada to report consuming 5 or more drinks per typical drinking day, as were youth who had started drinking at an earlier age.

Drinking Patterns

In terms of the quantity and frequency of alcohol consumed, respondents can be classified into one of six patterns of use:

• Lifetime abstainers, never had alcohol
  
  
• Former drinkers, drank sometime during their lives but not during the past 12 months
  
  
• Light infrequent drinkers, drink less often than once a week, usually fewer than 5 drinks when alcohol is used
  
  
• Light frequent drinkers, drink once a week or more, usually fewer than 5 drinks when alcohol is used
  
  
• Heavy infrequent drinkers, drink less often than once a week, usually 5 or more when alcohol is used
  
  
• Heavy frequent drinkers, drink once a week or more, usually 5 or more drinks when alcohol is used

The most common drinking pattern reported by youth was a light infrequent (38.7%) pattern, followed by light frequent (16.1%), heavy frequent (14.5%), heavy infrequent (13.3%), abstainer (9.3%), and former drinker (8.1%) (Table 3.4). Youth were more likely than adults to be abstainers (9.3% versus 6.6%), heavy infrequent drinkers (13.3% versus 4.1%) and heavy frequent drinkers (14.5% versus 5.8%), whereas adults were significantly more likely than youth to be former drinkers (14.8% versus 8.1%) and light frequent drinkers (30.2% versus 16.1%). Among youth, males were more likely than females to report a heavy frequent drinking pattern (19.2% versus 9.6%) and females were more likely to report a light infrequent pattern (49.4% versus 28.6%).

Tables 3.5, 3.6, 3.7 and 3.8 examine the relationship between each of the drinking patterns among current drinkers (heavy frequent, heavy infrequent, light frequent and light infrequent) and the demographic characteristics when all these characteristics are taken into account at the same time. Heavy frequent drinking was more common among males, youth aged 18 to 19, those from the Atlantic region and those in the middle and highest income categories (Table 3.5).

Heavy infrequent drinking was more prevalent among males, youth aged 15 to 17 and 18 to 19, and those from the Atlantic and Prairie regions (Table 3.6).

Males, youth aged 20 to 24 and those from Quebec were more likely to report drinking lightly and frequently. Alternatively, females and youth in the middle or highest income adequacy groups were significantly less likely to do so (Table 3.7).

Females were more likely than males and youth aged 15 to 17 were more likely than those aged 18 to 24 to report drinking light and infrequently, as were those who had started drinking at a later age (Table 3.8).

Given the relatively small number of respondents in some categories when examining the four different drinking patterns above, youth were classified into one of two drinking patterns: heavy (infrequent and frequent) and light (infrequent and frequent). The results of these analyses are presented in Tables 3.9 and 3.10.

Among current drinkers 15 to 24 years of age, males were more likely than females to report drinking heavily (frequently/infrequently) (42.7% versus 24.0%) (Table 3.9). Heavy drinking was highest among 18 to 19 year olds. In addition, youth from the Atlantic region were more likely (48.8%) to report drinking heavily than those from the rest of Canada, and youth from the Quebec region were less likely. Overall, there was an inverse relationship between heavy drinking and age of alcohol initiation; in general, youth who started drinking earlier were significantly more likely to report drinking heavily.

Among current drinkers (Table 3.10), females were more likely than males (76.0% versus 57.3%), youth aged 15 to 17 were more likely than 18 to 19 year olds (71.2% versus 57.5%), youth from the Atlantic region were less likely (51.2%) and those from the Quebec were more likely (80.6%) to report drinking lightly (frequently/infrequently). In addition, as age of alcohol initiation increased, so too did youths' likelihood of drinking lightly.

Heavy Drinking

Heavy drinking has been defined as having 5 drinks or more in a single sitting for men and 4 or more drinks on a single occasion for women (Hetzler and Burnham, 1991; Wechsler et al., 1995).

Monthly and weekly heavy drinking was examined in more detail using the CAS data. Forty-six percent (46.0%) of past-year youth drinkers reported heavy drinking at least once a month, and 13.8% reported this pattern of drinking at least once a week (Table 3.11). These numbers reported by youth are almost double those reported by the total population aged 15 or over (Adlaf et al., 2005) and more than double those reported by adults (21.7% and 4.8%, respectively).

Among youth, males were more likely than females (52.0% versus 39.7%), youth 18 to 19 years old were more likely than those 15 to 17 years old (51.8% versus 35.7%) and those from the Atlantic region were more likely than those from the rest of Canada to report heavy drinking at least once a month (54.3% versus 46.0%). The only demographic characteristic related to weekly heavy drinking among youth was sex; males were more likely than females to report a heavy drinking pattern (17.4% versus 10.0%). In addition, age of alcohol initiation was associated with heavy monthly and weekly drinking; youth who started drinking at a younger age were more likely than those who started drinking later, to report heavy drinking monthly or weekly.

Exceeding Low-Risk Drinking Guidelines

In examining the low-risk drinking guidelines among youth, it must be noted that these guidelines were not developed for youth, and thus examining them among a sample of youth must be done with caution and for descriptive purposes only. Specifically, the low-risk drinking guidelines apply to people of legal drinking age only and are intended to represent the low risk of the most important forms of harm. Overall, the reported rate of exceeding the low-risk drinking guidelines was higher among youth than adults (34.1% versus 20.7%) (Table 3.12).

Among youth, males (40.2%), youth from the Atlantic region (36.5%) and those in the highest income adequacy group (49.9%) were more likely to have exceeded the low-risk drinking guidelines than females (27.7%), youth from Canada overall (34.1%) or youth in the lowest income adequacy group (33.4%). Youth from the British Columbia region (28.9%) were less likely than youth from the other regions to exceed the guidelines. In addition, age of alcohol initiation was inversely related; those who started drinking at a younger age were more likely to exceed the low-risk drinking guidelines.

Hazardous Alcohol Use as Indicated by the Alcohol Use Disorders Identification Test (AUDIT)

Table 3.13 displays percentages of current drinkers aged 15 to 24 with AUDIT scores of 8 or higher. According to this criterion, the total of high-risk drinkers among youth is 36.1%, almost double the reported national average of 17% (Adlaf et al., 2005) and more than double that reported by adults aged 25 or over (13.4%).

Similar to results demonstrated by the general population, males 15 to 24 years of age were more than twice as likely as females to drink hazardously (44.7% versus 26.8%). The rate of hazardous drinking peaked among youth aged 18 to 19 (44.6%), with the odds doubling from 15 to 17 to 18 to 19 years of age. Similar to the provincial pattern found for the general population, rates of hazardous drinking among youth were higher in the Atlantic region (44.3%) and lower in Quebec (28.4%) than in the rest of the Canada. Among the general population, those in the highest income adequacy group were less likely to drink hazardously, but no such pattern was observed among youth. In addition, youth who started drinking earlier were more likely to drink hazardously.

These results, examining hazardous drinking, exemplify why patterns of use may often be more crucial to examine than actual non-descriptive prevalence rates of use. Specifically, youth from the Atlantic region show a lower prevalence of drinking yet higher rates of hazardous drinking; in contrast, youth from Quebec showed higher rates of use yet lower rates of hazardous drinking

Harms Because of One's Own Drinking

Prevalence and incidence of types of harms

Although nearly a quarter of adult former and current drinkers (22.8%) reported that their drinking has caused harms to themselves and to others at some time in their lives and fewer than 1 in 10 (6.3%) stated that harms occurred during the past year, these numbers were much higher among youth. Specifically, among current and former drinkers, 1 in 3 youth (33.7%) reported that their drinking has caused harms to themselves and to others at some time in their lives, and slightly more than 1 in 5 (21.8%) reported that harms occurred during the past year (Table 3.14). Whether or not it can be extrapolated that most lifetime harms occurred while the adults were youth is beyond the scope of the CAS data.

Among youth, some types of harms are more frequent than others. More specifically, lifetime adverse effects of drinking on "friendships and social life" and on "physical health" (15.9% and 18.4%, respectively) were more prevalent than other types of harms. Youth were more likely than adults to report lifetime harms to their physical health (18.4% versus 14.3%) and financial position (11.2% versus 6.2%), as well as one or more types of harms overall in their lifetime (33.7% versus 22.8%), whereas they were significantly less likely than adults to report lifetime harms to their home life or marriage (6.0% versus 8.6%).

The most prevalent types of past-year reported harms among youth were friendships and social life, physical health and financial position (7.6%, 12.0% and 8.7%, respectively). Differences in past-year reported harms between youth and adults were more pronounced than lifetime reported harms, with a higher proportion of youth than adults reporting harms in all areas examined: friendships and social life, physical health, home life or marriage, work, studies or employment opportunities, financial position, legal problems, and learning.

The emergence of differential harms to one's financial position between youth and adults could be seen as an indication that pricing of alcohol products as a means of controlling access may have a differential effect among youth and could act as a deterrent to use more effectively among youth. Of course, a more detailed examination of this question than is possible to do using data from the CAS would be necessary.

Characteristics associated with lifetime and past-year reported harms due to one's use of alcohol

Youth aged 18 to 19 were more likely than those aged 15 to 17 to report experiencing harm in their lifetime (35.5% versus 28.8%). Although there was no significant main effect of region when controlling for other factors, youth from the Quebec region were less likely to have reported harms (27.9%) and those from the Prairie region were more likely (38.1%) when compared with the Canadian average. Age of alcohol initiation was inversely associated with lifetime harms. Youth who started drinking at an earlier age were more likely to have reported harms due to their alcohol use (Table 3.15).

The alcohol-related harms experienced by an individual can be hypothesized to be associated with their alcohol-related behaviour. Table 3.16 examines past-year reported harms among youth as a function of demographic characteristics as well as past-year drinking patterns. Without taking alcohol use patterns into account, youth aged 18 to 19 reported more harms in the past year due to their alcohol use than those aged 15 to 17. In addition, youth who began drinking earlier were more likely to have reported harms. When drinking behaviour was controlled for, there was no difference in the reported harms of 15- to 17-year-olds and 18- to 19-year-olds; however, 20- to 24-year-olds were significantly less likely to report harm. This means that the difference in past-year reported harms between 18- to 19- and 15- to 17-year-olds that is demonstrated when not taking drinking patterns into account can be accounted for by the fact that 18- to 19-year-olds drink more heavily and frequently than those aged 15 to 17. As such, when drinking frequency and amount are controlled for, there are no differences in reported harms between these two age groups. On the other hand, youth aged 18 to 19 are more likely to experience harms from drinking than youth aged 20 to 24 when drinking at comparable levels.

In addition, youth who drank other than light and infrequently were more likely to experience harms as a result of their alcohol use; those who drank heavily at least monthly were approximately 5 times more likely to experience harms than those who did not (35.8% versus 6.0%). There was no difference apparent in reported harms between youth who never drank heavily and those who did so less than monthly.

Harms Because of Others' Use of Alcohol

Prevalence of types of harms

Due to the sensitive nature of some questions dealing with harms from others' alcohol use, respondents aged 15 to 17 were not asked these questions.

The rate of youth reporting one or more types of harms over the past year as a result of others drinking was double that reported by adults (59.6% versus 28.8%). More specifically, a higher proportion of youth reported past-year harms from others in terms of having been insulted or humiliated (36.1% versus 20.0%), having had family or marriage problems (13.9% versus 9.9%), having been pushed or shoved (32.7% versus 7.5%), having had serious arguments or quarrels (31.9% versus 13.0%), been verbally abused (25.4% versus 14.4%), or having been hit or physically assaulted (10.1% versus 2.2%) (Table 3.17).

Among youth, instances of negative verbal interactions were the most common types of harms experienced, with 36.1% reporting that they had been insulted or humiliated and 31.9% reporting serious arguments or quarrels over the past year. While the rates of physical altercations were much less frequent in adults than other types of harms, in youth these were just as frequent as the verbal harms. Specifically, one third (32.7%) of youth reported having been pushed or shoved by someone who had been drinking, and a lesser yet still substantial proportion reported having been hit or physically assaulted (10.1%).

An examination of the demographic characteristics associated with harm due to others' alcohol use among youth revealed that those who started drinking earlier were more likely to have reported past-year harms due to others' drinking than those who started drinking at a later age (Table 3.18).

Summary and Discussion

Despite the fact that the legal drinking age is 18 or 19 across Canada, the majority of youth consumed alcohol, both currently (82.9%) and in their lifetime (90.8%) even among those under the legal drinking age. Although there was no difference in the rate of alcohol use by youth and adults, when examining the frequency and patterns of use, many differences emerged. More specifically, youth consumed alcohol less frequently than adults; however, when they drank, they tended to drink more. The rates of heavy monthly and weekly drinking among youth were almost double that of adults, they had higher rates of exceeding the low-risk drinking guidelines, and more than doubled the rate of adults for hazardous drinking and quantity consumed per occasion. In light of these findings, it should come as no surprise that the rate of harms experienced by youth as a result of one's own drinking was also significantly higher than that of adults.

Youth are not a homogeneous group when it comes to alcohol use, frequency and quantity of use, and patterns of use. Among youth, there were no differences between males and females in terms of the prevalence of current and lifetime alcohol use; however, males were more likely than females to drink more frequently, to consume more per occasion and to report drinking heavily. In addition, youth aged 15 to 17 consumed less frequently, had fewer drinks per occasion and were less likely to drink heavily and hazardously. The mean age of alcohol initiation among youth was 15.6 years, and this was associated with several different outcome variables. More specifically, the younger that youth started drinking, the more likely they were to report consuming more per typical occasion, exceeding the low-risk drinking guidelines, and drinking heavily monthly and weekly. Youth who started drinking earlier were also more likely to have reported alcohol-related harms than those who started drinking at a later age. These findings reinforce the fact that age of initiation is an important factor to take into account in prevention and intervention efforts directed at youth since it is so tightly connected to the outcomes of alcohol use by youth.

Several findings from examination of the region variable should be noted. Firstly, youth from Quebec started drinking earlier and those from the Atlantic region later. Secondly, when looking at the above findings regarding age of alcohol initiation, one would expect that youth from the Quebec region would engage in more harmful patterns of drinking and exhibit more harm, whereas youth from the Atlantic region would display the opposite. This was not the case. Although youth from Quebec had a higher prevalence of current alcohol use, they did not display the significantly more harmful patterns of drinking than youth from the rest of Canada that one would expect given their younger age of initiation. Instead, youth from Quebec were more likely to consume fewer drinks per occasion, less likely to drink heavily (infrequently/frequently) and less likely to drink hazardously. In addition, Quebec youth were not significantly more likely to report alcohol-related harms. In contrast, although youth from the Atlantic region started drinking at a later age, these youth were less likely to consume fewer drinks per occasion and more likely to consume 5 or more, they were more likely to drink heavily, to have exceeded the low-risk drinking guidelines, and also more likely to drink hazardously than youth from the rest of Canada. These findings are interesting in that while age of initiation is an important factor to target in intervention efforts, it is clear that other factors are at play when it comes to the patterns of drinking by youth. Examining the nature of these factors is beyond the scope of this study; nonetheless, they are deserving of greater investigation, primarily for what they might offer in terms of prevention and intervention.