We’re almost at the end of our Big 6 blog series! Welcome to the fifth installment of this six-part series about “The Big 6:” the six major health behaviours that play a critical role in the physical and mental health of youth, now and in the long-term [1,2]. These six behaviours are: dietary intake, physical activity, sleep, sedentary recreational screen time, alcohol use, and tobacco/e-cigarette use.
In one of the largest school-based prevention clinical trials in Australia, the Health4Life program found significant associations between each of the Big 6 and depression, anxiety, and psychological distress symptoms in adolescents [1-3].
This blog post will cover the alcohol component of the Big Six and how it impacts youth wellbeing.
Alcohol and mental health in youth
Alcohol is the most commonly used drug in Australia, and the most common substance used by teenagers. The legal drinking age in Australia is 18 years old. However, the brain continues to develop until we are in our 20s, and research has shown that alcohol can damage the developing brain and impede healthy brain development during the teenage years [4].
Young people are also particularly vulnerable to harms from alcohol due to factors such as a lack of experience and education, peer pressure, lack of supervision, and having a smaller average body mass than adults (meaning the alcohol has a greater affect) [5].
There are differences in trends between males and females, where female intake has been on the rise in the past 3-4 years and males has been declining slightly. Overall, there has been a slight decline in alcohol use amongst young people aged 12-17 since 2019, with 22% of young people having used alcohol in the past month in 2022-2023 [6]. However, rates of high-risk drinking among young people remain concerningly high.
The Big 6: Alcohol
The 2023 study conducted using the Health4Life data investigated associations between the Big 6 health behaviours and mental health among adolescents in Australia [1,3].
For alcohol, the study found that:
- Young people who had not consumed a full standard alcoholic drink in the previous six months had 20% lower anxiety symptoms, 38% lower depression symptoms, and 28% lower psychological distress symptoms than those who had drank.
How does the Health4Life program target alcohol use?
The Health4Life program educates students on alcohol and risks according to the Australian Guidelines to reduce harms. It addresses the prevalence and patterns of alcohol use among young Australians, identifies reasons why teenagers choose to (or not to) drink, the consequences of use, and uses normative education to correct any misconceptions that young people may have. For example, some teenagers may be under the assumption that “heaps of other people my age are drinking,” when actually, it’s more “normal” not to be. This is backed up by the data (see image below taken from the Module 2 student summary as an example, and is also addressed within the cartoon storyline). However, although only a small proportion of teens aged 12-15 drink alcohol, exposure to alcohol often happens during adolescence. This is why harm-reduction is key. Health4Life also teaches students tips for saying no and resisting peer pressure, and provides important reasons for choosing not to drink.
See some example slides below where the coach is speaking to two characters about assertive ways to say ‘no’ (strategies to resist peer pressure). He goes through each step, giving examples and practicing it with the teens before giving some other strategies, too.
An example of a “Stop & Think” activity (that occur throughout the cartoons to consolidate knowledge):
The Health4Life program is the first online health education program teaching year 7-8 secondary school students about these Big 6 health behaviours. The program is aligned with the Australian HPE curriculum and the NSW PDHPE syllabus and requires no teacher training and minimal preparation for all class and homework activities. Read more about Health4Life here.
Author: Francesca Wallis.
With expert review by researchers at the Matilda Centre for Research in Mental Health and Substance Use.
References:
[1] S. Smout, L. A. Gardner, N. Newton, and K. E. Champion, “Dose–response associations between modifiable lifestyle behaviours and anxiety, depression and psychological distress symptoms in early adolescence,” Australian and New Zealand Journal of Public Health, vol. 47, no. 1, p. 100010, Feb. 2023, doi: https://doi.org/10.1016/j.anzjph.2022.100010.[2] Teesson M, Champion KE, Newton NC, et al, “Study protocol of the Health4Life initiative: a cluster randomised controlled trial of an eHealth school-based program targeting multiple lifestyle risk behaviours among young Australians.” BMJ Open 2020;10:e035662. doi: 10.1136/bmjopen-2019-035662
[3] S. Smout and L. Gardner, “The big six modifiable factors for youth mental health,” InSight+, 2023. https://insightplus.mja.com.au/2023/17/the-big-six-modifiable-factors-for-youth-mental-health/
[4] E. Black, “Alcohol: What You Need to Know,” Australian Government Department of Health, 2014. Available: https://positivechoices.org.au/documents/8cGOj1mJJs/alcohol-detailed-resource-for-parentsteachers/
[5] Positive Choices, “Alcohol: Factsheet,” Positive Choices, 2011. https://positivechoices.org.au/teachers/alcohol-factsheet
[6] Australian Institute of Health and Welfare, “National Drug Strategy Household Survey 2022–2023: Young people’s consumption of alcohol,” Australian Institute of Health and Welfare, Feb. 29, 2024. https://www.aihw.gov.au/reports/alcohol/young-people-alcohol
