There is a growing concern regarding the increase in preventable harms attributed to adolescent alcohol consumption [23
]. Such concern has prompted medical and research debate regarding the delaying of adolescent alcohol consumption for as long as possible [7
]. This study tried to investigate alcohol use among high school adolescents in eastern Ethiopia.
The findings indicate an alcohol use prevalence of 22.2% (95% CI 20.2 - 24.2%) among the sampled high school students. About 10% (95% CI 9.0-11.8%) have drank in the past 30 days. We have also identified that male gender (OR 2.09; 95% CI 1.45-3.00), older age (OR 1.16; 95% CI 1.01-1.34), having friends who drink alcohol (OR 10.09; 95% CI 6.84-14.89) or living with people who use alcohol (OR 2.77; 95% CI 1.89-4.07) as strong predictors of drinking among the students.
Our finding of ever and past month alcohol drinking of 22.2% and 10.4% respectively seem to be lower than the report from Addis Ababa which indicated alcohol drinking prevalence of 45.7% and 26.5% in the same order [25
]. The main explanation for this is probably that Harar town is more cultural and value oriented than those studied in Addis Ababa. Also the fact that there is less exposure to alcohol advertising compared to Addis Ababa where billboards and FM radio advertisements are abound and could contribute to the lower drinking level in this study [26
]. It is also lower than 41.8% past 30 days drinking by high school students in the USA [28
] and 51.9% ever-drinking prevalence of alcohol use reported among secondary school students in Kisumu town, Kenya [29
]. Similarly, a South African study reported an alcohol use prevalence of 39.1% among high school adolescents [18
]. Other studies among high school students in Africa also report similar finding of a high prevalence rates of alcohol use, ranging from 15% to 57.9% [16
]. The primary reason for the comparatively lower alcohol drinking level in this study could be lack of access due to cultural and economic reasons. Despite this, the level of drinking in this study is far from normal and should be a cause for concern as it is a dangerous precedent for other risky behaviors both during adolescence and in adult life [24
]. Already, 30 percent of ever drinkers have also smoked a cigarette. Furthermore there are no assurances that the observed level of drinking could not progress to high levels of drinking over time and multi-substance use.
In this study, the average age at which the respondents started using alcohol was 17.5 years. On average, both sexes seem to start drinking beyond the high risk age of 14 years, which is associated with high risk for alcohol abuse and dependence in later life according to studies on sample populations from the USA [24
]. However, a recent systematic review indicates that later adolescence drinking could progress into late adulthood drinking habits, and it was also associated with suicide, car crashes and mental and social problems [31
]. Currently, a legal age limit for drinking as well as other important ordinances that ban drinking in certain places and advertising that tempt adolescents do not exist in the country, probably indicating the little attention given to adolescent drinking [19
]. This is understandable given the infectious disease focus of health authorities in developing countries.
Our findings indicate that males have higher odds of drinking than females (2.09; 95% CI 1.45-3.00). This is a common finding in substance use studies where males use substances more and show higher tendency for dependence than females. Apart from measurement and reporting issues [32
], it could mainly be explained by higher exposure opportunities due to reasons such as psychological, family and social factors [32
]. The findings also indicate that having friends who drink alcohol and living with people who drink alcohol are very strong predictors of alcohol use among the sample studied. This is in line with the consistent findings in the literature concerning peer pressure, influence of social groups and the suggestibility of adolescents toward alcohol drinking as well as other substances [7
]. Hence, this calls for awareness campaigns that have more focus on social groups and peers.
This study has limitations. One of them is the use of self-reporting methods. Self-reporting is prone to recall bias and under reporting due to social desirability bias. As a result the reported data are most likely an underestimation of true levels of drinking. However, we could not also exclude the possibility of exaggeration [39
]. The other important consideration is that non-respondents might have higher levels of drinking compared to respondents. This is because one of the reasons of non-response in this study is absence from class which could be due to substance related delinquency. Furthermore, close to half of the sample is composed of ninth graders. The trend of decreasing student numbers in subsequent classes might be due to a range of underlying factors influencing school attendance, the role of risk behaviors such as substance use cannot be ruled out.