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1 The use of alcohol, tobacco, over-the-counter substances and illicit substances, among Tasmanian secondary school students in 2014 and trends over time Prepared by: Tahlia Williams Katherine Scalzo Centre for Behavioural Research in Cancer Cancer Council Victoria Prepared for: Cancer Council Tasmania 2016

2 ii TABLE OF CONTENTS Introduction... 1 Method... 2 Sample selection... 2 Procedure... 2 Questionnaire... 3 Sample size and data analysis... 4 School retention rates... 5 Executive summary of results... 6 Prevalence of alcohol use in Changes in the prevalence of alcohol use since Prevalence of smoking in Changes in the prevalence of smoking since Use of over-the-counter and illicit substances in 2014 and changes over time... 8 Alcohol use in Changes in prevalence of alcohol use since Summary: Alcohol use among Tasmanian secondary students Tobacco use in Changes in prevalence of tobacco use since Summary: Tobacco use among Tasmanian secondary students Use of over-the-counter and illicit substances in Changes in use of over-the-counter and illicit substances, Summary: Use of over-the-counter and illicit substances among Tasmanian secondary students Appendix 1: Tasmanian ASSAD survey Appendix 2: Prevalence of use for all substances in past year, month and week Appendix 3: Electronic cigarettes (e-cigarettes)

3 trends over time 1 INTRODUCTION In 2014, the eleventh in a series of surveys assessing Tasmanian secondary school students smoking and alcohol behaviours was conducted. This survey was part of a national study assessing substance use among secondary school students (the Australian School Students Alcohol and Drug (ASSAD) Survey). The ASSAD survey built on an earlier triennial study assessing secondary students tobacco and alcohol use first conducted in 1984 by a consortium of cancer councils and health departments across the country. Questions on the use of other drugs were first included in the 1996 survey to provide prevalence estimates of licit and illicit drug usage. The survey aims to provide up-to-date estimates of the prevalence of the use of different substances among secondary school students. Reported here are prevalence figures for use of alcohol, tobacco, over-the-counter substances and illicit substances from the Tasmanian component of the 2014 survey. In addition, changes in the prevalence of use of these substances are examined between 2008 and The 2014 survey in Tasmania was led by the Cancer Council Tasmania (CCT). CCT acknowledges and appreciates the support of the Department of Health and Human Services, Communities, Sport and Recreation, Department of Premier and Cabinet and the Department of Education for the Tasmanian component of the 2014 ASSAD study. The Commonwealth Department of Health also contributed funding to the project.

4 trends over time 2 METHOD Sample selection The methodology for school and student sampling and data collection were basically the same as those used for previous surveys in this series. The target population for sampling was all students in Years 7 to 12 in Tasmania. Population estimates were based on the most up-to-date figures available from the Tasmanian Department of Education at the time. Schools with fewer than 100 students enrolled were excluded from the study. Schools were sampled using a random sampling methodology designed to represent students from the three main education sectors: government, Catholic, and independent. The basic design of the sampling procedure was a stratified two-stage probability sample, with schools selected at the first stage of sampling and students selected within schools at the second stage of sampling. Schools were stratified by the three education sectors (government, Catholic and independent) and randomly selected from each sector. The number of schools selected from each education sector was proportional to the distribution of students across the three education sectors in Tasmania. Two school samples were drawn, one from schools with students in Years 7 to 10, and the other from schools that included students in Years 11 and 12. The study aimed to survey students from 33 Tasmanian schools. To achieve this, 63 secondary schools were approached to take part in the study. Twenty-six secondary schools participated in the study, giving an overall response rate for secondary schools of 41. All surveying took place in the 2014 academic school year. Procedure The survey was conducted in Tasmanian secondary schools between June and December Principals of selected schools were contacted and permission to conduct the survey at the school was obtained. If a school refused they were replaced by the school geographically nearest to them within the same education sector. The study aimed to have 80 students from each participating school complete the survey. Students were surveyed in intact classes which were randomly chosen within the required year levels from classes where students were not selected on any ability or performance measures (i.e. unstreamed or non-selected classes). This ensured a representative cross-section of the student population in each year. Following the protocol used in past surveys, members of the research team administered the pencil-and-paper questionnaire to each class. Students answered the questionnaire anonymously. Due to changes in school policies regarding presence of teachers during survey administration, there has been an increasing trend of students completing the survey with a teacher present. In 2014, all schools required this. If a teacher was present when the survey was being conducted, they were asked to remain at the front or back of the room and not to participate in the survey session.

5 trends over time 3 Questionnaire In 2014, students completed a 15-page core questionnaire. To reduce order effects, two versions of the questionnaire were used. The first version had alcohol-related questions first; the second had tobacco-related questions first. Questions regarding other substances always followed both the alcohol and tobacco sections. In 2014, the students completed a 12-page supplementary survey which included questions covering smoking behaviour of parents, siblings and close friends, household smoking restrictions, attitudes to smoking tobacco and drinking alcohol, awareness of drinking and smoking related harms, perceptions of cigarette packs, alcoholic energy drink consumption and awareness of alcohol advertising. A copy of the 2014 questionnaire is included in Appendix 1. Questions reported on in this report are described below. Alcohol: The alcohol-related questions were the same as those used in previous surveys. Questions assessed ever use of alcohol, use of alcohol in the past 12 months, past month and on each of the seven days preceding the survey. Students who had used alcohol were asked to indicate the usual type of alcohol consumed (e.g., beer, wine, spirits, premixed spirits), the source of their last alcoholic drink and where they consumed this drink. Students who obtained their alcohol by someone buying it for them, were asked to indicate who that person was. Students were also asked if their last alcoholic drink was consumed under adult supervision. Students also choose one of the following labels to describe their drinking behaviour: non-drinker, a party drinker, an occasional drinker, a light drinker or a heavy drinker. The 2011 survey included, for the first time, questions assessing students consumption of alcoholic energy drinks, awareness of alcohol advertising and awareness of alcohol-related harms. These questions were repeated in 2014, with the list of alcohol-related harms assessed extended. The 2014 survey also included for the first time a question assessing how many times students had consumed five or more alcoholic drinks on any one occasion in the past two weeks, month, year and lifetime using the response options: never, 1-2 times, 3-5 times, 6-9 times, times, times and 40 or more times. Tobacco: The majority of questions on tobacco contained in the core questionnaire were identical to those used in previous survey years, and covered the following: lifetime experience of smoking, smoking in the past 12 months, past month and past seven days. As in the previous surveys, smoking in the past seven days was assessed by use of a seven-day diary where students indicated the number of cigarettes they smoked, if any, on each of the seven days prior to the survey. Students who smoked in the past seven days indicated the brand of cigarette they usually smoked, the pack size they usually smoked cigarettes from, and where or from whom they obtained their last cigarette. Students were also asked to indicate how easy or difficult it would be for them to buy cigarettes or to get someone else to buy cigarettes for them. In addition, students who smoked in the past seven days and who had obtained their last cigarette by getting someone else to buy it for them were asked to indicate whom that person was. Since 2011, students were asked about smoking behaviour of parents, siblings and close friends, household smoking restrictions, awareness of smoking-related harms and their perceptions of cigarette packs. The list of harms assessed was extended in in 2014 to include three new questions.

6 trends over time 4 The 2014 survey also included for the first time questions assessing students use of electronic cigarettes (response options: yes or no), recency of use (response options: within the past month, within the past 12 months, longer than 12 months ago) and whether the last e-cigarette smoked contained nicotine (response options: yes, no, I don t know). Awareness of electronic cigarette advertising was also assessed. Results regarding use of electronic cigarettes and awareness of electronic cigarette advertising are shown Appendix 3. Over-the-counter and illicit substances: Questions relating to over-the-counter and illicit substances were the same as those asked in previous surveys. The substances included in the questionnaire represented a wide range of licit and illicit substances. For each substance, the technical name was used in the question and was accompanied by explanations, examples and alternative terminology to clarify what substance was included in that category. The substances were: analgesics, sedatives, cannabis, performance or image enhancing drugs, inhalants, amphetamines, ecstasy, cocaine, opiates and hallucinogens. For each substance, students were asked to indicate the number of times, if ever, they had used or taken the substance in four time periods: the past seven days, the past month, the past year, and their lifetime. Students could choose from seven response categories ranging from None to 40 or more times. Questions concerning the use of sedatives, performance or image enhancing drugs, amphetamines and opiates explicitly asked about the non-medical use of these substances. Students who had used cannabis, amphetamines, ecstasy and hallucinogens in the past year were asked if they had used any other substance(s) on the same occasion as using these substances. Students indicated the substances they had used from a list that included: alcohol, tobacco, analgesics, cannabis, amphetamines, sedatives and hallucinogens. Students who had not used any other substance could choose this response from the list. Sample size and data analysis A total of 2,066 students in Year levels 7 to 12 were surveyed from schools in Tasmania between June and December Six cases were removed after data cleaning due to large amounts of missing data or wildly exaggerated responses, leaving a total of 2,060 valid cases. Table 1 presents the number of students in each sex and age group between 12 and 17 years.

7 trends over time 5 Table 1: Sample sizes for Tasmanian 12- to 17-year-old male and female students in 2014 Age (years) Males Females Total A total of 1,888 students aged between 12 and 17 years who provided valid data on their sex answered the questionnaire. Data from students outside this age range were excluded from the analysis as the numbers in each age and sex group were too small to ensure reliable estimates. Due to the small numbers of 12-year-old males and females, data for this group are combined with data for 13-year-olds. For all tests of significance data are combined into two groups: 12- to 15-year olds and 16- and 17-year-olds. Probability levels of p<0.01 and p<0.05 are reported as significant. As this report is based on data from a sample and not a census of the total population, it is necessary to allow for sampling error. Sampling error depends on the size of the sample and the size of prevalence estimates associated with that sample. The sampling error will be largest when the sample size is small and estimates are around 50. In 2014, the sampling errors range from a high of ±10 among 17-year-old males to a low of ±6 among 12- to 13-year-old females. Thus for a reported percentage of 50 for 12- to 13-year-old females, for example, we can be 95 confident that the actual percentage for this group is between 44 and 56. Prevalence estimates for alcohol, tobacco and drug related behaviours are based on data that have been weighted to counteract any over-sampling or undersampling with respect to age, sex and education sector. Weighting of data was based on Tasmanian school enrolments for Semester 2, 2014, provided by the Australian Bureau of Statistics. All data were weighted unless otherwise specified. Binary logistic regression analyses were used to compare the results found in 2014 with results from other survey years. For the separate analysis of data for males and females, the effects of age and education sector (government, Catholic and independent) were controlled. When data for males and females were combined, sex was also included in the analysis as a covariate. School retention rates The school retention rates, which are available from the Australian Bureau of Statistics for year level rather than age, indicate that 68 of Tasmanian students remained in school until Year 12 in The retention rates for 2012 was slightly lower than in 2011 (70) but slightly higher than in 2008 (65). This fluctuation in retention rates over time indicates that the population of Year 11 and 12 students may differ slightly across survey years. As a result, when comparing data from different survey years, separate analyses were performed for 12- to 15- year-olds (populations which are not affected by different school retention rates) and 16- and 17-year-olds (populations which are affected by variations in retention rates).

8 trends over time 6 EXECUTIVE SUMMARY OF RESULTS Prevalence of alcohol use in 2014 Experience with alcohol increased with age, with ever use increasing from 58 of 12- to 13-year-olds to 95 of 17-year-olds. Past month consumption of alcohol increased over fivefold from 11 of 12- to 13-year-olds to 59 of 17-year-olds. Seventeen per cent of all students reported drinking in the seven days prior to the survey (defined as current drinkers). The proportion of current drinkers increased significantly with age from 10 of 12- to 15-year-olds to 34 of 16- and 17-yearolds. The 2009 guidelines suggest that adults who consume five or more drinks on a single occasion are putting themselves at risk of short-term harm. Drinking at this level of risk among all students increased significantly with age from two per cent of 12- to 15-year-olds to 13 among 16- and 17-year-olds. Among current drinkers, proportions drinking at this level of risk increased from 23 of 12- to 15- year-olds to 38 of 16- and 17-year-olds. For male and female current drinkers, premixed spirits (ready-to-drink) were the most common drink type (males: 25; females: 46). Across all 12- to 17-yearolds, more males than females reported drinking beer. Among all students, 4 reported consuming an alcoholic energy drink in the past seven days with this increasing to 20 in the past year. Older students were more likely to report consuming an alcoholic energy drink in the past year than younger students. Parents were the most common non-retail source of alcohol for those who drank in the past seven days (51), followed by someone else (22) and friends (16). Just over 40 of students believed it to be easy or very easy to access alcohol though friends or from their home. The majority of students have high awareness of some negative health outcomes that can be caused by alcohol consumption. Over 80 of students agreed that drinking alcohol can cause accidents and injury and that drinking while pregnant can harm unborn babies. Fewer students agreed that drinking alcohol can cause breast cancer (26). Changes in the prevalence of alcohol use since 2008 The proportion of 12- to 15-year-olds (71) drinking in their lifetime in 2014 was lower than proportions in 2011 (80) and 2008 (85). Among the older age group the proportion drinking in their lifetime in 2014 (93) was similar to the proportion in 2011 (92) but significantly lower than the proportion in 2008 (97). Similar to the pattern observed in lifetime drinking, the proportion of younger current drinkers in 2014 was significantly lower than the two previous survey years. While the proportion of older current drinkers in 2014 was less than in 2008, there was no difference between 2014 and 2011.

9 trends over time 7 The proportion of current drinkers who drank at risk of short-term harm changed little over time for 12- to 15-year-olds. Encouragingly, among 16- and 17-yearolds the proportion of current drinkers drinking at risky levels decreased over time (2008: 56; 2011: 54; 2014: 39). Prevalence of smoking in 2014 Seventy-seven per cent of Tasmanian secondary school students aged 12- to 17- year-old had never smoked even part of a cigarette. While the proportion of students who hadn t smoked decreased with age, 65 of 17-year-olds had not smoked even part of a cigarette in their lifetime. Sixteen per cent of all students reported smoking in the past year, nine per cent reported smoking in the past month and six per cent reported smoking in the past seven days (current smokers). Experience with smoking increased with age in all recency categories, for example students aged 16 and 17 years (31) were significantly more likely to have smoked in the past year than 12- to 15-year-olds (10). No sex differences were found for smoking in the past year, month or seven days among older or younger students. The most popular brand choice for current smokers was JPS (30), followed by Peter Jackson (24). Thirty-one per cent of current smokers reported their preferred pack size as a pack of 20, followed by 22s (19). Only 12 of current smokers reported that they had bought their last cigarette. The most common non-retail source of cigarettes was friends (44), followed by asking someone else to buy their cigarettes (25). Students were more likely to believe that it would be easy or very easy to get someone else to buy cigarettes for them (45) than to purchase cigarettes themselves (11). Students awareness of illnesses or harm caused by smoking was high, with the exception being smoking causes sexual dysfunction in men (51), smoking causes winkles and makes your hair grey (57), smoking causes infertility in men and women (50) and smoking causes blindness (45). Over 80 of students who had seen a cigarette pack in the past year agreed or strongly agreed that cigarette packs look ugly, look gross or disgusting and look unhealthy. Changes in the prevalence of smoking since 2008 Among all 12- to 15-year-olds, the proportion reporting smoking in the past year, past month and past seven days in 2014 (10; 5; 3, respectively) was less than in 2008 (16; 7; 5, respectively). While the proportion of older students smoking in the past year in 2014 (31) was significantly lower than the proportion in 2008 (39), the proportion smoking in the past month and past seven days remained stable between 2008 and 2014.

10 trends over time 8 Use of over-the-counter and illicit substances in 2014 and changes over time Analgesics Analgesics were the most commonly used over-the-counter substance by secondary school students, with 96 of 12- to 15-year-olds and 97 of 16- and 17-year-olds reporting lifetime use of these substances. Lifetime use of analgesics among 12- to 17-year-olds remained stable between 2008 (95) and 2014 (96). Sedatives Just under 20 of 12- to 17-year-olds report lifetime use of sedatives other than for medical reasons. Among 12- to 17-year olds, lifetime use of sedatives decreased from 2011 to 2014 but similar levels were found in 2008 and Cannabis Cannabis was the most commonly used illicit substance, with 32 of 16- and 17- year-old students and 11 of 12- to 15-year-old students reporting lifetime use. Among 12- to 17-year olds, lifetime use of cannabis remained stable between 2008 (16) and 2014 (18). Inhalants Inhalant use was more common among younger students (18) than older students (10). When data were combined for all 12- to 17-year-old students, the proportion of students using inhalants in their lifetime in 2014 was significantly lower from the proportions in 2011 and Amphetamines Few secondary school students had ever used amphetamines. Lifetime use of amphetamines increased from one per cent among 12- to 15-year-olds to five per cent of 16- and 17-year-olds. Lifetime use of amphetamines among 12- to 17- year-olds remained stable over time, (2008: 3; 2011: 3; 2014: 2). Performance or image enhancing drugs Performance or image enhancing drug use was very low among Tasmanian secondary students, with only two per cent of 12- to 17-year-olds reporting lifetime use of performance or image enhancing drugs. When data were combined across all 12- to 17-year-old students, the proportion of students who had used performance or image enhancing drugs in their lifetime in 2014 was similar to proportions found in 2011 and Cocaine Two per cent of 12- to 17-year-olds reported ever use of cocaine in The proportion of students using cocaine was very low across all survey years (2008: 2; 2011: 2; 2014: 2).

11 trends over time 9 Ecstasy Few students reported lifetime use of ecstasy, with use increasing from one per cent of 12- to 15-year-olds to four per cent of 16- and 17-year-olds. Lifetime use of ecstasy among 12- to 17-year-olds remained stable over time. Opiates Lifetime use of opiates was rare among Tasmanian secondary students, reported by only one per cent in When data were combined for all 12- to 17-yearolds, the proportion of lifetime users remained stable between 2014 and 2011 and between 2014 and Hallucinogens Lifetime use of hallucinogens increased from two per cent of 12- to 15-year-olds to five per cent of 16- and 17-year-olds. The proportion of 12- to 17-year-olds using hallucinogens decreased significantly from 4 in both 2008 and 2011 to 3 in Use of any illicit substance Lifetime use of any of the illicit substances (cannabis, amphetamines, cocaine, opiates, ecstasy or hallucinogens) increased with age from 10 among younger students to 30 among older students. The proportion of 12- to 17-year-old students using any illicit substance in 2014 (16) was significantly lower than the prevalence estimate in 2011 (19). Use of any illicit substance except cannabis Lifetime use of any of the illicit substances excluding cannabis increased with age from three per cent of 12- to 15-year-old students to nine per cent of 16- and 17- year-old students. The proportion of 12- to 17-year-old students using any illicit substance excluding cannabis in 2014 (5) was significantly lower than the prevalence estimate in 2011 (7) and 2008 (6).

12 trends over time 10 ALCOHOL USE IN 2014 The prevalence of alcohol use among 12- to 17-year-old Tasmanian students surveyed in 2014 is described in the following section. The estimated prevalence of drinking in various recency periods is presented in Table 2, for each age and sex grouping. The percentage of students drinking at levels risking short-term harm in the past seven days among all students and among current drinkers is also presented in Table 2. The average number of drinks consumed per week by current drinkers is also presented. Twenty-three per cent of 12- to 17-year-olds had never tried alcohol, 36 had tried just a few sips, 14 had fewer than 10 drinks, and 27 had consumed more than 10 alcoholic drinks in their lifetime. Experience with alcohol increased with age, more students aged between 16 and 17 years (93) had tried at least a sip of alcohol than 12- to 15-year-olds (71) (p<0.01). In addition, 58 of students in the older age group had consumed more than 10 drinks in their lifetime, compared to 14 of 12- to 15-year-olds (p<0.01). Among younger and older students, males and females were equally likely to report having consumed more than 10 drinks in their lifetime. Around 55 of 12- to 17-year-olds had consumed alcohol in the past year. Drinking in the past year increased significantly with age from 43 of 12- to 15- year-olds to 85 of 16- and 17-year-olds (p<0.01). Males and females were equally likely to report drinking in the past year among 16- and 17-year-olds. Among 12- to 15-year-olds, males (46) were more likely to report drinking in the past year than females (40; p<0.05). Approximately 29 of all 12- to 17-year-olds reported drinking in the past month. While 19 of students in the younger age group drank in the past month, this increased significantly to 54 among 16- and 17-year-olds (p<0.01). Among 16- and 17-year-olds, significantly more males (59) than females (49) drank alcohol in the past month (p<0.05). Among 12- to 15-year-olds males and females were equally likely to consume alcohol during this period. Seventeen per cent of all 12- to 17-year-olds had consumed alcohol in the seven days before the survey (current drinkers). Sixteen to 17-year-olds (34) were more likely to be current drinkers than 12- to 15-year-olds (10) (p<0.01). There were no sex differences in the proportion of current drinkers in either age group.

13 trends over time 11 Table 2: Lifetime prevalence and recency of alcohol consumption, by age and sex, Tasmania, 2014* # Drinking category Never drank Age (years) Males Females Total Just a few sips Males Females Total Less than 10 drinks Males Females Total More than 10 drinks Males Females Total Drank in past year Males Females Total Drank in past month Males Females Total Drank in past seven days (current drinker) Males Females Total Drank at risk of short-term harm^^ (all students) Males Females Total

14 trends over time 12 Table 2: Continued Drinking category Drank at risk of short-term harm^^ (current drinkers) Age (years) Males Females Total Mean number of drinks per week^ (current drinkers) Males Females Total * Totals may not equal 100 due to rounding. # Prevalence estimates are within ±10 of the true population values. ^^ Drinking at risk of short-term harm is defined as consuming five or more alcoholic drinks on any day in the past seven days (both sexes). Students who reported consuming more than 20 alcoholic drinks on any day in the past seven days were excluded from the analysis. ^ Based on unweighted data. These estimates exclude students who reported drinking more than 20 alcoholic drinks on any one day in the past seven days. The 2009 NHMRC guidelines on alcohol consumption recommend that abstaining from alcohol is the safest option for young people under the age of 18 years. Given this recommendation, the percentage of students ever having an alcoholic drink in their lifetime or in any of the recency periods discussed above reflects the percentages of students not adhering to this guideline. As in previous survey years, the percentage of students drinking at levels that could result in short-term harm was examined, based on the NHMRC guidelines for adults. The 2009 guidelines suggest that adults who consume five or more drinks on a single occasion are putting themselves at risk of short-term harm. While this particular guideline is for adults, it was of interest to examine the current cohort of adolescents consumption of alcohol at this risky level. In the current study, males and females drinking at levels that risk short-term harm is defined as consuming five or more alcoholic drinks on any one of the past seven days. Five per cent of all 12- to 17-year-olds had consumed alcohol at levels risking short-term harm in the past seven days before the survey. Drinking at risk among all students increased significantly with age from two per cent of 12- to 15-yearolds to 13 among 16- and 17-year-olds (p<0.01). While among the younger age group males (3) were more likely to consume alcohol at this level than females (1) (p<0.05), there were no significant sex differences observed in the older age group.

15 trends over time 13 Of 12- to 17-year-old current drinkers, just under one-third (32) reported drinking at risk of short-term harm in the seven days before the survey. Among current drinkers, drinking at risk of short-term harm increased with age from 23 of 12- to 15-year-olds to 38 of 16- and 17-year-olds (p<0.01). While males (30) were more likely to consume alcohol at this level than females (14) in the younger age group (p<0.05), no significant sex differences were found in the older age group. Among current drinkers, the average number of drinks consumed in the past seven days for 12- to 15-year-olds (6) was similar to the number consumed by 16- and 17-year-olds (7). In both age groups, male current drinkers consumed significantly more drinks than female current drinkers (p<0.05). Students were asked how old they were when they had their first full serve (i.e. a glass) of alcohol. Results are only presented for 16-year-olds, as students in this age group generally have a high level of involvement with alcohol, and drinking tends to increase with age. Table 3 below presents the results for 16-year-old students who had consumed at least one full serve of alcohol. Table 3: Percentage of 16-year-old students who had ever consumed at least one full serve of alcohol, having their first full serve of alcohol at different ages, Tasmania, 2014^ Age (years) of first full serve of alcohol 11 or younger year-olds ^ Base: 16-year-old students who had consumed at least one full serve of alcohol (n=251). 16 Nineteen per cent of 16-year-olds reported that they had their first full serve of alcohol at 12 years of age or younger. Most 16-year-olds who had consumed at least one full serve of alcohol had their first serve between the ages of 14 and 15 years. Students self-description of drinking status Students were asked to choose the label that described their drinking behaviours from the following: non-drinker, occasional drinker, light drinker, party drinker, and heavy drinker. The labels chosen by males and females in each age group are shown in Table 4.

16 trends over time 14 Table 4: Students self-description of drinking status, by age and sex, Tasmania, 2014 # Self-description of drinking status Non-drinker Age (years) 15 Males Females Total Occasional drinker Males Females Total Light drinker Males Females Total Party drinker Males Females Total Heavy drinker Males Females Total # Totals may not equal 100 due to rounding Across all 12- to 17-year-olds, students were most likely to classify themselves as non-drinkers (64), followed by either occasional drinkers (20) or party drinkers (12). Very few students thought they were heavy drinkers (1). Seventy-eight per cent of 12- to 15-year-olds saw themselves as non-drinkers, significantly higher than the 29 of 16- and 17-year-olds (p<0.01). Students in the older age group were more likely to see themselves as occasional drinkers (35) than were 12- to 15-year-olds (13) (p<0.01) and were also more likely to view themselves as party drinkers (29) compared to 12- to 15-year-olds (5) (p<0.01). Type of alcohol most often consumed Current drinkers (those who had consumed alcohol in the seven days prior to the survey) were asked to indicate what alcoholic drink they usually have. Table 5 shows the types of drinks most commonly consumed by males and females in the two age groups: 12 to 15 years and 16 to 17 years.

17 trends over time 15 Table 5: Drink types most commonly consumed by those who drank alcohol in the past seven days (current drinkers), by age group and sex, Tasmania, 2014 *# Drink type Males 12 to 15 years 16 to 17 years 12 to 17 years Females Total Males Females Total Males Females Total Premixed spirits Spirits Beer (ordinary) Wine * Multiple responses allowed. # Only the most frequent responses are listed. Premixed spirits were the most common type of drink consumed by 12- to 17- year-old current drinkers, with 35 indicating they drank premixed spirits. Spirits other than premixed drinks were the next most popular beverage type (22). In the older age group, the consumption of premixed spirits was significantly more common among females than males (p<0.05). In both age groups, beer was more likely to be consumed by males than females (p<0.01). Male and female current drinkers were equally likely to report drinking spirits. Prevalence of alcoholic energy drink consumption among students Students were asked if they had ever consumed an alcoholic energy drink in their lifetime, in the past year, past month and in the past seven days. Table 6 below presents these percentages by age and sex. Table 6: Percentage of all students who have ever consumed alcoholic energy drinks in their lifetime, in the past year, past month and in the past seven days, by age and sex, Tasmania, 2014 Consumption of alcoholic energy drinks Drank in lifetime Age (years) 15 Males Females Total Drank in past year Males Females Total Drank in past month Males Females Total Drank in past seven days Males Females Total

18 trends over time 16 Twenty-four per cent of all students had consumed an alcoholic energy drink in their lifetime and four per cent reported drinking them in the past seven days. With the exception of past seven days drinking, in all recency periods, alcoholic energy drink consumption increased with age for both males and females (p<0.01). When data were combined across sex, 16- and 17-year-olds (6) were equally as likely to have consumed these beverages in the past seven days as 12- to 15-year-olds (4). Access to alcohol Students who had ever consumed alcohol were asked how they had obtained their last alcoholic drink. Students indicated whether they bought or did not buy their last alcoholic drink themselves. Students also indicated specific sources under these two headings. Among current drinkers, few students indicated that they bought their last alcoholic drink themselves, and age was not related to this. The most common non-retail sources of alcohol for current drinkers are shown in Table 7 for males and females in the two age groups 12 to 15 years and 16 to 17 years. Table 7: Most common non-retail sources of alcohol for current drinkers, by age group and sex, Tasmania, 2014 #^ Alcohol Source Males 12 to 15 years 16 to 17 years 12 to 17 years Females Total Males Females Total Males Females Parents Friends Someone else bought # Additional sources of alcohol were included in the survey. As only the most common sources are shown, percentages do not add to 100. ^ Base: Current drinkers students who had used alcohol on any of the seven days prior to completing the survey and who did not buy their own alcohol (n=276). Total Table 7 shows that parents were the most common source of alcohol, reported by 51 of 12- to 17-year-old current drinkers. There was no significant difference in the proportion of current drinkers indicating parents as their source of alcohol between 12- to 15-year-olds (56) and 16- and 17-year-olds (49). In contrast, 16- and 17-year-old current drinkers were more likely to ask someone else to buy alcohol for them (30) than 12- to 15-year-olds (10) (p<0.01). The proportion of current drinkers indicating that friends were their main source of alcohol did not differ significantly between the younger (13) and the older students (17). Who students asked to buy alcohol for them Students reporting that someone else bought their last alcoholic drink were asked to indicate who that person was. Response options included: a friend who is 18 years or over; brother/sister 18 years or over; friend under 18 years; brother/sister under 18 years; or a stranger who was able to buy alcohol. Current drinkers who had someone else buy alcohol for them (n=59) were most likely to ask a friend aged 18 years or over (88).

19 trends over time 17 Perception of ease in accessing alcohol from various sources All students were asked to rate how easy or difficult it is for them to access alcohol from various sources. Possible responses were: 1) Very difficult; 2) Difficult; 3) Easy; 4) Very easy; 5) Don t know. Table 8 shows the percentage of students in each age and sex grouping that rated each source as easy or very easy to access alcohol from. Table 8: Percentage of students believing it is easy or very easy to access alcohol from different sources, by age group and sex, Tasmania, 2014 Alcohol Source Through your friends Age (years) Males Females Total In your home Males Females Total Through takeaway liquor outlets Males Females Total At licenced venues such as pubs and clubs Males Females Total The source that students rated the easiest to get alcohol from was their homes, followed by their friends (Table 8). Older students were more likely than younger students to believe they could access alcohol from each of the sources listed above (p<0.01). Where students drank alcohol Current drinkers were asked to indicate where they consumed their last alcoholic drink. Table 9 shows the most common responses to this question by sex for the age groups 12 to 15 years and 16 to 17 years. Overall, there were three main places current drinkers consumed alcohol: their home (32), a friend s home (29), or a party (23). The proportion of students drinking at home decreased with age from 44 of 12- to 15-year-olds to 25 of 16- and 17-year-olds (p<0.01). In contrast, the proportion of students drinking at a friend s home increased with age from 19 of 12- to 15-year-olds to 35 of 16- and 17-year-olds (p<0.01). More older students (29) than younger students (13) drank at a party (p<0.01).

20 trends over time 18 Table 9: Current drinkers most usual places for drinking, by age group and sex, Tasmania, 2014 #^ Drink location Males 12 to 15 years 16 to 17 years 12 to 17 years Females Total Males Females Total Males Females Home Party Friend s home Total # Additional locations of drinking were included in the survey. As only the most common sources are shown, percentages do not add to 100. ^ Base: Current drinkers students who had used alcohol on any of the seven days prior to completing the survey and provided information on where they drank their last alcoholic drink (n=296). Adult supervision of students drinking Students were asked if an adult was supervising them (and/or their friends) when they consumed their last alcoholic drink. Overall, the majority of current drinkers (67) reported that they had consumed their last alcoholic drink under adult supervision. Younger male current drinkers were more likely to report drinking their last alcoholic drink under adult supervision than older males (p<0.05). Among females, adult supervision of students drinking did not differ for the two age groups. Among 16- and 17-year-old students, females were more likely to have consumed their last alcohol drink under adult supervision than males (p<0.01). This sex difference was not observed among younger students. Students attitudes towards alcohol use Students were asked questions about the appeal of alcohol and the characteristics of drinkers, with the aim of assessing some general attitudes towards alcohol. Students were asked how much they agree or disagree with the statements listed in Table 10 below. Possible responses to these questions ranged from 1) Strongly disagree; to 4) Strongly agree; or 5) Don t know. Table 10 presents the percentage of students who agree/strongly agree with each alcohol attitude statement, by age group and sex.

21 trends over time 19 Table 10: Percentage of students who agree/strongly agree with attitude statements about alcohol use, by age group and sex, Tasmania, 2014 Alcohol attitude statements Getting drunk every now and then is not a problem Age (years) Males Females Total Having a few drinks is one of the best ways of relaxing Males Females Total Having a few drinks is one of the best ways of getting to know people Males Females Total If someone doesn t have a few drinks, then they re not really part of the group Males Females Total You can have a good time at a party where there is no alcohol Males Females Total People who drink alcohol are usually more popular than people who don t Males Females Total The data suggest that students attitudes towards alcohol use becomes more positive with increasing age (Table 10). Among males, older students (16 to 17 years) were significantly more likely than younger students (12 to 15 years) to agree or strongly agree that getting drunk every now and then is not a problem, that having a few drinks is a good way of relaxing, that it is a good way of getting to know people and that people who drink alcohol are usually more popular than people who don t (p<0.01). Among females, older students (16 to 17 years) were significantly more likely than younger students (12 to 15 years) to agree or strongly agree that getting drunk every now and then is not a problem, that having a few drinks is a good way of relaxing and that having a few drinks is also a good way of getting to know people (p<0.01). However, only a small percentage of

22 trends over time 20 students agreed or strongly agreed that non-drinkers are not really part of the group and in both age groups over 80 of students agreed that you can have a good time at a party without alcohol. Warning labels on alcoholic drinks All students were asked if they read a warning label on an alcoholic drink would that make them change their mind about having that drink. Possible responses included: 1) Agree; 2) Disagree; or 3) Don t know. Table 11 shows the percentage of students in each age and sex group that agreed with this statement. Table 11: Percentage of students who agreed that a warning label on an alcoholic drink would make them change their mind about having that drink, by age group and sex, Tasmania, 2014 A warning label on an alcoholic drink would make me change my mind about having that drink Age (years) Males Females Total As shown in Table 11, younger male students (aged between 12 to 15 years) were more likely than older male students (16 and 17 year olds) to agree that reading a warning label on an alcoholic drink would make them change their mind about having that drink (p<0.01). This difference between the two age groups was not observed among female students. Students understanding of alcohol-related illness and disease Students were asked about their understanding of alcohol use and the associated risks to health and wellbeing. Students indicated how much they agree or disagree with a list of negative health outcomes that some people have said are caused by alcohol, including the following: 1. Drinking alcohol can cause accidents and injury. 2. Drinking alcohol can cause breast cancer. 3. Drinking alcohol when pregnant can harm unborn babies. 4. Drinking alcohol when breast feeding can harm babies. 5. Drinking alcohol can cause cancer. 6. Drinking alcohol can cause liver cancer. Possible responses included: 1) Agree; 2) Disagree; or 3) Don t know. Table 12 presents the percentage of students who agreed that alcohol causes each of the illnesses or diseases listed above, by age group and sex.

23 trends over time 21 Table 12: Percentage of students who agreed that alcohol causes some negative health outcomes, by age group and sex, Tasmania, 2014 Negative health outcomes Drinking alcohol can cause accidents and injury Age (years) Males Females Total Drinking alcohol can cause breast cancer Males Females Total Drinking alcohol when pregnant can harm unborn babies Males Females Total Drinking alcohol when breast feeding can harm babies Males Females Total Drinking alcohol can cause cancer Males Females Total Drinking alcohol can cause liver cancer Males Females Total The findings in Table 12 show that the majority of students believe that alcohol causes a number of different illnesses and diseases with the exception of breast cancer and cancer in general. Sixteen- to 17-year-olds were significantly more likely than 12- to 15-year-olds to agree that alcohol can cause all illnesses/diseases listed in Table 12 (p<0.01), with the exception of breast cancer and cancer in general. In regards to sex differences, among 12- to-15-year old students, more females than males agreed that drinking alcohol can cause accidents and injuries, that drinking alcohol when pregnant can harm unborn babies and drinking alcohol when breast feeding can harm babies (p<0.01). However, among 12- to 15-yearolds more males than females agreed that drinking alcohol can cause breast

24 trends over time 22 cancer (p<0.01). Among 16- and 17 year-olds, more females than males agreed that drinking while pregnant can harm unborn babies and drinking alcohol when breast feeding can harm babies (p<0.01). It was of interest to examine the proportion of students who responded Don t know as to whether alcohol causes each of the illnesses or diseases listed in the survey. Table 13: Percentage of 12- to 17-year-old students who Don t know some illnesses or diseases are caused by alcohol Negative health outcomes Don t know Drinking alcohol can cause accidents and injury 5 Drinking alcohol can cause breast cancer 56 Drinking alcohol when pregnant can harm unborn babies 12 Drinking alcohol when breast feeding can harm babies 30 Drinking alcohol can cause cancer 44 Drinking alcohol can cause liver cancer 20 There was considerable variation in the percentage of students responding Don t know as to whether alcohol causes each of the illnesses or diseases listed above (Table 13). For example, while only five per cent of students did not know that drinking alcohol can cause accidents and injury, 56 did not know whether alcohol can cause breast cancer. Awareness of alcohol advertisements among students All students were asked how often in the past month they had seen advertisements for alcoholic drinks on TV or heard them on radio or seen them on billboards/magazines/newspapers, with possible responses being: 1) Never; 2) Once; 3) Twice; 4) 3-6 times per week; 5) 7-9 times; and 6) 10 or more times. The proportion of males and females within each age group who recalled seeing or hearing alcohol advertisements on various advertising mediums (TV/radio or billboards/magazines/newspapers) at least once in the past month is presented in Table 14.

25 trends over time 23 Table 14: Percentage of students who recalled seeing alcohol advertisements on different mediums at least once in the past month, by age group and sex, Tasmania, 2014 Advertising medium TV/radio (broadcast media) Age (years) Males Females Total Billboards/ magazines/ newspapers (print media) Males Females Total Awareness of alcohol advertisements on both broadcast and print media forums was very common across both age groups and sexes (Table 14) with around 80 of students in each age and sex grouping seeing or hearing alcohol advertisements at least once in the past month. A greater proportion of older female students than younger female students reported to have seen alcohol advertising on TV/radio and billboards/magazines or newspapers at least once a month (p<0.05). No differences between the two age groups were observed among males on these media forums. Students perceptions of alcohol advertisements In 2014 students were asked how much they agreed or disagreed with the following attitude statements about alcohol advertisements: 1) Advertisements for alcohol make drinking look fun; 2) Advertisements for alcohol make drinking look dangerous; 3) Advertisements for alcohol make it seem like everyone drinks; 4) Advertisements for alcohol make it more likely that I will drink now; 5) Advertisements for alcohol make drinking look attractive; 6) Advertisements for alcohol make drinkers seem successful; 7) Advertisements for alcohol make it seem like people who drink are better at sport; 8) Advertisements for alcohol make people who drink look cool. Possible responses were: 1) Agree; 2) Disagree; or 3) Don t know. Table 15 shows the percentage of students in each age and sex group that agreed with each statement.

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