Binge drinking, parental substance use and family socio-economic status in France: evidence for an alcohol harm paradox in adolescence

Background Adolescent heavy episodic drinking (HED) represents a serious health threat. We explore the relation of HED and of emergency room visit because of acute alcoholic intoxication during life (ERV) with family socioeconomic status (SES), family living arrangement (living in a non-intact family or living independently) and parental substance use. Setting: A cross-sectional nationwide exhaustive 12-day survey in March 2017 of French youth aged 17-18.5 participating in the national mandatory civic information day. Participants: 13,314 adolescents answering a pen and paper questionnaire about their own alcohol consumption and the consumption of tobacco and alcohol of their parents. Measurements: Outcomes were the number of past month heavy drinking episodes and ERV. Risk ratios (RR) were computed using modified Poisson regressions. Results Compared to the adolescents with the highest SES, those from the lowest SES were less likely to report 1-2 or 3-5 episodes of heavy drinking instead of none (RR=0.58, 95% CI=[0.50; 0.66] and 0.35 [0.27; 0.45]) but there was no difference for 6 episodes and above (RR=0.81 [0.59; 1.12]). At the extreme, ERV was more frequent among adolescents with the lowest SES (RR=1.86 [1.05; 3.30]). SES, parental substance use and family living arrangement were associated independently with HED; they were not confounded by each other and no interaction between these factors was significant. Conclusion Adolescents from disadvantaged families report fewer episodes of heavy drinking, but are more likely to report alcohol-related emergency room visit, showing the existence of a robust “alcohol harm paradox”.