Do public expenditures on health and families relate to alcohol abstaining in adolescents? Multilevel study of adolescents in 24 countries

Introduction and Aims: Several European countries have observed an increase in the proportion of adolescents that abstain from drinking alcohol in the last decade. The reasons for this trend remain underexplored. We hypothesised that more generous government expenditures on health services and benefits to families with children relate to a positive trend in abstainers. Design and Methods: We used data on 15-year-olds in four successive cycles of the World Health Organization Health Behaviour in School-aged Children study (2002 to 2014) in 24 North American and European countries (pooled n = 175 331). Generalised linear mixed-effects models were tested to analyse trends in alcohol abstinence and to investigate whether cross-country differences in these trends relate to public expenditures on health and families with children (in proportion to gross domestic product). Results: Overall, we observed an increase in the proportion of abstainers from 21% in 2002 to 35% in 2014. An exception was Greece where abstaining had decreased from 20% to 15%. Similar results were found in boys and girls. The upward trend in abstinence related to larger government expenditures on health and families. Discussions and Conclusions: More generous expenditures on health services and family benefits relate to more adolescents abstaining from alcohol.