National trends in alcohol and substance use among adolescents from 2005 to 2021: a Korean serial cross-sectional study of one million adolescents

World Journal of Pediatrics https://doi.org/10.1007/s12519-023-00715-9 ORIGINAL ARTICLE National trends in alcohol and substance use among adolescents from 2005 to 2021: a Korean serial cross‑sectional study of one million adolescents Sangil Park1 · Hyunju Yon2 · Chae Yeon Ban2 · Hyoin Shin2 · Seounghyun Eum2 · Seung Won Lee3 · Youn Ho Shin4 · Jung U. Shin5,25 · Ai Koyanagi6,7 · Louis Jacob6,8 · Lee Smith9 · Chanyang Min10 · Abdullah Özgür Yeniova11 · So Young Kim12 · Jinseok Lee13 · Vlasta Hadalin14 · Rosie Kwon10,15 · Min Ji Koo10,16 · Guillaume Fond17,18 · Laurent Boyer17,18 · Sunyoung Kim19 · Jong Woo Hahn20 · Namwoo Kim21 · Eléa Lefkir22 · Victoire Bondeville2 · Sang Youl Rhee10,23 · Jae Il Shin24 · Dong Keon Yon10,25 · Ho Geol Woo1 Received: 30 September 2022 / Accepted: 5 March 2023 © Children's Hospital, Zhejiang University School of Medicine 2023 Abstract Background Although previous studies have provided data on early pandemic periods of alcohol and substance use in adolescents, more adequate studies are needed to predict the trends of alcohol and substance use during recent periods, including the mid-pandemic period. This study investigated the changes in alcohol and substance use, except tobacco use, throughout the pre-, early-, and mid-pandemic periods in adolescents using a nationwide serial cross-sectional survey from South Korea. Methods Data on 1,109,776 Korean adolescents aged 13–18 years from 2005 to 2021 were obtained in a survey operated by the Korea Disease Control and Prevention Agency. We evaluated adolescents’ alcohol and substance consumption prevalence and compared the slope of alcohol and substance prevalence before and during the COVID-19 pandemic to see the trend changes. We define the pre-COVID-19 period as consisting of four groups of consecutive years (2005–2008, 2009–2012, 2013–2015, and 2016–2019). The COVID-19 pandemic period is composed of 2020 (early-pandemic era) and 2021 (midpandemic era). Results More than a million adolescents successfully met the inclusion criteria. The weighted prevalence of current alcohol use was 26.8% [95% confidence interval (CI) 26.4–27.1] from 2005 to 2008 and 10.5% (95% CI 10.1–11.0) in 2020 and 2021. The weighted prevalence of substance use was 1.1% (95% CI 1.1–1.2) from 2005 to 2008 and 0.7% (95% CI 0.6–0.7) between 2020 and 2021. From 2005 to 2021, the overall trend of use of both alcohol and drugs was found to decrease, but the decline has slowed since COVID-19 epidemic (current alcohol use: βdiff 0.167; 95% CI 0.150–0.184; substance use: βdiff 0.152; 95% CI 0.110–0.194). The changes in the slope of current alcohol and substance use showed a consistent slowdown with regard to sex, grade, residence area, and smoking status from 2005 to 2021. Conclusion The overall prevalence of alcohol consumption and substance use among over one million Korean adolescents from the early and mid-stage (2020–2021) of the COVID-19 pandemic showed a slower decline than expected given the increase during the prepandemic period (2005–2019). Keywords Alcohol · Adolescent · Corona virus disease 2019 · South Korea · Substance use Introduction * Jae Il Shin * Dong Keon Yon * Ho Geol Woo Extended author information available on the last page of the article Coronavirus disease 2019 (COVID-19) has resulted in considerable impacts on mortality and economic consequences [1, 2], and lockdown and physical distancing [3] have changed habitual or daily behaviors, physical activity and mental health [4]. The health and social consequences of this infectious disease are still under investigation [5], and alcohol and substance consumption may also arise as a significant risk factor. 13 Vol.:(0123456789) World Journal of Pediatrics In particular, alcohol and substance use can harm adolescents in various ways, and it is important to investigate the prevalence of adolescents’ substance use to prevent addiction [6]. The striatal reward/motivation and limbic-emotional circuits are hyperactive during adolescence, leading to greater emotional reactivity and reward-seeking behaviors [7]. The prefrontal cortex of adolescents cannot fully self-regulate, leading to high impulsivity and risk taking [7]. Therefore, early exposure to substance use may further impair the development of the prefrontal cortex, increasing the long-term risk for addiction. Despite the risk of alcohol and substance use in adolescents, however, limited studies have been performed on the prevalence of adolescents’ alcohol and substance use during the pandemic. Some studies have provided data only on early pandemic periods of substance use in adolescents [2, 8] that may be inadequate to predict the trends of substance use during this period [1, 9]. Additionally, there are studies that examine the prevalence of alcohol and substance use in adolescents reporting inconsistent results [2, 8]. Thus, the impact of the COVID-19 pandemic on alcohol and substance use in adolescents remains unclear. The interrupted global prediction for health indications based on pre-pandemic data on alcohol and substance use trends needs to be considered as a major public health issue. Therefore, this study aimed to investigate trend changes in alcohol and substance use among adolescents of South Korea in the early/mid-pandemic period and analyzed the changes. Methods Study population and data sources We obtained data from the Korea Youth Risk Behavior Web-based Survey (KYRBS) between 2005 and 2021, a survey operated by the Korea Disease Control and Prevention Agency (KDCA) for government policies [10]. The study investigated a sample of respondents to present representative data of the nation and estimate the total population of adolescents in South Korea. To account for this, the study population was selected using sophisticated statistical methods of two-step stratification, sample clustering, and weightings [10]. In the stratification stage, the population was divided into 117 layers using regional groups and school levels. Then, the number of sample schools was allocated by applying a proportional allocation method to match the population composition ratio and sample composition ratio by stratification variable. For sampling, the first extraction unit was school, and the second extraction unit was class using stratified cluster sampling. 13 Adolescents in middle to high school (aged 12–18 years) were voluntarily involved in a web-based survey in their schools (average response rate: 95%) [10]. The study protocol has been endorsed by the University of Sejong (endorsement for data use; SJU-HR-E-2020-003) and KDCA (endorsement for study construction). Endpoints and covariates The adolescent participants were asked to respond how many days they consumed an alcohol drink within 30 days: none, 1–2 days, 3–5 days, 6–9 days, 10–19 days, 20–29 days, and every day. We sorted participants into nondrinkers and current drinkers and defined current drinkers as those who drink alcohol in 1–30 (...truncated)