Alcohol use among Croatian adolescents: the alignment of 13-year-old and 15-year-old girls with boys, and the impact of the COVID-19 pandemic.

Aim: To determine age and gender patterns of alcohol use among Croatian pupils and assess whether alcohol use was associated with factors related to school, peers, family, and the COVID-19 pandemic.

Methods: Data were collected from the 2022 Health Behavior in School-aged Children cross-sectional study conducted in Croatia involving 5338 pupils. Pearson χ2 test and multivariate logistic regression were performed.

Results: At the age of 11, boys were drinking alcohol more than girls (P<0.001), while 13- and 15-year-old girls aligned with boys. Lifetime alcohol use was positively associated with schoolwork pressure in 11-year-old girls (OR 3.28, CI 1.36-7.75) and boys (OR 1.87, CI 1.03-3.37). The COVID-19 pandemic negatively affected mental health in 13- (OR 2.21, 1.56-3.13) and 15-year-old girls (OR 1.50, CI 1.01-2.23), and life in 15-year-old boys (OR 1.83, 1.03-3.27). Recent alcohol use was positively associated with hospitalization of a close family member for COVID-19 in 11-year-old girls (OR 2.35, 1.05-5.28), low peer support in 13-year-old boys (OR 1.49, 1.01-2.20), difficult communication with father in 15-year-old girls (OR 1.49,1.05-2.12), negative COVID-19 impact on mental health in 13-year-old girls (OR 1.67,1.13-2.47), and negative COVID-19 impact on life in 15-year-old boys (OR 1.79, 1.08-2.98). Lifetime drunkenness was positively associated with negative COVID-19 impact on mental health in 13- (OR, 2.03,1.28-3.21) and 15-year-old girls (OR 2.12, 1.49-3.01), and with positive or neutral COVID-19 impact on life in 15-year-old girls (OR 0.65, 0.43-0.97).

Conclusion: Preventive activities should offer support systems to minimize the negative COVID-19 impact, with special attention to girls' needs.