Alcohol-free and low-alcohol beverage consumption and concurrent and subsequent alcohol outcomes among young adults.

Background and aims: Alcohol-Free and Low-Alcohol Beverages (AFLABs) have grown in popularity, yet predictors and longitudinal outcomes of their use remain unclear. We aimed to measure the association between AFLAB consumption and (1) concurrent and (2) subsequent alcohol consumption, risk and change measures (e.g. consequences, quit attempts, abstention) and drinking motives among young adults.

Design: Observational study using two survey waves (W15 and W16; 2022-2024) from a longitudinal cohort study (STRATA).

Setting: California, USA (surveys fielded 2022-2024).

Participants: Cross sectional analysis of young adults (n = 877 individuals, of which 849 were followed in W16) who report past-month alcohol consumption in W15 from a California-based cohort study, and analysis of those with past-month alcohol consumption at both W15 and W16 (n = 693).

Measurements: Individuals completed survey items on past-month AFLAB consumption, alcohol consumption (past-month heavy episodic drinking and past-year abstention), alcohol risk and change measures (alcohol-related consequences, indicators of a change effort and the alcohol contemplation ladder) and drinking motives (from the drinking motives questionnaire).

Findings: Twenty-four percent of participants reported past-month AFLAB use at baseline. Adjusted cross-sectional models using W15 data indicated that AFLAB use was associated with lower social drinking motives [coefficient = -0.005; 95% confidence interval (CI) = -0.011 to 0.0001] but was not statistically significantly associated with other alcohol consumption, risk or change measures. In adjusted prospective models, baseline AFLAB use was associated with a 5.1 percentage point (pp) higher probability of alcohol abstention at W16 (95% CI = 1.1-9.1) than lack of AFLAB use. In adjusted prospective models, baseline AFLAB use was not statistically significantly associated with heavy episodic drinking, alcohol-related consequences or most change-related measures, although there was suggestive evidence of a higher likelihood of reporting a quit attempt in the past 3 months.

Conclusions: Use of alcohol-free and low-alcohol beverages appears to be common among young adults in California, USA, and appears to be concurrently associated with lower social drinking motives and prospectively associated with subsequent alcohol abstention.