Declining trends in adolescent alcohol consumption and related harms: No room for complacency (an empirical reply to Vieira et al. 2025)

Vieira et al. [1] report the results of an important and timely systematic review of trends in adolescent alcohol-related harms in high-income countries where a decline in alcohol consumption has occurred. They conclude that “alcohol-related harms for young people have generally declined in countries where youth drinking has fallen”. However, in this commentary, we highlight some methodological decisions that change several of their interpretations. First, Vieira et al. focus their review on high-income countries identified in Vashishtha et al. [2] where at least a 30% decrease in adolescent alcohol consumption is calculated, but we present issues of selection effects. Second, the authors report relative but not absolute risk estimates and neglect critical discussion of whether current prevalence rates of adolescent alcohol consumption and harms are practically meaningful. Third, they adapt their comparison date from 2020 onward to 2019 due to the COVID-19 pandemic but do not state how this impacts their inferences. Fourth, they focus on the age range of 10-19 but some of their data extends up to 34 years of age, and data for the age category of 19–24-year-olds (late adolescence) is omitted. By performing reproducibility analyses on Vieira et al.’s raw data, we show that their findings are more nuanced and complex. Through secondary data analyses, we present findings for 19–24-year-olds, indicating that this age range confers elevated vulnerability to alcohol-related harms. In doing so, we make the case that any discussion of declining trends in adolescent alcohol consumption and related harms should acknowledge that current prevalence rates and harms in adolescence remain unacceptably high and should remain a public health focus.