Patterns of alcohol use among adolescents in India based on National Family Health Survey data

Alcohol regulations in India vary widely by state, with significant implications for adolescent exposure. Understanding recent trends and regional differences is essential for effective policy planning. To (1) describe the state-wise distribution of self-reported alcohol use among Indian adolescents, (2) conduct an exploratory review of state-level alcohol policies, and (3) analyse district-level patterns to assess the uniformity of alcohol use distribution within states as a potential indicator of enforcement differences. We analysed data from NFHS IV (2014–15) and V (2019–21) for adolescents aged 15–19 years ( N = 144,473 and 258,727). The outcome was any self-reported alcohol use (yes/no). Prevalence estimates were calculated at national, state, and district levels. Logistic regression assessed associations between alcohol use and sociodemographic characteristics (age, gender, wealth, residence, family history), accounting for cluster sampling. Nationally, adolescent alcohol use declined from 2.2% to 1.6%. However, high-prevalence clusters persist in northeastern regions. The proportion of districts above the national average dropped from 42.8% to 20.6%. Higher prevalence was observed among males, rural residents, those from poorer households, and those with a family history of alcohol use. States with more permissive laws showed higher adolescent use and unequal distribution across districts. Significant regional disparities in adolescent alcohol use remain despite overall declines. Policy differences and variation in enforcement likely contribute to these patterns, though they are not directly measured. Targeted, context-specific strategies and harmonised state policies are needed to further reduce early alcohol exposure among Indian adolescents.