Heavy alcohol drinking among adolescents aged 10–17 years in Zambia: findings from the CHAZ SBIRT project

Heavy alcohol drinking is a major global public health concern, contributing to premature mortality and a wide spectrum of disease outcomes. Although much of the discourse emphasizes adult populations, alcohol remains the most widely used psychoactive substance among adolescents, with underage drinking posing unique risks due to limited legal and social protections. We conducted a cross-sectional study in December 2023 across 19 health facilities supported by the CHAZ SBIRT project. Adolescents aged 10–17 years who consumed alcohol were recruited from the CHAZ database. Data were collected using pre-tested digital questionnaires administered via KoboCollect, capturing socio-demographic, behavioral, and alcohol-use information. Descriptive statistics, chi-square tests, and multivariate logistic regression were applied to identify factors associated with heavy alcohol drinking. Analyses controlled for key demographic and behavioral covariates, with significance set at p < 0.05. Among 331 adolescents aged 10–17 years identified through the CHAZ SBIRT program, more than 85% reported heavy alcohol drinking across most socio-demographic groups. Prevalence was highest among those out of school (95.5%), sexually active (94.5%), or using drugs (95.4%). Multivariate analysis confirmed drug use (aOR 4.17), sexual activity (aOR 3.51), and lower school attendance (aOR 0.20) as strong associated factors. Household socioeconomic context was also associated with heavy alcohol drinking, with adolescents from households headed by unemployed or informally employed caregivers showing higher odds. Religious denomination and education level were also associated with heavy alcohol drinking. Heavy alcohol drinking was highly prevalent among adolescents aged 10–17 years identified through the CHAZ SBIRT program and was associated with several behavioral, educational, and household socioeconomic factors. These findings support the need for strengthened adolescent alcohol prevention and behavioral support interventions.