Yonago Acta medica 2003;46:35–43

Adolescent Alcohol Use in Japan, 1996
Yoneatsu Osaki, Masumi Minowa*, Kenji Suzuki† and Kiyoshi Wada‡
Division of Environmental and Preventive Medicine, Department of Social Medicine, Tottori
University Faculty of Medicine, Yonago 683-8503, *Department of Epidemiology, National Institute of Public Health, Wako 351-0197, †Department of Psychiatry, National Institute on Alcoholism, Kurihama National Hospital, Yokosuka 239-0841 and ‡Division of Drug Dependence andPsychotropic Drug Clinical Research, National Institute of Mental Health, National Center of
Neurology and Psychiatry, Ichikawa 272-0827 Japan
We conducted the 1st nationwide survey on the use of alcohol by Japanese high school
students. The survey design was a cross-sectional sampling survey. The targets of thesurvey were junior and senior high schools throughout Japan. Sample schools were selectedby stratified cluster sampling. Self-administered anonymous questionnaires were sent tosample schools for all students to fill out. Among sampled schools, 65.6% and 67.0% ofjunior high schools and senior high schools responded, respectively. A total of 117,325
students responded and 115,814 questionnaires were subjected to analysis. The current
drinking rate was defined as the percentage of students who had drank alcohol at least 1
day within the 30 day period before answering the questionnaire, starting at 26.0% forboys and 22.2% for girls in the 1st grade of junior high and increasing to 54.9% for boys
and 43.4% for girls in the 3rd grade of senior high school. The experience rate of alcohol
drinking on ceremonial occasions was much higher. The experience rates of drinking
with peers, at parties, in bars and drinking alone increased with age. The cumulative
experience rate of drinking with peers was dramatically increased in senior high school
students. The most popular alcohol beverage was beer among boys, and sweet fruit-flavoredliquor among girls. The most prevalent sources of alcohol for student drinkers were convenience stores, bars, liquor stores and vending machines. The results showed that adolescentdrinking in Japan is quite widespread; this suggests that education toward the preventionof drinking should start in primary school. Adults around junior and senior high school
students should take adolescent drinking seriously.
Key words: adolescent behavior; alcohol drinking; drinking behavior; Japan

Adolescent drinking is associated with a variety ofproblems, such as traffic accidents and delinquency
and not just alcohol-related health problems; it has
become a major social issue. Moreover, the younger the age at which drinking behavior begins, thegreater these problems become (Suzuki, 1995), andthus it is important to begin alcohol education at an

early age. In Western countries, adolescent drinking has been investigated on a nationwide scale(Kann et al., 1998). Moreover, many of the surveys
have been periodically conducted, and by gathering
data on changes over time they have provided important information for controlling of adolescentdrinking. In Japan, many minors are thought toThis work was done in National Institute of Public Health, Tokyo, and Tottori University Faculty of Medicine,
Yonago, Japan.
Abbreviation: CI, confidence interval

35

Y. Osaki et al.

already be drinking despite the fact that there is an“Act to prohibit minors from alcohol drinking.”
However, no surveys representative of the entire
country have ever been conducted on the drinkingof alcohol by young people, although several surveys targeting regions of the country and schools
have been published (Kawabata, 1991; Suzuki, 1995;
Matsushita et al., 1996). We therefore planned a survey on the drinking behavior of youth by a representative sampling method. As a result, the actual
state of alcohol use by junior and senior high school
students in Japan and related factors were revealed.
This basic information can be applied to measures
for the prevention and control of adolescent drinking.

of the survey. Accordingly, the selection method
was adopted in which the schools were regarded asa single cluster.
The number of samples was calculated by using the variance of smoking rates according toschool and survey response rate obtained in a nationwide survey on junior and senior high school
smoking behavior conducted in 1990 (Osaki and
Minowa, 1996). The calculations were made byassuming that the variance of drinking rates among
the schools was similar to those of the smoking
rates. Since the estimated 95% CI of the drinking
rates in junior high schools throughout the country
was ± 0.5%, and the estimated 95% CI for the drinking
rates of each regional block was ± 2%, 122 schools
had to be selected (Matsui, 1989). Since the variance of smoking rates according to school wasmuch larger for senior high schools than for juniorhigh schools, the estimated 95% CI for the drinking
rates in senior high schools in the country as awhole was ± 1.5% and the 95% CI for drinking rates
according to regional block was ± 3%, and thus 109
were needed (Matsui, 1989). The selection numbers were assigned according to the numbers of students in each regional block. The target schools ineach regional block were selected according to thenumber of students in each school.

Subjects and Methods

Subjects
The survey design was a cross-sectional sampling
survey. The targets of the survey were students belonging to junior and senior high schools throughout Japan. The survey was conducted by sampling
122 of the 11,274 junior high schools (selection
rate: 1.1%) and 109 of the 5501 senior high schools(selection rate: 2.0%) registered in the 1996 National School Directory. The survey period was from
December 1996 to the end of January 1997.

Questionnaire
The content of the survey was decided by referringto the content of surveys on the drinking behavior ofminors that had been conducted in Japan and invarious other countries. In order to be able to compare the drinking frequency and age at the time of
the 1st drink, the same criteria were established asin surveys in other countries, including the UnitedStates. Because characteristics such as occasions
for drinking, drinking settings, types of alcoholic
beverages, sources of alcoholic beverages, alcoholrelated problems, etc., vary from country to country, minor adjustments to the content of the survey
were made by referring to previous surveys that had
been conducted in Japan.

Sampling
The sampling method used was a stratified, singlestage cluster sampling. In order to avoid samplingbias toward any regional blocks, stratified sampling
was performed with regional blocks as the strata.
Because it was foreseen that there would be a greater drinking rate variance among the senior highschools, the breaks between the regional blocks,
and the selection rate were made larger in order tomake the confidence interval (CI) of drinking rate
smaller. As a result, the junior high schools wereselected by creating 12 strata, and the senior highschools, by creating 6 strata. All of the students inthe schools that were sampled were used as subjects
36Adolescent alcohol use in Japan

90.8% in the senior high schools and 93.8% as awhole. Accordingly, the overall response rate was
64.1% in the junior high schools, 62.5% in thesenior high schools and 63.0% as a whole. Afterexcluding 2 forms because the sex or grade was unknown, and 1419 forms because of inconsistencies
in the forms (for example, a questionnaire whichindicated “non-drinker” in one question whereas“daily drinker” was indicated in another question),a total of 115,814 questionnaires were adopted foranalyses.

Survey procedure
Letters requesting cooperation in conducting thesurvey were addressed to the principals of theschools that had been selected. The survey was carried out in the classrooms, and the forms were distributed and collected by the homeroom teacher.
After anonymously filling out their own forms, thestudents placed them in a sealed envelope. The survey instruction manual requested that the teacher
not walk around the room or look at the survey
forms while administering the survey. The teacher
then collected the envelopes and mailed them backto the National Institute of Public Health without
breaking the seal of the individual envelopes.

Drinking prevalence
We classified alcohol drinking status among highschool students using the information about the
number of drinking days during the 30 days preceding the day of the survey. The prevalence rates
of both boys and girls who answered “1 day ormore” (current drinkers) increased with school
grade. The prevalence of subjects who drank “10days or more”, 1.9% among 1st-grade junior highboy students (7th graders in the United States), rose
to 7.0% among 3rd-grade senior high boys (12thgraders in the United States). The rate was 1.3%
among 1st-grade junior high girl students, andwhile the increase was only slight, it rose to 2.5%
among 3rd-grade senior high girls (Table 1). Few
subjects drank every day, and there were no clear
trends. Large changes were observed between the
3rd-grade junior and 1st-grade senior high school
students. The prevalence of alcohol drinking
among boys tended to be higher than among girls.
The prevalence of boys who drank once ormore a week was 4.4% in the 1st grade of juniorhigh school, and rose to 16.8% by the 3rd grade ofsenior high school. Among girls, it was 3.1% in the
1st grade of junior high school, and rose to 7.0% by
the 3rd grade of senior high school.

Data analysis
The data were analyzed by using SAS for Windows
version 8.1 Software (SAS Institute Inc., Cary, NC).
The prevalence of the items surveyed was calculated according to the selection method used in thissurvey. The percentage of persons who replied tothe individual questions was calculated in eachstratum. The values obtained by each stratum wereadded to obtain percentages of the whole by multiplying the weight of each stratum. The weights
were the values obtained by placing the total number of students in each stratum in the numerator andthe total number of students in the country in the
denominator.

Results

Response rates
Replies were obtained from 80 of the 122 juniorhigh schools (school response rate: 65.6%) and 73
of the 109 senior high schools (school response
rate: 67.0%; combined junior and senior highschool response rate: 66.2%). A total of 117,325
envelopes were collected. The student response
rate as a proportion of enrolled students in sampledschools was 99.3% in the junior high schools,

Drinking occasions
When we calculated the experienced rate by drinking occasions, ceremonial occasions (festivals,
weddings, funerals, etc.) were the most common
occasions for both boys and girls: 1st-grade junior37

Y. Osaki et al.

Table 1. Drinking prevalence among junior and senior high school students, Japan, 1996

GenderHigh school

Grade

Number of
subjects

Experience
rate

Current

Boy

Junior

1st
2nd
3rd
1st
2nd
3rd

7,211
7,152
7,108
12,07912,645
10,921

71.5
74.9
77.5
84.4
88.2
89.2

26.0
30.4
32.1
43.9
52.5
54.9

4.4
6.7
8.1
10.7
14.1
16.8

0.5
0.5
0.8
0.5
0.7
1.2

1st
2nd
3rd
1st
2nd
3rd

7,158
6,966
7,203
12,617
12,771
11,983

70.4
72.8
75.9
83.7
87.5
89.2

22.2
24.6
25.4
34.9
43.3
43.4

3.2
4.0
4.4
5.4
6.6
7.0

0.4
0.4
0.4
0.5
0.2
0.3

SeniorGirl

JuniorSeniorDrinker classification
WeeklyDaily

Experience rate: experienced any drinking occasion.
Current drinkers: drank alcohol ≥ 1 of the 30 days preceding the survey.
Weekly drinkers: (every week end) + (several times a week) + (daily).
Daily drinker: drank every day of the 30 days preceding the survey.

high boys 54.0%, girls 52.3%; 3rd-grade seniorhigh boys 61.3%, girls 61.1%. The experience rate
for drinking with the family was also high: 1stgrade junior high boys 35.6%, girls 37.1%; 3rdgrade senior high boys 46.3%, girls 47.6%. Although the experience rates did not rise very muchas the grade level increased, the percentages of
those who answered that they drank “during classmeetings, at the close of events or at parties” (1stgrade junior high boys 3.5%, girls 2.6%; 3rd-gradesenior high boys 45.2%, girls 40.9%), “with peers attaverns, karaoke rooms or bars” (1st-grade juniorhigh boys 4.0%, girls 3.2%; 3rd-grade senior highboys 45.4%, girls 40.6%) or “with peers in someone’s room” (1st-grade junior high boys 4.9%, girls
5.2%; 3rd-grade senior high boys 56.3%, girls
51.3%) increased with grade. The differences between boys and girls in experience rates according
to drinking occasions were small. The percentagesof subjects who had drunk “on ceremonial occasions” and “with my family at mealtime” were relatively high, even among those whose drinking frequency was low, but the percentages of those who
had drunk “during class meetings, at the close of
events or at parties,” “with peers at taverns, etc.,”“with peers in someone’s room” or “alone” rose as
the drinking frequency increased.

Age at the time of the 1st drink
The percentages of both boys and girls in their 1st
grade of junior high school who replied that they
had taken their 1st drink at 9 to 10 years of age were
the highest, and in the 3rd grade of senior highschool, the percentages who replied that it was at
15–16 years of age were the highest (Table 2).
In this study we proposed drinking with peers
as one of the starting points that leads to problem
drinking, and we asked when they started drinking
with peers. The highest percentages of the 1stgrade junior high students, both boys and girls, replied 11 to 12 years of age, whereas the most common reply of the 3rd-grade senior high students was
15 to 16 years (Table 2). As the drinking frequency
increased, the percentage of those who had their 1st
drink with peers at 8 years of age or less increased.

Type of alcohol consumed
Among the 1st-grade boys of junior high school,
58.0% of drinkers were found to prefer beer, and thepercentage increased with grade, reaching 77.5%
among the 3rd-grade boys of senior high school.
Among boys, about 50% of the drinkers at all gradelevels drank sweet, fruit-flavored alcoholic38Adolescent alcohol use in Japan

Table 2. Cumulative proportion of the 1st experience of drinking, and trying drinking with peers,
Japanese high school students, 1996

GenderHighschoolNumber of
Grade subjects≤8

Age (year)
9–10 11–12 13–14

Boy

Junior

1st
2nd
3rd
1st
2nd
3rd
1st
2nd
3rd
1st
2nd
3rd

7,211
7,152
7,108
12,07912,645
10,921
7,158
6,966
7,203
12,617
12,771
11,983

24.3
22.5
22.9
19.0
18.7
17.9
23.0
21.5
21.2
18.4
17.4
16.8

50.9
43.5
38.6
31.4
29.7
26.7
48.1
41.6
35.9
31.6
28.7
25.1

69.3
66.9
60.0
51.5
46.1
40.3
69.0
65.0
57.2
50.7
44.6
37.7

71.5
74.9
75.6
75.9
69.8
61.8
70.4
72.8
74.4
74.2
66.4
57.4

1st
2nd
3rd
1st
2nd
3rd
1st
2nd
3rd
1st
2nd
3rd

7,211
7,152
7,108
12,07912,645
10,921
7,158
6,966
7,203
12,617
12,771
11,983

3.3
2.3
1.9
1.0
1.1
1.1
2.6
1.5
1.2
0.8
0.5
0.6

8.4
5.5
4.1
2.3
1.8
1.7
6.4
4.1
2.8
1.6
1.2
0.9

19.0
16.9
12.0
8.7
6.4
5.5
15.3
13.3
10.2
7.7
5.8
4 .1

21.9
28.7
34.7
39.0
30.7
24.5
16.9
23.2
29.0
31.3
24.6
18.7

15–16

≥ 17

77.5
84.4
87.4
85.3

88.2
89.2

75.9
83.7
86.6
83.6

87.5
89.2

39.6
61.3
70.8
68.2

72.9
78.6

32.6
52.4
64.2
61.5

67.0
75.9

Age at the 1st drinking

SeniorGirl

JuniorSeniorAge at trying drinking with peersBoy

JuniorSeniorGirl

JuniorSeniorbeverages (Table 3). This was followed by sake
(Japanese wine), shochu (cheap spirit) and wine
(Table 3). The percentage of boys who drank highproof, strong alcoholic beverages, i.e., whiskey,
brandy and vodka, rose as the grade level increased.
Among girls, more than 60 to 70% at all gradelevels drank sweet, fruit-flavored alcoholic
beverages. They were followed by beer, shochu
and wine (Table 3).
Beer and sweet, fruit-flavored alcoholic
beverages were the most often consumed even by
those with a relatively low drinking frequency. As
the drinking frequency increased, the percentagesof those who consumed strong alcoholic beverages
and shochu increased.

Usual sources of alcoholic beverages
Among the 1st-grade junior high students, thelargest percentages of both boys and girls consuming alcoholic beverages found them at home. This
trend hardly increased as the grade increased: 1stgrade junior high boy students 66.5%, girl students
74.9%; 3rd-grade senior high boys 52.9%, girls
53.1%. The next most common sources were “purchase from convenience stores or supermarkets” (1stgrade junior high boys 9.4%, girls 11.9%; 3rd-gradesenior high boys 61.5%, girls 59.8%), “purchase at
liquor stores” (1st-grade junior high boys 5.6%,
girls 5.8%; 3rd-grade senior high boys 36.7%, girls
28.8%), “drinking at bars, etc.” (1st-grade juniorhigh boys 4.7%, girls 4.3%; 3rd-grade senior high39

Y. Osaki et al.

Table 3. Type of alcohol consumed by students classified by sex and grade

GenderHighschoolBoy

JuniorseniorGirl

JuniorSeniorGrade

Numberofsubjects

Beer

Sake
(Japanese
wine)

Wine

Shochu Sweet, fruit(cheap
flavoredStrongspirit)liquor*liquor†

1st
2nd
3rd
1st
2nd
3rd

4,565
4,709
4,930
9,279
10,477
9,308

58.0
59.1
62.1
68.0
73.7
77.5

26.2
23.7
25.2
23.1
22.8
25.2

21.9
22.0
22.4
20.0
18.4
18.3

14.6
14.3
17.1
20.1
24.8
29.3

49.9
51.8
51.6
53.8
49.5
42.3

8.7
10.6
11.4
14.4
17.3
20.9

1st
2nd
3rd
1st
2nd
3rd

4,174
4,270
4,664
9,299
10,245
10,077

46.2
45.6
44.0
44.9
46.9
49.0

18.8
18.7
16.6
14.3
12.6
13.1

22.2
24.6
23.9
20.6
19.9
19.7

14.9
17.3
17.0
19.3
26.7
33.8

67.5
68.9
72.4
77.3
77.1
75.7

6.5
7.7
8.1
7.1
7.9
8.6

Percentages add up to more than 100%, as some students mentioned more than 1 alcohol type.
* Liqueurs.
† Whiskey, brandy and vodka.

boys 40.6%, girls 38.9%), “purchase from vending
machines” (1st-grade junior high boys 6.1%, girls
5.0%; 3rd-grade senior high boys 35.9%, girls 21.1%):
in every instance the percentages increased withgrade. Small gender differences among these percentages were observed. Even when the drinking
frequency was low, the most common source wasalcoholic beverages that were at home. Among
senior high school students, convenience stores werecommonly used as a source even by those with a low
drinking frequency. Vending machines, liquor storesand bars were sources that were used frequently
when the drinking frequency became high.

that the experiment rates with alcohol-related problems increased for every item as the frequency ofdrinking rose. The percentages of those who were“scolded by parents” did not rise very much as thefrequency of drinking increased, but “fighting” and“trouble with police” were much higher in thegroup with the highest drinking frequency.

Discussion
This survey is the 1st nationwide survey on drinking behavior of high school students in Japan. A
sampling method that would yield a sample thatwould be representative of the entire country was
adopted, and the response rate was almost on thesame level as in nationwide surveys in the UnitedStates (Kann et al., 1995, 1996, 1998). In addition,
because a method that thoroughly ensured the anonymity of the respondents’ replies was adopted in
the survey procedure, the results are believed tomore accurately reflect the actual drinking situationof high school students in Japan.
The drinking rates observed in this survey
were lower than in the results of previous surveys inJapan. The “current drinking rates” in this survey

Alcohol-related problems
The most common experiences with alcohol-related
problem were “vomiting,” “blacking out” and “scolded by parents” (Table 4). They all increased as
school grade increased. The percentages of “vomiting” were higher among boys, but there was little
difference between boys and girls in “blacking out”
and “being scolded by parents.” Among the 3rdgrade senior high boy drinkers, 37.9% were foundto have already experienced “vomiting” and 20.4%
had already experienced “blacking out.” We found40

Adolescent alcohol use in Japan

Table 4. Experience rates of alcohol-related problems, Japanese high school students, 1996

GenderHighschoolBoy

JuniorSeniorGirl

JuniorSeniorGrade

Numberof subjects

Vomiting

Fighting

Blackingout

Trouble with
policeScoldedby parents

1st
2nd
3rd
1st
2nd
3rd

7,211
7,152
7,108
12,07912,645
10,921

6.3
6.5
8.5
14.8
23.8
33.9

1.6
1.9
2.4
3.5
4.0
4.9

5.1
6.0
9.2
13.0
16.5
18.2

1.2
0.8
1.4
1.2
1.8
2.3

6.6
6.4
5.8
7.3
7.1
6.9

1st
2nd
3rd
1st
2nd
3rd

7,158
6,966
7,203
12,617
12,771
11,983

2.9
3.1
4.3
7.3
12.8
18.9

0.6
0.9
1.1
1.1
1.1
1.4

3.4
5.1
5.3
10.0
12.9
15.5

0.3
0.6
0.6
0.6
0.5
0.6

3.5
4.6
3.9
4.5
4.8
5.4

were higher for both the 1st- and 2nd-grade boys
and girls of junior high schools than in the 1989
survey (Kawabata et al., 1991), and they were lower
for the other grades. The once-or-more-a-week
drinker rates (weekly drinking rates) among seniorhigh school boys were slightly lower than in previous surveys, and for the girls they were in the middle of the results of previous studies (Tani et al.,
1978; Ikegami et al., 1983; Ohmoto et al., 1986a,
1986b; Suzuki et al., 1991, 1993; Toyama et al.,
1995; Matsushita et al., 1996). The reason why the
drinker rates in this survey were relatively low may
be because the samples in earlier surveys were biased because the target schools were selected
arbitrarily or because schools in which student
drinking had become a problem were sampled.
The drinking rates observed in this survey
were low when compared with the results of surveys in European countries, and were almost on thesame level as in the United States. The drinking
rate in the United States occupies a median position
among the rates in Western countries (Hiebell et al.,1997). The weekly drinking rate in Japan corresponds to the European countries that have low
weekly drinking rates (King et al., 1996). Our survey yielded lower current drinking rates for bothboys and girls than in the Center for Disease Control Youth Risk Behavior Survey, which has yielded the highest current drinking rates among the surveys conducted in the United States (Kann et al.,

1995, 1996, 1998), but the differences tend toshrink as the grade level increases. The drinking
experience rates among boys and girls were both
higher in our survey, but both the weekly drinking
rates (May, 1992; King et al., 1996) and the current
drinking rates (Rahkonen and Ahlstrom, 1989)
tended to be higher in Europe than in Japan. Thus,
it can be concluded that the drinking rates among
junior and senior high school students in Japan has
already reached the median position of Westerncountries, and that the differences from drinking
rates between Japan and Western countries become
smaller as the grade level increases.
Birth cohort analysis has revealed that thedrinking experience of youth in the United States is
occurring at younger ages (Johnson, 1998). We observed a phenomenon in which the percentage of
those whose first experience was at a young age increased as the school grade became lower. Since it
may be caused by the recall bias, it will be necessary to reveal this phenomenon by carrying out
periodical nationwide surveys.
However, even when the results of a crosssectional nationwide survey in the United States
were compared with the age of the 1st drinking experience in our survey, the junior and senior highschool students in Japan were found to have experienced drinking at a younger age (Warren et al.,1997). There was a high rate of drinking experienceamong high school students on ceremonial occa-

41

Y. Osaki et al.

sions in Japan (Wada et al, 1998), and almost all ofthem had some experience before they entered junior high school. We can conclude then that drinking
alone and drinking alcoholic beverages obtained by
the students themselves are important starting
points. The rate of drinking experience associatedwith these opportunities rose as age increased, especially after entering high school. And there were
only small number of weekly drinkers in the 1stgrade junior high students. Thus it is important toemphasize alcohol education in early junior highschool.
In earlier surveys, beer was the most common
alcoholic beverage among both sexes, but in our
survey girls reported drinking sweet, fruit-flavoredalcoholic beverages, many different kinds of whichhave recently come onto the market. Young people
in other countries have also been reported to preferalcoholic beverages with low alcohol concentrations (Rio et al., 1995). The popularity of sweet alcoholic beverages among girls in Japan may be responsible for lowering their resistance to startdrinking alcoholic beverages, and it is feared thatdrinking may become even more widespreadamong young women in the future.
Analysis of the usual sources of alcoholic beverages showed that as drinking behavior became
more established, the percentages of subjects who“purchase from some stores” and who “drink atbars, etc.” increased. This contrasts with the factthat the major source of cigarettes by adolescentsmokers is vending machines (Osaki and Minowa,
1996). A considerable number of subjects obtained
alcoholic beverages in over-the-counter sales settings and that minors were drinking at bars. Thissuggests that the adults who are selling alcoholic
beverages need to be more concerned about adolescent drinking.
Alcohol-related youth problems have beenmonitored in New York, but it is difficult to makecomparisons, because a different definition wasused (Barnes et al., 1997). However, 47% of boys
and 32% of girls in their 3rd grade of senior highschool in Japan had already experienced alcoholrelated problems. In spite of this, not many of themhad been reprimanded by their parents, and it issuspected that their parents were unconcerned
about their children’s drinking.
The above results show that adolescent drinking in Japan is quite widespread even among 1st
graders of junior high schools, and they suggest that
education to prevent drinking should start in primary school. The adults around them should takeadolescent drinking seriously.

Acknowledgments: This study was carried out as aproject of the Research Team for Surveying the Drinking
Behavior of Minors, a Special Research Project of the1996 Ministry of Health and Welfare Health Science
Research Fund, Japan.

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Received April 14, 2003; accepted June 4, 2003
Corresponding author: Yoneatsu Osaki, MD

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