Adolescent extracurricular activities and perception of risk of harm from binge drinking

Underage binge drinking can lead to numerous adverse health consequences. Preventing excessive alcohol consumption by targeting perception of risk of harm is one approach with demonstrated success. This study examined the association between participation in extracurricular activities and perception of risk of harm from binge drinking among adolescents. A cross-sectional analysis of adolescents aged 12-17 years was performed using the 2019 National Survey on Drug Use and Health dataset. Participation in any extracurricular activity as well as four types of extracurricular activities (e.g., school-based, community-based, faith-based, and other) were the main independent variables. The primary outcome was perception of risk of harm from weekly binge drinking. Bivariate and multivariate logistic regression models were used to examine this association. Of the 11,870 adolescents included in the analysis, 4.2% reported that weekly binge drinking presented no harm. Compared to adolescents who did not participate in any extracurricular activity, adolescents who participated in one or more extracurricular activity, regardless of type, had 86% higher odds of reporting risk of harm from weekly binge drinking after adjusting for relevant covariates (aOR=1.86, 95% CI: 1.39, 2.49). This finding was similar across all levels of school-based, but different for community, faith-based and other types of activities. Compared to adolescents who did not participate in school-based, adolescent who participated in 1, 2, or 3+ school-based activities were more likely to report that weekly binge drinking was harmful (<i>School</i> AOR 1 activity = 1.75, 95% CI: 1.29, 2.37, AOR 2 activities = 1.83, 95% CI:1.32, 2.53, AOR 3+ activities = 1.91, 95% CI:1.35, 2.75), The association between participation in community-based activities and perception of risk of harm was significant at one or two activities but not at three or more activities (<i>Community</i> AOR 1 activity = 1.35, 95% CI: 1.02, 1.79, AOR 2 activities = 1.47, 95% CI:1.06, 2.02, AOR 3+ activities = 1.41, 95% CI: 0.98, 2.02) while the association between participation in faith-based activities and perception of risk of harm from weekly binge drinking was significant only at 3+ activities (<i>Faith</i> AOR 3+ activities = 2.07, 95% CI: 1.48, 2.88). No significant association was found for participation in other activities in the adjusted model. Our results suggest that participation in extracurricular activities may be a factor that contributes to increased perception of risk of harm from weekly binge drinking among adolescents, but this protective effect may vary by type and level of activity, suggesting different mechanistic pathways. Future studies are needed to further elucidate these findings to inform targeted preventive interventions and policy-level support.