Abstract
BACKGROUND: Alcohol use is a major risk factor for injuries, which are the leading cause of significant morbidity and mortality among young people in sub-Saharan Africa (SSA). In Tanzania, high rates of alcohol use disorders (AUD) and heavy episodic drinking have been documented. However, limited studies have examined age differences in alcohol use and related harm among injury patients. Understanding these differences is essential for designing targeted interventions, particularly for populations at heightened risk. METHODS: We conducted a cross-sectional analysis using linked data from the Kilimanjaro Christian Medical Centre (KCMC) Trauma Registry and the Pragmatic Randomized Adaptive Clinical Trial (PRACT). The sample included injured patients aged ≥18 years presenting within 24 hours of injury. Alcohol use was assessed using the Alcohol Use Disorders Identification Test (AUDIT), and alcohol-related consequences were measured using the Drinker Inventory of Consequences (DrInC). We compared prevalence of alcohol use disorder, risk levels, and consequences between young people (18-24 years) and adults (≥25 years) using descriptive statistics and age-stratified analyses. RESULTS: Of the 2,427 injury patients included, young people (18-24 years) had a mean age of 21.5 (SD 1.9), and adults (25+ years) had a mean age of 41.7 (SD 14.3). Of these, 46.5% of young people and 59.4% of adults reported being current drinkers. A higher proportion of adults had consumed alcohol in the past four weeks (28.7%) and within six hours before injury (21.3%) compared to young people (18.9% and 1.4%, respectively). Drinking frequency differed significantly, with adults more likely to drink four or more times per week than young people (14.1% vs. 5.8%, p < 0.001). Young people were significantly more likely to report that they or someone else had been injured as a result of their drinking within the past year (14.0% vs. 9.4%, p = 0.026). The majority of participants experienced alcohol-related consequences, with young people reporting significantly higher physical consequences (85.7%) than adults (73.5%) (p = 0.010). Despite these differences, the prevalence of alcohol use disorder (AUD) was comparable between the two groups (37.2% in young people vs. 39.6% in adults; p = 0.524). CONCLUSION: Although adults reported more frequent alcohol consumption, young people experienced higher occurrences of alcohol-related harms, including a higher frequency of reporting that they or someone else had been injured due to their drinking, as well as having physical consequences. Despite these differences, both groups exhibited a comparable burden of problematic drinking, as measured by screening positive for AUD on the AUDIT. These findings highlight the need for age-specific interventions: for young people, strategies should target episodic, high-risk drinking behaviors associated with acute harms such as injury, while for adults, interventions may focus on habitual patterns of alcohol use.