1. Key points and recommendations
• From the data analyses:
a. Alcohol-related hospital admissions in young people (aged 15-17 years) have been used here as a proxy measure of alcohol misuse in these age groups1, and have been compared with teenage conceptions (in females aged under 182).
b. At both lower tier local authority and ward levels there is a significant positive relationship between teenage conceptions and alcohol-related hospital admissions in young people. This relationship is independent of deprivation.
c. After taking deprivation3 at ward level into account, the teenage conception rate was 34 per 1000 females (aged 15-17 years) in wards with the lowest levels of alcohol-related hospital admissions, compared with 41 per 1000 females in wards with the highest levels of alcoholrelated hospital admissions.
d. Local authorities that have seen increases in teenage conceptions between 2006 and 2007 have also seen disproportionate annual increases in teenage alcohol-related hospital admissions.
e. While England as a whole saw a 0.8% increase in alcohol-related hospital admissions in young people, local authorities which documented increases in teenage conceptions saw a five-fold greater increase (5.2%).

• From the evidence review:
a. A rapid evidence review, although not a full structured systematic review, was conducted to provide an overview of some of the key studies examining associations between alcohol consumption and sexual behaviours.
b. Early regular alcohol consumption is associated with early onset of sexual activity.
c. Any amount of current drinking by teenagers is associated with being sexually active, especially binge drinking and drinking in greater quantities.
d. Alcohol use at first sex is associated with lower levels of condom use at first intercourse.
e. Beginning to drink alcohol at an early age is strongly associated with having a higher (or multiple) number of sexual partners. Those drinking more and at higher frequencies are at greater risk of having multiple partners.
f. Evidence of a routine association between non-condom use and alcohol consumption is equivocal. However, there is better evidence to support higher levels of non-condom use in those who binge drink or have alcohol problems.
g. In young people there is some evidence of an association between the misuse of alcohol and sex without any contraception. However, the relationship between risk and increasing levels of consumption is unclear.
h. Alcohol consumption, and especially binge drinking and drinking greater quantities, is associated with an increased risk of becoming pregnant in females and getting someone pregnant in males.
i. There is good evidence to suggest that alcohol consumption in young people contributes to levels of regretted sex and that increasing consumption is associated with a greater probability of having experienced regretted sex.
j. There is good evidence to suggest an association between drinking in young people, especially binge drinking, and increased risk of forced sex.

• Suggested further steps
a. Better intelligence on the relationships between alcohol and teenage pregnancy could be developed from existing data sets. Comprehensive analyses of the relationships between alcohol-related hospital admissions and teenage conceptions should be undertaken once new data are available.4
b. Additional data sets are likely to provide a more comprehensive picture of the relationships between alcohol consumption, teenage conceptions, and also other key sexual health issues. Use of the National Drug Treatment Monitoring Data5 may improve understanding of links. For some parts of the country, accident and emergency department data relating to alcohol can also be utilised. Such analyses should examine relationships with alcohol and levels of terminations, and with sexually transmitted infections (including Chlamydia) as well as with teenage conceptions.
c. We would suggest that this combination of data sets (on sexual heath and substance use such as alcohol and drugs) is used to create a model of youth (i.e. under 18 year olds) behaviour at ward, local authority and NHS/primary care trust levels across England. Unlike typical analyses on single issues this could help inform strategies for delivering holistic support for young people.
d. A model using sexual health, alcohol and drugs data could also be used to examine the match of service need to service provision for young people at local levels.
e. Research studies on the relationships between alcohol and sexual health issues in England are relatively few and far between. High quality research on understanding how these issues are linked in
England is urgently needed.
f. Adequate evidence is already available to suggest strong links between alcohol, teenage conceptions and other sexual health issues. Future developments in both alcohol and sexual health services should examine how prevention messages and initiatives can be delivered to address both issues together.
g. Services dealing with sexual health or substance misuse should be encouraged to provide seamless support for young people who may present with either a sexual health or an alcohol problem, recognising they will often have problems with both.