About 1,000 people in Wales die each year from causes attributed to alcohol, with drink a factor in more than one in 25 male deaths, a study has found.
The profile of alcohol and health also found over 25% of 13-year-olds had been drunk at least twice, a higher number than in 40 other countries surveyed.
The risk of drink-related death is three times as high in deprived areas.
The National Public Health Service for Wales (NPHSW) and the Wales Centre for Health carried out the research.
They found nearly 13,000 people are admitted to hospital per year because of alcohol.
The profile includes data on underage drinking, alcohol-related deaths, drinking during pregnancy, binge drinking and hospital admissions related to alcohol.
Blaenau Gwent has the highest number of alcohol-related hospital admissions of any local authority.
This is the first time alcohol-related factors in health have been calculated and analysed for Wales according to the report's main author, Andrea Gartner.
In the report, she says: "Alcohol consumption in children and young people is of particular concern.
"Wales had the highest percentage of all 40 countries surveyed in 13-year-olds having been drunk more than twice (27% of boys and 26% of girls).
"In children aged under 16, more girls were admitted to hospital than boys with 215 admissions in boys and 295 in girls for alcohol related conditions in 2006."
She also suggested comparisons with UK alcohol sales suggest that surveys including this one may be underestimating the extent of consumption and may only represent 55-60% of the real figure.
Judith Greenacre, director of health intelligence at the NPHSW, said: "It is clear that the effect of alcohol presents a major public health challenge for Wales and the rest of the UK.
"Alcohol misuse can bring significant harm to individuals, families and communities.
"This report identifies areas that will need to be monitored in future and will help contribute towards the new 10-year strategy launched by the Welsh Assembly Government to tackle all substance misuse, including alcohol."
The Welsh Assembly Government said the strategy, Working Together to Reduce Harm, would place a greater emphasis on reducing the problems caused by the "inappropriate or risky use of alcohol".
A spokesman said tackling the availability of alcohol to young people and education were crucial elements.
"We will also be rolling this programme out to non-mainstream education settings in order to do more to tackle those most at risk," said the spokesman.
A review of deaths in which coroners judged alcohol to be the major contributing factor started earlier this year.