The study examined relationships between alcohol control policies and adolescent alcohol use in 26 countries. Cross-sectional analyses of alcohol policy ratings are based on the Alcohol Policy Index (API), per capita consumption and national adolescent survey data. Data are from 26 countries. Particpants are adolescents (aged 15–17 years) who participated in the 2003 European School Survey Project on Alcohol and Other Drugs (ESPAD) or national secondary school surveys in Spain, Canada, Australia, New Zealand and the United States. Measurements are alcohol control policy ratings based on the API, prevalence of alcohol use, heavy drinking and first drink by age 13 based on national secondary school surveys and per capita alcohol consumption for each country in 2003. Correlational and linear regression analyses were conducted to examine relationships between alcohol control policy ratings and past 30-day prevalence of adolescent alcohol use, heavy drinking and having first drink by age 13. Per capita consumption of alcohol was included as a covariate in regression analyses. More comprehensive API ratings and alcohol availability and advertising control ratings were related inversely to the past 30-day prevalence of alcohol use and prevalence rates for drinking three to five times and six or more times in the past 30 days. Alcohol advertising control was also related inversely to the prevalence of past 30-day heavy drinking and having first drink by age 13. Most of the relationships between API, alcohol availability and advertising control and drinking prevalence rates were attenuated and no longer statistically significant when controlling for per capita consumption in regression analyses, suggesting that alcohol use in the general population may confound or mediate observed relationships between alcohol control policies and youth alcohol consumption. Several of the inverse relationships remained statistically significant when controlling for per capita consumption. More comprehensive and stringent alcohol control policies, particularly policies affecting alcohol availability and marketing, are associated with lower prevalence and frequency of adolescent alcohol consumption and age of first alcohol use.