Very early drinking: Event history models predicting alcohol use initiation from age 4 to 11 years

The potential adverse effects of minors' exposure to alcohol-related stimuli via licenced venues: A narrative review

ISSUES

Young people are particularly impressionable when it comes to forming expectations and attitudes around alcohol consumption. Any stimuli that normalise and foster positive expectations around alcohol use may increase the risk of underage alcohol consumption. Alcohol venues that market themselves as being appropriate 'family friendly' establishments for children risk exposing minors to environments that are saturated with alcohol-related stimuli. However, research examining how exposure to licenced venues affects underage people is very limited. The aim of this narrative review was to identify and synthesise relevant evidence to better understand how attending these venues might affect minors.

APPROACH

A narrative review of research published between January 2016 and November 2022 was conducted to investigate the potential effects on underage people of exposure to licenced venues and stimuli encountered in/around these venues. Examined stimuli included alcohol advertising, people consuming alcohol and alcohol outlets.

KEY FINDINGS

The reviewed literature indicates that the risk of alcohol-related harm among minors is likely to increase with greater exposure to alcohol venues due to the associated exposure to alcohol advertising, exposure to others consuming alcohol and higher outlet density. In combination, these factors are likely to normalise alcohol consumption for minors and create positive alcohol expectancies.

IMPLICATIONS AND CONCLUSION

Venues serving alcohol should be discouraged from targeting families and parents should be warned about the risks associated with taking minors to venues where alcohol is sold and consumed.

Pandemic-Related Changes in the Prevalence of Early Adolescent Alcohol and Drug Use, 2020-2021: Data From a Multisite Cohort Study

PURPOSE

Evaluate changes in early adolescent substance use from May 2020 to May 2021 during the coronavirus disease 2019 pandemic using data from a prospective nationwide cohort: the Adolescent Brain Cognitive Development Study.

METHODS

In 2018-2019, 9,270 youth aged 11.5-13.0 completed a prepandemic assessment of past-month alcohol and drug use, then up to seven during-pandemic assessments between May 2020 and May 2021. We compared the prevalence of substance use among same-age youth across these eight timepoints.

RESULTS

Pandemic-related decreases in the past-month prevalence of alcohol use were detectable in May 2020, grew larger over time, and remained substantial in May 2021 (0.3% vs. 3.2% prepandemic, p <.001). Pandemic-related increases in inhalant use (p = .04) and prescription drug misuse (p < .001) were detectable in May 2020, shrunk over time, and were smaller but still detectable in May 2021(0.1%-0.2% vs. 0% pre-pandemic). Pandemic-related increases in nicotine use were detectable between May 2020 and March 2021 and no longer significantly different from prepandemic levels in May 2021 (0.5% vs. 0.2% prepandemic, p = .09). There was significant heterogeneity in pandemic-related change in substance use at some timepoints, with increased rates among youth identified as Black or Hispanic or in lower-income families versus stable or decreased rates among youth identified as White or in higher-income families.

DISCUSSION

Among youth ages 11.5-13.0 years old, rates of alcohol use remained dramatically reduced in May 2021 relative to prepandemic and rates of prescription drug misuse and inhalant use remained modestly increased. Differences remained despite the partial restoration of prepandemic life, raising questions about whether youth who spent early adolescence under pandemic conditions may exhibit persistently different patterns of substance use.

A prospective investigation of youth alcohol experimentation and reward responsivity in the ABCD study

Rationale

Greater risk-taking behaviors, such as alcohol experimentation, are associated with different patterns of brain functioning in regions implicated in reward (nucleus accumbens, NA) and cognitive control (inferior frontal gyrus, IFG). These neural features have been observed in youth with greater risk-taking tendencies prior to substance use initiation, suggesting NA-IFG disruption may serve as an early marker for subsequent substance use disorders. Prospective studies are needed to determine if NA-IFG neural disruption predicts future substance use in school-age children, including those with minimal use of alcohol (e.g., sipping). The present large-sample prospective study sought to use machine learning to: (1) examine alcohol sipping at ages 9, 10 as a potential behavioral indicator of concurrent underlying altered neural responsivity to reward, and (2) determine if alcohol sipping and NA-IFG activation at ages 9, 10 can be used to predict which youth reported increased alcohol use at ages 11, 12. Additionally, low-level alcohol use and brain functioning at ages 9, 10 were examined as predictors of substance use and brain functioning at ages 11, 12.

Design and methods

This project used data from the baseline (Time 1) and two-year follow-up (Time 2) assessments of the Adolescent Brain Cognitive Development (ABCD) Study (Release 3.0). Support Vector Machine (SVM) learning determined if: (1) NA-IFG neural activity could correctly identify youth who reported alcohol sipping at Time 1 (n = 7409, mean age = 119.34 months, SD = 7.53; 50.27% female), and (2) NA-IFG and alcohol sipping frequency at Time 1 could correctly identify youth who reported drinking alcohol at Time 2 (n = 4000, mean age = 143.25 months, SD = 7.63; 47.53% female). Linear regression was also used to examine the relationship between alcohol sipping and NA-IFG activity at Time 1 and substance use and NA-IFG activity at Time 2. Data were also examined to characterize the environmental context in which youth first tried sips of alcohol (e.g., with or without parental permission, as part of a religious experience).

Results

Approximately 24% of the sample reported having tried sips of alcohol by ages 9, 10. On average, youth reported trying sips of alcohol 4.87 times (SD = 23.19) with age of first sip occurring at 7.36 years old (SD = 1.91). The first SVM model classified youth according to alcohol sipping status at Time 1 no better than chance with an accuracy of 0.35 (balanced accuracy = 0.52, sensitivity = 0.24, specificity = 0.80). The second SVM model classified youth according to alcohol drinking status at Time 2 with an accuracy of 0.76 (balanced accuracy = 0.56, sensitivity = 0.21, specificity = 0.91). Linear regression demonstrated that frequency of alcohol sipping at Time 1 predicted frequency of alcohol use at Time 2 (p < 0.001, adjusted R 2 = 0.075). Alcohol sipping at Time 1 was not linearly associated with NA or IFG activity at Time 2 (all ps > 0.05), and NA activity at Time 1 and Time 2 were not related (all ps > 0.05). Activity in the three subsections of the IFG at Time 1 predicted activity in those same regions at Time 2 (all ps < 0.02).

Conclusions and implications

Early sips of alcohol appear to predict alcohol use in early adolescence. Findings do not provide strong evidence for minimal early alcohol use (sipping) as a behavioral marker of underlying alterations in NA-IFG neural responsivity to reward. Improving our understanding of the neural and behavioral factors that indicate a greater propensity for future substance use is crucial for identifying at-risk youth and potential targets for preventative efforts.

Incipient alcohol use in childhood: Early alcohol sipping and its relations with psychopathology and personality

Prior research has shown that sipping of alcohol begins to emerge during childhood and is potentially etiologically significant for later substance use problems. Using a large, community sample of 9- and 10-year-olds (N = 11,872; 53% female), we examined individual differences in precocious alcohol use in the form of alcohol sipping. We focused explicitly on features that are robust and well-demonstrated correlates of, and antecedents to, alcohol excess and related problems later in the lifespan, including youth- and parent-reported externalizing traits (i.e., impulsivity, behavioral inhibition and activation) and psychopathology. Seventeen percent of the sample reported sipping alcohol outside of a religiously sanctioned activity by age 9 or 10. Several aspects of psychopathology and personality emerged as small but reliable correlates of sipping. Nonreligious sipping was related to youth-reported impulsigenic traits, aspects of behavioral activation, prodromal psychotic-like symptoms, and mood disorder diagnoses, as well as parent-reported externalizing disorder diagnoses. Religious sipping was unexpectedly associated with certain aspects of impulsivity. Together, our findings point to the potential importance of impulsivity and other transdiagnostic indicators of psychopathology (e.g., emotion dysregulation, novelty seeking) in the earliest forms of drinking behavior.

The effect of sensation seeking on alcohol use among middle school students: a latent state-trait analysis

BACKGROUND

Sensation seeking has been implicated as a major risk factor for underage alcohol use, however little research into this personality trait has been conducted among children.

OBJECTIVE

The current study examined if sensation seeking presents as a state or trait in children, and if the state or trait predicted future alcohol use.

METHODS

A latent state-trait (LST) analysis was conducted among 552 individuals (54.3% female; age range 8-13; mean age 9.3) to determine the state or trait-based aspects of sensation seeking, and if this state or trait predicted future alcohol use. Sensation seeking behavior and lifetime alcohol use were assessed at four time points using two previously validated measures.

RESULTS

Between 49.4% and 95.3% of individual differences in sensation seeking could be attributed to a stable underlying sensation seeking trait. Further, logistic regression of the stable trait of sensation seeking predicted future alcohol use. A one unit increase in the latent trait increased the odds a student would try alcohol by 7.83 times (95% CI = 1.49-41.11, p = .015). Standardized regression coefficients revealed that an increase of one standard deviation in the latent trait of sensation seeking increased the odds of experimentation with alcohol by 1.29 times (95% CI = 1.11-1.49, p = .001).

CONCLUSION

Findings suggest sensation seeking presents as a stable trait during childhood, which can cause children to seek out a novel or exciting behaviors such as alcohol use. Future substance use interventions may need to account for the influence of the underlying trait.

The Association Between Early Drinking and Dependence Varies by Drinking Context

Evidence regarding the association between early drinking (ED) and later dependence is controversial. It has been alternately hypothesized that ED either plays a causal role in the development of dependence or that it is an early marker of increased psychosocial vulnerabilities. Despite a clear rationale for delaying youth consumption, it is important to discern this relationship. However, most epidemiological evidence comes from individual studies and high-income countries. If there is a causal link between ED and dependence, an association at the aggregate level would be expected. Furthermore, if the link is due to biological mechanisms, the association should be rather invariable regardless of the drinking context, while if the association is due to psychosocial factors, a wider variability is to be expected. We explored whether the association between ED and dependence varied across countries clustered by their shared contextual drinking characteristics. We used data from 169 countries from the Global Information System on Alcohol and Health of the World Health Organization: ED, alcohol dependence, heavy episodic drinking (HED), actual drinkers, and alcohol policy. To cluster countries by their shared drinking characteristics (prevalences of HED and actual drinkers, and alcohol policy), we used, sequentially, two multivariate data reduction techniques: a multiple correspondence analysis (MCA) and a hierarchic classification. To estimate the association between ED and alcohol dependence, beta regressions were performed, and then adjusted by country income-level and repeated by gender. The results indicated four country clusters: primarily abstainers (class 1), low drinking countries (class 2), high drinking countries (class 3), and very high drinking countries (class 4). Positive relationships between ED and alcohol dependence were found for all the countries in the world and for those in classes 1 and 2. No significant relationships were found for class 3 or class 4. These results were similar for males, but not for females, where no significant relationships were found after adjusting for income level. The association between ED and dependence varies according to the drinking context. Our findings either suggest that the ED–dependence association may be due to individual or environmental vulnerabilities that promote consumption outside cultural norms or that, if there is a causal link between ED and dependence, it is strongly moderated by psychosocial characteristics.

An examination of the association between early initiation of substance use and interrelated multilevel risk and protective factors among adolescents

One of the major goals of drug use prevention programs is to delay the age of onset of substance use. What is called early initiation, usually occurring in adolescents under the age of 15, is a salient predictor of Substance Use Disorders later in adulthood. The causes of early initiation are complex and multifaceted and this has led to the identification of a rich set of risk and protective factors that influence age of onset. Nonetheless, there is little knowledge about the interdependence of these factors in their impact on early initiation. This paper addresses this question by applying Multiple Correspondence Analysis to data on family, community and social risk and protective factors from over 1200 adolescents. We find that community and to a lesser extent social factors are the most clearly associated to early initiation and we compare our results to those obtained from linear regression analyses of the same data that do not incorporate interdependence and find opposite results. We discuss the differences between linear regressions and MCA to evaluate the interplay of risk and protective factors and the implications of our findings for health policy and the design of prevention interventions aimed at delaying age of onset.

[Current State of Family-Based Prevention and Therapy of Substance-Use Disorders in Children and Adolescents: A Review]

Current State of Family-Based Prevention and Therapy of Substance-Use Disorders in Children and Adolescents: A Review Adolescence is a vulnerable period for substance use disorders (SUD) as indicated by epidemiological studies. Research demonstrates the family's role for the etiology of SUD and provides a rationale for interventions based on family-associated risk and resilience factors. In this article, we summarize published results for family-based interventions from 2008-2018. Taken together, prevention programs can be effective when they focus on the promotion of broader developmental competencies and familial resources, rather than narrowly addressing substance use. Moreover, programs could benefit from targeting youth and parents as done in the "Strengthening Families Program 10-14"; most existing programs however target parents and do not include the adolescents. Family-based treatment programs with an evidence base are Multisystemic Therapy, Functional Family Therapy, Multidimensional Family Therapy and Brief Strategic Family Therapy. Overall, the effects of family-based interventions are small-to-middle sized but vary significantly across populations. Across the field of family-based interventions, there is a need for more knowledge on effective components and differential effects. The results could be improved by translational research such as on the emerging concept of mindfulness. Moreover, there is a need for implementation research and the effectiveness of service delivery programs on the community level in Germany.