Associations between different aspects of alcohol habits in adolescence, early adulthood, and early middle age: a prospective longitudinal study of a representative cohort of men and women

Polygenic contributions to alcohol use and alcohol use disorders across population-based and clinically ascertained samples

BACKGROUND

Studies suggest that alcohol consumption and alcohol use disorders have distinct genetic backgrounds.

METHODS

We examined whether polygenic risk scores (PRS) for consumption and problem subscales of the Alcohol Use Disorders Identification Test (AUDIT-C, AUDIT-P) in the UK Biobank (UKB; N = 121 630) correlate with alcohol outcomes in four independent samples: an ascertained cohort, the Collaborative Study on the Genetics of Alcoholism (COGA; N = 6850), and population-based cohorts: Avon Longitudinal Study of Parents and Children (ALSPAC; N = 5911), Generation Scotland (GS; N = 17 461), and an independent subset of UKB (N = 245 947). Regression models and survival analyses tested whether the PRS were associated with the alcohol-related outcomes.

RESULTS

In COGA, AUDIT-P PRS was associated with alcohol dependence, AUD symptom count, maximum drinks (R2 = 0.47-0.68%, p = 2.0 × 10-8-1.0 × 10-10), and increased likelihood of onset of alcohol dependence (hazard ratio = 1.15, p = 4.7 × 10-8); AUDIT-C PRS was not an independent predictor of any phenotype. In ALSPAC, the AUDIT-C PRS was associated with alcohol dependence (R2 = 0.96%, p = 4.8 × 10-6). In GS, AUDIT-C PRS was a better predictor of weekly alcohol use (R2 = 0.27%, p = 5.5 × 10-11), while AUDIT-P PRS was more associated with problem drinking (R2 = 0.40%, p = 9.0 × 10-7). Lastly, AUDIT-P PRS was associated with ICD-based alcohol-related disorders in the UKB subset (R2 = 0.18%, p < 2.0 × 10-16).

CONCLUSIONS

AUDIT-P PRS was associated with a range of alcohol-related phenotypes across population-based and ascertained cohorts, while AUDIT-C PRS showed less utility in the ascertained cohort. We show that AUDIT-P is genetically correlated with both use and misuse and demonstrate the influence of ascertainment schemes on PRS analyses.

Adolescents' healthy lifestyle

OBJECTIVE

Using a wide and representative sample of adolescents from 37 countries, this study aimed to analyze how age changes adolescents' healthy lifestyle.

METHODS

The study included 148,839 adolescents who participated in the Health Behavior in School-aged Children 2010 survey. A composite score of a healthy lifestyle was created using the combination of daily physical activity, daily fruit and vegetable consumption, <2h daily on screen-based behaviors, abstinence from alcohol, and abstinence from tobacco products. Healthy lifestyle measures were based on self-report.

RESULTS

4.7% of boys and 4.4% of girls aged 11 years, 3% of boys and 2% of girls aged 13 years, and 1.5% of boys and 0.8% of girls aged 15 scored perfectly on the healthy lifestyle score. As age increased, the prevalence of adolescents with a healthy lifestyle decreased. In 37 countries and regions, the prevalence of healthy behaviors decreased linearly between early adolescence and the age of 15 years.

CONCLUSIONS

In general, adolescents do not have a healthy lifestyle. Results from this study highlight that there is still much work to be done in promoting healthy lifestyles and to raise awareness among adolescents of the potential risk to their health status.

Personality traits as predictors of early alcohol inebriation among young adolescents: Mediating effects by mental health and gender-specific patterns

The aim of this study was to predict alcohol inebriation and mental health (internalizing and externalizing problems plus well-being), and potential gender-specific patterns among young adolescents, by a biopsychosocial model of personality traits. Self-reported data from 853 adolescents (479 girls) in Sweden, aged 13-15 years, from the Longitudinal Research on Development In Adolescence (LoRDIA) program were used. Predictions from personality to inebriation and mediating effects of mental health were estimated by means of logistic regression and generalized structural equation modelling. Separated gender analyses were performed throughout the study to reveal potential gender-specific patterns. Externalizing problems, Novelty Seeking and Cooperativeness had independent effects on alcohol inebriation for both genders as well as Harm Avoidance among girls and Internalizing problems among boys. Novelty Seeking and Self-Directedness had indirect effects through externalizing problems and Harm Avoidance and Self-Directedness had indirect effects through internalizing problems for boys. Self-directedness showed an indirect effect through externalizing problems for girls. The combination of an immature character (low Self-directedness and Cooperativeness) with an extreme temperament profile (high Novelty Seeking and low Harm Avoidance) was a predictor of inebriation across gender, both directly and indirectly through mental health. This study contributes with valuable information about gender-specific considerations when developing and conducting preventative interventions targeting psychological risk and resilience factors for early alcohol inebriation among young adolescents.

Follow-up of an age-period-cohort analysis on alcohol-related mortality trends in Sweden 1970-2015 with predictions to 2025

BACKGROUND AND AIMS

Several studies have indicated that birth cohorts are important in explaining trends in alcohol-related mortality. An earlier study from Sweden with data up to 2002 showed that birth cohorts that grew up under periods of more liberal alcohol policies had higher alcohol-related mortality than those cohorts growing up under more restrictive time periods. In spite of increasing alcohol consumption, predictions in 2002 also indicated lower alcohol-related mortality in the future. The aim of this study is to follow-up whether the effects of birth cohorts and the predictions made for Sweden still holds using data up to 2015.

METHOD

The study comprised an age-period-cohort analysis and predictions based on population predictions from Statistics Sweden. The analysis was based on all alcohol-related deaths in the Swedish population between 1969 and 2015 for the cohorts born in the decades 1920 through 1990. Data were restricted to people 15-84 years of age. In total, the analysis covered 68,341 deaths and more than 284 million person-years.

RESULTS

Male and female cohorts born in the 1940s to 1950s exhibited the highest alcohol-related mortality, while those born in the 1970s continued to have the lowest alcohol-related mortality rates. The predicted mortality rates for males are still anticipated to decrease somewhat through 2025.

CONCLUSIONS

The updated age-period-cohort analysis further supports the importance of focusing on restrictive alcohol policies targeting adolescents.

Alcohol habits in a suburban male cohort

Objective: Using data from a prospective birth-to-maturity project, the study presents normally occurring variations in alcohol involvement of alcohol-related problems among a representative cohort of Swedish males in young middle age, born in a Swedish metropolitan area (n=106). Methods: Description and classification were based on an analysis of self-reported information (collected at about 36 years of age) about frequency and quantity of alcohol consumption (four-week timeline), self-reported alcohol-related symptoms, and registry data. Results: According to a broad, operationally defined classification of ``harmful drinking'' (at least three alcohol-related symptoms, including alcohol-related crimes), 43 subjects (41%) had experienced a substantial drinking problem during their lifetime, to an extent that might warrant labels such as ``alcoholism'' or ``hazardous drinking''. About one-third of these misusers were currently using other drugs. Of the 106 subjects, 80 (75%) reported having had at least one alcohol-related symptom or problem at some time during their life. Taking various life events into account, including sociomedical circumstances and heavy consumption at 18 and 25 years, 23 subjects (22%) were classified as having a lifetime prevalence of alcohol abuse/dependence according to DSM-III criteria. Conclusion: Problem drinking was largely unknown to the healthcare system and only a few subjects had received treatment. The results are discussed in the light of data from other national and international epidemiological surveys.

Self-affirmation, intentions and alcohol consumption in students: a randomized exploratory trial

AIMS

This study tests whether enhancing alcohol risk messages with self-affirmation, the process of focusing on cherished aspects of oneself, increases intentions to reduce alcohol consumption and reduces actual alcohol consumption. It was also examined whether these effects differed by risk status as indicated by standard drinks consumed in an average week.

METHODS

Participants (n = 121) were randomly allocated to a self-affirmation or matched control condition before viewing emotive graphic alcohol warning posters in a questionnaire-based study.

RESULTS

There were significant increases in intentions to reduce alcohol consumption in self-affirmed participants, and these effects were stronger in participants with higher behavioural risk. Intentions in turn significantly predicted a reduction in self-reported alcohol consumption.

CONCLUSIONS

These findings support the use of self-affirmation to enhance alcohol awareness campaigns, particularly in individuals with high behavioural risk.

Adult consequences of late adolescent alcohol consumption: a systematic review of cohort studies

BACKGROUND

Although important to public policy, there have been no rigorous evidence syntheses of the long-term consequences of late adolescent drinking.

METHODS AND FINDINGS

This systematic review summarises evidence from general population cohort studies of drinking between 15-19 years old and any subsequent outcomes aged 20 or greater, with at least 3 years of follow-up study. Fifty-four studies were included, of which 35 were assessed to be vulnerable to bias and/or confounding. The principal findings are: (1) There is consistent evidence that higher alcohol consumption in late adolescence continues into adulthood and is also associated with alcohol problems including dependence; (2) Although a number of studies suggest links to adult physical and mental health and social consequences, existing evidence is of insufficient quality to warrant causal inferences at this stage.

CONCLUSIONS

There is an urgent need for high quality long-term prospective cohort studies in order to better understand the public health burden that is consequent on late adolescent drinking, both in relation to adult drinking and more broadly. Reducing drinking during late adolescence is likely to be important for preventing long-term adverse consequences as well as protecting against more immediate harms. Please see later in the article for the Editors' Summary.

What is the predictive value of established risk factors for total and cardiovascular disease mortality when measured before middle age? Pooled analyses of two prospective cohort studies from Scotland

AIMS

To examine the association of physiological, behavioural and social characteristics in pre-middle age with future total and cardiovascular disease (CVD) mortality.

METHODS AND RESULTS

Risk factor data on 1503 individuals aged 16-35 years at baseline were collected in two prospective cohort studies using standard protocols. Their association with total and CVD mortality ascertained during 40 years of follow-up was summarized using Cox proportional hazards regression. A median follow-up of 39.6 years gave rise to 255 deaths (103 from CVD). In age-adjusted and sex-adjusted analyses, impaired lung function [one standard deviation increases in forced expiratory volume in 1 s: hazards ratio 0.69; 95% confidence interval 0.55, 0.86; and in forced vital capacity: 0.76; 0.59, 0.98], current cigarette smoking (4.16; 2.22, 7.80) and higher alcohol consumption (one standard deviation increase in standard units consumed: 1.20; 1.02, 1.41) were associated with CVD. In fully adjusted analyses associations generally held. For total mortality, these factors and obesity and socioeconomic disadvantage were predictive.

CONCLUSION

A range of risk factors measured before middle age were related to risk of total and CVD mortality up to four decades later, indicating that public health interventions should be implemented earlier in the life course than is currently the case.

Trends in alcohol-related mortality in Sweden 1969-2002: an age-period-cohort analysis

AIM

To study the effects of age, period and cohorts on alcohol-related mortality trends in Sweden.

DESIGN

The study comprises an age-period-cohort analysis.

SETTING AND PARTICIPANTS

The analysis was based on all deaths in the Swedish population between 1969 and 2002.

MEASUREMENTS

Data on alcohol-related deaths in Sweden from 1969 to 2002 excluding accidental injury and homicide were used. The analysis covered 43 021 deaths.

FINDINGS

Time period and birth cohort both influenced alcohol-related mortality. Male cohorts born in the 1930-40s exhibited the highest alcohol-related mortality, while for females those born in the 1940-50s had the highest alcohol-related mortality. For both men and women, those born in the 1960-70s had the lowest age-adjusted alcohol-related mortality. High-risk cohorts were young or in early adulthood during the periods that alcohol became more available in Sweden. The low-risk cohorts of the 1960-70s were brought up during a period when society was concerned with increasing alcohol problems and more emphasis was placed on issuing alcohol awareness information in schools.

CONCLUSIONS

Cohort effects were found suggesting that the link between alcohol consumption and non-accident alcohol-related mortality at the population level is dependent on other factors that may change over time. One such factor may be that restrictive alcohol policies have a greater effect on drinking in those who are younger at the time they are put into effect.

Childhood temperament and adult alcohol habits: a prospective longitudinal study from age 4 to age 36

The purpose of the present study was to relate childhood temperament dimensions at age 4 to alcohol habits until young middle age. Data were derived from the male cohort (n = 122) in a larger prospective longitudinal project. At age 4, a professional psychologist rated the child's behavior on 30 aspects of temperament, which, in turn, were factor-analyzed and cross-validated to other measures of personality at ages 10, 25 and 36. The five extracted factors at age 4 were correlated to the level of consumption at age 18, frequency of intoxication at age 25, lifetime alcohol problem up to age 36 and registered drug-related criminality. There was a positive correlation between a factor denoted Extravert/outgoing and lifetime alcohol problems and a negative correlation between a factor denoted Social reactivity and alcohol problems. Although all correlations were modest (typically ranging between .20 and .30), the findings have theoretical implications and these were further discussed.

Psychosocial characteristics at age 10; differentiating between adult alcohol use pathways: a prospective longitudinal study

The objective of the present study was to relate psychosocial characteristics at age 10 to alcohol use pathways in adulthood up to age 36 using data from the male cohort (n = 122) of a longitudinal study. Psychosocial characteristics at age 10 were measured along five dimensions: parental socioeconomic status, intelligence, ability to concentrate, anxiousness, and school achievement. Subjects whose hazardous alcohol habits were limited to adolescence/early adulthood had parents with a significantly lower socioeconomic status compared to persistently hazardous alcohol consumers. In addition, two psychosocial configurations at age 10 were typically linked to future alcohol problems. One pathway included motivational difficulties in school and the second a general adjustment problem. The discussion relates these configurations to existing typologies and theories of development.