Sipping, drinking, and early adolescent alcohol consumption: a cautionary note

The validity of self-rated alcohol susceptibility in predicting alcohol use in early adolescents in Latin America

BACKGROUND

The measurement of substance use susceptibility was first conceived as part of the preparatory stage that precedes youth smoking initiation and is defined as the lack of a firm commitment not to smoke in the future. Despite being a consistent and validated predictor of smoking initiation, there has been little research on whether susceptibility can predict alcohol use. This study assessed the validity of an adapted alcohol susceptibility measure to predict alcohol consumption among early adolescent students in Argentina and Mexico who had not previously consumed alcohol.

METHODS

A school-based longitudinal study was conducted among first-year students in 33 secondary schools in Argentina and 57 in Mexico. The baseline sample included 1504 never-drinker adolescents in Argentina and 5264 in Mexico, of whom 1055 and 3540, respectively, completed a follow-up survey one and a half years later. Logistic regression with school as a random effect was used to estimate the adjusted odds ratios for the transitions from never-drinker to ever-drinker, current drinker, and binge drinker.

RESULTS

At baseline, 34% and 23.6% of adolescent never-users in Argentina and Mexico, respectively, were susceptible to alcohol. After controlling for other known predictors of alcohol use initiation, alcohol susceptibility was positively associated with ever-drinking (OR = 3.23, 95% CI 2.38-4.36 in Argentina, OR = 1.73, 95% CI 1.43-2.10 in Mexico), current drinking (OR = 2.41, 95% CI 1.71-3.4 in Argentina, OR = 1.77, 95% CI 1.37-2.28 in Mexico), and binge drinking (OR = 2.27, 95% CI 1.78-2.91 in Argentina, OR = 1.89, 95% CI 1.32-1.99 in Mexico).

CONCLUSIONS

The susceptibility measure adapted for use with alcohol appears valid for identifying individuals or groups at risk of drinking initiation and problematic drinking among early adolescents in Argentina and Mexico.

Declining drinking among adolescents: Are we seeing a denormalisation of drinking and a normalisation of non-drinking?

BACKGROUND

In the early 2000s, alcohol use among young people began to decline in many western countries, especially among adolescents (ages between 12-17 years old). These declines have continued steadily over the past two decades, against the backdrop of much smaller declines among the general population.

ARGUMENT

Hypotheses examining individual factors fail adequately to provide the necessary 'big picture' thinking needed to understand declines in adolescent drinking. We use the normalisation thesis to argue that there is strong international evidence for both processes of denormalisation of drinking and normalisation of non-drinking occurring for adolescents in many western countries.

CONCLUSIONS

Research on declining adolescent drinking provides evidence of both denormalisation of alcohol consumption and normalisation of non-drinking. This has implications for enabling policy environments more amenable to regulation and increasing the acceptability of non-drinking in social contexts. Normalisation theory (and its various interpretations) provides a useful multi-dimensional tool for understanding declines in adolescent drinking.

Substance use patterns in 9-10 year olds: Baseline findings from the adolescent brain cognitive development (ABCD) study

BACKGROUND

The Adolescent Brain Cognitive Development ™ Study (ABCD Study®) is an open-science, multi-site, prospective, longitudinal study following over 11,800 9- and 10-year-old youth into early adulthood. The ABCD Study aims to prospectively examine the impact of substance use (SU) on neurocognitive and health outcomes. Although SU initiation typically occurs during teen years, relatively little is known about patterns of SU in children younger than 12.

METHODS

This study aims to report the detailed ABCD Study® SU patterns at baseline (n = 11,875) in order to inform the greater scientific community about cohort's early SU. Along with a detailed description of SU, we ran mixed effects regression models to examine the association between early caffeine and alcohol sipping with demographic factors, externalizing symptoms and parental history of alcohol and substance use disorders (AUD/SUD).

PRIMARY RESULTS

At baseline, the majority of youth had used caffeine (67.6 %) and 22.5 % reported sipping alcohol (22.5 %). There was little to no reported use of other drug categories (0.2 % full alcohol drink, 0.7 % used nicotine, <0.1 % used any other drug of abuse). Analyses revealed that total caffeine use and early alcohol sipping were associated with demographic variables (p's<.05), externalizing symptoms (caffeine p = 0002; sipping p = .0003), and parental history of AUD (sipping p = .03).

CONCLUSIONS

ABCD Study participants aged 9-10 years old reported caffeine use and alcohol sipping experimentation, but very rare other SU. Variables linked with early childhood alcohol sipping and caffeine use should be examined as contributing factors in future longitudinal analyses examining escalating trajectories of SU in the ABCD Study cohort.

Alcohol consumption in early adolescence: Associations with sociodemographic and psychosocial factors according to gender

Introduction

Early alcohol consumption can irreversible damage the adolescents’ brain and may affect their quality of life. In order to better prevent such a deleterious behaviour, knowing its determinants is needed. So far, only few studies among adolescents aged <15 years exist, of which the majority failed to include gender differences. Therefore, the aim of this study was to investigate whether gender differences in the association between alcohol use and sociodemographic and psychosocial characteristics among 10-14-year olds exist.

Methods

Data came from the 2018 Health Behaviour in School-Aged Children (HBSC) study conducted in French-speaking schools of Belgium. The sample analysed here comprised 4,364 10-14-year olds from the Walloon Region. Associations of the recent alcohol consumption (at least one glass during the past month) with sociodemographic and psychosocial characteristics were estimated using gender-stratified multivariable logistic regression modelling.

Results

Prevalence of early alcohol consumption was 14% (boys: 16%; girls: 12%). Migration status and family affluence scale (FAS) were associated with early alcohol consumption only in boys. Second-generation immigrant boys (vs. natives: OR = 0.66 [0.47–0.92]) and boys from “low” FAS families (vs. “high”: OR = 0.56 [0.32–0.98]) or “medium” FAS (vs. “high”: OR = 0.63 [0.43–0.92]) were less likely to have consumed alcohol in the past month. In both genders, alcohol consumption was positively associated with age and inversely associated with school satisfaction and family support. No association was observed with family structure, peer support and life satisfaction in the multivariable models.

Conclusion

Our findings showed that gender differences may exist in the determinants of alcohol consumption among young adolescents. They will contribute to the development of public health policies and actions for the most vulnerable adolescents, which should take gender differences into account.

Parental supply of sips and whole drinks of alcohol to adolescents and associations with binge drinking and alcohol-related harms: A prospective cohort study

BACKGROUND

Parents frequently supply alcohol to their children, often only sips. We investigated whether supply of sips and whole drinks, from parents and other sources, are differentially associated with subsequent drinking outcomes.

METHODS

A cohort of 1910 adolescents (mean age 12.9yrs) were surveyed annually over seven years from 2010-11. We examined prospective, adjusted associations between the quantity of supply from parental and non-parental sources in the preceding 12 months and five outcomes in the subsequent year, over several consecutive years: binge drinking; alcohol-related harms; symptoms of alcohol abuse, dependence and alcohol use disorder (AUD).

RESULTS

In early waves, most parental supply comprised sips, while supply of whole drinks increased in later waves. Among those not receiving alcohol from other sources, parental supply of sips was associated with increased odds of binge drinking (OR: 1.85; 99.5 % CI: 1.17-2.91) and alcohol-related harms (OR: 1.70; 99.5 % CI: 1.20-2.42), but not with reporting symptoms of alcohol abuse, dependence or AUD, compared with no supply. Relative to no supply, supply of sips from other sources was associated with increased odds of binge drinking (OR: 2.04; 99.5 % CI: 1.14-3.67) only. Compared with supply of sips, supply of whole drinks by parents or others had higher odds of binge drinking, alcohol-related harms, symptoms of dependence and of AUD. Secondary analysis demonstrated that supply of larger quantities was associated with an increased risk of all outcomes.

CONCLUSION

Parental provision of sips is associated with increased risks and the supply of greater quantities was associated with an increasing risk of adverse outcomes.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov (NCT02280551).

Parental supply of alcohol as a predictor of adolescent alcohol consumption patterns: A prospective cohort

BACKGROUND

Recent research has not supported the idea that parental supply of alcohol to adolescents prevents later alcohol-related harm. Yet the specific role of parental supply in shaping patterns of drinking over time remains unclear. This study investigated the role of parental supply of alcohol in patterns of drinking across adolescence, and assessed whether that role remained consistent over time.

METHOD

Using a longitudinal cohort of 1927 adolescents (mean age 12.9 years), recruited in 2010 and 2011 from schools across Australia and followed up annually until 2016, we assessed three outcomes using mixed-effect negative binomial regression: frequency of consumption, typical quantity consumed, and overall alcohol consumption in the year (frequency * quantity). Child, parental, familial, and peer confounders of adolescent alcohol consumption were measured and adjusted for in the analyses.

FINDINGS

Parental supply was associated with greater overall consumption in earlier adolescence: Grade 7-8 (incidence rate ratio [IRR]: 3.61; 95% CI: 2.55, 5.12; no supply IRR: 1.00), Grade 8-9 (IRR: 4.84; 95% CI: 3.66, 6.39; no supply IRR: 1.44) and Grade 9-10 (IRR: 8.33; 95% CI: 6.28, 11.05; no supply IRR: 4.75). Alcohol consumption continued to increase in later adolescence regardless of whether parental supply occurred.

CONCLUSIONS

Parental supply of alcohol was associated with increased alcohol consumption by their children during early adolescence. While parental supply appears to have less impact on drinking in later adolescence, there was no evidence to suggest it is protective. Parents should be advised to avoid supplying children with alcohol, particularly in early adolescence.

Comparison of age of first drink and age of first intoxication as predictors of substance use and mental health problems in adulthood

BACKGROUND

International public policy on age of first alcoholic drink (AFD) has emphasised the long-term benefits of delaying AFD. This study aimed to compare AFD to age of first intoxication (AFI) as predictors of substance use disorder and mental disorder outcomes in adulthood.

METHODS

Data were obtained from a longitudinal birth cohort in Christchurch, New Zealand. Participants were born in 1977. Analysis samples ranged from n = 1025 (age 18) to n = 962 (age 35). Measures of AFD and AFI were generated using parental- and self-report data collected from age 11. Outcomes at age 18-35 were alcohol quantity consumed, DSM-IV alcohol use disorder (AUD) and AUD symptoms, major depression, anxiety disorder, and nicotine, cannabis, and other illicit drug dependence. Covariate factors measured during childhood included family socioeconomic status, family functioning, parental alcohol-related attitudes/behaviours, and individual factors.

RESULTS

There was a significant unadjusted association between AFD and symptoms of AUD (p < .001) and nicotine dependence (p < .05) but not other outcomes. AFI was significantly (p < .05) associated with all outcomes. After adjustment for covariates, the association between AFD and outcomes was not statistically significant. Conversely, in adjusted models, statistically significant (p < .05) associations remained between AFI and all AUD and substance use disorder outcomes but not alcohol consumption or mental disorder outcomes.

CONCLUSIONS

AFI was a more robust predictor of adult substance use disorder outcomes than AFD. Public health and policy interventions aimed at prevention of long term harms from alcohol should therefore focus on AFI rather than AFD.

Parental Supply of Alcohol in Childhood and Risky Drinking in Adolescence: Systematic Review and Meta-Analysis

Whether parental supply of alcohol affects the likelihood of later adolescent risky drinking remains unclear. We conducted a systematic review and meta-analysis to synthesize findings from longitudinal studies investigating this association. We searched eight electronic databases up to 10 September 2016 for relevant terms and included only original English language peer-reviewed journal articles with a prospective design. Two reviewers independently screened articles, extracted data and assessed risk of bias. Seven articles met inclusion criteria, six of which used analytic methods allowing for meta-analysis. In all seven studies, the follow-up period was ≥12 months and attrition ranged from 3% to 15%. Parental supply of alcohol was associated with subsequent risky drinking (odds ratio = 2.00, 95% confidence interval = 1.72, 2.32); however, there was substantial risk of confounding bias and publication bias. In all studies, measurement of exposure was problematic given the lack of distinction between parental supply of sips of alcohol versus whole drinks. In conclusion, parental supply of alcohol in childhood is associated with an increased likelihood of risky drinking later in adolescence. However, methodological limitations preclude a causal inference. More robust longitudinal studies are needed, with particular attention to distinguishing sips from whole drinks, measurement of likely confounders, and multivariable adjustment.

Parental supply of alcohol and alcohol consumption in adolescence: prospective cohort study

BACKGROUND

Parents are a major supplier of alcohol to adolescents, yet there is limited research examining the impact of this on adolescent alcohol use. This study investigates associations between parental supply of alcohol, supply from other sources, and adolescent drinking, adjusting for child, parent, family and peer variables.

METHOD

A cohort of 1927 adolescents was surveyed annually from 2010 to 2014. Measures include: consumption of whole drinks; binge drinking (>4 standard drinks on any occasion); parental supply of alcohol; supply from other sources; child, parent, family and peer covariates.

RESULTS

After adjustment, adolescents supplied alcohol by parents had higher odds of drinking whole beverages [odds ratio (OR) 1.80, 95% confidence interval (CI) 1.33-2.45] than those not supplied by parents. However, parental supply was not associated with bingeing, and those supplied alcohol by parents typically consumed fewer drinks per occasion (incidence rate ratio 0.86, 95% CI 0.77-0.96) than adolescents supplied only from other sources. Adolescents obtaining alcohol from non-parental sources had increased odds of drinking whole beverages (OR 2.53, 95% CI 1.86-3.45) and bingeing (OR 3.51, 95% CI 2.53-4.87).

CONCLUSIONS

Parental supply of alcohol to adolescents was associated with increased risk of drinking, but not bingeing. These parentally-supplied children also consumed fewer drinks on a typical drinking occasion. Adolescents supplied alcohol from non-parental sources had greater odds of drinking and bingeing. Further follow-up is necessary to determine whether these patterns continue, and to examine alcohol-related harm trajectories. Parents should be advised that supply of alcohol may increase children's drinking.

Does parental drinking influence children's drinking? A systematic review of prospective cohort studies

AIMS

To evaluate evidence of the capacity for causal inference in studies of associations between parental and offspring alcohol consumption in the general population.

METHODS

A systematic search for, and narrative analysis of, prospective cohort studies of the consequences of drinking, except where assessed prenatally only, or with clinically derived instruments. Primary outcome measures were alcohol use or related problems in offspring, which were collected at least 3 years after exposure measures of parental drinking. The systematic review included 21 studies comprising 26,354 families or parent-child dyads with quantitative effect measures available for each study. Criteria for capacity of causal inference included (1) theory-driven approach and analysis; (2) analytical rigour; and (3) minimization of sources of bias.

RESULTS

Four of the 21 included studies filled several, but not all, criteria and were assessed to have some capacity for causal inference. These four studies found some evidence that parental drinking predicted drinking behaviour in adolescent offspring. The remaining 17 studies had little or no such capacity.

CONCLUSIONS

There is a fairly large and consistent literature demonstrating that more parental drinking is associated with more drinking in offspring. Despite this, existing evidence is insufficient to warrant causal inferences at this stage.

Early Adolescent Alcohol Use: Are Sipping and Drinking Distinct?

BACKGROUND

Sipping alcohol is common during early adolescence, but research has ignored the distinction between sipping and drinking whole alcohol beverages, conflating the 2, or else simply classifying "sippers" as abstainers. Research has not addressed whether sippers are different to drinkers, in relation to variables known to be associated with adolescent alcohol consumption, or considered whether sipping and drinking behaviors may have quite different associations.

METHODS

Parent-child dyads (N = 1,823) were recruited in 3 states from Australian grade 7 classes. Multinomial logistic analyses compared adolescents who had only had a sip/taste of alcohol (sippers) with adolescents who had consumed at least a whole drink (drinkers) in the past 6 months. The multivariate model assessed a broad range of demographics, parenting practices, peer influences, and adolescent externalizing and internalizing behaviors, and controlled for school clustering.

RESULTS

Compared to drinkers, sippers were less likely to come from 1-parent households (odds ratio [OR] = 0.59, 95% confidence interval [CI]: 0.35 to 0.98); less likely to come from low-socioeconomic status (SES) households (OR = 0.54, 95% CI: 0.31 to 0.94); more likely to come from families where parents provide stricter alcohol-specific rules (OR = 1.21, 95% CI: 1.11 to 1.32), stricter monitoring of the child's activities (OR = 1.10, 95% CI: 1.04 to 1.16), more consistent parenting practices (OR = 1.13, 95% CI: 1.05 to 1.23), and more positive family relationships (OR = 1.56, 95% CI: 1.02 to 2.43); and report having fewer substance-using peers (OR = 0.80, 95% CI: 0.70 to 0.91) and greater peer disapproval of any substance use (OR = 1.30, 95% CI: 1.19 to 1.42). After adjustment for confounders, the associations with household composition and SES were no longer significant, but the familial and peer associations remained significant in the multivariate analysis, χ(2) (40) = 1,493.06, p < 0.001.

CONCLUSIONS

Sipping alcohol has different associations with known predictors of adolescent alcohol use than drinking whole beverages, and sipping may be a distinct or separable behavior. Future research should better define quantities of early consumption and assess the relationship between early sipping and drinking on long-term outcomes separately.

Individual, school-related and family characteristics distinguish co-occurrence of drinking and depressive symptoms in very young adolescents

INTRODUCTION AND AIMS

Alcohol misuse and depressed mood are common during early adolescence, and comorbidity of these conditions in adulthood is associated with poorer health and social outcomes, yet little research has examined the co-occurrence of these problems at early adolescence. This study assessed risky and protective characteristics of pre-teens with concurrent depressed mood/early alcohol use in a large school-based sample.

DESIGN AND METHODS

School children aged 10-14 years (n = 7289) from late primary and early secondary school classes in government, Catholic and independent sectors participated with parental consent in the cross-sectional Healthy Neighbourhoods Study. Key measures included depressed mood, recent alcohol use, school mobility, family relationship quality, school engagement and coping style. Multinomial logistic regression analyses were used to identify school and family-related factors that distinguished those with co-occurring drinking and depressive symptoms from those with either single condition. Gender and school-level interactions for each factor were evaluated.

RESULTS

Co-occurring conditions were reported by 5.7% of students [confidence interval (CI)95 5.19, 6.19]. Recent drinkers were more likely than non-drinkers to have symptoms consistent with depression (odds ratio 1.80; CI95 1.58, 2.03). Low school commitment was associated with co-occurring drinking/depressive symptoms (odds ratio 2.86; CI95 2.25, 3.65 compared with null condition). This association appeared to be weaker in the presence of adaptive stress-coping skills (odds ratio 0.18; CI95 0.14, 0.23).

CONCLUSIONS

We have identified factors that distinguish pre-teens with very early co-occurrence of drinking and depressed mood, and protective factors with potential utility for school-based prevention programmes targeting these conditions. [Salom CL, Kelly AB, Alati R, Williams GM, Patton GC, Williams JW. Individual, school-related and family characteristics distinguish co-occurrence of drinking and depressive symptoms in very young adolescents. Drug Alcohol Rev 2016;35:387-396].