Longitudinal effects of age at onset and first drinking situations on problem drinking

Outcomes from a randomized controlled trial of a multi-component alcohol use preventive intervention for urban youth: project northland Chicago

AIMS

The goal of this group-randomized trial was to test the effectiveness of an adapted alcohol use preventive intervention for urban, low-income and multi-ethnic settings.

DESIGN AND SETTING

Sixty-one public schools in Chicago were recruited to participate, were grouped into neighborhood study units and assigned randomly to intervention or 'delayed program' control condition.

PARTICIPANTS

The study sample (n = 5812 students) was primarily African American, Hispanic and low-income.

INTERVENTION

Students, beginning in sixth grade (age 12 years), received 3 years of intervention strategies (curricula, family interventions, youth-led community service projects, community organizing).

MEASUREMENTS

Students participated in yearly classroom-based surveys to measure their alcohol use and related risk and protective factors. Additional evaluation components included a parent survey, a community leader survey and alcohol purchase attempts.

FINDINGS

Overall, the intervention, compared with a control condition receiving 'prevention as usual', was not effective in reducing alcohol use, drug use or any hypothesized mediating variables (i.e. related risk and protective factors). There was a non-significant trend (P = 0.066) that suggested the ability to purchase alcohol by young-appearing buyers was reduced in the intervention communities compared to the control communities, but this could be due to chance. Secondary outcome analyses to assess the effects of each intervention component indicated that the home-based programs were associated with reduced alcohol, marijuana and tobacco use combined (P = 0.01), with alcohol use alone approaching statistical significance (P = 0.06).

CONCLUSIONS

Study results indicate the importance of conducting evaluations of previously validated programs in contexts that differ from the original study sample. Also, the findings highlight the need for further research with urban, low-income adolescents from different ethnic backgrounds to identify effective methods to prevent and reduce alcohol use.

Behavioral responses during the initial exposures to a low dose of cocaine in late preweanling and adult rats

Human drug experimentation begins during late childhood and early adolescence, a critical time in physical and CNS development, when the immature CNS is vulnerable to the long-term effects of psychoactive drugs. Few preclinical animal studies have investigated responses to such drugs in a developmental stage equivalent to late childhood of humans. We used a rodent model to examine behavioral responses of female Sprague-Dawley late preweanling and adult rats during acute and repeated exposures to a low dose of cocaine. Results show that after cocaine injection, preweanling rats (18-21 days old) have locomotor responses that differ from adults, but after postnatal day 22, the responses are indistinguishable from adults even though rats are still not weaned. Before day 22, locomotor effects of cocaine differ from those in adults in three ways: preweanlings are active for a longer time after cocaine injection at day 18; preweanling activity peaks more rapidly after subcutaneous administration; and after only three injections of cocaine, a tolerance-like pattern is seen in preweanlings whereas an emerging pattern of sensitization to cocaine is seen in adults. The behavioral patterns of this age group offer a preclinical model of the early effects of drugs of abuse.

Meta-analysis of the association of the Taq1A polymorphism with the risk of alcohol dependency: a HuGE gene-disease association review

The human dopamine 2 receptor Taq1A allele has been implicated as a vulnerability factor for alcohol dependence in a number of studies and reviews. To determine whether this allele is associated with alcoholism, the authors conducted a Human Genome Epidemiology review and meta-analysis. Forty-four studies with 9,382 participants were included. An odds ratio of 1.38 (95% confidence interval: 1.20, 1.58; heterogeneity, 50.5%) was found for the A1A1 + A1A2 versus the A2A2 genotype. Sensitivity analyses suggested lack of ethnic matching as a possible source of heterogeneity; a small, significant association was detected in studies with ethnic-matched controls (odds ratio = 1.26, 95% confidence interval: 1.02, 1.56; heterogeneity, 37%). Significant associations were also found in analyses restricted to studies reporting use of blinding and those with adequate screening of controls for alcohol dependency. For the A1A1 versus the A1A2 + A2A2 genotype, the odds ratio was 1.22 (95% confidence interval: 1.05, 1.43; heterogeneity, 0%). Sensitivity analyses on groups of studies reporting use of ethnic-matched controls and those that screened controls for alcohol dependency still showed significant associations. The relatively small effect for the association of the A1 allele, or another genetic variant linked to it, with alcohol dependence indicates a multigene causality for this complex disorder.

Socioeconomic differences in alcohol-specific parenting practices and adolescents' drinking patterns

The aim of this study was to investigate to what extent alcohol-specific parenting practices relate to adolescents' alcohol use, binge drinking, and alcohol-related problems, and whether these associations are moderated by socioeconomic status (SES), i.e. parents' education level and family income. The present data were collected within the framework of a representative study on alcohol use among Dutch students. The present findings are based on data from respondents who had been drinking in the past year (81.5%), and of whom one of the parents had filled out a short questionnaire including SES characteristics (52%). The sample consisted of 1,344 adolescents. Adolescents were approached in a school setting; parents received a short questionnaire at the home address. The results show that applying strict rules about alcohol use and having qualitative good conversations about drinking alcohol seem to prevent adolescents from heavy drinking patterns, whereas parental alcohol use seems to promote adolescents' drinking. A positive association was found between frequency of alcohol communication and availability of alcohol at home on the one hand and adolescents' drinking on the other. Some moderating effects of SES were found.

Effects of home access and availability of alcohol on young adolescents' alcohol use

AIMS

The purpose of the present study was to examine the effects of parental provision of alcohol and home alcohol accessibility on the trajectories of young adolescent alcohol use and intentions.

DESIGN

Data were part of a longitudinal study of alcohol use among multi-ethnic urban young adolescents who were assigned randomly to the control group of a prevention trial.

SETTING

Data were collected from a cohort of youth, and their parents, who attended public schools in Chicago, Illinois (2002-2005).

PARTICIPANTS

The sample comprised the 1388 students, and their parents, who had been assigned randomly to the control group and were present and completed surveys at baseline, in the beginning of 6th grade (age 12). The sample was primarily low-income, and African American and Hispanic.

MEASUREMENTS

Students completed self-report questionnaires when in the 6th, 7th and 8th grades (age 12-14 years; response rates 91-96%). Parents of the 6th grade students also completed questionnaires (70% response rate).

FINDINGS

Student report, at age 12, of parental provision of alcohol and home alcohol availability, and parental report of providing alcohol to their child and the accessibility of alcohol in the home, were associated with significant increases in the trajectories of young adolescent alcohol use and intentions from ages 12-14 years. Student report of receiving alcohol from their parent or taking it from home during their last drinking occasion were the most robust predictors of increases in alcohol use and intentions over time.

CONCLUSIONS

Results indicate that it is risky for parents to allow children to drink during early adolescence. When these findings are considered together with the risks associated with early onset of alcohol use, it is clear that parents can play an important role in prevention.

Evidence of association between early alcohol use and risk of later problems

OBJECTIVES: To investigate the relationship between age of onset, alcohol consumption patterns and related problems. METHOD: In 2004, one self-administered questionnaire was completed by 1,990 students from the 5th to 11th grades of schools in Paulínia-SP. Data collection was conducted at the classroom without the presence of the teacher. The participation in the study was voluntary and anonymous. RESULTS: Prevalence of lifetime alcohol use was 62.2%. The mean age of first use of alcohol was 12.35 (sd = 2.72) and ranged between 5 and 19 years of age. In 78% of the cases, the first use occurred before the age of 15, and more than 22% of the students reported having tried alcohol before 10 years of age. There were significant differences regarding current pattern of use: those who started earlier consumed more drinks per occasion (p = 0.013) and had more drunkenness episodes in the last 30 days (p = 0.05). A relationship between the age of first alcohol use and the use of tobacco (p = 0.017) and other drugs (p = 0.047) was observed. CONCLUSIONS: Adolescents first use alcohol in early ages, what impacts the current consumption patterns. This study emphasizes the need of actions regarding public alcohol policies in Brazil in order to prevent or delay the initiation of alcohol use and its related problems.

Early initiation of substance use and subsequent risk factors related to suicide among urban high school students

OBJECTIVE

To examine the association between onset of substance use and risk factors related to suicide.

METHOD

1252 adolescents in two urban school districts completed surveys as part of a large, randomized controlled prevention effectiveness trial. Risk factors measured included depressive symptoms, suicide ideation, suicide ideation specifically with alcohol and/or drug use, endorsement of suicide as a personal option, and suicide attempt.

RESULTS

In our final multivariate models that controlled for current substance use and demographic characteristics, we found that earlier onset of hard drug use among boys was associated with all five suicide risk factors. In comparison, among girls, earlier onset of regular cigarette smoking, getting drunk, and hard drug use was associated with some of suicide risk factors.

CONCLUSIONS

The findings confirm the importance of screening for substance use in early adolescence. The association between early substance use and suicide risk factors differed by gender; both research and intervention efforts need to incorporate gender differences.

Update on sun protection and tanning in children

PURPOSE OF REVIEW

In this article we examine the latest information regarding pediatric sun protection and specifically focus on the impact of indoor tanning on children.

RECENT FINDINGS

We examine and discuss the prevailing views and trends on ultraviolet radiation exposure, sun protection and the attendant adverse health effects among children. We identify the challenges related to limiting ambient ultraviolet exposure in children. As children, particularly adolescents, gain an understanding of sun protection, their use of ultraviolet radiation protection does not increase concordantly. We discuss health policies regarding ultraviolet radiation protection, compliance with these policies and potential methods to increase compliance. We also examine addiction-like behavior and other psychosocial factors affecting those who are regular indoor tanners. Finally, we consider possible alternatives to ultraviolet radiation induced tanning and whether encouraging these options leads to a confusing, mixed message from healthcare providers.

SUMMARY

In this article we examine and discuss current practices, attitudes and recent trends in sun protection. We discuss indoor tanning, with special emphasis on the potential addictive qualities of ultraviolet radiation. Our goal is to identify opportunities and future directions to promote sun safety and protect children from harmful ultraviolet radiation exposure.

A Test of Three Alternative Hypotheses Regarding the Effects of Early Delinquency on Adolescent Psychosocial Functioning and Substance Involvement

This study compared alternative hypotheses (from general deviance, life course, and developmental psychopathology perspectives) regarding the effects of early adolescent delinquency on psychosocial functioning in family, school, and peer contexts, and on alcohol use. Analyses also examined parent-child negative affective quality, prosocial school orientation, and peer substance use as possible direct predictors of problem substance use. Participants in this longitudinal study, extending from age 11 to age 18, were 429 rural teens (222 girls) and their families. Path model comparisons supported the tenability of a partial mediation model that included mediating pathways and a direct effect of delinquency on alcohol use, as hypothesized by developmental psychopathology. A supplemental analysis controlling for the stability of the family, school, and peer variables revealed that delinquency had less pervasive direct effects on, and a nonsignificant indirect effect through, changes in the mediators over time. Results also showed that peer substance use was a direct positive predictor of problem use.

Predictors of risky alcohol consumption in schoolchildren and their implications for preventing alcohol-related harm

Background

While alcohol-related health and social problems amongst youths are increasing internationally, both consumption and associated harms are particularly high in British youth. Youth drinking patterns, including bingeing, frequent drinking and drinking in public spaces, are associated with increased risks of acute (e.g. violence) and long-term (e.g. alcohol-dependence) health problems. Here we examine economic, behavioural and demographic factors that predict these risky drinking behaviours among 15–16 year old schoolchildren who consume alcohol. A cross-sectional survey was conducted among schoolchildren in North West England (n = 10,271) using an anonymous questionnaire delivered in school settings. Analysis utilised logistic regression to identify independent predictors of risky drinking behaviour.

Results

Of all respondents, 87.9% drank alcohol. Of drinkers, 38.0% usually binged when drinking, 24.4% were frequent drinkers and 49.8% drank in public spaces. Binge, frequent and public drinking were strongly related to expendable income and to individuals buying their own alcohol. Obtaining alcohol from friends, older siblings and adults outside shops were also predictors of risky drinking amongst drinkers. However, being bought alcohol by parents was associated with both lower bingeing and drinking in public places. Membership of youth groups/teams was in general protective despite some association with bingeing.

Conclusion

Although previous studies have examined predictors of risky drinking, our analyses of access to alcohol and youth income have highlighted eradicating underage alcohol sales and increased understanding of children's spending as key considerations in reducing risky alcohol use. Parental provision of alcohol to children in a family environment may also be important in establishing child-parent dialogues on alcohol and moderating youth consumption. However, this will require supporting parents to ensure they develop only moderate drinking behaviours in their children and only when appropriate.

Native Americans and alcohol: past, present, and future

Native Americans have higher rates of alcohol use, frequency of use, and increased rates of fetal alcohol syndrome, compared with other ethnic groups (J. Hisnanick, 1992; P. A. May, 1996; J. M. Wallace et al., 2003). High prevalence rates of alcohol misuse among Native Americans must be understood in light of their unique history, which has resulted in trauma and exposure to many risk factors for problem alcohol use. Many risk factors have been identified in the general population; however, only some of these risk factors have been examined among Native American populations. The unique history and world view of Native Americans mean that, often, risk factors operate differently from the way they do in other populations. The authors discuss interventions and promising treatments.

Childhood depressive symptoms and early onset of alcohol use

OBJECTIVES

Few studies have assessed the relationship between depressive symptoms and early onset of alcohol use in children and early adolescents. We aimed to determine whether depressive symptoms in children are associated with subsequent initiation of alcohol use and, if so, whether this association is merely a result of demographic, parental, and/or individual risk factors shared by depression and alcohol use or independent of these shared risk factors.

METHODS

Analyses were based on a subsample of 10- to 13-year-old children (N = 1119) from the Boricua Youth Study, a longitudinal study of psychopathology among Puerto Rican children and early adolescents. Children in the study were assessed over 3 waves between 2000 and 2004. In-person structured interviews were conducted with both parents and children.

RESULTS

Depressive symptoms and alcohol use shared some significant risk and protective factors, such as parental psychopathology, parenting, child exposure to violence, and antisocial behaviors. After controlling for these factors, the association between depressive symptoms and alcohol use was reduced, but childhood depressive symptoms were still positively associated with subsequent alcohol use initiation. Children with medium or high levels of depressive symptoms were more than twice as likely to use alcohol as those with <2 depressive symptoms.

CONCLUSIONS

The finding of the current study that early life depressive symptoms may lead to earlier onset of alcohol use indicates the importance of identifying and treating depressive symptoms in preadolescent children. It also demonstrates the importance of examining shared risk and protective factors for understanding the relationship between depressive symptoms and alcohol use.

Behavioral control and resiliency in the onset of alcohol and illicit drug use: a prospective study from preschool to adolescence

The developmental trajectories of behavioral control and resiliency from early childhood to adolescence and their effects on early onset of substance use were examined. Behavioral control is the tendency to express or contain one's impulses and behaviors. Resiliency is the ability to adapt flexibly one's characteristic level of control in response to the environment. Study participants were 514 children of alcoholics and matched controls from a longitudinal community sample (Time 1 age in years: M=4.32, SD=0.89). Children with slower rates of increase in behavioral control were more likely to use alcohol and other drugs in adolescence. Children with higher initial levels of resiliency were less likely to begin using alcohol.

Trends in Initiation of Alcohol Use in the United States 1975 to 2003

INTRODUCTION

Alcohol is the drug of choice for youth in the United States. By 8th grade, more than 40% of youth have used alcohol; by 12th grade, almost 80% have done so (MTF, 2003). And many of these young people begin drinking at relatively early ages. On average, boys start drinking earlier than girls, and whites and Native Americans start drinking earlier than youth of other race/ethnicities. As alcohol consumption is such a high prevalence behavior among young people, it is crucial to understand the initiation of drinking as well as possible, so as to facilitate and inform interventions to delay this behavior. One facet of this involves investigating trends in the initiation of drinking.

METHODS

Multiple years of data from 3 national surveys, Monitoring the Future (MTF)-1975 to 2003 for 12th graders, 1993 to 2003 for 8th and 10th graders; the National Household Survey on Drug Abuse (NHSDA) [now called the National Survey on Drug Use and Health (NSDUH)]-1991 to 1998; and the Youth Risk Behavior Surveillance System (YRBSS)-1991 to 2003, were analyzed using joinpoint analysis to further understanding of trends in the initiation of drinking by youth. The present analysis examines whether the age of drinking initiation has changed over time and evaluates trends in the percentages of youth who start drinking by various grades.

RESULTS

Simultaneous examination of data from the 3 surveys indicates that 7th and 8th grades (when most youth are 13-14) are peak years for the initiation of drinking. Further, the present analysis shows that although the percentage of youth who start drinking early (before age 13) has declined (YRBSS, MTF), the average age of initiation of drinking for these "very early starters" did not change over the period 1991 to 1998 (NHSDA/NSDUH). At the same time, an upward shift in the "normative" age of initiation has occurred (NHSDA/NSDUH, MTF). Results of analyses by gender and race/ethnicity indicate similar trends over time.

CONCLUSION

A more nuanced understanding of the initiation of drinking can have important implications for prevention.

Do adolescent indoor tanners exhibit dependency?

BACKGROUND

Indoor tanning is a common adolescent risk behavior that has been hypothesized to be motivated and maintained by the mood-altering effects of ultraviolet light.

OBJECTIVE

Our purpose was to explore heretofore anecdotal reports that indoor tanning leads to dependency.

METHODS

A telephone interview was conducted among 1275 adolescents, ages 14 to 17 years. Self-reported difficulty in quitting indoor tanning was assessed among 267 adolescents (20.9% of total) who tanned indoors more than once in the previous year in relation to age of initiation, frequency of use, and positive or negative consequences of the practice.

RESULTS

Difficulty in quitting was more likely with younger age at initiation (age 13 years or younger vs ages 16 to 17; odds ratio = 4.3, 95% confidence interval 1.3-14.7) and higher frequency of use (P = .009), even after accounting for positive or negative consequences of indoor tanning and other demographic characteristics.

LIMITATIONS

This was a cross-sectional study design with a limited outcome measure.

CONCLUSION

Although preliminary, our findings for age at initiation and frequency of use in relation to difficulty in quitting indoor tanning are consistent with other potentially addictive behaviors taken up during adolescence.

Age of onset of drinking and the use of alcohol in adulthood: a follow-up study from age 8-42 for females and males

AIM

To investigate longitudinally for both genders the relation between the age of onset of drinking and several indicators of alcohol use.

DESIGN AND SETTING

In the Finnish Jyväskylä Longitudinal Study of Personality and Social Development, data have been collected by interviews, inventories, and questionnaires. Data on alcohol consumption was gathered at ages 14, 20, 27, 36 and 42 years; behavioural data at age 8.

PARTICIPANTS

A total of 155 women and 176 men; 90.4% of the original sample consisting of 12 complete school classes in 1968.

MEASUREMENTS

The age of onset of drinking was determined based on participants' responses that were closest to the actual age of onset of drinking. Four indicators of the adult use of alcohol were used: frequency of drinking, binge drinking, Cut-down, Annoyed, Guilt, Eye-opener (CAGE) and Malmö modified Michigan Alcoholism Screening Test (Mm-MAST). Socio-emotional behaviour at age 8 was assessed using teacher ratings and peer nominations.

FINDINGS

Early onset of drinking was related to the four indicators of the use of alcohol in adulthood both in men and women. The level of adult alcohol use and alcohol problems was significantly higher in men. The risk for heavy drinking was highest in men and women if drinking was started at less than age 16 years. Socio-emotional behaviour and school success at age 8 did not predict the age of onset of drinking.

CONCLUSIONS

Delaying the initiation of drinking from early adolescence to late adolescence is an important goal for prevention efforts. No clear risk group for early initiators of drinking could be identified on the basis of preceding behaviour among 8-year-olds.

Epidemiology of heavy alcohol use in Ukraine: findings from the world mental health survey

AIMS

To describe the epidemiology of heavy alcohol use in Ukraine, using data from the world mental health (WMH) survey in Ukraine.

METHODS

The WMH composite international diagnostic interview was administered in 2002 to a national probability sample of Ukrainian adults (n=4725). An algorithm for classifying heavy use in the past year was developed from self-reports about the quantity and frequency of drinking, and its convergent validity was demonstrated. Prevalence rates and socio-demographic risk factors were examined separately for men and women.

RESULTS

The 12-month rates of heavy alcohol use were 38.7% in men and 8.5% in women (22.0% overall). Among heavy alcohol users, 92% of men and 52% of women consumed at least 80 g of ethanol in a typical drinking day on a monthly basis in the year before the interview. The most significant risk factors in men and women were age (26-54 years for men; 18-25 years for women), living in the Southeast region, being in the labour force whether employed or unemployed, and for men, low education and being the father of a young child. A highly significant linear relationship of number of risk factors with heavy alcohol use was found for both sexes.

CONCLUSIONS

The rates for men were similar to those reported in a Russian national survey with the exception of Southeast Ukraine where the rate was >10% higher. The highest rates were among men who were middle-aged, fathers and unemployed. Future prospective studies are needed to assess the impact of heavy alcohol use on Ukrainian health, mental health and occupational and social functioning.