A systematic review of children's alcohol-related knowledge, attitudes and expectancies

From childhood trauma to alcohol use disorder severity - significance of depressive symptoms and expectations towards analgesic effects of alcohol

AIMS

The objective of the current study was to describe and analyse associations between childhood emotional abuse, severity of depressive symptoms, and analgesic expectations of drinking in individuals with alcohol use disorder (AUD).

METHODS

A total of 240 individuals aged 43.85 ± 11.0 with severe AUD entering an inpatient, abstinence-based, and drug-free treatment program were assessed. The data on AUD severity, depressive symptoms, expectations towards the analgesic effects of alcohol and childhood emotional trauma was collected using questionnaire measures. The PROCESS SPSS macro for serial mediation with bootstrapping was used to test whether current severity of depressive symptoms and expectations towards analgesic effects of alcohol use serially mediated the association between childhood emotional abuse on AUD symptom severity.

RESULTS

There was evidence for two simple mediated effects, whereby the severity of depressive symptoms mediated the association between childhood emotional abuse on AUD symptom severity, and expectations towards analgesic effects of alcohol mediated the association between childhood emotional abuse on AUD symptom severity. There was also evidence to support serial mediation whereby both severity of depressive symptoms and expectations towards analgesic effects of alcohol mediated the association between childhood emotional abuse on AUD symptom severity.

CONCLUSIONS

It might be clinically relevant to address experiences of childhood emotional trauma, as well as individual expectations of analgesic effects of alcohol, in AUD treatment programs.

"She gives it to her child who doesn't even talk": a qualitative exploration of alcohol and drug use among primary school-age children in Uganda

BACKGROUND

There is little research on alcohol and other drugs (AOD) use by school-age children in low-resource settings like Uganda. Including the voices of children in research can inform prevention and early intervention efforts for those at risk of AOD use. The aim of this study was to understand the perspectives of children aged 6 to 13 years regarding AOD in Uganda.

METHODS

This qualitative study was conducted in Mbale district, Uganda from February to March 2020. Eight focus group discussions (FGDs) were conducted with 56 primary school-age children, stratified by age (6-9 and 10-13 years), sex (male and female), and school status (in school and out of school). All FGDs were conducted in either Lumasaaba or Luganda. The FGDs were audio-recorded, transcribed verbatim, and translated into English. Data were coded, and overarching themes were identified using thematic framework analysis.

RESULTS

Two themes identified were (1) Children's perceptions and experiences with AODs. The participants understood alcohol by its consistency, colour, odour, and by brand/logo. They described the types and quantities of AOD consumed by school-age children, brewing processes for homemade alcoholic drinks, and short and long-term consequences of the use of alcohol. (2) Contributing factors to childhood drinking included: Stress relief for children who experienced multiple adversities (orphaned, poverty-stricken, and hailing from broken homes), fitting in with friends, influence from families, and media exposure that made alcohol look cool. Children would start drinking at an early age) or were given alcohol by their parents, sometimes before they could start talking. In the community, alcohol and other drugs were cheap and available and children could drink from anywhere, including in the classroom.

CONCLUSIONS

Children eligible for primary education in Uganda can easily access and use AOD. Several factors were identified as contributing to alcohol and other drug use among children, including availability and accessibility, advertising, lack of parental awareness and supervision, peer influence, adverse childhood experiences, socioeconomic factors, and cultural norms. There is a need for multi-sectoral action for awareness of childhood AOD use and deliberate consideration of children in the planning, design, and implementation of research, policies, and programs for prevention and early intervention.

Characterizing Alcohol Expectancies in the ABCD Study: Associations with Sociodemographic Factors, the Immediate Social Environment, and Genetic Propensities

Alcohol expectancies (AEs) are associated with likelihood of alcohol initiation and subsequent alcohol use disorders. It is unclear whether genetic predisposition to alcohol use and/or related traits contributes to shaping how one expects to feel when drinking alcohol. We used the Adolescent Brain Cognitive Development study to examine associations between genetic propensities (i.e., polygenic risk for problematic alcohol use, depression, risk-taking), sociodemographic factors (i.e., parent income), and the immediate social environment (i.e., peer use and disapproval toward alcohol) and positive and negative AEs in alcohol-naïve children (max analytic N = 5,352). Mixed-effect regression models showed that age, parental education, importance of the child's religious beliefs, adverse childhood experiences, and peer disapproval of alcohol use were associated with positive and/or negative AEs, to varying degrees. Overall, our results suggest several familial and psychosocial predictors of AEs but little evidence of contributions from polygenic liability to problematic alcohol use or related phenotypes.

Ambivalence in Adolescents’ Alcohol Expectancies: A Longitudinal Mixed Methods Study Among 12-to-18-Year-Olds

Drawing on the framework of alcohol expectancies and their importance for drinking behaviors, this longitudinal mixed-methods study examined changes and continuities in development of alcohol expectancies during adolescence. Quantitative and qualitative data were prospectively collected at four time points between 2015 and 2020 from nationwide, socio-economic, and gender-balanced samples of Norwegian adolescents aged 12–18. Quantitative data ( n = 3425) were analyzed using linear mixed-effects models, and qualitative data ( nT1 = 118) using thematic analysis. Quantitative and qualitative results were juxtaposed in the discussion. Quantitative results indicated an increase in social facilitation and tension reduction expectancies from age 13 to 18, and a simultaneous decrease in negative emotional expectancies. This development could partly be explained by experience with alcohol use in adolescence. Similarly, qualitative findings showed adolescents’ expectancies of alcohol evolving with age; from one-sided negative expectancies of aggression and harm to increased positive expectancies of fun, sociability, and relaxation. Both analyses showed that negative expectances remained high throughout the study period, but by late adolescence, many participants held positive and negative expectations simultaneously. The qualitative data illustrated how adolescents’ alcohol expectancies became increasingly ambivalent and complex with age, as alcohol use became more common. Prevention strategies aiming to reduce underage alcohol use should acknowledge this complexity.

The Relationship between Parental Monitoring, Peer Pressure, and Motivations for Responsible Drinking among Italian Adolescents: The Mediating Role of Positive Alcohol Expectancies

This study investigated the associations between parental monitoring, peer pressure, and motivations for responsible drinking, while also taking the mediating role of positive alcohol expectancies into account. The participants were 579 Italian adolescents, aged 14-20 years (M = 16.39 years, SD = 1.27; 55.3% females), involved in a cross-sectional survey. They were administered online self-report questionnaires. Structural equation modeling revealed both direct and indirect positive associations between study variables. Parental monitoring was positively associated, both directly and indirectly, with adolescents' motivations for responsible drinking through the mediation of positive alcohol expectancies; peer pressure was negatively and indirectly associated with adolescents' motivations for responsible drinking, via the mediating role of positive alcohol expectancies. Findings highlighted the importance of environmental factors with regard to motivations for responsible drinking, suggesting the opportunity to implement prevention programs to improve parental monitoring and increase adolescents' skills to manage peer pressure and to develop realistic expectancies about drinking.

What Children and Adolescents Know and Need to Learn about Cancer

Despite cancer's devastating effects on health and longevity, and the critical role of health habits formed during childhood and adolescence in its prevention, children's knowledge of contributors to cancer is understudied. In this paper, the first developmental analysis of the literature, we outline relevant theoretical perspectives and three early emerging intuitions about illness evident among preschool children-contagion/germ, contamination, and unhealthy lifestyle theories-and then review research on elementary and secondary school students' awareness of risk factors for cancer in light of these early intuitive theories. Our analysis centers on the 16 studies we could locate, done in seven countries, that allowed calculating the percentages of children of different age groups who mentioned various risk factors in response to open-ended questions or endorsed them in response to structured questions. Awareness of primary known risk factors (led by smoking), lifestyle contributors, and personal factors (genetics and old age) increased with age, while contact myths decreased with age until adolescents began to show awareness of sexual contact as a contributor to certain cancers. In addition, the analysis revealed higher levels of awareness in response to structured questions than in response to open-ended questions; a glaring need for research asking young school-aged children about key risk factors and exploring not only their knowledge but their causal understanding; a need for attention to sociocultural influences; and connections between preschool children's intuitive theories of disease and older children's patterns of belief about cancer that can help guide school-based cancer education.

Prevention of Alcohol Consumption Programs for Children and Youth: A Narrative and Critical Review of Recent Publications

Background

Youth substance use is a public health problem globally, where alcohol is one of the drugs most consumed by children, and youth prevention is the best intervention for drug abuse.

Objective

Review the latest evidence of alcohol use prevention programs in empirical research, oriented to all fields of action among children and youth.

Methods

A narrative and critical review was carried out within international databases (PsychInfo, Pubmed, Web of Science, and Scopus) in August 2021 and was limited to empirical studies that appeared in the last five years (2017-2021). A flow diagram was used according to the PRISMA statements. Empirical research articles in English with RCTs and quasi-experimental design that included alcohol, children, and young people up to 19 years of age (universal, selective, or indicated programs) were included. The authors examined the results and conceptual frameworks of the Prevention programs by fields of action.

Results

Twenty-two articles were found from four fields of action: school (16), family (2), community (2), and web-based (2), representing 16 alcohol prevention programs. School-based alcohol prevention programs are clinically relevant [Theory of Planned Behavior, Refuse, Remove, Reasons, Preventure, The GOOD Life, Mantente REAL, Motivational Interviewing (BIMI), Primavera, Fresh Start, Bridges/Puentes], they are effective in increasing attitudes and intentions toward alcohol prevention behavior, while decreasing social norms and acceptance of alcohol, reducing intoxication, and increasing perceptions with regards to the negative consequences of drinking.

Discussion

This narrative and critical review provides an updated synthesis of the evidence for prevention programs in the school, family, community, and web-based fields of action, where a more significant number of programs exist that are applied within schools and for which would have greater clinical relevance. However, the prevention programs utilized in the other fields of action require further investigation.

Parent/caregiver attitudes, motivations and behaviours in relation to alcohol use among offspring aged 13-18 years: a qualitative study

BACKGROUND

Parental alcohol consumption and alcohol-related behaviour play a critical role in shaping adolescent alcohol use, but comparatively little is known about the perspectives of parents regarding adolescent alcohol use from qualitative studies in England. This study aimed to explore parental views and attitudes towards alcohol use during adolescence, among their offspring and among young people in general.

METHODS

Twenty-three parents (21 mothers, 2 fathers) of children aged 13-18 years were recruited via schools, workplaces and community settings, predominantly in the West of England (n = 19) between 2017 and 2018. Data were collected via in-depth one-to-one interviews and analysed thematically, using an inductive, constructionist approach.

RESULTS

Five major themes were identified in the data: (1) the parental alcohol environment, (2) balance and acceptance, (3) influences of the parental approach, (4) boundaries and parental monitoring, and (5) wider influences shaping young people's behaviour. Overall, parents were aware of the risks and consequences of alcohol use and the wide range of influences shaping drinking behaviour, and expressed broad disapproval of alcohol use among young people. However, adolescent alcohol use was viewed as inevitable, and set within a context of a tolerant drinking culture. Many parents therefore chose a balanced and reluctantly accepting approach. This approach was determined by weighing disapproval of drinking against consistency with wider culture and parental behaviour, support for autonomy of the child, and avoidance of social sanctions. Parents' responses were also determined by a desire to protect the parent-child relationship, maintain an open, communicative and trusting relationship, and ultimately limit risk and minimise harm. Various boundaries and strategies were employed to this end, including care around role modelling, gradual introductions to alcohol, boundaried provision, clear risk reduction messaging and parental monitoring.

CONCLUSIONS

Parents employ a range of mechanisms to reduce alcohol-related risk and to balance harms of alcohol use among their offspring against adolescent behavioural norms. A downward shift in community consumption and changing socio-cultural norms could alter the accepting context in which parents are required to navigate adolescent alcohol use.

Associations between pre-adolescents' cognitive responses to alcohol-related cues, maternal drinking, and direct exposure to alcohol

The current study investigated pre-adolescent children's (N = 140, M_age = 10.11 years, SD = 1.48, 59.5% girls) implicit evaluations of and explicit expectancies about alcohol-related cues as a function of their mothers' drinking behaviors and their exposure to alcohol. Children's implicit evaluative responses were measured using the Affect Misattribution Procedure (AMP), which consisted of trials that depicted pictures of either alcoholic or non-alcoholic beverages, half of which were presented alone (inactive) and half of which were presented with a human interacting with the beverage (active). In addition, children's explicit expectancies, whether they had ever tasted alcohol, and their mothers' alcohol dependency and escape drinking motivations were measured. Results indicated that overall children's implicit evaluations were less positive for alcohol- than for non-alcohol-related cues, and those whose mothers reported higher alcohol dependency evaluated inactive alcohol-related cues more negatively. Moreover, those who had previously tasted alcohol endorsed positive expectancies more than negative expectancies. These findings contribute to our understanding of the processes through which implicit associations are learned in the context of addiction. Understanding cognitive as well as other potential biological and environmental factors that may predict drinking behaviors in youth will aid in the development of more effective evidence-based strategies for the prevention of alcoholism.

Effects of a web-based alcohol drinking prevention program linking school-to-home in elementary students

OBJECTIVES

We investigated the effects of a web-based alcohol drinking prevention program among early elementary school students in South Korea using the theory of planned behavior. This study utilized a combined family and school intervention approach.

DESIGN

This was a quasi-experimental study with a non-equivalent control group.

SAMPLE

A total of 251 third graders (experimental group: 170, control group: 81) from four public schools were included.

MEASUREMENTS

A web-based alcohol drinking prevention program was implemented in five weekly sessions. Students' attitudes, subjective norms, perceived behavioral control (PBC), and intentions toward alcohol drinking prevention behavior were evaluated through pre- and post-tests.

RESULTS

The average age of the participants was 9 years in both the experimental (82 male and 88 female students) and control (44 male and 37 female students) groups. A significant improvement in attitudes, PBC, and intentions toward alcohol drinking prevention behaviors was found in the experimental group.

CONCLUSIONS

A web-based alcohol drinking prevention program combining family and school interventions for lower elementary school students was effective at increasing intentions toward alcohol drinking prevention behavior. Alcohol drinking prevention programs should target lower elementary school students to effectively postpone the onset of alcohol drinking.

The association between child alcohol sipping and alcohol expectancies in the ABCD study

BACKGROUND

Underage drinking is a serious societal concern, yet relatively little is known about child sipping of alcohol and its relation to beliefs about alcohol. The current study aimed to (1) examine the contexts in which the first sip of alcohol occurs (e.g., type of alcohol, who provided sip, sip offered or taken without permission); (2) examine the association between sipping and alcohol expectancies; and (3) explore how different contexts of sipping are related to alcohol expectancies. We expected to find that children who had sipped alcohol would have increased positive expectancies and reduced negative expectancies compared to children who had never sipped alcohol.

METHODS

Data were derived from the 2.0 release of the Adolescent Brain Cognitive Development (ABCD) study, a longitudinal study of children in the United States. We utilized data from 4,842 children ages 9-11; 52% were male, 60% were White, 19% were Hispanic/Latinx, and 9% were Black/African American.

RESULTS

We found that 22% of the sample had sipped alcohol. Children reported sipping beer most frequently, and the drink most often belonged to the child's father. We found that children who had sipped had higher positive alcohol expectancies than children who had not while accounting for variables related to alcohol expectancies. Child sipping was not significantly associated with negative expectancies and the context of the first sip of alcohol was not significantly associated with positive and negative expectancies.

CONCLUSIONS

Providing sips of alcohol to children is associated with them having more favorable expectations about drinking.

Consumer alcohol exposure in supermarkets: legislatively adherent, but a societal problem

OBJECTIVE

The Sale and Supply of Alcohol Act 2012 came into force to promote the safe and responsible sale, supply, and consumption of alcohol in New Zealand. The Act was intended to minimise harm caused by excessive consumption of alcohol and reduce exposure to alcohol promotion. This study assessed supermarket adherence to sections 112-114 of the Act related to the display and advertisement of alcohol. It also assessed consumer exposure to alcohol marketing in these businesses.

METHODS

This paper reports on an audit of nine supermarkets in a major New Zealand city.

RESULTS

Supermarkets exhibited high average adherence with the Act (86% adherence across audit fields); despite this, exposure to alcohol displays, promotions and advertisements remained an issue regardless of supermarket geographic location, size or chain affiliation.

CONCLUSIONS

Supermarkets are an increasingly popular source of off-licence alcohol sales. Exposure to alcohol marketing in these businesses will likely influence consumer purchasing behaviour. Implications for public health: As an important public health challenge, based on this study, it would appear that supermarkets mostly meet the provisions of the Sale and Supply of Alcohol Act 2012, but not the intent. Additional work is required to strengthen their response to the Act.

Childhood social context in relation to alcohol expectancy through early adolescence: A latent profile approach

BACKGROUND

The present study aims to (i) identify patterns in the changes of endorsed positive alcohol expectancies (AEs) through early adolescence and (ii) examine associated childhood social context predictors of such profiles.

METHODS

We used three waves of longitudinal data from the Alcohol-Related Experiences among Children. The baseline sample comprised 928 6th graders from 17 elementary schools in northern Taiwan (response rate = 60 %); subsequent follow-up was conducted at 7th and 8th grade (follow-up rate = 88 %). Data concerning three domains of positive AEs (i.e., global positive transformation, enhancing social behaviors, and promoting relaxation), social context, and alcohol drinking were collected by self-administered questionnaires. Longitudinal latent profile and survey multinomial logistic regression analyses were used to evaluate the association estimates, stratified by childhood alcohol initiation.

RESULTS

Three distinct profiles (decreasing, stable, and increasing) of positive AEs were identified for the alcohol-naïve children (n = 466); observing paternal drinking and watching TV more than two hours per day at baseline were strongly linked with the stable and increasing AE profiles (aOR = 1.96-4.80). For the alcohol-experienced children, four profiles (low decreasing, low increasing, high decreasing, and high increasing) emerged; observing maternal drinking was predictive for the high-increasing profile (aOR = 2.94). Regardless of childhood alcohol initiation, recent alcohol use appeared to be the strongest predictor for the increasing profiles of positive AEs.

CONCLUSIONS

Strategies addressing pro-alcohol social contexts that facilitate a prominent increase in positive AEs should be considered when devising preventive programs targeting underage drinking behaviors and problems.

Exploring the Trajectory and Prevention of Alcohol Use Among Young People From the Perspective of Professional Youth Workers

Excessive alcohol use is a significant health issue. Underage drinking is one expression of excessive alcohol use. Researchers have identified a trajectory of alcohol involvement. Gaps exist in understanding the influences that delay and promote the trajectory of alcohol use among young people. The purpose of this study was to explore the contexts and influences that limited and contributed to the trajectory of alcohol use among young people. A qualitative descriptive design was used. Eight youth workers from a city in Northern England participated in individual audio-recorded semistructured interviews. Transcriptions were coded. Data were analyzed within, and across, codes to identify themes. The theme "Alcohol is an Expected Part of Life" characterized a hypothetical trajectory of alcohol involvement. "Fostering Community in Youth Centers" characterized how participants' perceptions informed their work. The results increase understanding of how contexts may influence initiation, promotion, and prevention of alcohol use among young people.

"GiochiAMO," a Gaming Intervention to Prevent Smoking and Alcohol Habits Among Children: A Single-Arm Field Trial

Objectives: To evaluate the efficacy of the "GiochiAMO" prevention program on modifying children's knowledge and belief regarding the use and abuse of alcohol and tobacco smoking. Materials and Methods: "GiochiAMO" is a multicomponent single-arm field trial based on card and board games to teach and enhance knowledge about risk factors related to smoking and alcohol consumption. A structured questionnaire was administered before and after the intervention to assess any change in knowledge. Results: A total of 167 students between 9 and 11 years of age took part in the intervention. Data concerning knowledge about cigarette smoking showed a statistically significant improvement (P = 0.008) with an increase of the mean scores from 5.93 (standard deviation [SD] = 2.05) to 7.90 (SD = 2.03). The scores related to the life skills of the intervention performed in the fourth grade classes demonstrated statistically significant improvements (P = 0.027). The scores related to the knowledge about alcohol consumption highlighted a statistically significant improvement (P < 0.001), with mean scores that rose from 7.44 (SD = 1.99) to 9.41 (SD = 1.94). The scores related to the life skills of the intervention performed in the fifth grade classes demonstrated improvements, although they were not statistically significant (P = 0.770). Conclusions: "GiochiAMO" demonstrated significantly improved knowledge about the risk and consequences of cigarette smoking and alcohol consumption on health. Longer follow-up studies, including a larger sample size, will be needed.

Specificity of expectancies prospectively predicting alcohol and marijuana use in adulthood in the Pittsburgh ADHD longitudinal study

Alcohol and marijuana use expectancies are presumed to be drug-specific, but prospective study of this assumption is lacking. In addition, these associations may operate differently for adults with attention-deficit/hyperactivity disorder (ADHD) histories, as expectancies have been found to be less associated with alcohol and marijuana use among this population. The first aim of the present study was to investigate whether associations between alcohol and marijuana expectancies and substance use were specific to the substances they assess. The second aim was to determine whether these associations differed as a function of ADHD history. Participants (N = 491; 281 ADHD, 210 non-ADHD) were young adults followed longitudinally between ages 21 to 23 and 29 as part of the Pittsburgh ADHD Longitudinal Study (PALS). Autoregressive models were estimated separately for positive and negative expectancies for frequency of alcohol and marijuana use and compared between ADHD groups. Although there were exceptions, results generally support the specificity of associations between outcome expectancies and respective substance use both concurrently and prospectively, but this specificity was primarily present for those without a history of ADHD. These findings suggest that young adults perceive and respond distinctly to the effects of alcohol and marijuana, but a history of ADHD may interfere with this process. These findings also extend our prior cross-sectional findings that expectancies are less associated with alcohol and marijuana use for individuals with ADHD histories. Additional research examining implicit cognitions is needed to further examine risk for substance use among those with ADHD histories. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Parental drinking and characteristics of family life as predictors of preschoolers' alcohol-related knowledge and norms

While risky drinking in adolescence has been found to be rooted in childhood, evidence is scarce regarding where early alcohol-related knowledge originates. This study investigates preschoolers' alcohol-related knowledge about beverage names, content and social norms (i.e. drinking to be common among men and at parties) depending on parental alcohol consumption patterns and characteristics of family life. In French-speaking Switzerland, 214 three to six year olds completed the electronic Appropriate Beverage Task (Kuntsche, Le Mével, & Zucker, 2016) while their parents (205 mothers, 154 fathers) were surveyed with a questionnaire. The results showed that when parents drank frequently, at higher quantity, or during meals, their children knew more about the names of alcoholic beverages and the social norms of consumption. No effect was found for parental binge drinking or living in a single-parent household. Frequent contact with adults outside the immediate family (visits from relatives and going to fairs and neighborhood parties) but not television viewing was associated with both knowing the name and the alcoholic content of alcoholic beverages. To conclude, this study indicates that the knowledge of children aged three to six about the content, name and consumption norms of alcoholic beverages does not only depend on the drinking frequency and quantity of their parents, but also on contact with adults outside the immediate family. When frequently surrounded by alcohol-consuming adults, children may get the impression that alcohol consumption is a common human behavior, which may put them at risk for early alcohol initiation and risky drinking later in life.

Pervasive, hard-wired and male: Qualitative study of how UK adolescents view alcohol-related aggression

Laboratory studies of alcohol-inexperienced adolescents show that aggression can be primed by alcohol-related stimuli, suggesting that alcohol-related aggression is partly socially learned. Script theory proposes that alcohol-related aggression 'scripts' for social behaviors are culturally-available and learned by individuals. The purpose of the study was to understand the content and origins of alcohol-related aggression scripts learned by adolescents. This qualitative focus group study of 40 adolescents (ages 14-16 years) examined alcohol-related aggression scripts. Participants believed aggression and severe injury to be pervasive when young people drink. Viewed through a biological lens, participants described aggression as an 'instinctive' and 'hard-wired' male trait facilitated by intoxication. As such, alcohol-related aggression was not seen as intended or personally controllable and participants did not see it in moral terms. Females were largely viewed as either bystanders of inter-male aggression or potential victims of male sexual aggression. Participants attributed their views on the frequency and nature of alcohol-related aggression to current affairs and reality television, which they felt portrayed a reality of which they had little experience. The origins of the explicitly biological frameworks that participants used seemed to lie in pre-existing beliefs about the nature of gender differences. Perceptions of the pervasiveness of male alcohol-related aggression, and the consequent failure to view alcohol-related aggression in moral terms, could dispose some young people to alcohol-related aggression. Interventions could target (1) the beliefs that alcohol-related aggression is pervasive and uncontrollable in males, and (2) participants' dysfunctional views of masculinity that underpin those beliefs.