A developmental approach to alcohol drinking behaviour in adulthood: a follow-up study from age 8 to age 42

Alcohol, HMGB1, and Innate Immune Signaling in the Brain

PURPOSE

Binge drinking (i.e., consuming enough alcohol to achieve a blood ethanol concentration of 80 mg/dL, approximately 4-5 drinks within 2 hours), particularly in early adolescence, can promote progressive increases in alcohol drinking and alcohol-related problems that develop into compulsive use in the chronic relapsing disease, alcohol use disorder (AUD). Over the past decade, neuroimmune signaling has been discovered to contribute to alcohol-induced changes in drinking, mood, and neurodegeneration. This review presents a mechanistic hypothesis supporting high mobility group box protein 1 (HMGB1) and Toll-like receptor (TLR) signaling as key elements of alcohol-induced neuroimmune signaling across glia and neurons, which shifts gene transcription and synapses, altering neuronal networks that contribute to the development of AUD. This hypothesis may help guide further research on prevention and treatment.

SEARCH METHODS

The authors used the search terms "HMGB1 protein," "alcohol," and "brain" across PubMed, Scopus, and Embase to find articles published between 1991 and 2023.

SEARCH RESULTS

The database search found 54 references in PubMed, 47 in Scopus, and 105 in Embase. A total of about 100 articles were included.

DISCUSSION AND CONCLUSIONS

In the brain, immune signaling molecules play a role in normal development that differs from their functions in inflammation and the immune response, although cellular receptors and signaling are shared. In adults, pro-inflammatory signals have emerged as contributing to brain adaptation in stress, depression, AUD, and neurodegenerative diseases. HMGB1, a cytokine-like signaling protein released from activated cells, including neurons, is hypothesized to activate pro-inflammatory signals through TLRs that contribute to adaptations to binge and chronic heavy drinking. HMGB1 alone and in heteromers with other molecules activates TLRs and other immune receptors that spread signaling across neurons and glia. Both blood and brain levels of HMGB1 increase with ethanol exposure. In rats, an adolescent intermittent ethanol (AIE) binge drinking model persistently increases brain HMGB1 and its receptors; alters microglia, forebrain cholinergic neurons, and neuronal networks; and increases alcohol drinking and anxiety while disrupting cognition. Studies of human postmortem AUD brain have found elevated levels of HMGB1 and TLRs. These signals reduce cholinergic neurons, whereas microglia, the brain's immune cells, are activated by binge drinking. Microglia regulate synapses through complement proteins that can change networks affected by AIE that increase drinking, contributing to risks for AUD. Anti-inflammatory drugs, exercise, cholinesterase inhibitors, and histone deacetylase epigenetic inhibitors prevent and reverse the AIE-induced pathology. Further, HMGB1 antagonists and other anti-inflammatory treatments may provide new therapies for alcohol misuse and AUD. Collectively, these findings suggest that restoring the innate immune signaling balance is central to recovering from alcohol-related pathology.

Developmental trajectories of child and adolescent emotional problems: associations with early adult alcohol use behaviors

BACKGROUND

Whether emotional problems during childhood and adolescence are longitudinally associated with adult alcohol use behaviors is unclear. This study examined associations between developmental trajectories of emotional problems and early adult alcohol use behaviors, while considering co-occurring conduct problems, developmental change/timing, sex differences, and potential confounds.

METHODS

Participants were from the Twins Early Development Study (analytic N = 19,908 individuals). Emotional and conduct problems were measured by parent reports at child ages 4, 7, and 9 years and via self-reports at ages 9, 11, and 16 years on the Strengths and Difficulties Questionnaire. Alcohol use behaviors (alcohol consumption and alcohol-related problems) were self-reported by the twins on the Alcohol Use Disorders Identification Test at age 22 years. Piecewise latent growth curve models described nonlinear developmental trajectories of emotional and conduct problems from ages 4 to 16. At age 22, alcohol use was regressed on emotional and conduct problems' intercepts and slopes from piecewise latent growth curve model and sex differences in regression coefficients were tested. Using twin modeling, Cholesky decompositions and direct path models were compared to test whether significant phenotypic associations were best explained by direct phenotypic influences or correlated genetic and environmental influences.

RESULTS

Emotional problems had different associations with alcohol-related problems versus alcohol consumption. After accounting for direct influences from conduct problems, emotional problems were not associated with alcohol-related problems, while emotional problems at age 9 were negatively associated with alcohol consumption in males.

CONCLUSIONS

Overall, findings did not support emotional problems as prospective risk factors for severe alcohol use above and beyond risks associated with conduct problems. Sex- and age-specific links between emotional problems and alcohol consumption in early adulthood may be worthy of further exploration, particularly as twin analyses improved our confidence that such links may be underpinned by causal mechanisms.

Sexual Identity Disclosure and Alcohol Experiences Among LGBTQ+ Adolescents

Sexual and gender minority youth (SGMY) report greater alcohol use in comparison to their heterosexual counterparts. Prior research has found that elevated alcohol use among SGMY can be explained by minority stress experiences. Sexual identity outness may be another factor that drives alcohol use among SGMY, given that outness is associated with alcohol use among older sexual and gender minority samples. We examined how patterns of sexual identity outness were associated with lifetime alcohol use, past-30-day alcohol use, and past-30-day heavy episodic drinking. Data were drawn from the LGBTQ National Teen Survey (N = 8884). Participants were SGMY aged 13 to 17 (mean age = 15.59) years living in the US. Latent class analysis was used to identify sexual identity outness patterns. Multinomial regressions were used to examine the probability of class membership by alcohol use. Six outness classes were identified: out to all but teachers (n = 1033), out to siblings and peers (n = 1808), out to siblings and LGBTQ+ peers (n = 1707), out to LGBTQ+ peers (n = 1376), mostly not out (n = 1653), and very much not out (n = 1307). SGMY in classes characterized by greater outness to peers, friends, and family had greater odds of lifetime alcohol use compared with SGMY in classes characterized by lower outness. These findings suggest that SGMY with greater sexual identity outness may be a target for alcohol use prevention programming. Differences in sexual identity outness may be explained by minority stress factors.

Pathways from childhood socioemotional characteristics and cognitive skills to midlife health behaviours

OBJECTIVE

This longitudinal study investigated the pathways from childhood socioemotional characteristics and cognitive skills to health behaviours in midlife. Methods: Participants in the Jyväskylä Longitudinal Study of Personality and Social Development (JYLS) were followed from age 8 (n = 369) to age 50 (n = 271). Outcomes included physical activity, smoking, alcohol consumption and body mass index (BMI) assessed at ages 36, 42 and 50. Predictors were socioemotional characteristics (behavioural activity, negative emotionality, and well-controlled behaviour) and parents' occupational status collected at age 8, cognitive skills (school success at age 14 and the highest education at age 27) and adulthood personality traits (extraversion, neuroticism and conscientiousness). Longitudinal path modelling was used for analyses. Results: Well-controlled behaviour and extraversion predicted physical activity in women. Behavioural activity predicted alcohol consumption in women and smoking in men. Negative emotionality was not directly connected to health behaviours. Adulthood neuroticism was associated with smoking in men and with alcohol-related problems in both men and women. There were some indirect paths from childhood socioemotional characteristics to midlife health behaviours through cognitive skills. None of the study variables predicted midlife BMI. Conclusions: Childhood socioemotional characteristics have some predictive value on midlife health behaviours, both directly and through cognitive skills.

Supplemental data for this article is available online at https://doi.org/10.1080/08870446.2022.2041639 .

Paternal and Maternal Problem Drinking and Lifetime Problem Drinking of Their Adult Children

Parents' alcohol use is associated with alcohol use of their adolescent offspring, but does this association extend to the adulthood of the offspring? We examined associations of paternal and maternal problem drinking with lifetime problem drinking of their adult offspring prospectively assessed in a population-based Finnish twin-family cohort (FinnTwin16). Problem drinking (Malmö-modified Michigan Alcoholism Screening Test) was self-reported separately by mothers and fathers when their children were 16. The children reported on an extended lifetime version of the same measure during their mid-twenties (21-28 years) and mid-thirties (31-37 years). 1235 sons and 1461 daughters in mid-twenties and 991 sons and 1278 daughters in mid-thirties had complete data. Correlations between fathers' and their adult children's problem drinking ranged from .12 to .18. For mothers and their adult children, these correlations ranged from .09 to .14. In multivariate models, adjustment for potential confounders had little effect on the observed associations. In this study, parental problem drinking was modestly associated with lifetime problem drinking of their adult children. This association could be detected even when the children had reached the fourth decade of life.

Targeting Persistent Changes in Neuroimmune and Epigenetic Signaling in Adolescent Drinking to Treat Alcohol Use Disorder in Adulthood

Studies universally find early age of drinking onset is linked to lifelong risks of alcohol problems and alcohol use disorder (AUD). Assessment of the lasting effect of drinking during adolescent development in humans is confounded by the diversity of environmental and genetic factors that affect adolescent development, including emerging personality disorders and progressive increases in drinking trajectories into adulthood. Preclinical studies using an adolescent intermittent ethanol (AIE) exposure rat model of underage binge drinking avoid the human confounds and support lifelong changes that increase risks. AIE increases adult alcohol drinking, risky decision-making, reward-seeking, and anxiety as well as reductions in executive function that all increase risks for the development of an AUD. AIE causes persistent increases in brain neuroimmune signaling high-mobility group box 1 (HMGB1), Toll-like receptor, receptor for advanced glycation end products, and innate immune genes that are also found to be increased in human AUD brain. HMGB1 is released from cells by ethanol, both free and within extracellular vesicles, that act on neurons and glia, shifting transcription and cellular phenotype. AIE-induced decreases in adult hippocampal neurogenesis and loss of basal forebrain cholinergic neurons are reviewed as examples of persistent AIE-induced pathology. Both are prevented and reversed by anti-inflammatory and epigenetic drugs. Findings suggest AIE-increased HMGB1 signaling induces the RE-1 silencing transcript blunting cholinergic gene expression, shifting neuronal phenotype. Inhibition of HMGB1 neuroimmune signaling, histone methylation enzymes, and galantamine, the cholinesterase inhibitor, both prevent and reverse AIE pathology. These findings provide new targets that may reverse AUD neuropathology as well as other brain diseases linked to neuroimmune signaling. SIGNIFICANCE STATEMENT: Adolescent underage binge drinking studies find that earlier adolescent drinking is associated with lifelong alcohol problems including high levels of lifetime alcohol use disorder (AUD). Preclinical studies find the underage binge drinking adolescent intermittent ethanol (AIE) model causes lasting changes in adults that increase risks of developing adult alcohol problems. Loss of hippocampal neurogenesis and loss of basal forebrain cholinergic neurons provide examples of how AIE-induced epigenetic and neuroimmune signaling provide novel therapeutic targets for adult AUD.

A longitudinal analysis on determinants of problem drinking among Korean women: focusing on a gender perspective

Background

In recent years, female drinking has been on the rise worldwide, and this trend can be observed in Korea as well. Accordingly, this study aimed to examine the heterogeneous longitudinal changes in drinking patterns among Korean women, while also exploring the determinants of these changes. In particular, the study identified the gender perspective-related determinants of the classified patterns of problem drinking.

Methods

Data on 4615 adult women who participated in the Korea Welfare Panel Study (KOWEPS) for 3 years (2018–2020) were analyzed longitudinally using SPSS Statistics 22.0 and M-plus 7.0. The changes in female drinking patterns were analyzed using latent class growth analysis. Subsequently, multinomial logistic regression analysis was performed to identify the predictive factors affecting the changes in drinking patterns.

Results

Latent class analysis yielded three classes: “low problem drinking/decreased,” “moderate problem drinking/maintained,” and “high problem drinking/increased.” Of the participants, 80.4% were in the first class, 14.5% in the second, and 5.1% in the third. After controlling for sociodemographic and psychosocial factors, we found: i) domestic violence, work–family balance stress, and gender role perception were not statistically significant for the “moderate problem drinking/maintained” class; lower levels of depression (odds ratio; OR = .750, p < .05) and higher levels of satisfaction with social relationships (OR = 1.257, p < .05) increased the probability of belonging to the “moderate problem drinking/maintained” group compared to the low problem drinking/decreased class; ii) in the “high problem drinking/increased” class, relative to the low problem drinking/decreased class, experience of domestic violence (OR = 1.857, p < .05), work–family balance stress (OR = 1.309, p < .05), and gender role perception (OR = .705, p < .05) were significant predictors of drinking behavior.

Conclusions

Problem drinking in Korean women demonstrated heterogeneous patterns of change, with gender-specific factors being the main predictors of this change. Therefore, this study developed a strategy for reducing the harmful effects of female drinking, which considers the characteristics of the changes in women’s drinking patterns as well as factors from the gender perspective.

Suicidal ideation among inpatients with substance use disorders: Prevalence, correlates and gender differences

We examined the prevalence of suicidal ideation (SI) among inpatients with substance use disorders (SUD) and investigated the association between SI and demographic (age, education, gender) and clinical factors (SUD, psychiatric disorders, anxiety/depression symptoms, substance use onset age). We collected medical record data including types of ICD-10 SUD and psychiatric diagnoses (i.e. mood: F30-39; anxiety: F40-48; personality: F60-F60.9; F61.0; F62; ADHD: F90-F90.9) and patient-reported data from 563 patients admitted to inpatient SUD treatment. Lifetime SI was measured by one question from the Addiction Severity Index (ASI). Gender differences in SI rates were examined using Chi-square tests. To determine variables that were uniquely associated with SI we conducted hierarchical regression analyses. The overall prevalence of SI was 50%, and it occurred more frequently among females (61.9%) than males (45.4%). SI was associated with female gender, younger age of substance use onset, mood and personality disorders, and higher anxiety/depression symptoms. Male gender accounted for the significant association between younger age of onset and SI. Diagnostic information on mood and personality disorders, and screening of patient-reported anxiety/depression symptoms at treatment intake may be useful for clinicians in identifying and providing personalized treatment for SUD inpatients who are at increased risk of SI.

Are dietary patterns in early childhood associated with alcohol consumption at the age of 17 years? Analysis of data from the Avon Longitudinal Study of Parents and Children (ALSPAC) prospective cohort study

OBJECTIVE

To examine the relationship between a posteriori dietary patterns in early childhood and alcohol consumption in adolescence.

DESIGN

Data were obtained from the Avon Longitudinal Study of Parents and Children (ALSPAC) prospective cohort study. Dietary information was obtained using FFQ at the age of 3 and 7 years. The association between dietary patterns, derived using principal components analysis and the Alcohol Use Disorders Identification Test (AUDIT) scores (to assess harmful intake) and frequency of alcohol consumption at the age of 17 years were examined. Secondary analysis considered sugar intake as a percentage of total energy intake.

SETTING

Women who gave birth between 1 April 1991 and 31 December 1992 in the Avon area in southwest England were eligible for the ALSPAC cohort study.

PARTICIPANTS

Totally, 14 541 pregnancies were enrolled in ALSPAC during its initial recruitment phase. For this analysis, complete data were available for between 3148 and 3520 participants.

RESULTS

Adherence to the 'healthy' dietary pattern at both 3 and 7 years of age was positively associated with consuming more than one alcoholic drink per week at 17 years of age, whilst adherence to the 'traditional' dietary pattern at both ages was protective of harmful alcohol intake at 17 years of age. Sugar intake was not associated with either alcohol outcome after adjustment for ethnicity, maternal level of education, parental social class and maternal AUDIT score.

CONCLUSIONS

For the population studied, changes to diet in early childhood are unlikely to have an impact on harmful alcohol use in adolescence given the lack of consistency across the results.

Externalizing Risk Pathways for Adolescent Substance Use and Its Developmental Onset: A Canadian Birth Cohort Study: Trajectoires de comportements extériorisés et le risque pour l'initiation et l'usage de substances des adolescents : Une étude de cohorte de naissance canadienne

OBJECTIVE

Only a minority of drug and alcohol users develops a substance use disorder. Previous studies suggest that this differential vulnerability commonly reflects a developmental trajectory characterized by diverse externalizing behaviors. In this study, we examined the relation between child and adolescent externalizing behaviors and adolescent substance use in a prospectively followed Canadian birth cohort, accounting for the temporal sequence of a wide variety of contributing factors.

METHODS

Two hundred and forty-two adolescents followed since birth (date range: 1996 to 2012) were assessed on externalizing behavior (age 17 months to 16 years), alcohol and cannabis use at age 16, age of alcohol use onset, family history of substance use problems, family functioning (age 11 to 15), sensation seeking (age 16), prenatal substance exposure, socioeconomic status (age 1 to 9), and sex.

RESULTS

Age of alcohol use onset was predicted by a family history of substance use problems, externalizing traits from ages 6 to 10 and 11 to 16, sensation seeking at age 16, prenatal alcohol and tobacco exposure and family functioning at ages 11 to 15. High frequencies of alcohol and cannabis use at age 16 were both predicted by externalizing traits from ages 11 to 16, a family history of substance use problems and sensation seeking after controlling for other individual, environmental and familial variables. The association between familial substance use problems and substance use during adolescence was partially mediated by externalizing traits from age 11 to 16.

CONCLUSIONS

The present findings provide prospective evidence for a developmental risk pathway for adolescent substance use, potentially identifying those who could benefit from early interventions.

Early life mental health and problematic drinking in mid-adulthood: evidence from two British birth cohorts

PURPOSE

Accumulating evidence suggests that externalising problems are consistently associated with alcohol use behaviours, but findings are inconsistent regarding the role of internalising problems. We investigate whether externalising and internalising problems are associated with problematic drinking in mid-adulthood, and whether potential associations are modified by age, sex and cohort.

METHODS

The National Child Development Study (NCDS58, n = 17,633) and 1970 British Cohort Study (BCS70, n = 17,568) recruited new-borns in Great Britain in a single week in 1958 and 1970. Mental health was assessed with the Rutter Behaviour Questionnaire at ages 7, 11, and 16 in NCDS58 and ages 5, 10 and 16 in BCS70. Problematic drinking was measured with the CAGE questionnaire at age 33 in NCDS58 and age 34 in BCS70, and the AUDIT scale at age 44/45 in NCDS58 and age 46 in BCS70. Latent scores of externalising and internalising problems were added chronologically into lagged logistic regression models.

RESULTS

Externalising and internalising problems were associated in opposite directions with problematic drinking in mid-adulthood. Externalising was a risk factor (OR [95% CI] ranging from 1.06 [1.03, 1.10] to 1.11 [1.07, 1.15] for different ages), and internalising was a protective factor (OR [95% CI] ranging from 0.95 [0.92, 0.99] to 0.90 [0.86, 0.94] for different ages). Associations between early life mental health and mid-adulthood problematic drinking did not differ by developmental timing but were stronger in males.

CONCLUSION

Our study provides new insights on links of externalising and internalising difficulties with alcohol use and has implications for public policy in the UK.

A cluster randomized controlled trial evaluating the effectiveness of the school-based drug prevention program #Tamojunto2.0

AIMS

The study aimed to evaluate the effectiveness of the government school-based program #Tamojunto2.0, the third Brazilian version of the European drug prevention program, Unplugged, in preventing the use of alcohol and other drugs.

DESIGN

A parallel, two-arm cluster randomized controlled trial was conducted in 205 classes in 73 public schools (37 intervention and 36 control) with a baseline assessment and follow-up after 9 months.

SETTING

Schools in the cities of São Paulo, Fortaleza and Eusebio in Brazil.

PARTICIPANTS

A total of 5208 students in the 8th grade with a mean age of 13.2 years (standard deviation = 0.8 years) and an equal gender ratio.

INTERVENTION

In 2019, the intervention group attended 12 classes of the program #Tamojunto2.0, under the supervision of a team from the Ministry of Health. The control group did not receive any intervention to prevent alcohol and drug use.

MEASUREMENTS

The primary outcome measured was prevalence of binge drinking (five or more doses of alcohol in an occasion) within the past month. Secondary outcomes were prevalence of initiation and use of alcohol, tobacco, inhalants, marijuana and cocaine within the past month.

FINDINGS

A statistically significant difference was not found in the prevalence of binge drinking within the past month between intervention and control groups [odds ratio (OR) = 0.934; 95% confidence interval (CI) = 0.761-1.146]. However, students who were exposed to the program were less likely to initiate alcohol use than those in the control group (OR = 0.782; 95% CI = 0.636-0.961). The Bayes factor for reduction in binge drinking was 0.01, providing evidence in favor of the null hypothesis for this variable.

CONCLUSIONS

The drug prevention program #Tamojunto 2.0 reduced alcohol initiation, but appeared not to reduce past-month binge drinking among 8th grade students in Brazil.

The Effects of Individual and Dual ACE Domains on Binge Drinking: Comparisons by Gender

BACKGROUND

Adverse Childhood Experiences (ACEs) show predictive utility concerning binge drinking. However, the literature is limited by 1. a focus on cumulative ACEs with little regard to specific domains, 2. a focus on those with the highest ACE scores, and 3. little consideration for gender differences. These approaches are problematic as ACE categories are fundamentally different, yet little distinction is given to specific ACE domains. The current study investigates which individual and dual ACE domain combinations are associated with binge drinking.

METHODS

Data were obtained from the Behavioral Risk Factor Surveillance System (2011-2017; N = 80,391). A series of ANCOVAs were conducted to determine the association between single and dual combination ACE domains and binge drinking.

RESULTS

Results show gendered effects of ACEs on binge drinking such that at 0, 1, and 2 ACEs, males reported statistically higher rates. For males with exactly two ACEs, combinations of either sexual abuse or family incarceration presented the highest levels of binge drinking- with the highest mean binge drinking score being the exact combination of the two. This contrasts with males with 1 ACE, where experiencing family incarceration or sexual abuse, as a single domain, did not represent significant risk above the average of having a single ACE.

CONCLUSIONS

Results suggest that males may be resilient to either of these domains as singular events, yet when found in combination, may present a synergistic effect that increases the likelihood of binge drinking. Due to lower overall binge drinking rates, no significant patterns were found among females.

The Finnish Drinking Habits Survey: Implications for alcohol policy and prevention

Aims/materials

This reflection piece reviews some of the key results and conclusions from the book Näin Suomi juo (This is how Finns drink, 2018), based on the Finnish Drinking Habits Survey. Our aim was to go through the results taking the perspective of prevention workers and policymakers: how could they benefit from the scientific findings when tackling alcohol-related harm?

Results/reflections

The reflections displayed in this article provide some useful arguments and justifications for population-level alcohol policy in the controversial alcohol policy debate. Harms do not only arise among the heaviest drinkers, and efficient methods to prevent harm may be found among the prevention efforts that apply to populations rather than only to the heaviest drinkers. The article also illustrates how the results from a population survey can be used in order to identify specific challenges and solutions for alcohol prevention in a given population. The results help in identifying the population groups and situations with an elevated risk of alcohol-related harm and in characterising the drinking patterns and social situations in which drinking takes place in these vulnerable parts of the population.

Conclusions

The review illustrates that a many-sided understanding of alcohol consumption and the related harm, based on survey results, is more far-reaching in terms of prevention and policy than a knowledge base built solely on register data on the development of alcohol consumption and harm. For example, the respondents' drinking patterns are linked not only to their attitudes and risk perceptions but also to what people consider to be appropriate means to reduce alcohol use and the related harm in terms of alcohol policy, informal social control and people's life management.

Persistent offenders and adolescence-limited offenders: Differences in life-courses

BACKGROUND AND AIMS

As our previous study indicated, almost half of juvenile delinquents continued offending in adulthood, while the rest ceased to do so. We compared these groups with each other and with non-offenders in the life-course use of alcohol, identity development and life situation.

METHODS

Based on the Jyväskylä Longitudinal Study of Personality and Social Development, four groups were formed at age 42 for men and women: persistent, adolescence-limited and adult-onset offenders and non-offenders. Longitudinal data (N = 369; 53% males) have been collected at ages 8, 14, 20, 27, 36, 42 and 50.

RESULTS

Persistent offending, but not adolescence-limited offending, was associated with the accumulation of problems in adulthood and an elevated risk of death before age 54. For males, persistent offending was associated with heavy drinking from adolescence to middle age, diffuse identity, high divorce rates and poverty. For females, persistent offending was associated with heavy drinking in adulthood and a higher rate of being outside the workforce in middle age. In males, adolescence-limited offending was associated with more controlled drinking in adulthood, and in females, with early divorce from the partner and advanced identity.

CONCLUSIONS

Detecting the risks of the accumulation of problems and potential for positive transitions of juvenile delinquents until middle age will be important for prevention and treatment.

The association between early life mental health and alcohol use behaviours in adulthood: A systematic review

This systematic review aims to summarise current evidence on the association between early life mental health and alcohol use behaviours in adulthood. Peer-reviewed publications were located by searching EMBASE, Medline, PsycINFO, and the ISI Web of Science up to 31 October 2018. Prospective longitudinal studies reporting associations between externalising problems (EXT), internalising problems (INT), depression, anxiety before age 18, and alcohol use behaviours (alcohol consumption, heavy/problematic drinking, alcohol use disorder) after age 18 were included. After screening 17259 articles, 36 articles met the inclusion criteria. Information extracted included strength of associations, age when mental health and alcohol use behaviours were measured, sex differences in the association, and other sample characteristics. 103 tests in 23 articles were identified on the externalising domain and 135 tests in 26 articles on the internalising domain. 37 out of 103 tests reported positive associations between EXT and alcohol use behaviours. The likelihood of observing positive associations was higher for more severe alcohol use outcomes, but this trend disappeared among high-quality studies. Findings on associations between internalising domain and alcohol use varied across their subtypes. INT tended to be negatively associated with alcohol consumption but positively associated with more severe outcomes (heavy/problematic drinking, alcohol use disorder). Depression tended to be positively associated with alcohol outcomes, while no clear association between anxiety and alcohol outcomes was evident. Variation of the association across developmental timing, sex, culture, historical period was explored where appropriate. Great heterogeneity in the current literature calls for greater attention to view the relationship developmentally.

Sexual and Gender Minority Youth Alcohol Use: Within-Group Differences in Associations with Internalized Stigma and Victimization

Sexual and gender minority (SGM) youth are more likely to use alcohol than their heterosexual cisgender peers. At the same time, SGM youth experience sexuality- and gender identity-specific stressors known to exacerbate negative health outcomes. Though scholars have established a link between minority stressors (e.g., internalized stigma and victimization) and increased alcohol use for SGM youth as a whole, there is little indication of whether internalized stigma and victimization are more strongly associated with alcohol use for specific groups of SGM youth. A United States sample of 11,811 racially and geographically diverse 13-17 year old SGM youth was used to employ a series of gender-stratified multivariable regression models to examine the association among internalized stigma, victimization, and alcohol-related behaviors, and whether they differed for specific groups of sexual minority youth. Sexual orientation moderated several associations between sexual minority stressors (i.e., victimization and stigma) and youth's alcohol use (i.e., recent use and heavy episodic drinking) across models stratified by gender (i.e., male, female, and non-binary). For example, bisexual boys had stronger associations between SGM-specific victimization and alcohol use frequency and heavy episodic drinking relative to gay boys; conversely, victimization and alcohol use frequency were more weakly associated among bisexual girls relative to lesbian/gay girls. Pansexual girls showed weaker associations between internalized stigma and alcohol use frequency compared to lesbian/gay girls. This paper demonstrates who among SGM youth are more likely to engage in alcohol-related behaviors as a function of differential forms of SGM-related victimization and stigma. These findings can inform substance use interventions that are tailored to youth of diverse sexual orientations and gender identities.

Polygenic and environmental influences on the course of African Americans' alcohol use from early adolescence through young adulthood

The study examined (a) whether alcohol use subgroups could be identified among African Americans assessed from adolescence through early adulthood, and (b) whether subgroup membership was associated with the interaction between internalizing symptoms and antisocial behavior polygenic risk scores (PRSs) and environmental characteristics (i.e., parental monitoring, community disadvantage). Participants (N = 436) were initially recruited for an elementary school-based prevention trial in a Mid-Atlantic city. Youths reported on the frequency of their past year alcohol use from ages 14-26. DNA was obtained from participants at age 21. Internalizing symptoms and antisocial behavior PRSs were created based on a genome-wide association study (GWAS) conducted by Benke et al. (2014) and Tielbeek et al. (2017), respectively. Parental monitoring and community disadvantage were assessed at age 12. Four classes of past year alcohol use were identified: (a) early-onset, increasing; (b) late-onset, moderate use; (c) low steady; and (d) early-onset, decreasing. In high community disadvantaged settings, participants with a higher internalizing symptoms PRS were more likely to be in the early-onset, decreasing class than the low steady class. When exposed to elevated community disadvantage, participants with a higher antisocial behavior PRS were more likely to be in the early-onset, increasing class than the early-onset, decreasing and late-onset, moderate use classes.

Adolescent perspectives about their participation in alcohol intervention research in emergency care: A qualitative exploration using ethical principles as an analytical framework

AIMS

To explore adolescents' experiences of consenting to, and participating in, alcohol intervention trials when attending for emergency care.

METHODS

In-depth semi-structured interviews with 27 adolescents (16 males; aged 14-17 years (Mage = 15.7)) who had taken part in one of two linked brief alcohol intervention trials based in 10 accident and emergency departments in England. Interviews were transcribed verbatim and subject to thematic analysis.

RESULTS

Research and intervention methods were generally found to be acceptable though confidentiality was important and parental presence could hinder truthful disclosures regarding alcohol use. Participants discussed the importance of being involved in research that was relevant to them and recognised alcohol consumption as a normative part of adolescence, highlighting the importance of having access to appropriate health information. Beyond this, they recognised the benefits and risks of trial participation for themselves and others with the majority showing a degree of altruism in considering longer term implications for others as well as themselves.

CONCLUSIONS

Alcohol screening and intervention in emergency care is both acceptable and relevant to adolescents but acceptability is reliant on confidentiality being assured and may be inhibited by parental presence.

TRIAL REGISTRATION

ISRCTN Number: 45300218.

Associations of child and adolescent anxiety with later alcohol use and disorders: a systematic review and meta-analysis of prospective cohort studies

BACKGROUND AND AIMS

Despite a wealth of literature, the relationship between anxiety and alcohol use remains unclear. We examined whether (a) child and adolescent anxiety is positively or negatively associated with later alcohol use and disorders and (b) study characteristics explain inconsistencies in findings.

DESIGN AND SETTING

We conducted a systematic review of 51 prospective cohort studies from 11 countries. Three studies contributed to a meta-analysis. We searched PubMed, Scopus, Web of Science and PsycINFO databases, and studies were included if they met the following criteria: English language publication, human participants, anxiety exposure (predictor variable) in childhood or adolescence and alcohol outcome at least 6 months later.

PARTICIPANTS

Study sample sizes ranged from 110 to 11 157 participants. Anxiety exposure ages ranged from 3 to 24 years, and alcohol outcome ages ranged from 11 to 42 years.

MEASUREMENTS

Ninety-seven associations across 51 studies were categorized by anxiety exposure (generalized anxiety disorder, internalizing disorders, miscellaneous anxiety, obsessive compulsive disorder, panic disorder, separation anxiety disorder, social anxiety disorder and specific phobias) and alcohol use outcome (drinking frequency/quantity, binge drinking and alcohol use disorders).

FINDINGS

The narrative synthesis revealed some evidence for a positive association between anxiety and later alcohol use disorders. Associations of anxiety with later drinking frequency/quantity and binge drinking were inconsistent. Type and developmental period of anxiety, follow-up duration, sample size and confounders considered did not appear to explain the discrepant findings. The meta-analysis also showed no clear evidence of a relationship between generalized anxiety disorder and later alcohol use disorder (odds ratio = 0.94, 95% confidence interval = 0.47-1.87).

CONCLUSIONS

Evidence to date is suggestive, but far from conclusive of a positive association between anxiety during childhood and adolescence and subsequent alcohol use disorder.

Predicting Alcohol Misuse Among Australian 19-Year-Olds from Adolescent Drinking Trajectories

BACKGROUND

Alcohol use in adolescence predicts future alcohol misuse. However, the extent to which different patterns of adolescent use present risk remains unclear.

OBJECTIVES

This study investigated how adolescent trajectories of alcohol consumption during the school years predict alcohol misuse at age 19 years.

METHODS

Data were drawn from 707 students from Victoria, Australia, longitudinally followed for 7 years. Five alcohol use trajectories were identified based on the frequency of alcohol use from Grade 6 (age 12 years) to Grade 11 (age 17 years). At age 19 years, participants completed measures indicating Heavy Episodic Drinking (HED), dependency - Alcohol Use Disorders Identification Test (AUDIT) and social harms.

RESULTS

At 19 years of age, 64% of participants reported HED, 42% high AUDIT scores (8+), and 23% social harms. Participants belonging to a steep escalator trajectory during adolescence had twice the odds at 19 years of age of high AUDIT scores and social harms, and three times greater odds of HED than participants whose alcohol use slowly increased. Stable moderate consumption was also associated with an increased risk of HED compared to slowly increasing use. Abstinence predicted a reduced likelihood of all forms of misuse at 19 years of age compared to slowly increased alcohol use.

CONCLUSIONS

Trajectories of drinking frequency during adolescence predict alcohol misuse at age 19 years. Although rapid increasing use presents the greatest risk, even slowly increasing drinking predicts increased risk compared to abstinence. The findings indicate that alcohol policies should recommend nonuse and reduced frequency of use during adolescence.

The Influence of Economic Pressure on Emerging Adult Binge Drinking: Testing the Family Stress Model over Time

The Family Stress Model proposes that disrupted family processes may help explain the association between economic adversity and poor child developmental outcomes. In this study, the Family Stress Model was tested across adolescence to emerging adulthood. Participants included 451 rural White youth who participated with their parents from age 13-23 (52% female). The data were analyzed at five developmental time periods with separate pathways for mothers and fathers. The findings reveal for both parents that economic pressure at time 1 (age 13) led to parental emotional distress which was related to harsh couple interaction at time 2 (ages 14 and 15). This marital conflict was related to harsh parenting toward the adolescent (time 2), which was then directly associated with higher levels of offspring drinking when youth were in middle adolescence (age 16) at time 3. Alcohol use in middle adolescence was associated with binge drinking in late adolescence (age 18, time 4) into emerging adulthood (age 23, time 5). Drinking behaviors did not differ for boys and girls. The current results show that economic adversity has an effect on family processes which influence offspring binge drinking patterns in later adolescence that continue into emerging adulthood.

Trends in Alcohol-Related Disparities Between Heterosexual and Sexual Minority Youth from 2007 to 2015: Findings from the Youth Risk Behavior Survey

PURPOSE

The purpose of this study was to assess trends in alcohol-related disparities between heterosexual and sexual minority adolescents in the United States from 2007 to 2015.

METHODS

Data were pooled from the 2007, 2009, 2011, 2013, and 2015 Youth Risk Behavior Surveys (N = 207,367) to estimate trends, disparities, and changes in disparities of four alcohol-related behaviors (i.e., lifetime alcohol use, early onset use (<13 years of age), past 30-day use, and past 30-day heavy episodic drinking [HED]) among heterosexual youth and three subgroups of sexual minority youth (SMY) (i.e., gay/lesbian, bisexual, and unsure). Models were sex stratified and adjusted for age, race/ethnicity, and state of data collection.

RESULTS

The prevalence of all alcohol-related behaviors declined from 2007 to 2015 for heterosexual youth, but not as consistently for SMY. Disparities in alcohol-related behaviors between heterosexual youth and SMY largely remained stable or widened from 2007 to 2015. Disparities in lifetime alcohol use and past 30-day use were larger between heterosexual boys and gay boys in 2015 relative to 2007. Disparities in early onset use and past 30-day HED were also larger between heterosexual girls and lesbian girls in 2015 relative to 2007. The disparity in past 30-day use between heterosexual girls and bisexual girls was smaller in 2015 compared with 2007.

CONCLUSIONS

Despite overall declines in adolescent alcohol use, alcohol-related disparities between heterosexual youth and SMY persist and, for some SMY, they have widened.

Persistence of Shifts in Beliefs Associated With Exposure to Alcohol Advertising Among Adolescents

OBJECTIVE

The purpose of this study was to quantify the persistence of immediate changes in adolescents' alcohol-related beliefs associated with exposure to alcohol advertising.

METHOD

Middle school students (N = 606) carried handheld devices for 14 days and logged all of their exposures to alcohol advertisements as they naturally occurred. Perceptions of the typical person one's age who drinks ("prototype perceptions") and perceived norms regarding alcohol use were assessed after each exposure to advertising and at random prompts issued daily throughout the assessment period. Generalized additive modeling was used to determine how long pro-drinking shifts in beliefs persisted after exposure to advertising.

RESULTS

Following exposure to advertisements, positivity of youth's prototype perceptions immediately increased (β = .07, 95% CI [.06, .09]) and then decreased (β = -.05, 95% CI [-.07, -.03]) over the subsequent 1.5 days, whereas perceived normativeness of alcohol use immediately increased (β = .04, 95% CI [.01, .06]) and then decreased (β = -.03, 95% CI [-.05, -.01]) over the subsequent 2 days. Changes in beliefs occurring after 1.5 days for prototype perceptions and after 2 days for perceived norms were not statistically significant, suggesting that these beliefs were no longer affected by the advertising exposure.

CONCLUSIONS

Findings are consistent with theories of alcohol advertising effects that presume that repeated exposure results in cumulative, enduring effects on beliefs. Given the rate of decay of alcohol advertising effects, it may be important to limit youth exposures to one every 2 days to avoid cumulative, lasting pro-drinking shifts in beliefs or to devise ways to interrupt cumulative effects with counter-messaging through media, parents, or other influential others at similar intervals.

Assessing Associations in Substance Use across Three Generations: From Grandparents to Sons and from Sons to Their Children

The Three Generational Study (3GS) began in the early 90s and involves the third generation (G3) offspring of second generation (G2) fathers who were originally recruited in 1984 as part of the Oregon Youth Study (OYS) in mid childhood (ages 9-10 years) along with their first- generation (G1) parents. As boys, the G2 fathers lived in higher delinquency neighborhoods of a medium-sized Pacific Northwestern United States city. The OYS-3GS examines questions concerning socially mediated intergenerational transmission versus discontinuity (or moderation) of antisocial behavior, substance use, and related problem behaviors. Questions address influences of the grandparents, or Generation 1 (G1), on their sons in G2 and in turn of these sons and their partners on their own children in G3. In this article, we present an overview of the study design-and underlying theory-related to general and outcome-specific transmission pathways. We then summarize key issues and findings to date related to the current main focus of the study regarding intergenerational associations in substance use.

The Gender Difference in the Association between Early Onset of Drinking and Problem Drinking between the U.S. and Japan

Using comparable survey data from the GENACIS Project, collected from representative samples of people aged 20 to 70 years old in the U.S. (n=2,598) and Japan (n=1,734), this study examined, across these two diverse societies, the gender difference in the association between the early onset of drinking and the development of drinking problems. The results of this study suggest that there does not appear to be a cross-national causal relationship between the early onset of drinking and problem drinking because of significant country and gender variations in this association and because there is no association found among Japanese females. As hypothesized, the early onset of drinking predicted problem drinking among males more strongly than among females in both countries.

Early maturation and substance use across adolescence and young adulthood: A longitudinal study of Finnish twins

Early maturation, indexed by pubertal development (PD), has been associated with earlier initiation and greater frequency of adolescent substance use, but this relationship may be biased by confounding factors and effects that change across development. Using a population-based Finnish twin sample (N = 3,632 individuals), we conducted twin modeling and multilevel structural equation modeling of the relationship between PD and substance use at ages 12-22. Shared environmental factors contributed to early PD and heavier substance use for females. Biological father absence was associated with early PD for boys but not girls, and did not account for the relationship between PD and substance use. The association between early PD and heavier substance use was partially due to between-family confounds, although early PD appeared to qualitatively alter long-term trajectories for some substances (nicotine), but not others (alcohol). Mediation by peer and parental factors did not explain this relationship within families. However, higher peer substance use and lower parental monitoring were themselves associated with heavier substance use, strengthening the existing evidence for these factors as targets for prevention/intervention efforts. Early maturation was not supported as a robust determinant of alcohol use trajectories in adolescence and young adulthood, but may require longer term follow-up. Subtle effects of early PD on nicotine and illicit drug use trajectories throughout adolescence and adulthood merit further investigation.

Are alcohol-related disparities between sexual minority and heterosexual youth decreasing?

BACKGROUND AND AIMS

Although sexual orientation-related alcohol use disparities are well established, researchers have not identified whether disparities are diminishing as societal attitudes towards lesbian/gay and bisexual (LGB) people become more accepting. We examined changes in four alcohol-related disparities between heterosexual and LGB youth from 1998 to 2013 by (1) estimating the prevalence of these behaviors; (2) estimating disparities in alcohol-related outcomes between heterosexual and LGB youth within each wave year; and (3) testing whether the degree of difference in alcohol-related disparities between heterosexual and LGB youth has changed.

DESIGN

Logistic regression models and year × sexual orientation interactions with repeated, cross-sectional, provincially representative data.

SETTING

British Columbia, Canada.

PARTICIPANTS

Students (ages 12-19) from the 1998 (n = 22 858), 2003 (n = 29 323), 2008 (n = 25 254) and 2013 (n = 21 938) British Columbia Adolescent Health Survey (total n = 99 373, 48.7% male, mean age = 14.84).

MEASUREMENTS

We modeled age-adjusted differences in life-time alcohol use, age of onset, past 30-day drinking and past 30-day heavy episodic drinking between heterosexual and three subgroups of sexual minority youth (i.e. mostly heterosexual, bisexual and lesbian/gay).

FINDINGS

Generally, alcohol use declined for all youth, although less so among LGB youth [average adjusted odds ratio (aOR) = 0.58 and aOR = 0.53 for heterosexual males and females and aOR = 0.71 and aOR = 0.57 for sexual minority males and females, respectively). Within-year comparisons demonstrated elevated rates of alcohol use among LGB compared with heterosexual youth for each of the four survey years, especially among females. Findings indicate few changes over time; however, results show an increase in risky alcohol use from 1998 to 2013 among mostly heterosexual (aOR = 1.58 for life-time alcohol use, aOR = 1.58 for 30-day alcohol use and aOR = 1.34 for 30-day heavy episodic drinking), and bisexual (aOR = 1.95 for life-time alcohol use) females.

CONCLUSION

Despite the general decline in the prevalence of alcohol use among young people in Canada since 1998, lesbian/gay and bisexual youth in Canada continue to show elevated rates of alcohol use compared with heterosexual youth.

The Relations Between Parental Socioeconomic Status, Personality, and Life Outcomes

Studies have shown that cognitive ability is correlated with parental socioeconomic status (pSES). However, little is known about the correlation between personality and pSES. To better understand this relation, we conducted a meta-analysis of the correlations between pSES and personality traits and temperament dimensions. The correlations were generally very small with the exception of the correlation between pSES and openness to experience. Our results were replicated in a large ( N = 2,183,377) data set of self-reported personality scores collected online. Using this data set, we also examined the interaction between pSES and personality on attained education and socioeconomic status. We found evidence for the resource substitution hypothesis, which proposes that personality compensates for background disadvantage.

Genetic and environmental sources of covariation between early drinking and adult functioning

The vast majority of individuals initiate alcohol consumption for the first time in adolescence. Given the widespread nature of its use and evidence that adolescents may be especially vulnerable to its effects, there is concern about the long-term detrimental impact of adolescent drinking on adult functioning. While some researchers have suggested that genetic processes may confound the relationship, the mechanisms linking drinking and later adjustment remain unclear. The current study utilized a genetically informed sample and biometric modeling to examine the nature of the familial influences on this association and identify the potential for genetic confounding. The sample was drawn from the Minnesota Twin Family Study (MTFS), a longitudinal study consisting of 2,764 twins assessed in 2 cohorts at regular follow-ups from age 17 to age 29 (older cohort) or age 11 to age 29 (younger cohort). A broad range of adult measures was included assessing substance use, antisocial behavior, personality, socioeconomic status, and social functioning. A bivariate Cholesky decomposition was used to examine the common genetic and environmental influences on adolescent drinking and each of the measures of adult adjustment. The results revealed that genetic factors and nonshared environmental influences were generally most important in explaining the relationship between adolescent drinking and later functioning. While the presence of nonshared environmental influences on the association are not inconsistent with a causal impact of adolescent drinking, the findings suggest that many of the adjustment issues associated with adolescent alcohol consumption are best understood as genetically influenced vulnerabilities. (PsycINFO Database Record

The Influence of Paternal Separation, Paternal History of Alcohol Use Disorder Risk, and Early Substance Use on Offspring Educational Attainment by Young Adulthood

OBJECTIVE

This study aimed to determine the associations among paternal alcohol problems, separation, and educational attainment in European American and African American offspring and whether offspring early alcohol/tobacco/marijuana use influenced these associations.

METHOD

Families with offspring ages 13-19 years at intake were selected from state birth records and screened by telephone to determine high-risk or low-risk status (with/without paternal heavy drinking). Families of men with two or more driving-under-the-influence offenses were added as a very-high-risk group. Data from 340 African American and 288 European American offspring who were not enrolled in school at their last interview were analyzed. Educational attainment was modeled as less than high school, high school only (reference category), and some college or higher. Separation was defined as offspring report of not having lived continuously in the same household with their biological father from birth to age 14. Analyses were stratified by race.

RESULTS

In European Americans, neither family risk status nor early alcohol/tobacco/marijuana use was associated with educational outcomes. However, paternal separation significantly elevated the likelihood of not completing high school in all models (relative risk ratios [RRRs] = 6.0-8.1, p <.001). For African American offspring, likelihoods of high school noncompletion were elevated marginally for paternal separation in only one model, but significantly for early marijuana use (RRRs = 2.8-3.2, p < .05). Very-high-risk status significantly reduced the likelihood of post-high school education in an adjusted model (RRR = 0.4, p < .05).

CONCLUSIONS

High school noncompletion was significantly associated with paternal separation in European Americans and with early marijuana use in African American offspring. In addition, very-high-risk status reduced the likelihood of post-high school education in African American offspring only, suggesting that research with ethnically diverse samples yields important differences when examining outcomes of both separation and substance use on offspring education.

Mothers Who abuse Alcohol and Drugs: Health and Social Harms among Substance-Abusing Mothers of Small Children in three Child Cohorts

AIMS – The study looks at the prevalence and register-based indicators of substance abuse-related harms among mothers of small children. We examined the living conditions, various health and social harms and the differences between the users of different kinds of substances (alcohol only vs. drugs only vs. alcohol and other drugs). DATA & METHODS – Population-level register data was collected of all biological mothers of three Finnish birth cohorts (1991, 1997, 2002) describing the women's social problems, health and use of services during the period when the child was under seven years old. RESULTS – The substance-abusing mothers of small children had a higher rate of mortality and psychological disorders and increased risk of using hospital services than the comparison group. Their children had been taken into custody dramatically more often than the children of the comparison group. Also, mothers with substance abuse problems had lower education and income level, and their purchases of prescribed psychopharmacological medications were manifold compared to other mothers. Mixed use of both alcohol and illegal drugs coincided with the highest prevalence of health and social problems. CONCLUSIONS – Substance-abusing mothers of small children are in a serious risk of health and social problems ranging from poverty to poor mental health and high mortality. The study shows also that the social and health care professionals have a potentially important role in giving support to the mothers and their children, as the substance-abusing mothers have had several contacts with them. Prevention of harms to children of substance-abusing mothers should perhaps focus more on the possibilities offered by these contacts in different health and social services.

Associations between early internalizing symptoms and speed of transition through stages of alcohol involvement

Alcohol use disorders and internalizing disorders are highly comorbid, but how this comorbidity unfolds over development is not well understood. The present study investigated effects of internalizing symptoms in late childhood on speed of transition between three alcohol involvement milestones: first drink, first binge, and onset of first alcohol dependence symptom. Greater early internalizing symptoms were expected to predict a later age of first drink, a slower transition from first drink to first binge, and a faster transition from first binge to first dependence symptom. The effects of age and moderating effects of gender were also examined. Data were from a longitudinal study of children of alcoholics and matched controls (N = 454) followed from late childhood to midlife. Generally, stage-specific hypotheses were not supported; rather, greater internalizing symptoms predicted an earlier age of first drink and a faster transition through the full interval from first drink to first dependence symptom. Regarding gender moderation, internalizing significantly predicted a faster transition between each milestone as well as through the full interval among women but not men. These results suggest that early internalizing problems confer risk for a rapid transition through all stages of alcohol involvement, and this risk may be limited to women.

The effects of social anxiety on alcohol and cigarette use across adolescence: Results from a longitudinal twin study in Finland

Conflicting reports exist on the direction of the relationship between social anxiety (SA) and alcohol/cigarette use (AU/CU) and alcohol/nicotine dependence (AD/ND), with both positive and negative associations reported. A prospective, longitudinal sample of Finnish twins (n = 1,906) was used to test potential explanations for these discrepancies. Specifically, this study used peer, parent, and teacher ratings of SA, and a clinical interview screening item for social anxiety disorder (SAD-Sc) to examine associations between SA and AU/CU and AD/ND from early adolescence into young adulthood. Peer-rated SA was negatively associated with AU, CU, and AD from age 14 through age 22, implying a protective effect (β = -0.01 to -.03). Teacher- and parent-rated SA associations were in the same directions but weaker or nonsignificant, indicating that aspects of SA that are recognizable by peers may be most relevant to AU/CU. Self-reported SAD-Sc was also negatively associated with AU, but positively associated with AD symptoms in young adulthood (β = 0.38). Our findings partially support the existence of different associations between SA and AU versus AD, but only in the context of SAD-Sc rather than trait SA. Neither trait SA nor SAD-Sc significantly predicted ND symptoms, although SAD-Sc was associated with both cigarette abstinence and daily smoking. These findings suggest that adolescent SA is modestly associated with lower AU/CU, although there may be some individuals with more severe SA who develop alcohol problems later in life. There was little evidence of a common underlying liability contributing to both SA and alcohol/cigarette use. (PsycINFO Database Record

Intergenerational continuity in parents' and adolescents' externalizing problems: The role of life events and their interaction with GABRA2

We examine whether parental externalizing behavior has an indirect effect on adolescent externalizing behavior via elevations in life events, and whether this indirect effect is further qualified by an interaction between life events and adolescents' GABRA2 genotype (rs279871). We use data from 2 samples: the Child Development Project (CDP; n = 324) and FinnTwin12 (n = 802). In CDP, repeated measures of life events, mother-reported adolescent externalizing, and teacher-reported adolescent externalizing were used. In FinnTwin12, life events and externalizing were assessed at age 14. Parental externalizing was indexed by measures of antisocial behavior and alcohol problems or alcohol dependence symptoms in both samples. In CDP, parental externalizing was associated with more life events, and the association between life events and subsequent adolescent externalizing varied as a function of GABRA2 genotype (p ≤ .05). The association between life events and subsequent adolescent externalizing was stronger for adolescents with 0 copies of the G minor allele compared to those with 1 or 2 copies of the minor allele. Parallel moderation trends were observed in FinnTwin12 (p ≤ .11). The discussion focuses on how the strength of intergenerational pathways for externalizing psychopathology may differ as a function of adolescent-level individual differences.

A developmental model for alcohol use disorders in Swedish men

BACKGROUND

Alcohol use disorder (AUD) is a classic multifactorial syndrome and it is critical to understand the diversity of the relevant risk factors and how they inter-relate over development.

METHOD

We examined 21 risk factors for AUD in four developmental tiers reflecting (i) birth, (ii) childhood and early adolescence, (iii) late adolescence, and (iv) early adulthood in 47 414 Swedish men of whom 3907 (8.2%) were registered for AUD at or after age 25 with a mean length of follow-up of 33.9 (6.6) years. Structural equational model fitting was performed using Mplus.

RESULTS

The best-fitting model provided a good fit to the data and explained 23.4% of the variance in AUD. The five strongest predictors were: externalizing behaviors, criminal behavior, father's alcohol consumption, genetic risk, and low educational attainment. Two developmentally early familial/genetic risk factors had substantial direct paths to AUD: father's alcohol consumption and genetic liability. Other broad developmental pathways to risk for AUD were evident: externalizing, psychosocial and internalizing. Overall, the externalizing pathway to AUD was the strongest. However, these pathways were substantially interwoven over time such that risk factors from one domain were commonly predicted by and/or predicted risk factors from the other broad domains of risk.

CONCLUSION

AUD in men is an etiologically complex syndrome influenced by familial-genetic, psychosocial, internalizing, and especially externalizing risk factors that act and interact over development and have complicated mediational pathways.

The Relationships of Parental Alcohol Versus Tobacco and Marijuana Use With Early Adolescent Onset of Alcohol Use

OBJECTIVE

This study examined whether the use of tobacco and marijuana by fathers or mothers predicted onset of alcohol use in their offspring over and above effects of parental alcohol use.

METHOD

The present study included 146 children of 93 parents (90 fathers and 85 mothers). The fathers were originally recruited as boys to the Oregon Youth Study, a study of community, familial, and individual risk factors for delinquency.

RESULTS

Only mothers' but not fathers' alcohol use was associated with children's age at onset. Children's age at onset was predicted by mothers' tobacco use and by the interaction of fathers' marijuana use and alcohol use. These effects were observed when controlling for parental education, child's gender, and also child's antisocial behavior-a general developmental risk factor for substance use onset in adolescence.

CONCLUSIONS

Mothers' substance use played a major role in childhood onset of alcohol use, yet the role of maternal substance use as a risk factor for their children has previously received less attention than the role of paternal substance use. Also, findings imply that it may be important to identify children of polysubstance-using parents for targeted prevention programs.

The Genetic and Environmental Association Between Parental Monitoring and Risk of Cannabis, Stimulants, and Cocaine Initiation in a Sample of Male Twins: Does Parenting Matter?

Our aim was to test the direction of causation between self-report parental monitoring (PM) and the liability to illicit drug initiation (DI) as indicated by cannabis, cocaine, and stimulants. We fitted a multiple indicator model to test causal and non-causal models based on a large, genetically informative cross-sectional sample of male twins. The sample comprised 1,778 males aged 24-62 years from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders. Data came from self-report measures of lifetime cannabis, stimulants, and cocaine initiation, and retrospective assessment of PM between ages 8-17 years. Multivariate modeling showed that familial aggregation in PM and DI were both explained by a combination of additive genetic and shared environmental effects. Moreover, the significant association between PM and DI was best explained by a correlated liability model versus causal models. PM has typically been assumed to be an environmental, causal risk factor for drug use and has been shown to be among the more salient environmental risk factors for illicit DI. Our data were not consistent with this causal hypothesis. Instead, a correlated liability model in which PM and risk of DI share common genetic and environmental risks provided a better fit to the data.

Lost in translation: a focus group study of parents' and adolescents' interpretations of underage drinking and parental supply

Background

Reductions in underage drinking will only come about from changes in the social and cultural environment. Despite decades of messages discouraging parental supply, parents perceive social norms supportive of allowing children to consume alcohol in ‘safe’ environments.

Methods

Twelve focus groups conducted in a regional community in NSW, Australia; four with parents of teenagers (n = 27; 70 % female) and eight with adolescents (n = 47; 55 % female). Participants were recruited using local media. Groups explored knowledge and attitudes and around alcohol consumption by, and parental supply of alcohol to, underage teenagers; and discussed materials from previous campaigns targeting adolescents and parents.

Results

Parents and adolescents perceived teen drinking to be a common behaviour within the community, but applied moral judgements to these behaviours. Younger adolescents expressed more negative views of teen drinkers and parents who supply alcohol than older adolescents. Adolescents and parents perceived those who ‘provide alcohol’ (other families) as bad parents, and those who ‘teach responsible drinking’ (themselves) as good people. Both groups expressed a preference for high-fear, victim-blaming messages that targeted ‘those people’ whose behaviours are problematic.

Conclusions

In developing and testing interventions to address underage drinking, it is essential to ensure the target audience perceive themselves to be the target audience. If we do not have a shared understanding of underage ‘drinking’ and parental ‘provision’, such messages will continue to be perceived by parents who are trying to do the ‘right’ thing as targeting a different behaviour and tacitly supporting their decision to provide their children with alcohol.

Is 'age at first drink' a useful concept in alcohol research and prevention? We doubt that

AIM

To address and discuss the weaknesses of age at first drink (AFD) as a concept in alcohol research and prevention.

METHODS

Narrative literature review.

RESULTS

Varying from one sip to the consumption of several full drinks, and sometimes including the specification of particular conditions (e.g. without parental consent), no exact definition and operationalization of AFD was found. Evidence reveals poor test-retest reliability when the same individuals report their AFD two or more times. Theoretical arguments and empirical evidence fail to explain why having one sip or one drink earlier than peers should cause heavier drinking and related problems later in life. Alternative explanations such as self-selection, third variable effects and systematic report bias are not considered in most studies. These shortcomings also make AFD unsuitable as an indicator or marker of underlying problems such as conduct problems and academic failure. Together with unjustified causal inferences, this has led to an over-emphasis on the relevance of postponing AFD as a way to prevent problems later in life.

CONCLUSION

We argue in favour of shifting the focus of alcohol research and prevention away from AFD towards a better understanding of the progression from infrequent, low-quantity drinking to more detrimental drinking patterns and the prevention of associated acute and short-term harm.

Substance Use Disorder in Early Midlife: A National Prospective Study on Health and Well-Being Correlates and Long-Term Predictors

This study used national multicohort panel data from the Monitoring the Future study (N = 25,536 from senior year classes 1977–1997 followed up to the age of 35 years in 1994–2014) to examine how early midlife (age 35 years) alcohol use disorder (AUD) and cannabis use disorder (CUD) are associated with adolescent and adult sociodemographics and health and well-being risk factors. Survey items adapted from DSM-5 diagnostic criteria were used to identify individuals who (a) showed symptoms consistent with criteria for AUD or CUD at age 35 years, (b) used the substance without qualifying for a disorder (nondisordered users), and (c) abstained from using alcohol or marijuana during the past five years. At age 35 years, the estimated prevalence of past five-year AUD was 28.0%, and that of CUD was 6.1%. Multinomial logistic regressions were used to identify variations in the relative risk of disorder symptoms as a function of sociodemographic characteristics, age 18 educational and social indices and substance use, and age 35 health and satisfaction indices and substance use. In the full models, age 18 binge drinking and marijuana use were found to be among the strongest predictors of age 35 AUD and CUD, respectively. Among age 35 health and well-being indicators, lower overall health, more frequent cognitive difficulties, and lower satisfaction with spouse/partner were consistently associated with greater risks of AUD and CUD. Some evidence was found for a J-shaped association between age 35 AUD or CUD status and health and well-being indices, such that nondisordered users were sometimes better off than both abstainers and those experiencing disorder. Finally, nondisordered cannabis use, but not CUD, was found to be more common in more recent cohorts. Implications are discussed regarding the importance of placing early midlife substance use disorder within the context of both adolescent substance use and adult health and well-being.

Alcohol-Branded Merchandise Ownership and Drinking

CONTEXTS

Alcohol-branded merchandise (ABM) has a longer shelf-life than other forms of alcohol marketing and the potential to become integrated into children's self-identities.

OBJECTIVE

This review sought to explore the current literature on children's exposure to, and the impact of, ABM.

DATA SOURCES

PsycInfo, Proquest, Science Direct, and ABI-Inform databases were searched from the earliest available date to May 2015. Additional studies were identified by a manual review of the reference lists of retrieved articles and contacting the corresponding author of each included study.

STUDY SELECTION

Articles that reported on child or adolescent ownership of ABM and/or the relationship between ABM ownership and drinking were included.

DATA EXTRACTION

Data on key measures were tabulated; where data of interest were not reported, requests for further information were sent to the articles' authors.

RESULTS

Nine cross-sectional and 4 longitudinal studies were identified. ABM ownership ranged from 11% to 59% and was higher among older children and males. Seven cross-sectional studies reported associations between ABM ownership and drinking-related behaviors. All 4 longitudinal studies reported a significant relationship between ownership at baseline and drinking initiation at follow-up.

LIMITATIONS

The small number of available studies, with different measures of ABM ownership and of associations/effects.

CONCLUSIONS

The few studies exploring ABM ownership are consistent in showing high rates of ownership and associations between ownership and current and future drinking. There is a need for further research into specific aspects of ABM ownership. However, there is also a need for policy interventions to reduce children's access to and ownership of ABM.

A prospective longitudinal model predicting early adult alcohol problems: evidence for a robust externalizing pathway

BACKGROUND

Risk factors for alcohol problems (AP) include biological and environmental factors that are relevant across development. The pathways through which these factors are related, and how they lead to AP, are optimally considered in the context of a comprehensive developmental model.

METHOD

Using data from a prospectively assessed, population-based UK cohort, we constructed a structural equation model that integrated risk factors reflecting individual, family and peer/community-level constructs across childhood, adolescence and young adulthood. These variables were used to predict AP at the age of 20 years.

RESULTS

The final model explained over 30% of the variance in liability to age 20 years AP. Most prominent in the model was an externalizing pathway to AP, with conduct problems, sensation seeking, AP at age 17.5 years and illicit substance use acting as robust predictors. In conjunction with these individual-level risk factors, familial AP, peer relationships and low parental monitoring also predicted AP. Internalizing problems were less consistently associated with AP. Some risk factors previously identified were not associated with AP in the context of this comprehensive model.

CONCLUSIONS

The etiology of young adult AP is complex, influenced by risk factors that manifest across development. The most prominent pathway to AP is via externalizing and related behaviors. These findings underscore the importance of jointly assessing both biologically influenced and environmental risk factors for AP in a developmental context.

Time-Clustered Deaths and Substance Use Disorder among Young Adults*

This study assesses whether experiencing multiple deaths of loved ones clustered in time increases risk for substance use problems. Using survey data from a community sample of young adults in Miami, Florida (N = 1747), time-clustered deaths were categorized based on the age of the respondent at the time of each death, with less time between deaths representing greater time-clustering. Results indicate that young adults experiencing multiple deaths that are highly time clustered are at increased risk for substance use disorder and alcohol use. This study provides an alternative way of thinking about how young people may be affected by major life events. It suggests that the increased risk for substance use disorder associated with multiple deaths may be more likely to materialize when the deaths are highly clustered in time.

Disorders of cognitive and emotional development in children of mothers with substance abuse and psychiatric disorders

Aims

The aim of this study was to investigate whether the mother's substance abuse, psychiatric problems and socioeconomic situation are related to 1) disorders of psychological development, 2) behavioural and emotional disorders, and 3) mood disorders and neurotic, stress-related and somatoform disorders in children aged 0–12 years.

Data & Methods

The research is based on data on all children born in Finland in 1997 who have not died before their first birthday (n=58 761). These children were followed until their 12th birthday. Information from national registers covering health and social care, education, relationship status, age and receipt of income support were analysed using cross-tabulation with χ2-tests and logistic regression analysis.

Results

Based on the register data of children, 1.4% (n = 798) had a mother with substance abuse problems only, 3.2% (n = 1854) had a mother with psychiatric disorders only, and 1.1% (n = 652) had a mother with both substance abuse and psychiatric disorders. Among children with mothers with substance abuse, psychiatric disorders or both, the risks of all categories of psychiatric diseases studied were significantly higher than in the comparison group. It was a bigger risk for the child to have a mother with both substance abuse and psychiatric disorders than either of these alone.

Conclusion

The mother's substance abuse and her other psychiatric disorders are significant risk factors for her children's psychiatric development, even when the socioeconomic factors are taken into account. Children of mothers with both substance abuse and psychiatric disorders are at a particularly high risk.