A Cohort Study on Long-Term Adverse Effects of Parental Drinking: Background and Study Design

Harm to children from others' drinking: A survey of caregivers in Australia

AIMS

This study aimed to identify the prevalence and types of harm to children from others' drinking in Australia, as indicated by caregivers, and examine socio-demographic characteristics of caregivers who indicated a child was affected by others' drinking.

DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS

A subsample of 854 adult respondents, who were caregivers of children under 18 years from the 2021 Australian Alcohol's Harm to Others study, were asked questions about whether children in their care had been negatively affected by others' drinking in the past year. Weighted prevalence estimates of overall and specific harms to children are presented. Logistic regressions were conducted to determine characteristics associated with indicating harms to children from others' drinking.

FINDINGS

Over 17% of caregivers (95% confidence interval [CI] = 13.0-19.0) indicated that one or more children in their care had been affected by others' drinking in the past 12 months. Verbal abuse (6.2%; 95% CI = 4.3-8.3) was the most common harm indicated, followed by financial harm (4.3%; 95% CI = 2.7-6.2). One percent of caregivers (95% CI = 0.4-2.3) indicated a child was physically hurt and less than 1% (95% CI = 0.2-1.4) indicated a child was the subject of a child protection call due to someone's drinking. Women and caregivers over 65 years were more likely to indicate a child had been affected compared with men and caregivers under 65 years. Caregivers who drank five or more drinks at least three times per week were four times more likely to indicate a child was affected compared with abstainers. Living in a household with someone who drinks heavily and who had negatively affected the child's caregiver was associated with an increased likelihood of child harm.

CONCLUSIONS

In 2021, a weighted survey estimate for caregivers in Australia indicated that almost one in six children had been affected by others' drinking. Heavier drinking of caregivers and other household members was the most substantial predictor for indicating a child had been negatively affected by others' drinking.

Parental binge drinking and offspring's high school non-completion: A prospective HUNT survey and educational registry study

BACKGROUND

Alcohol-use disorders (AUD) in parents are associated with adverse outcomes in offspring. It is less known whether other forms of parental drinking such as binge drinking may also be a risk factor for offspring's outcomes -- specifically, high school non-completion.

METHODS

These questions were examined in a sample of 3101 offspring (M_age = 16.1 , SD = 1.68; 49.5% girls) from 2510 2-parent families who participated in the Nord-Trøndelag Health Study in Norway (HUNT3; Young-HUNT3) in 2006-08 and were followed-up through the National Education Database (NUDB) until 2014. Associations between maternal and paternal binge drinking patterns as reported in HUNT during offspring's adolescence and offspring's subsequent high school completion were examined using logistic regression models while accounting for a comprehensive set of socio-demographic, parental, and offspring characteristics as assessed at HUNT baseline. Effect modifications of these putative associations by offspring characteristics were also explored.

FINDINGS

Approximately 1 in 6 offspring (13.6% girls, 21.1% boys) failed to graduate high school within the officially designated time period, while roughly 1 in 5 mothers (20.4%) and 1 in 2 fathers (51.2%) reported any binge drinking. Weekly or more frequent binge drinking in fathers was prospectively associated with more than doubled odds of high school non-completion in offspring; OR = 2.23, 95% CI = 1.50-3.31. This effect remained substantively identical after adjustment for all covariates (aOR = 2.20, 95% CI = 1.38-3.50) and uniform across offspring characteristics such as gender, academic orientation and performance, anxiety and depression, typical alcohol consumption, and witnessing parental intoxication as assessed at HUNT baseline.

CONCLUSIONS

Weekly or more frequent binge drinking in fathers negatively affected high school graduation prospects in their offspring.

Parental risk constellations and future alcohol use disorder (AUD) in offspring: A combined HUNT survey and health registries study

OBJECTIVE

We examined the risk of developing a future alcohol use disorder (AUD) among offspring of families with different constellations of parental risk factors.

METHOD

We analyzed a sample of 8,774 offspring (50.2% male) from 6,696 two-parent families who participated in the Nord-Trøndelag Health Study in Norway when offspring were 13-19 years old in 1995-1997 or 2006-2008. Based on population registry information and parental Nord-Trøndelag Health Study self-reports, families were classified via Latent Profile Analysis into fiver risk constellations reflecting parents' education, drinking quantities and frequencies, and mental health. Information about AUD-related diagnoses, treatments, and prescriptions for all offspring in the period between 2008 and 2016 was obtained from 3 national health registries and pooled to reflect any AUD. The likelihood of AUD in offspring was examined with a set of nested logistic regression models.

RESULTS

Registry records yielded 186 AUD cases (2.1%). Compared with the lowest-risk constellation, offspring from two constellations were more likely to present with AUD in unadjusted analyses. After adjusting for all covariates, including offspring's alcohol consumption and witnessing parental intoxication during adolescence, AUD risk remained elevated and statistically significant (adjusted odds ratio = 2.34, 95% confidence interval = 1.14, 4.85) for offspring from the constellation characterized by at least weekly binge drinking, low education, and poor mental health in both parents.

CONCLUSION

Weekly binge drinking by both parents was associated with future AUD risk among community offspring in Norway when clustered with additional parental risks such as poor mental health and low educational attainment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Alcohol use and binge drinking among U.S. men, pregnant and non-pregnant women ages 18-44: 2002-2017

BACKGROUND

Drinking during pregnancy dropped sharply in the U.S. in the 1980s. More recent time trends in adult drinking and binge drinking in men, non-pregnant and pregnant women have not been directly compared.

METHODS

Using logistic regression and National Surveys on Drug Use and Health (NSDUH) 2002-2017 data on any drinking and 2002-2014 data on binge drinking, trends in men, non-pregnant and pregnant women were compared. Analyses of any drinking included 470,309 participants (221,344 men; 236,197 non-pregnant women; 12,768 pregnant women); of binge drinking, 379,379 participants (178,869 men; 189,923 non-pregnant women; 10,587 pregnant women).

RESULTS

In all participants, drinking decreased (62.2%-60.3%). Among adults ages 18-20, drinking decreased in men, non-pregnant women, and pregnant women (-18.4%; -11.1%; -5.3%), as did binge drinking (-11.8%; -5.6%; -3.7%). Among adults ages 21-44, drinking increased in non-pregnant women (+2.3%), and decreased in men and pregnant women (-2.6% and -3.3%), while binge drinking increased in non-pregnant women (+2.7%), but not in pregnant women (-1.8%) or men (0.0%).

CONCLUSIONS

Drinking increased in U.S. women ages 21-44, but not those who were pregnant. Increases in women and continuing high rates in men indicate the need for better public health efforts. Divergent trends in men, non-pregnant, and pregnant women ages 21-44 suggest differential influences on drinking. Continued low rates in pregnant women are encouraging, but maintaining public health messages about drinking during pregnancy and innovative efforts to prevent such drinking are needed. Different results in ages 18-20 and 21-44 highlight the importance of developmental stages in drinking.

Self-reported harm from others' alcohol, cigarette and illegal drug use in Norway

AIMS

While it is documented that substance use harms others than the user, less is known about which substances people experience most harm from, and who the victims and perpetrators are. The aims were: (i) to estimate the prevalence of and overlap in self-reported harm from others' alcohol, cigarette, and illegal drug use; (ii) to examine potential differences in the prevalence of harm from close relations' and strangers' use; and (iii) to examine how the prevalence of harm varies according to demographics and the respondents' substance use.

METHODS

Population surveys conducted among 16-64-year-old Norwegians in 2012 and 2016 (N = 3407) assessed self-reported harm from others' alcohol, cigarette and illegal drug use with identical measures, demographic variables and the respondents' substance use.

RESULTS

Experience of harm from others' alcohol use was most common, followed by others' smoking. For all three substances, a higher proportion experienced harm from close relations' use. Nearly half had experienced harm from others' use of at least one substance. Women and younger participants were more likely to report harm from others' alcohol and cigarette use. While alcohol and illegal drug users were more often harmed by others' use of these substances, smokers reported being less often harmed by others' smoking.

CONCLUSIONS

Self-reported harm from others' alcohol, cigarette and illegal drug use corresponds with the prevalence of use of these substances in Norway. For all three substances, close relations' use accounted for more harm than strangers' use. Own substance use was an important correlate of experienced harm.

Association of Constellations of Parental Risk With Children's Subsequent Anxiety and Depression: Findings From a HUNT Survey and Health Registry Study

IMPORTANCE

The research focus on children of parents with alcohol use disorder has eclipsed the potentially wider-reaching detrimental effects of subclinical parental drinking, both alone and in combination with other parental risk factors.

OBJECTIVE

To identify constellations of early parental risk characterized by variations in drinking, mental health, and education in both parents and examine their prospective associations with children's contact with the health care system for anxiety and/or depression (ie, diagnoses or treatment).

DESIGN, SETTING, AND PARTICIPANTS

This prospective study was based on linked survey and health registries data. The sample included 8773 children from 6696 two-parent families in Norway who participated in the Nord-Trøndelag Health Study (HUNT) survey in 1995 to 1997 or 2006 to 2008, when the children were aged 13 to 19 years. Data were analyzed from January to September 2018.

EXPOSURES

Five constellations of early parental risks, characterized by variations in drinking frequencies and amounts, mental health, and education for both parents, as identified through latent profile analysis.

MAIN OUTCOMES AND MEASURES

Children's diagnoses or treatment of anxiety and/or depression from 2008 to 2016 were recorded in 3 health registries. The primary outcome was the total number of registries where participants presented (ranging from 0 to 3).

RESULTS

Of the 8773 included children, 4404 (50.2%) were boys, and the mean (SD) age at the time of participation in the Nord-Trøndelag Health Study was 16.1 (1.8) years. Prevalence of anxiety and/or depression, as evidenced in at least 1 registry record, was 24.3% (2132 of 8773). Early parental risk profiles risks marked by (1) the lowest parental education (adjusted relative risk, 1.13; 95% CI, 1.01-1.25) and (2) elevated drinking in both parents and elevated mental health symptoms in fathers (adjusted relative risk, 1.52; 95% CI, 1.03-2.22) were associated with a significant increase in risk of anxiety and/or depression in children from those families compared with children from no-risk families.

CONCLUSIONS AND RELEVANCE

Studies seeking to understand prospective associations of parental drinking with children's mental health need to consider additional risk factors in combination with one another as well as parental behaviors and characteristics below clinically defined levels. When accumulated at a family level, even seemingly innocuous characteristics contributed to meaningful increases in risk of anxiety and/or depression among children, potentially translating into poorer mental health outcomes for many young people.

Fathers' Alcohol Consumption and Long-Term Risk for Mortality in Offspring

Aim

This study examined associations between fathers’ alcohol consumption and risk for total and cause-specific mortality in offspring.

Short summary

We examined the associations between fathers’ alcohol consumption and total and cause-specific mortality in adult offspring. Fathers’ alcohol consumption was associated with increased risk of alcohol-related mortality in offspring. The association appeared to be weaker for causes of death in which alcohol plays a smaller, or less direct, role.

Methods

Data on fathers’ alcohol consumption, and offspring’s risky use of alcohol, smoking, mental health and contact with police/childcare authorities were collected among 46,284 men (sons) aged 18–20 years, during conscription for compulsory military training in 1969/70. Data on offspring mortality were obtained from the National Cause of Death register, 1971–2008. The mortality outcomes included total mortality, alcohol-related causes of death and violent causes of death (categorized into suicides vs violent/external causes excluding suicides).

Results

Compared to sons whose fathers never used alcohol, the risk for total and alcohol-related mortality among sons increased with the father’s consumption level. The risk of violent death was significantly elevated among sons whose fathers drank alcohol occasionally or often, but the risk of suicide increased in the highest consumption category only. After adjustment for covariates, the results remained for alcohol-related mortality whereas they were significantly attenuated, or disappeared, for total mortality, violent death and suicide.

Conclusions

Fathers’ alcohol consumption is associated with increased risk of alcohol-related mortality in the offspring. Alcohol use among fathers also increases the offspring’s risk of later total mortality, suicide and violent death, but these associations appear to be mediated or confounded by factors related to parental drinking and/or adverse childhood psychosocial circumstances.

Challenges in Estimating Population Impacts of Alcohol's Harm to others

Background

There is a renewed interest in alcohol's harm to others (AHTO), and survey studies in the general population are often used to estimate the extent of harm, to address the severity and variety of harms, and to identify the victims of such harm. While cross-sectional survey studies are attractive in several respects, they also entail several methodological challenges.

Aim

We discuss some of these issues, paying particular attention to the problems of causal attribution, transferability, survey data collection and range of harms.

Conclusions

We offer some suggestions for study design to enhance causal inferences from studies examining alcohol's harm to others.