Keyes Katherine M, Schulenberg John E, O'Malley Patrick M, Johnston Lloyd D, Bachman Jerald G, Li Guohua, Hasin Deborah
Arch Gen Psychiatry. 2012 Dec;69(12):1304-13. doi: 10.1001/archgenpsychiatry.2012.787.
CONTEXT The substantial changes in adolescent alcohol use prevalence over time suggest that population-level environmental factors are important determinants of use, yet the potential influence of such environmental factors is inadequately understood. OBJECTIVE To investigate whether adolescents in birth cohorts and/or time periods characterized by restrictive social norms toward alcohol were at decreased risk for alcohol use and binge drinking, controlling for individual attitudes (disapproval) toward use. DESIGN, SETTING, AND PARTICIPANTS In 32 annual national surveys of US high school students, a total of 967 562 students contributed outcome data from 1976 through 2007. MAIN OUTCOME MEASURES Frequency of past-year alcohol use and any instance of binge drinking (≥5 drinks) in the past 2 weeks, analyzed using multilevel models clustering individuals within periods and birth cohorts. Period- and cohort-specific social norm scores (indicating the proportion disapproving of weekend binge drinking) were modeled as predictors, controlling for individual attitudes and demographic characteristics. RESULTS Individuals who matured in birth cohorts with more restrictive social norms were less likely to use alcohol compared with individuals who matured in cohorts with more permissive norms; each 5% increase in the cohort-specific disapproval was associated with a 12% decrease in the odds of past-year alcohol use (odds ratio = 0.88; 99% CI, 0.87-0.89). The effects of cohort-specific disapproval were notably stronger among white adolescents than nonwhite adolescents. CONCLUSIONS This study documents the importance of considering time-varying population-level risk factors in the study of adolescent alcohol use and indicates that, even after an individual's personal attitudes are accounted for, risk is shaped by cohort effects whereby the norms within the cohort contribute to the risk of adolescent alcohol use.
背景 青少年饮酒流行率随时间的显著变化表明，人群层面的环境因素是饮酒行为的重要决定因素，但此类环境因素的潜在影响尚未得到充分理解。目的 探讨在以对酒精持限制社会规范为特征的出生队列和/或时间段中的青少年，在控制个人对饮酒的态度（不赞成）的情况下，饮酒和暴饮的风险是否降低。设计、背景和参与者 在对美国高中生进行的32次年度全国性调查中，共有967562名学生提供了1976年至2007年的结果数据。主要结局指标 过去一年饮酒的频率以及过去2周内任何一次暴饮（≥5杯）的情况，使用多水平模型进行分析，该模型对时间段和出生队列中的个体进行聚类。将特定时间段和队列的社会规范得分（表明不赞成周末暴饮的比例）作为预测因素进行建模，同时控制个人态度和人口统计学特征。结果 与在规范较为宽松的队列中成熟的个体相比，在社会规范更为严格的出生队列中成熟的个体饮酒的可能性较小；特定队列中不赞成比例每增加5%，过去一年饮酒的几率就会降低12%（优势比=0.88；99%可信区间，0.87-0.89）。特定队列不赞成的影响在白人青少年中比在非白人青少年中更为明显。结论 本研究证明了在青少年饮酒研究中考虑随时间变化的人群层面风险因素的重要性，并表明，即使考虑了个体的个人态度，风险仍受队列效应的影响，即队列中的规范会影响青少年饮酒的风险。
