Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland.
Eur J Public Health. 2020 Apr 1;30(2):357-363. doi: 10.1093/eurpub/ckz136.
The school context is associated with adolescent alcohol use, but it is not clear whether this association continues into adulthood. This study examined whether exposure to drunkenness oriented drinking culture in 9th grade school class is associated with individuals' heavy episodic drinking (HED) from adolescence to midlife.
Participants in the 'Northern Swedish Cohort' study aged 16 years in 1981 were followed-up when aged 18, 21, 30 and 43 (N = 1080). Individual-level factors were HED, positive attitudes towards drunkenness, early initiation of HED and peer-oriented spare-time. School class-level drinking culture was measured as classmate reported HED, positive attitudes, early initiation of HED and peer-oriented spare time. Multilevel log-binomial regression analyses were adjusted for gender, parental socioeconomic background, family structure and HED at age 16.
After adjustment for sociodemographic factors several cross-sectional and longitudinal associations were found between class-level indicators of drinking culture and individual HED. After additional adjustment for age 16 HED, most associations attenuated. The risk ratio (95% confidence interval) for engaging in HED at age 43 was 1.58 (1.03-2.42) times higher for those who at age 16 had many classmates reporting positive attitude towards drunkenness.
These findings suggest that drinking culture in school may have a long-lasting impact on drinking habits in adulthood. The associations with HED at follow-ups are likely mediated by HED in adolescence. Studies on alcohol use would benefit from taking into account both individual and contextual factors in a life course perspective.
学校环境与青少年饮酒行为有关，但尚不清楚这种关联是否会持续到成年期。本研究旨在探讨 9 年级班级中学生醉酒导向的饮酒文化暴露是否与个体从青春期到中年期的重度间断性饮酒（HED）有关。
“瑞典北部队列研究”的参与者在 1981 年 16 岁时入组，随后在 18、21、30 和 43 岁时进行随访（N=1080）。个体水平的因素包括 HED、对醉酒的积极态度、HED 的早期开始和同伴导向的业余时间。班级层面的饮酒文化通过同学报告的 HED、对醉酒的积极态度、HED 的早期开始和同伴导向的业余时间来衡量。多水平对数二项式回归分析调整了性别、父母社会经济背景、家庭结构和 16 岁时的 HED。
在调整了社会人口因素后，发现班级层面的饮酒文化指标与个体 HED 之间存在几种横断面和纵向关联。在进一步调整了 16 岁时的 HED 后，大多数关联减弱。在 43 岁时发生 HED 的风险比（95%置信区间）对于那些在 16 岁时有许多同学报告对醉酒的积极态度的人来说，是 1.58（1.03-2.42）倍。
这些发现表明，学校的饮酒文化可能对成年期的饮酒习惯产生持久影响。与后续 HED 的关联可能是通过青春期的 HED 来介导的。从生命历程的角度考虑个体和环境因素，对酒精使用的研究将从中受益。
