National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, New South Wales, Australia;
National Centre for Youth Substance Use Research and.
Pediatrics. 2020 Oct;146(4). doi: 10.1542/peds.2020-0440. Epub 2020 Sep 23.
Adolescents often display heterogenous trajectories of alcohol use. Initiation and escalation of drinking may be important predictors of later harms, including alcohol use disorder (AUD). Previous conceptualizations of these trajectories lacked adjustment for known confounders of adolescent drinking, which we aimed to address by modeling dynamic changes in drinking throughout adolescence while adjusting for covariates.
Survey data from a longitudinal cohort of Australian adolescents ( = 1813) were used to model latent class alcohol use trajectories over 5 annual follow-ups (mean age = 13.9 until 17.8 years). Regression models were used to determine whether child, parent, and peer factors at baseline (mean age = 12.9 years) predicted trajectory membership and whether trajectories predicted self-reported symptoms of AUD at the final follow-up (mean age = 18.8 years).
We identified 4 classes: abstaining ( = 352); late-onset moderate drinking ( = 503); early-onset moderate drinking ( = 663); and early-onset heavy drinking ( = 295). Having more alcohol-specific household rules reduced risk of early-onset heavy drinking compared with late-onset moderate drinking (relative risk ratio: 0.31; 99.5% confidence interval [CI]: 0.11-0.83), whereas having more substance-using peers increased this risk (relative risk ratio: 3.43; 99.5% CI: 2.10-5.62). Early-onset heavy drinking increased odds of meeting criteria for AUD in early adulthood (odds ratio: 7.68; 99.5% CI: 2.41-24.47).
Our study provides evidence that parenting factors and peer influences in early adolescence should be considered to reduce risk of later alcohol-related harm. Early initiation and heavy alcohol use throughout adolescence are associated with increased risk of alcohol-related harm compared with recommended maximum levels of consumption (late-onset, moderate drinking).
青少年的饮酒行为通常表现出异质性轨迹。饮酒的开始和升级可能是日后伤害的重要预测因素，包括酒精使用障碍（AUD）。以前对这些轨迹的概念化缺乏对青少年饮酒的已知混杂因素的调整，我们旨在通过在调整协变量的同时，对整个青春期的饮酒动态变化进行建模来解决这些问题。
使用来自澳大利亚青少年纵向队列的调查数据（n=1813），对 5 次年度随访期间的潜在类别饮酒轨迹进行建模（平均年龄为 13.9 岁至 17.8 岁）。回归模型用于确定基线时（平均年龄为 12.9 岁）的儿童、父母和同伴因素是否预测轨迹成员身份，以及轨迹是否预测最终随访时的 AUD 自我报告症状（平均年龄为 18.8 岁）。
我们确定了 4 个类别：不饮酒（n=352）；晚发性中度饮酒（n=503）；早发性中度饮酒（n=663）；早发性重度饮酒（n=295）。与晚发性中度饮酒相比，更多的酒精特定家庭规则降低了早发性重度饮酒的风险（相对风险比：0.31；99.5%置信区间[CI]：0.11-0.83），而更多的使用物质的同伴则增加了这种风险（相对风险比：3.43；99.5%CI：2.10-5.62）。早发性重度饮酒增加了成年早期符合 AUD 标准的几率（比值比：7.68；99.5%CI：2.41-24.47）。
我们的研究提供了证据表明，青少年早期的父母因素和同伴影响应该被考虑以降低日后酒精相关伤害的风险。与推荐的最大消费水平（晚发性，中度饮酒）相比，整个青春期的早期开始和大量饮酒与更高的酒精相关伤害风险相关。
