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Aim: We sought to elucidate whether stress, peers, and in vivo (i.e., direct) alcohol cues elicit alcohol craving in daily life among adolescents and to test whether individual variation in working memory function and biological sex alters these associations., Methods: We leveraged ecological momentary assessment (EMA) to examine momentary associations between stress, peers, and direct alcohol cues with craving, assessed as "urge to drink alcohol," among 86 male (51.2 %) and female (48.8 %) frequent drinkers (i.e., two or more drinking days per week). Participants were ages 14-24 years (M = 20.7 years, SD = 2.1). Participants completed EMA throughout the day for about one week prior to randomization to a treatment condition for an AUD clinical trial. Pre-registered, secondary analyses focused on craving for assessments when adolescents were not drinking, and assessments occurring after drinking on drinking days were removed. Working memory performance was assessed in the laboratory via the Memory for Words subtest of the Woodcock-Johnson III Tests of Cognitive Abilities., Results: Craving was heightened at more stressful moments and when adolescents were with their peers and in the presence of direct alcohol cues. Working memory function was not related to craving but altered the relation of momentary stress, peers, and cues with craving once biological sex-related differences were considered. Females generally had lower craving than males, but working memory function served to buffer against stress-induced craving for males., Conclusions: Higher working memory function buffered the in-the-moment relation of stress with alcohol craving for males but not females., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Epidemiological evidence suggests offspring exposed to prenatal alcohol are at increased risk of alcohol use disorders in adulthood. The evidence on the risk of developing harmful alcohol use in adolescence is less clear., Methods: We used data from the Raine Study, a multi-generational birth cohort study, to examine the association between prenatal alcohol exposure and the risk of harmful alcohol use in offspring at the age of 17 years. Log binomial regression was used to estimate the relative risks (RRs) of harmful alcohol use in offspring exposed to maternal alcohol use in the first (early) and third (late) trimesters of pregnancy. Maternal pre-pregnancy alcohol use was used as a negative control for intrauterine exposure for comparison., Results: Complete data were available for 1200 mother-offspring pairs. After adjustment for potential confounders, we found increased RRs of harmful alcohol use in offspring born to mothers who consumed four or more standard drinks of alcohol per week during the first trimester [RR 1.45(95% CI: 1.08-1.93)], third trimester [RR 1.34 (95% CI: 1.04-1.72)] and during both trimesters of pregnancy [RR 1.86 (95% CI: 1.16-2.96)]. Maternal pre-pregnancy alcohol use was not associated with an increased risk of harmful alcohol use in offspring [RR 1.15 (95% CI: 0.89-1.48)]., Conclusion: Observed associations for maternal prenatal alcohol exposure but not maternal pre-pregnancy alcohol use suggests a biological mechanism for intrauterine alcohol exposure on the risk of harmful alcohol use in the offspring., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective: Developmental theory posits interacting individual and contextual factors that contribute to alcohol use across adolescence. Despite the well-documented salience of peer environmental influences on adolescent drinking, it is not known whether peer environments moderate polygenic risks for trajectories of alcohol use. The current theoretically based investigation aimed to test developmental gene-environment interaction (G×E) effects across adolescence., Method: Latent growth curve models tested interactive associations of polygenic risk scores and adolescents' perceived friend drinking and disruptive behavior with adolescents' initial level of alcohol use frequency at age 16 years old and change in alcohol frequency from ages 16 to 20. The sample comprised 8,941 White adolescents (49% female) from Great Britain within the Avon Longitudinal Study of Parents and Children (ALSPAC)., Results: Greater polygenic risk was associated with more frequent initial drinking as well as escalations in drinking frequency over the subsequent 5 years in latent growth curve models. Contrary to study hypotheses, no significant G×E effects were identified after controlling for confounding main and interaction effects., Conclusions: Adolescents at heightened genetic risk may accelerate their alcohol use across adolescence, although not significantly more so in the presence of these alcohol-promoting peer environments. Future well-powered, theoretically driven replication efforts are needed to examine generalizability of these findings across diverse samples.

Background: As e-cigarette use continues to increase in the U.S., research is needed to understand its prospective risk for cigarette smoking and other substance use in young adulthood, including alcohol, marijuana, and nonmedical prescription drugs (NMPDs)., Methods: This study used data from the Monitoring the Future (MTF) study a nationally representative annual survey of 12 th graders (modal age 18) in the US. The analytic sample included 2014-2016 MTF cohorts that were selected and completed follow up one year later (modal age 19; n = 717). Using logistic regression, we examined cross-sectional and prospective associations of past 30-day e-cigarette use with past 30-day cigarette, alcohol, marijuana, and NMPD use. We examined prospective associations among the full sample and associations with incidence of each of these substances among those who reported no history of use in 12 th grade., Results: In cross-sectional analysis, those who reported past 30-day e-cigarette use at age 18 were more likely to report past 30-day cigarette use, alcohol use, marijuana use, and NMPD use at age 19. In multivariable longitudinal analysis, past 30-day e-cigarette users at age 18 were more likely to report past 30-day cigarette, marijuana, and NMPD use at age 19, including e-cigarette users who had no history of using these substances at age 18., Conclusions: This study suggests that e-cigarette use may be an indicator of future substance use risk in young adulthood. Adolescent e-cigarette users may benefit from secondary prevention efforts to mitigate this risk., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Introduction and Aims: Adolescent drinking has decreased in numerous high-income countries in the 2000s, and how to explain this downward trend is far from clear. Focussing on the decline in drinking to intoxication among youth in Norway, we examined the following potential explanatory factors: family/home-based and peer-oriented leisure-time activities, perceived parental drinking, drug substitution, school conscientiousness and delinquency., Design and Methods: Data stemmed from cross-sectional surveys of adolescents aged 13-17 years in the four largest cities in Norway in 2002 (n = 1204) and in 2013/2015 (n = 31 441). We examined the extent to which the decline in intoxication prevalence was attributable to the possible explanatory variables using logistic regression analysis., Results: The proportion reporting any past-year intoxication episodes dropped markedly from 2002 (41%) to 2013/2015 (22%). Family/home-oriented leisure-time activities and school conscientiousness increased, whereas hanging out with friends in the evening and delinquent behaviours decreased. These factors together accounted for 43% of this decline. Decrease in going out with friends was the most important factor. We found no empirical support for assumptions that perceived parental drinking or drug substitution had contributed to the decrease in drinking to intoxication., Discussion and Conclusions: Since the millennium shift, urban adolescents in Norway have become more home-, family- and school-oriented, and less involved in unsupervised socialising with peers and delinquency. These changes may have contributed to some of the reduction in the prevalence of intoxication in this population group., (© 2020 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Background: Adolescent drug use has long term health consequences, like substance use disorders and psychiatric illnesses. Proximal health risks, especially for overdose, are amplified when multiple substances are combined. Existing literature on polysubstance use among adolescents has largely focused on alcohol, tobacco, and marijuana, but has largely excluded other drugs like opioids. Understanding how adolescents combine illicit drugs is essential for intervening to prevent poor health outcomes., Methods: We aimed to explore patterns of lifetime polysubstance use among adolescents in Baltimore City. We used data on 9th-12th graders recruited to participate in the 2017 local Baltimore Youth Risk Behavior Survey who reported any lifetime drug use (n = 387; 60 % female, 77 % non-Hispanic Black). We then conducted a latent class analysis using 10 indicators of lifetime drug and alcohol use. After selecting the class model, we tested for associations between the class profiles and race, sex, school grade, and lifetime injection drug use., Results: We identified three profiles of lifetime polysubstance use in our sample: alcohol and marijuana (68.6 % of sample), polysubstance (22.0 %), and alcohol/pain medication/inhalant use (9.4 %). Members of the polysubstance use class were more likely to be male and to report injection drug use., Conclusions: Understanding broader patterns of drug use beyond alcohol, tobacco and marijuana among adolescents is a crucial step towards preventing adverse drug and health-related outcomes later in life. More research is needed to characterize the full health impact of youth polysubstance use patterns and related risk behaviors like injection drug use., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: There are thousands of e-liquid flavors available, and some are named after alcohol beverages (e.g., "pina colada"). It is unclear whether use of e-liquids with alcohol beverage names is associated with adolescent alcohol use. E-cigarettes and alcohol are co-used in adolescents; therefore, it is important to investigate these associations., Methods: Eight Southeastern Connecticut high schools were surveyed in Spring 2015 (N = 7045). We examined the association between preference for using e-liquid flavors and alcohol drinking status (i.e., no past month alcohol use, past month alcohol use but no binge drinking, and past month binge drinking) in ever e-cigarette users (N = 1311)., Results: Among ever e-cigarette users who preferred using e-liquids with alcohol beverage names (N = 111), 30.6 % had no past month alcohol use, 19.8 % had past month alcohol use but did not binge drink in the past month, and 49.5 % binge drank in the past month. Multinomial logistic regression (controlling for demographics and including other e-cigarette flavors that were highly endorsed, i.e., fruit and candy) revealed that the preferences of alcohol beverage-named-e-liquid (OR: 2.84, CI: 1.70-4.75) and fruit flavored e-liquids (OR: 1.55, CI: 1.14-2.11), but not candy flavored e-liquids was associated with past-month binge drinking compared to no past-month alcohol use., Conclusion: This evidence suggests that the preference for using alcohol beverage- and fruit-named e-liquid flavors is associated with past-month binge drinking among adolescents. Understanding the associations between alcohol beverage-named e-liquids and alcohol use in adolescents may help inform tobacco regulatory strategies that aim to decrease the use/appeal of e-cigarettes., Competing Interests: Declaration of Competing Interest Dr. Morean is a consultant for Gofire, Inc, with a restricted stock agreement. All other authors have no financial relationships relevant to this article to disclose., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective: The purpose of this randomized controlled study was to examine sex as a moderator of the efficacy of a brief, web-based personalized feedback intervention (eCHECKUP TO GO) on decreasing cognitive risk factors for alcohol use, increasing protective behavioral strategies, and reducing alcohol use among high school seniors., Method: Participants (n = 311) were high school seniors randomized by class period to the eCHECKUP TO GO intervention or assessment-only control group. Participants completed online surveys at baseline and 30-day follow-up (91.0%; n = 283)., Results: Students in the intervention group reported a significant reduction in normative perceptions of peer drinking, positive alcohol expectancies, and alcohol use relative to those in the control group. Intervention effects for perceptions of frequency of peer drunkenness and frequency of alcohol use were moderated by sex, with results favoring females. In contrast, we did not find evidence for sex as a moderator of intervention effects for normative perceptions of peer drinking frequency, sex-specific perceptions of peer heavy episodic drinking, positive alcohol expectancies, or peak drinking quantity. Further, we did not find significant intervention or moderator effects for protective behavioral strategies., Conclusions: Results of this study extend the literature by demonstrating the efficacy of the eCHECKUP TO GO for both males and females on reducing cognitive risk factors and alcohol use, although results were significant for a broader range of variables for females. Results also indicate that program content regarding normative feedback and protective behavioral strategies may need modification to be more effective for this age group.

Background: The present study aims to (i) identify patterns in the changes of endorsed positive alcohol expectancies (AEs) through early adolescence and (ii) examine associated childhood social context predictors of such profiles., Methods: We used three waves of longitudinal data from the Alcohol-Related Experiences among Children. The baseline sample comprised 928 6th graders from 17 elementary schools in northern Taiwan (response rate = 60 %); subsequent follow-up was conducted at 7th and 8th grade (follow-up rate = 88 %). Data concerning three domains of positive AEs (i.e., global positive transformation, enhancing social behaviors, and promoting relaxation), social context, and alcohol drinking were collected by self-administered questionnaires. Longitudinal latent profile and survey multinomial logistic regression analyses were used to evaluate the association estimates, stratified by childhood alcohol initiation., Results: Three distinct profiles (decreasing, stable, and increasing) of positive AEs were identified for the alcohol-naïve children (n = 466); observing paternal drinking and watching TV more than two hours per day at baseline were strongly linked with the stable and increasing AE profiles (aOR = 1.96-4.80). For the alcohol-experienced children, four profiles (low decreasing, low increasing, high decreasing, and high increasing) emerged; observing maternal drinking was predictive for the high-increasing profile (aOR = 2.94). Regardless of childhood alcohol initiation, recent alcohol use appeared to be the strongest predictor for the increasing profiles of positive AEs., Conclusions: Strategies addressing pro-alcohol social contexts that facilitate a prominent increase in positive AEs should be considered when devising preventive programs targeting underage drinking behaviors and problems., Competing Interests: Declaration of competing interest The authors declare no conflict of interest with respect to the conduct or content of this work., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background and Aims: Youth alcohol consumption has declined significantly during the past 15 years in many high-income countries, which may have significant public health benefits. However, if the reductions in drinking occur mainly among lighter drinkers who are at lower risk, then rates of alcohol-related harm among young people today and adults in future may not fall in line with consumption. There is conflicting evidence from Swedish school studies, with some suggesting that all young people are drinking less, while others suggest that alcohol consumption among heavier drinkers may be stable or rising while average consumption declines. This paper extends the geographical focus of previous research and examines whether the decline in youth drinking is consistent across the consumption distribution in England., Design: Quantile regression of 15 waves of repeat cross-sectional survey data., Setting: England, 2001-16., Participants: A total of 31 882 schoolchildren (50.7% male) aged 11-15 who responded to the Smoking Drinking and Drug Use among Young People surveys., Measurements: Past-week alcohol consumption in UK units at each fifth percentile of the consumption distribution., Findings: Reductions in alcohol consumption occurred at all percentiles of the consumption distribution analysed between 2001 and 2016, but the magnitude of the decline differed across percentiles. The decline in consumption at the 90th percentile [β = -0.21, confidence interval (CI) = -0.24, -0.18] was significantly larger than among either lighter drinkers at the 50th percentile (β = -0.02, CI = -0.02, -0.01) or heavier drinkers at the 95th percentile (β = -0.16, CI = -0.18, -0.13)., Conclusions: Alcohol consumption among young people in England appears to be declining across the consumption distribution, and peaks among heavy drinkers. The magnitude of this decline differs significantly between percentiles of the consumption distribution, with consumption falling proportionally less among the lightest, moderate and very heaviest youth drinkers., (© 2019 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)

Background: Peer victimization is consistently linked to adolescents' alcohol use. However, the relative influence of relational and physical peer victimization on alcohol use, and timing of drinking initiation, is not well understood. In this study, we evaluate the impact of both relational and physical peer victimization on adolescent girls' alcohol use initiation, and the extent to which depression severity moderates these associations., Methods: Participants were 2,125 girls in the Pittsburgh Girls Study, a longitudinal community-based study. Participants reported experiences of relational and physical peer victimization, depression severity, and alcohol use each year from ages 10 to 17. Cox proportional hazards (PH) regression analyses predicting the timing of first drink were conducted in 2 stages, testing for main effects of peer victimization in Model 1 and moderation by depression severity in Model 2., Results: Analyses were split at age 14 to adjust for PH violations. Model 1 results supported a main effect for relational (Hazards ratio [HR] = 1.83, CI: 1.46 to 2.28 ≤ age 13; HR = 1.23, CI: 1.05 to 1.45 ≥ age 14) but not physical victimization on timing of alcohol use onset (HR = 1.10, CI: 0.88 to 1.39). Model 2 results show that depression severity moderates the association between relational victimization and alcohol use initiation: the association between relational victimization and early alcohol use onset was stronger for lower depression severity (-1 SD HR = 2.38, CI: 1.68 to 3.39 ≤ age 13; -1 SD HR = 1.48, CI: 1.10 to 1.52 ≥ age 14)., Conclusions: Results demonstrate that relational (and not physical) victimization predicts earlier drinking among adolescent girls. Relational peer victimization conferred greater risk for alcohol use initiation when depression severity was lower, whereas girls with high depression severity engaged in early alcohol use regardless of peer victimization. Results suggest that interventions focused on relational peer victimization may have spillover effects for delaying girls' alcohol use initiation, particularly in early adolescence, when this association is most robust., (© 2019 by the Research Society on Alcoholism.)

Background: The primary objective of this study is to determine whether age at first alcohol use is a determinant for adolescent acute alcohol intoxication characteristics, such as age at first acute alcohol intoxication and blood alcohol concentration (BAC) at hospital admission. Around the world, as in the Netherlands, a key aim of alcohol policy is to postpone the age at first alcohol use. This is based on cohort studies that indicate a relationship between a younger age at first alcohol use and subsequent adult alcohol use disorders., Methods: This study was conducted using a cohort of data comprising individuals under 18 years of age. Data were collected between 2007 and 2017 by the Dutch Pediatric Surveillance System (NSCK) in order to monitor trends in admissions for acute alcohol intoxication. Multivariate linear regression analyses were used to determine the association between age at first alcohol use and acute alcohol intoxication characteristics, such as age at first acute alcohol intoxication and BAC at admission., Results: This study indicates that among adolescents admitted for acute alcohol intoxication, adolescents who started drinking at ≤ 14 years of age are significantly more often female, lower educated, and raised in nontraditional family structures than adolescents who started drinking between 15 and 18 years of age. Multiple linear regression analyses indicated that age at first alcohol use, corrected for covariates, significantly predicted the age at acute alcohol intoxication and BAC at admission. The association between age at first alcohol use and age at intoxication was also found to be clinically relevant., Conclusions: Although causation cannot be implied based on the results of these analyses, the results of this study suggest that interventions delaying the age at first alcohol use could be successful in increasing the average age that adolescents are admitted to the hospital for acute alcohol intoxication., (© 2019 The Authors. Alcoholism: Clinical & Experimental Research published by Wiley Periodicals, Inc. on behalf of Research Society on Alcoholism.)

Background: Using intergenerational prospective data from the Millennium Cohort Study (MCS), we examine whether parents allowing 14-year-olds to drink alcohol is associated with greater likelihood of early adolescents' heavy episodic drinking (i.e., lifetime, rapid escalation from first drink, and frequent past year), beyond shared risk factors for parental alcohol permissiveness and adolescent alcohol use., Methods: The MCS is a unique, contemporary, nationally representative study with mother, father, and child data from infancy through age 14 years (n = 11,485 children and their parents). In a series of multivariate logistic regressions, we estimated whether teenagers whose parents allowed them to drink alcohol (16% of parents said "yes") faced an elevated likelihood of heavy alcohol use at age 14, controlling for a large host of likely child and parent confounders measured when children were age 11. To further assess plausible intergenerational associations of parental alcohol permissiveness and offspring heavy alcohol use, coarsened exact matching (CEM) was used to match 14-year-olds whose parents allowed them to drink alcohol with teens whose parents did not allow them to drink on these childhood antecedent variables., Results: Adolescents whose parents allowed them to drink had higher odds of heavy drinking (odds ratio [OR] = 2.40; 95% confidence interval [CI] = 1.96 to 2.94), rapidly escalating from initiation to heavy drinking (OR = 1.94; CI = 1.52 to 2.49), and frequent heavy drinking (OR = 2.32; 1.73 to 3.09), beyond child and parent confounders and using CEM methods., Conclusions: Adolescents who were allowed to drink were more likely to have transitioned quickly from their first drink to consuming 5 or more drinks at 1 time and to drinking heavily 3 or more times in the past year. Given well-documented harms of adolescent heavy drinking, these results do not support the idea that parents allowing children to drink alcohol inoculates them against alcohol misuse., (© 2019 by the Research Society on Alcoholism.)

Background: Adolescents who live near more alcohol outlets tend to consume more alcohol, despite laws prohibiting alcohol purchases for people aged <21 years. We examined relationships between adolescents' exposure to alcohol outlets, the sources through which they access alcohol, and their alcohol consumption., Methods: Participants for this longitudinal study (n = 168) were aged 15-18 years and were from 10 cities in the San Francisco Bay Area. We collected survey data to measure participant characteristics, followed by 1 month of GPS tracking to measure exposure to alcohol outlets (separated into exposures near home and away from home for bars, restaurants, and off-premise outlets). A follow-up survey approximately 1 year later measured alcohol access (through outlets, family members, peers aged <21 years, peers aged ≥21 years) and alcohol consumption (e.g. count of drinking days in last 30). Generalized structural equation models related exposure to alcohol outlets, alcohol access, and alcohol consumption., Results: Exposure to bars and off-premise outlets near home was positively associated with accessing alcohol from peers aged <21, and in turn, accessing alcohol from peers aged <21 was positively associated with alcohol consumption. There was no direct association between exposure to alcohol outlets near home or away from home and alcohol consumption., Conclusions: Interventions that reduce adolescents' access through peers aged <21 may reduce adolescents' alcohol consumption., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Purpose: Certain groups, particularly sexual minority youth, demonstrate notable disparities in alcohol use risk. Assessing trends in alcohol use behaviors by sexual orientation over time is therefore important to the epidemiologic study of adolescent health equity., Methods: We analyzed age at first drink, lifetime drinking behavior, current drinking, and binge drinking in a large, national sample of high school youth across six time points, beginning in 2007 and biennially through 2017. We assessed trends by sex, sexual identity, and sexual behavior, controlling for race/ethnicity and age., Results: Our results demonstrated that, although overall alcohol use is decreasing among youth, disparities between heterosexual and sexual minority youth remain significant. The largest decreases were seen in current alcohol use among lesbian youth, which fell from a prevalence of 56.1% in 2007 to 38.9% in 2017, and among bisexual females (64.3% in 2007 to 41.1% in 2017). Despite this, alcohol use behaviors were still elevated among lesbian and bisexual female youth compared with heterosexual sex-matched counterparts. Heterosexual-identified male students saw significant decreases in alcohol use, whereas most alcohol use behaviors among sexual minority males decreased but not to a statistically significant degree, with the exception of binge drinking among those who identified as gay (2007: 36.0% to 2017: 12.6%) and bisexual (2007: 24.7% to 2017: 11.6%). Results by sexual behavior are presented within., Conclusions: Sexual minority youth continued to demonstrate markedly high prevalence of alcohol use behaviors compared with heterosexual peers across all time points. Downward trends in alcohol use may thus mask serious population health risks if not adequately explored. Research and health promotion efforts must consider sexual minority orientation to avoid incomplete or inaccurate representation of findings., (Copyright © 2019 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

This study examined the parallel mediational processes between sensation seeking and parental rules on alcohol, in the emergence of heavy episodic drinking (HED) in adolescents. Data were drawn from a U.K. clustered randomized control trial (control arm only, N ≈ 6,300, M age at baseline = 12.5). Using parallel process latent growth curve analysis, stricter parental rules at baseline were found to be associated with greater declines in sensation seeking over time and a lower risk of HED at follow-up (+33 months). Higher initial levels of sensation seeking predicted a faster relaxation of parental rules and a greater risk of HED. By maintaining strict rules about alcohol, parents may promote a positive reduction in sensation seeking and a lower risk of HED., (© 2018 Society for Research on Adolescence.)

Rationale: Alcohol consumption in adolescents and emerging adults is a significant issue. However, our understanding of the topography of alcohol use within drinking episodes in this population is at a nascent stage., Objectives: This study characterized rate of alcohol consumption in the daily lives of problem drinkers ages 16-24 years (N = 75). We examined whether AUD symptoms and the presence of peers, factors relevant to alcohol consumption in youth, were associated with rate of consumption., Methods: Ecological momentary assessment (EMA) was used (N observations  = 799). Rate of consumption was defined as change in estimated blood alcohol concentration (eBAC) relative to the start of the drinking episode. Piecewise multi-level modeling was used to test hypotheses. As a comparison, we examined whether indicators of quantity and frequency (Q-F) were associated with AUD symptoms and presence of peers., Results: For all participants, eBAC increased sharply early in the episode, then plateaued. Participants with more AUD symptoms or who were in the presence of peers had significantly steeper increases in eBAC over the early part of the episode. Participants with more AUD symptoms were also more likely to engage in binge-like behavior. For Q-F, only peak eBAC and peak number of standard drinks were associated with AUD symptoms, and not presence of peers., Conclusions: Findings highlight the value of rate of consumption as an indicator of use in youth, one sensitive to the influence of relevant person-level and situational factors. Intervention efforts may benefit from targeting the speed at which youth drink.

Background: Substance use by young people is strongly associated with that of their peers. Little is known about the influence of different types of peers. We tested the relationship between perceived substance use by five types of peers and adolescents' use of illicit drugs, smoking, and alcohol consumption., Methods: We used data collected from 1285 students aged 12-13 as part of a pilot cluster randomized controlled trial (United Kingdom, 2014-2016). The exposures were the perceived use of illicit drugs, smoking and alcohol consumption by best friends, boy or girlfriends, brothers or sisters, friends outside of school and online. Outcomes were self-reported lifetime use of illicit drugs, smoking and alcohol consumption assessed 18-months later., Results: The lifetime prevalence of illicit drug use, smoking and alcohol consumption at the 18-month follow-up were 14.3%, 24.9% and 54.1%, respectively. In the fully adjusted models, perceived substance use by friends outside of school, brothers or sisters, and online had the most consistent associations with outcomes. Perceived use by friends online was associated with an increased risk of ever having used illicit drugs (odds ratio [OR] = 2.43, 95% confidence interval [CI] = 1.26, 4.69), smoking (OR = 1.61, 95% CI 0.96, 2.70) and alcohol consumption (OR = 2.98, 95% CI = 1.71, 5.18)., Conclusions: Perceived substance use by friends outside of school, brothers and sisters and online could be viable sources of peer influence. If these findings are replicated, a greater emphasis should be made in interventions to mitigate the influence of these peers., (Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Adolescent alcohol consumption has fallen in most Western countries over the past two decades, while immigrants and children of immigrants from low-consumption countries constitute a growing proportion of teenagers in many Western nations. We investigate the extent to which immigrants and children of immigrants have contributed to the decline in adolescent heavy episodic drinking in Oslo, the capital of Norway., Methods: We use repeated cross-sectional survey data on adolescents in grades 9-11 in Oslo (aged around 14-16, N = 54,474) from 1996 to 2018. We use data on heavy episodic drinking/intoxication in the past 12 months (dichotomized), immigrant background, sex and grade. We decompose the trend into components attributable to changes in the demographic composition of the adolescent population (by immigrant background, grade and sex), and to changes in drinking patterns within different groups. Confidence intervals (CIs) are obtained by bootstrap resampling., Results: The proportion of adolescents with immigrant backgrounds increased from 21% to 35% over the time span. The proportion reporting having been intoxicated fell from 42% to 25%. Most of the decline stems from reduced heavy episodic drinking in the majority population, accounting for 70.8% of the reduction (95% CI: 67.5-74.2). The increased proportion of adolescents with an immigrant background accounts for 21.4% of the decline (95% CI: 19.2-23.8)., Conclusions: An increasing proportion of immigrants and children of immigrants with low alcohol consumption explains one-fifth of the decline in the prevalence of adolescent heavy episodic drinking in Oslo., (Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Alcohol use has decreased among Swedish adolescents in the past few decades. We examined peer and parent factors (i.e. time spent with peers, time spent with parents and parental monitoring) that could contribute to explaining this trend by investigating their main effects and interaction effects with investigation years on alcohol use. We furthermore examined whether municipality-level socioeconomic conditions could contribute to explaining the trend., Methods: We used data from a repeated cross-sectional study that took place eight times between 1988 and 2011. The study targeted all ninth grade students (15-16 years old) in Värmland County, Sweden. Adolescents (N = 22 257) reported their monthly alcohol use, time spent with peers and parents and parental monitoring. Municipality-level socioeconomic conditions were based on parent education levels., Results: Logistic multilevel regression analyses showed that peer and parent factors and municipality-level socioeconomic conditions were associated with alcohol use among adolescents. The interaction effects between peer and parent factors and investigation years were not significant. The decreased trend in time spent with peers was associated with the decreased trend in frequency of alcohol use over time., Conclusions: The findings of the current study provide an indication that the decreased trend in alcohol use that has been observed in Swedish adolescents over the past few decades may be related to changes in adolescents' social interactions with peers., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Public Health Association.)

Adolescence is a tumultuous period in the lifetime of an individual confronted to major changes in emotional, social and cognitive appraisal. During this period of questioning and doubt, while the executive functions are still maturing, the abstract reasoning remains vague and the response inhibition loose; ultimately the adolescent scarcely resists temptation. Consequently, adolescence is often associated with uninhibited risk-taking, reckless behaviours, among which are alcohol and illicit drugs use. Here, we discuss how the development of the prefrontal cortex (which critically contributes to rational decision-making and temporal processing of complex events) can be associated with the idiosyncratic adolescent behaviour, and potentially uncontrolled alcohol use. Most importantly, we present clinical and preclinical evidence supporting that ethanol exposure has deleterious effects on the adolescent developing brain. Ultimately, we discuss why a late maturing prefrontal cortex represents a ripe candidate to environmental influences that contribute to shape the adolescent brain but, potentially, can also trigger lifelong maladaptive responses, including increased vulnerability to develop substance use disorder later in life., (© 2018 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.)

Background: Why adolescents' drinking is associated with their parents' drinking remains unclear. We examined associations in a prospective cohort study, adjusting for socio-demographic characteristics and family factors., Methods: We recruited 1927 children from grade 7 classes (mean age 13 years), and one of their parents, in three Australian states, contacted participants annually from 2010 to 2014, and analysed data from assessments at ages 13, 14, 15 and 16 years. We used the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) subscale to identify hazardous drinking in parents (score ≥5) and children (score ≥3) and constructed mixed-effect logistic regression models, accounting for clustering within school and adjusting for likely confounders. We evaluated the sensitivity of estimates by imputing missing values assuming the data were missing at random vs. missing not at random., Results: Parent hazardous drinking predicted mid-adolescent hazardous drinking, e.g. 15 years olds whose parents [adjusted odds ratio (aOR) 2.00; 95% confidence interval 1.51-2.64] or parents' partners (aOR 1.94; 1.48-2.55) were hazardous drinkers had higher odds of being hazardous drinkers at age 16. The magnitude of univariate associations changed little after adjusting for covariates, and sensitivity analyses confirmed the robustness of the association, across a wide range of assumptions about the missing data., Conclusions: The associations between parents' and their adolescent children's hazardous drinking are unlikely to be due to confounding by socio-demographic and family factors. Parents should be encouraged, and supported by public policy, to reduce their own alcohol consumption in order to reduce their children's risk of becoming hazardous drinkers., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Aims: Alcohol-related blackouts can result in acute injuries and other negative outcomes. Among underage risky drinkers, we examined longitudinal trajectories of blackout frequency following an emergency department (ED) visit, and identified baseline characteristics associated with blackout trajectory membership., Methods: Participants (ages 14-20; N = 836) attending an ED who screened positive for risky drinking and enrolled in a randomized-controlled trial of brief alcohol interventions were assessed at baseline, 3-, 6-, and 12-months. We used group-based trajectory modeling to determine characteristic trajectories of blackout frequency over 12-months in relation to baseline characteristics: demographics, substance use, delinquency, depression/anxiety symptoms, sexual assault, dating violence, and peer and sibling influences., Results: We identified four groups: No/Low blackouts (n = 248; 29.7%), Declining blackouts (n = 92; 11.0%), Moderate blackouts (n = 337; 40.3%) and High blackouts (n = 159; 19.0%); group membership did not differ based on intervention receipt. In adjusted analyses, compared to the No/Low group all other groups had higher odds of having an alcohol-related baseline ED visit. Female sex, alcohol consumption, prescription drug misuse, sexual assault while incapacitated due to substances, and negative peer influences were positively associated with membership in the High group; College/Greek life involvement was also highest. Negative peer influences and being in high school (vs. College/Greek life) also distinguished the Moderate group., Conclusion: Blackout frequency was largely stable over time and riskier trajectories were marked by risk factors such as negative peer influences and college/Greek life involvement. Findings may inform targeted interventions, particularly for women who were in higher risk trajectories., (© The Author(s) 2019. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Background: Binge drinking accounts for several adverse health, social, legal, and academic outcomes among adolescents. Understanding trends and correlates of binge drinking and alcohol abstention has important implications for policy and programs and was the aim of this study. The current study examined trends in adolescent binge drinking and alcohol abstention by age, gender, and race/ethnicity over a 15-year period., Methods: Respondents between the ages of 12 and 17 years who participated in the National Survey on Drug Use and Health (NSDUH) between 2002 and 2016 were included in the sample of 258,309. Measures included binge drinking, alcohol abstention, and co-morbid factors (e.g., marijuana, other illicit drugs), and demographic factors., Results: Logistic regression analyses were conducted to examine the significance of trend changes by sub-groups while controlling for co-morbid and demographic factors. Findings indicated that binge drinking decreased substantially among adolescents in the US over the last 15 years. This decrease was shown among all age, gender, and racial/ethnic groups. In 2002, Year 1 of the study, 26% of 17-year-olds reported past-month binge drinking; in 2016, past-month binge drinking dropped to 12%. Findings also indicated comparable increases in the proportion of youth reporting abstention from alcohol consumption across all subgroups. Black youth reported substantially lower levels of binge alcohol use and higher levels of abstention, although the gap between Black, Hispanic and White youth narrowed substantially between 2002 and 2016., Conclusion: Study findings are consistent with those of other research showing declines in problem alcohol- use behavior among youth., (Copyright © 2019. Published by Elsevier B.V.)

Background: A range of school-based prevention programs has been developed and used to prevent, delay, or reduce alcohol use among adolescents. Most of these programs have been evaluated at the community-level impact. However, the effect of contextual risk factors has rarely been considered in the evaluation of these programs. The aim of this study was to investigate the potential moderating effects of 2 important contextual risk factors (i.e., socioeconomic status [SES] and peer victimization) on the effectiveness of the school-based personality-targeted interventions (Preventure program) in reducing adolescent alcohol use over a 2-year period using a cluster-randomized trial., Methods: High-risk adolescents were identified using personality scores on the Substance Use Risk Profile Scale and randomized to intervention and control groups. Two 90-minute cognitive behavioral therapy-based group sessions targeted 1 of 4 personality risk profiles: Anxiety Sensitivity, Hopelessness, Impulsivity, or Sensation Seeking. Multilevel linear modeling of alcohol use, binge drinking, and drinking-related harm was conducted to assess the moderating effect of baseline peer victimization and SES., Results: Results indicated that the Preventure program was equally beneficial to all adolescents, regardless of SES and victimization history, in terms of their alcohol outcomes and related harm. Receiving the intervention was additionally beneficial for adolescents reporting peer victimization regarding their alcohol-related harm compared to nonvictimized youth (β = -0.29, SE = 0.11, p = 0.014)., Conclusions: Findings suggest that the content of personality-targeted interventions is beneficial for all high-risk youth regardless of their SES or experience of peer victimization. The current study suggests that using targeted approaches, such as targeting underlying personality risk factors, may be the most appropriate substance use prevention strategy for high-risk youth, as it is beneficial for all high-risk youth regardless of their contextual risk factors., (© 2019 by the Research Society on Alcoholism.)

Recent surveys have found a strong decrease in alcohol consumption among young people and this trend has been identified in European countries, Australia and North America. Previous research suggests that the decline in alcohol consumption may be explained by changes in parenting style, increased use of social media, changes in gender identities or a health and fitness trend. We use qualitative interviews with drinking and non-drinking young people from Sweden (N = 49) to explore in what way and in what kinds of contexts these explanations may hold true and how they alone or together may explain declining alcohol consumption among young people. By using the pragmatist approach, we pay attention to what kinds of concerns, habits, practices, situations and meanings our interviewees relate to adolescents' low alcohol consumption or decline in drinking. By analyzing these matters, we aim to specify the social mechanisms that have reduced adolescents' drinking. Our paper discovers social mechanisms similar to previous studies but also a few that have previously been overlooked. We propose that the cultural position of drinking may have changed among young people so that drinking has lost its unquestioned symbolic power as a rite of passage into adulthood. There is less peer pressure to drink and more room for competing activities. This opening of a homogeneous drinking culture to the acceptance of differences may function as a social mechanism that increases the success of other social mechanisms to reduce adolescents' drinking. Furthermore, the results of the paper suggest a hypothesis of the early maturation of young people as more individualized, responsible, reflective, and adult-like actors than in earlier generations. Overall, the paper provides hypotheses for future quantitative studies to examine the prevalence and distribution of the identified social mechanisms, as well as recommends directions for developing effective interventions to support young people's healthy lifestyle choices., (Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.)

Aims: Population data suggest that a significant proportion of young drinkers are reducing or ceasing their alcohol use; however, there is a lack of information about the characteristics of young people who do so. Our study aimed to determine characteristics associated with self-reported attempted and successful alcohol reduction and cessation among young people in Victoria, Australia., Methods: Data are from a cross-sectional online survey with young people aged 15-29 years living in Victoria, Australia. Participants who reported consuming alcohol in the past 12 months were included in the analysis (N = 1,162)., Results: Alcohol drinking cessation in the past 12 months was reported by 3.8% (n = 44) and reduced alcohol consumption was reported by 32.1% (n = 371) of participants. Characteristics associated with trying to reduce or cease alcohol consumption were older age, being born overseas, drinking at hazardous levels, experiencing alcohol-related harms and interest in health content on social media. Characteristics associated with successful alcohol reduction or cessation were being born overseas and experiencing alcohol-related harm, while being a member of a religious group was negatively associated., Conclusions: Recent reduction in alcohol consumption was common among young people in this study. Recent reduction in alcohol consumption was common among young people in this study. A combination of factors appear to be correlated with recent attempts to reduce drinking young people including socio-demographic characteristics, religiosity, drinking practices and experience of harm, and interest in health., (© The Author(s) 2019. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Aim: To evaluate the effectiveness of a universal parent-oriented alcohol prevention program ("Effekt") in Estonia. The main objective of the program was to delay and reduce adolescents' alcohol consumption by maintaining parental restrictive attitudes towards adolescents' alcohol use over time., Methods: A matched-pair cluster randomized controlled trial with a three-year assessment period (baseline (T1), 18-months (T2) and 30-months (T3) follow-ups) was undertaken in 2012-2015 among 985 fifth grade adolescents and 790 parents in sixty-six schools (34 intervention, 32 control). The primary outcome measure was adolescents' alcohol use initiation. Secondary outcome measures were lifetime drunkenness and alcohol use in the past year. Intermediate outcomes were restrictive parental attitudes towards adolescents' alcohol use reported by parents and perceived restrictive parental attitudes and parental alcohol supply reported by adolescents., Results: There were no significant differences in adolescents' alcohol use initiation, lifetime drunkenness, alcohol use in the past year, parental alcohol supply, and adolescent's perception of parental restrictive attitudes between intervention and control school participants at T2 and T3. There were significant differences in parental attitudes - the odds of having restrictive attitudes were 2.05 (95% confidence interval (CI) = 1.32-3.17) times higher at T2 and 1.92 (95% CI = 1.31-2.83) times higher at T3 in the intervention group than in the control group., Conclusions: The Estonian version of the "Effekt" program had a positive effect on parental attitudes, but it did not succeed in delaying or reducing adolescents' alcohol consumption., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: Changes in gray matter volume and thickness are associated with adolescent alcohol and cannabis use, but the impact of these substances on surface area remains unclear. The present study expands on previous findings to examine the impact of alcohol and cannabis on surface area before and after use initiation., Method: Scans for 69 demographically similar youth were obtained at baseline (ages 12-14 years; before substance use) and at 6-year follow-up (ages 17-21 years). Participants were classified into three groups based on substance use: alcohol use initiators (ALC, n = 23), alcohol and cannabis use initiators (ALC+CU, n = 23), and individuals with minimal substance use (<3 lifetime alcohol and 0 marijuana use episodes; CON, n = 23). For each hemisphere, group differences in surface area across time (pre- and post-substance use initiation) and significant group-by-time interactions were examined individually for 34 cortical regions using repeated measures analysis of covariance. A vertex-wise analysis assessed group differences in surface area percent change., Results: A significant group-by-time interaction was found in three regions, bilateral medial orbitofrontal cortices and right insula. Although all regions showed decreases in surface area over time (ps < .05), a more substantial decrease was identified in the ALC group. Of note, the right medial orbitofrontal cortex survived the conservative vertex-wise analyses (p < .001), as a more substantial decrease was found in the ALC compared to the ALC+CU group in this region., Conclusions: Surface area in the medial orbitofrontal cortex may be a useful intermediate phenotype for exploring the mechanisms underlying the effects of substance use on brain development.

Background: The directionality of the relationship between impulsivity and heavy drinking patterns remains unclear. Recent research suggests it could be reciprocal and depends on different facets of impulsivity and different patterns of drinking. The aim of this study was to analyze this potential reciprocal relationship between self-reported and behavioral measures of impulsivity and sensation seeking with specific patterns of heavy drinking in a sample of Spanish adolescents across 2 years., Methods: The study has a cross-lagged prospective design in which participants were evaluated 3 times over 2 years (once a year). Participants were 1,430 adolescents (53.9% male; mean age at study commencement = 13.02, SD = 0.51) from 22 secondary schools in Spain. Computerized versions of the following instruments were used: 2 subscales of Impulsive Sensation Seeking, 2 behavioral measures (Stroop Test and Delay Discounting [DD] task), frequency of intoxication episodes (IE), and the Rutgers Alcohol Problem Index to evaluate alcohol-related problems (ARP). Random intercepts cross-lagged panel models of reciprocal relationships between impulsivity measures and alcohol use outcomes were used., Results: Individual levels of self-reported impulsivity and sensation seeking significantly predicted prospective involvement in IE and ARP. Performance in behavioral measures (Stroop Test and DD) did not predict subsequent heavy drinking or alcohol problems. No measure of drinking was found to be a significant predictor of prospective changes in impulsivity., Conclusions: Within-person levels of self-reported impulsivity and sensation seeking significantly predicted further heavy drinking from as early as 13 years old, whereas behavioral measures were not predictive. In our study, neither IE nor ARP predicted prospective changes in impulsivity. Further studies should address additional specific relationships between facets of impulsivity and specific outcomes of heavy drinking., (© 2018 by the Research Society on Alcoholism.)

Background: Globally, there is a male excess in the occurrence of heavy drinking once alcoholic beverages are consumed and some new evidence that this 'gender gap' might be null among underage drinkers. Here, we estimate age-specific male-female differences in heavy drinking episode (HDE) incidence across the first eight calendar-quarters after first full drink., Methods: Study population is non-institutionalized civilians in the United States (2006-2014). Standardized audio computer-assisted self-interviews were used to assess the date of first full drink and the date of first HDE (i.e., 5+ drinks on one occasion) among ∼33,000 12-to-21-year-old newly incident drinkers (all with 1st full drink and HDE evaluated within 24 months of drinking onset). Time-to-HDE survival analyses are used to estimate age-specific male-female ratios in the hazard of HDE onset., Results: We found that among early adolescent new drinkers (drinking onset at age 11-14), the newly incident drinking females progress to HDE more quickly than males (HR = 1.3, 95% CI = 1.1, 1.6). In contrast, male excess risk is observed when drinking starts at or after age 15 years. For underage drinkers, age-specific hazard ratios (HR) depend upon age at first full drink., Conclusions: Based on recent survey data from the US, this study's survival analyses support early adolescent female excess in the onset of HDE. When drinking starts at or after age 15 years, a male excess becomes apparent within two years since first full drink. Future studies may probe any sex-specific mechanisms toward the rapid onset of HDE at different age groups., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Parental alcohol problems are associated with adverse adolescent outcomes such as risky drinking and conduct problems. Important questions remain about the unique roles of fathers' and mothers' alcohol problems and differences and/or similarities in pathways of risk across ethnicity and gender. In this study, we used a family systems approach to consider spillover and crossover effects of fathers' and mothers' alcohol problems (number of alcohol dependence symptoms [ADS]) and parenting behaviors in relation to adolescents' risky drinking and conduct problems., Methods: The sample included 1,282 adolescents (aged 12 to 17) and their parents from the Collaborative Study on the Genetics of Alcoholism. Parents completed the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA), and adolescents completed an adolescent version of SSAGA. Data were analyzed using multivariate structural equation modeling., Results: Fathers' ADS count was associated with higher adolescent risky drinking and conduct problems indirectly via disruption to fathers' and mothers' positive parenting behaviors, whereas mothers' ADS count was not associated with adolescents' risky drinking and conduct problems directly or indirectly via positive parenting behaviors. No differences in these associations were found across ethnic background and offspring gender., Conclusions: Findings highlight the importance of considering the unique roles of fathers' and mothers' ADS in influencing family processes and adolescent outcomes., (© 2018 by the Research Society on Alcoholism.)

: media-1vid110.1542/5789654654001PEDS-VA&#95;2017-3498 Video Abstract BACKGROUND AND OBJECTIVES: Adolescent substance use is a prevalent modifiable health behavior; understanding long-term trends is essential to inform prevention efforts and public health policy. We investigated changes in the proportion of substance nonuse among adolescents over a 40-year period and associations between abstinence and individual risk and protective factors., Methods: Data from the nationally representative Monitoring the Future survey, administered 1975-2014, were analyzed to determine the annual proportion of abstinent students. The 2014 Monitoring the Future cohort was analyzed to determine associations between nonuse and risk and protective factors., Results: The prevalence of abstaining seniors between 1976 and 2014 increased fivefold for lifetime abstinence and more than doubled for past 30 days; similar increases were reported by younger students between 1991 and 2014. Trend lines were distinct for alcohol, which increased steadily over the past 38 years; tobacco, which increased dramatically over the past 20 years; and marijuana and illicit drugs, which increased slightly, although not consistently, between 1976 and 2014. In 2014, students that identified as male, African American, or other race and those who reported greater religious commitment were significantly more likely to report lifetime abstinence. Students that lived in single-parent households, spent more evenings out, worked more hours during the school year, and reported lower grades and more truancy had lower abstinence rates., Conclusions: Abstinence is a realistic choice for a growing proportion of high school students. With the differences in abstinence trends for individual substances, we suggest strategies for advancing prevention efforts., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2018 by the American Academy of Pediatrics.)

Aims: To estimate temporal trends in adolescents' current cigarette, alcohol and cannabis use in Europe by gender and region, test for regional differences and evaluate regional convergence., Design and Setting: Five waves of the European School Survey Project on Alcohol and Other Drugs (ESPAD) from 28 countries between 1999 and 2015. Countries were grouped into five regions [northern (NE), southern (SE), western (WE), eastern Europe (EE) and the Balkans (BK)]., Participants: A total of 223 814 male and 211 712 female 15-16-year-old students., Measurements: Daily cigarette use, weekly alcohol use, monthly heavy episodic drinking (HED) and monthly cannabis use. Linear and quadratic trends were tested using multi-level mixed-effects logistic regression; regional differences were tested using pairwise Wald tests; mean absolute differences (MD) of predicted prevalence were used for evaluating conversion., Findings: Daily cigarette use among boys in EE showed a declining curvilinear trend, whereas in all other regions a declining linear trend was found. With the exception of BK, trends of weekly drinking decreased curvilinear in both genders in all regions. Among girls, trends in WE, EE and BK differed from trends in NE and SE. Monthly HED showed increasing curvilinear trends in all regions except in NE (both genders), WE and EE (boys each). In both genders, the trend in EE differed from the trend in SE. Trends of cannabis use increased in both genders in SE and BK; differences were found between the curvilinear trends in EE and BK. MD by substance and gender were generally somewhat stable over time., Conclusions: Despite regional differences in prevalence of substance use among European adolescents from 1999 to 2015, trends showed remarkable similarities, with strong decreasing trends in cigarette use and moderate decreasing trends in alcohol use. Trends of cannabis use only increased in southern Europe and the Balkans. Trends across all substance use indicators suggest no regional convergence., (© 2018 Society for the Study of Addiction.)

Objective: The effect of drinking during adolescence on adult functioning is a public health concern. A variety of mechanisms have been proposed where drinking in adolescence has an adverse impact on later outcomes; unfortunately, few studies have included methodologies that account for confounding influences that might link adolescent drinking with subsequent problems. To address this limitation, the current study used a co-twin control design, which uses members of twin pairs that differ from each other on their adolescent drinking., Method: We used a prospective longitudinal sample drawn from the Minnesota Twin Family Study, consisting of 2,764 twins (1,434 female) assessed at regular follow-ups from age 17 to age 29. Adolescent drinking was defined by measures of early initiation of use and a measure of overall consumption at age 17. Adult outcomes included indicators of substance use, antisocial behavior, personality, socioeconomic status, and social functioning., Results: The co-twin control analyses suggested that many of the associations between adolescent drinking and later outcomes were largely influenced by genetic confounding. However, for the measure of adolescent alcohol consumption, results were consistent with a small causal impact of drinking on multiple domains of adult functioning. This pattern was less consistently observed for the measures of early initiation., Conclusions: These results provide empirical justification for policies designed to alleviate long-term consequences associated with adolescent drinking by reducing the level of alcohol consumption in adolescence. In contrast, the evidence did not suggest that delaying drinking would have a broad impact on later-life adjustment.

Objective: Recent studies showed that reducing the minimum legal drinking age (MLDA) could cause negative health outcomes among youth. This evidence was drawn primarily from a limited set of geographical regions. This study seeks to widen available evidence by using data from Japan, where the government started considering reducing the MLDA from 20 to 18., Method: Using a regression discontinuity design, we compared emergency service event rates related to alcohol intoxication and mortality rates through external causes between those who were slightly younger and older than the age of 20., Results: We showed that granting legal access to alcohol at age 20 doubled the use of emergency services used for alcohol intoxication but had little impact on mortality as measured by traffic fatalities, suicide, and other accidents., Conclusions: Our findings suggest that lowering the MLDA in Japan will increase (potentially reckless and excessive) drinking behavior among young adults ages 18 and 19 but will not increase their mortality from accidents.

Objective: The Rutgers Alcohol Problem Index (RAPI) has been used extensively as a measure of alcohol-related problems experienced by adolescents and young adults. The present study aimed to comprehensively examine the psychometric profile and criterion-related validity of an 18-item RAPI adapted to measure negative consequences resulting from alcohol and other drug use in an at-risk adolescent population., Method: Categorical confirmatory factor analysis and the graded response model were used for evaluations of the latent factor structure, item properties, test information, and item invariance across gender, age groups (middle vs. late adolescence), and drug use profiles (readily available drugs vs. other illicit drugs), as well as computation of the item response theory scale scores for each of 617 alternative high school students (44% female)., Results: A reduced set of 16 RAPI items provided plausible evidence of unidimensionality and good measurement precision at a relatively wide range of the latent trait continuum. All but two items were invariant across the drug use profiles. The other illicit drug group had higher levels of the latent substance-related problems than the readily available drug group. Criterion-related validity was supported using a measure of past-year polysubstance use., Conclusions: The RAPI can be effectively modified to measure negative consequences resulting from alcohol and other drug use and reflects a sufficiently wide range of the latent continuum of problem use.

Background: Pregaming is a common, high-risk drinking activity among college students that has been largely unchangeable despite targeted intervention approaches. Therefore, identifying profiles of pregamers could enhance understanding of the risks associated with this practice and inform intervention development., Methods: This study identified subtypes of pregamers in undergraduates (N = 911; 60% female, 42.9% White) attending 3 U.S. universities in 2012. Self-report data assessed recent alcohol use (overall, heavy, and pregaming), pregaming motives, and demographics. Alcohol-related consequences were assessed via the Young Adult Alcohol Consequences Questionnaire., Results: Latent profile analysis using pregaming-specific indicators assessing motives (e.g., to avoid getting caught) and consumption (e.g., estimated pregaming blood alcohol concentration) yielded 5 unique profiles. Three profiles were characterized by pregaming on 50% or more of all drinking events that differed by pregaming consumption and motives: Instrumental (5.3%; heavy consumption, intoxication-driven motives), Global (16.0%; moderate consumption, indistinct motives), and Risk-averse (18.3%; moderate-to-heavy consumption, negatively reinforcing motives). Two profiles reported lower levels of pregaming: Occasional (32.4%; moderate consumption, indistinct motives) and Infrequent (28.0%; lowest pregaming involvement). Cross-profile differences were then examined for demographics, general drinking and pregaming-specific motives, and alcohol-related consequences. Profile comparisons indicated differences in overall alcohol consumption, ethnicity, gender, current living arrangements, Greek involvement, and a variety of alcohol-related consequences (ps < 0.01)., Conclusions: Overall, pregaming is a very heterogeneous behavior among college students in that some students utilize this drinking practice as a means to mitigate risk and others use it to promote intoxication. Results suggest that distinguishing pregamers by consumption as well as motives can facilitate the development of more tailored intervention approaches for students who engage in this high-risk practice., (Copyright © 2018 by the Research Society on Alcoholism.)

Objective: This study examined whether social inequality in frequent drunkenness among Danish adolescents changed from 1991 to 2014., Method: We used data from the international Health Behaviour in School-aged Children (HBSC) study, which provided nationally representative samples of 15-year-olds from seven comparable cross-sectional studies in Denmark (N = 8,655). The students provided data about frequency of drunkenness and parents' occupation., Results: In total, 38.6% reported to have been drunk at least four times, decreasing from 44.2% in 1991 to 21.2% in 2014. Most of the decrease took place in the latter part of the period. This decrease was found in all occupational social classes, but there was no change in absolute social inequality in drunkenness four or more times reported from 1991 to 2014. The sex- and yearadjusted odds ratio for frequent drunkenness was 0.80, 95% CI [0.70, 0.93] in low compared with high occupational social class. The statistical interaction between survey year and occupational social class was insignificant (p = .3601); that is, there was no change in relative social inequality in frequent drunkenness over time., Conclusions: Drunkenness was more prevalent among adolescents from the high occupational social class, and this social inequality did not change from 1991 to 2014.

Background: Reducing underage drinking is a public health priority given increased risk for injury and other consequences. Emergency department (ED) visits offer a potential "teachable moment" to initiate interventions among youth engaged in risky drinking. Given mixed findings for alcohol brief interventions (BIs), this paper examined baseline markers of BI response in order to inform future interventions., Method: We conducted secondary analyses of data from a randomized controlled trial of an alcohol BI delivered to youth in an ED. Among 475 participants (M age  = 18.6, SD = 1.4; 48.7% Female, 78.6% White/Caucasian) receiving a computer or therapist BI, we examined baseline characteristics (i.e., demographic, substance use, mood, risk/protective factors, and readiness to change) that predicted positive intervention response (i.e., BI responder) at 3-month follow-up using AUDIT-C scores (cut offs: <3 for ages 14-17; <4 for ages 18-20)., Results: Mediated logistic regression analysis (controlling for demographics) showed that greater readiness to change at baseline was positively related to BI response and baseline alcohol consumption was negatively related to BI response. Having a mentor was indirectly related to BI response via baseline alcohol consumption. Baseline readiness to change and alcohol consumption mediated the association between positive peer influences and BI response, whereas readiness to change mediated the relation between depression and BI response., Conclusion: Findings suggest that BI response is influenced by protective social factors, such as positive peers and mentors, and depression, via baseline alcohol severity indicators (i.e., readiness to change, consumption), thus providing clues for enhancing the content and dose of early interventions., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Aim: To quantify the occurrence of alcohol content, including alcohol branding, in the popular primetime television UK Reality TV show 'Geordie Shore' Series 11., Methods: A 1-min interval coding content analysis of alcohol content in the entire DVD Series 11 of 'Geordie Shore' (10 episodes). Occurrence of alcohol use, implied use, other alcohol reference/paraphernalia or branding was recorded., Results: All categories of alcohol were present in all episodes. 'Any alcohol' content occurred in 78%, 'actual alcohol use' in 30%, 'inferred alcohol use' in 72%, and all 'other' alcohol references occurred in 59% of all coding intervals (ACIs), respectively. Brand appearances occurred in 23% of ACIs. The most frequently observed alcohol brand was Smirnoff which appeared in 43% of all brand appearances. Episodes categorized as suitable for viewing by adolescents below the legal drinking age of 18 years comprised of 61% of all brand appearances., Conclusions: Alcohol content, including branding, is highly prevalent in the UK Reality TV show 'Geordie Shore' Series 11. Two-thirds of all alcohol branding occurred in episodes age-rated by the British Board of Film Classification (BBFC) as suitable for viewers aged 15 years. The organizations OfCom, Advertising Standards Authority (ASA) and the Portman Group should implement more effective policies to reduce adolescent exposure to on-screen drinking. The drinks industry should consider demanding the withdrawal of their brands from the show., Short Summary: Alcohol content, including branding, is highly prevalent in the MTV reality TV show 'Geordie Shore' Series 11. Current alcohol regulation is failing to protect young viewers from exposure to such content.

Introduction and Aims: As alcohol use has decreased among Finnish adolescents, we aim to assess: (i) time trends in alcohol use, heavy episodic drinking (HED) and potential explanatory variables among adolescents; (ii) the relationship between trends of explanatory variables and trends in alcohol use and HED; and (iii) which of the explanatory variables can account for the temporal change in alcohol use and HED., Design and Methods: The analyses are based on European School Survey Project on Alcohol and Other Drugs data collected from 15- to 16-year-old Finnish adolescents in 1999, 2003, 2007, 2011 and 2015., Results: The decline in alcohol use and HED among underage youth in Finland is associated with at least three factors: (i) obtaining alcohol has become more difficult; (ii) parents know better than before where their children spend their Friday nights; and (iii) the risk attached to going out with friends on drinking has decreased., Discussion and Conclusions: Formal policy measures and adults' attitudes have probably affected the availability of alcohol for adolescents, and thus they partly explain the decline in youth drinking. This decline coincides with the introduction of new digital technologies, new forms of interaction within families and peer groups, and more conscientious teenagers. All these changes are not necessarily causes of the decline but are part of a similar broader change in adolescents' lives., (© 2018 Australasian Professional Society on Alcohol and other Drugs.)

Adolescent alcohol consumption has been in decline across many high-income countries since the early to mid-2000s. This is a significant public health trend, with few documented examples from history where such a global downward shift in alcohol consumption has occurred primarily among the adolescent segment of the population. In this commentary we describe the nature and breadth of the trend; reflect on the environmental, social and policy factors that have been proffered; and argue that to adequately understand and support the maintenance of these trends, three important methodological considerations are needed for future research. Firstly, longitudinal panel and qualitative studies are needed to complement and inform continuing cross-sectional research. Secondly, a collaborative cross-cultural approach is needed to contextualise the international scale of the trend and thirdly, future research must be situated within a historical and generational perspective to understand declines in adolescent drinking in the context of a broader shift in adolescent behaviours., (© 2018 Australasian Professional Society on Alcohol and other Drugs.)

Introduction and Aims: There is a need to explain reported trends of reduced alcohol and drug (substance) use in school-aged children in Australia. This study used student survey data collected in the states of Victoria, Western Australia and Queensland to examine trends in substance use and associated influencing factors., Design and Methods: Youth self-reports were examined from 11 cross-sectional surveys completed by 41 328 adolescents (average age 13.5 years, 52.5% female) across 109 Australian communities between 1999 and 2015. Multi-level modelling was used to identify trends in adolescent reports of lifetime alcohol, tobacco and cannabis use, adjusted for age, gender, social disadvantage and minority status. Trends in influencing factors were also examined that included: individual attitudes, and family, school and community environments. Multivariate analyses estimated the main contributors to alcohol use trends., Results: Alcohol, tobacco and cannabis use all fell significantly from 1999 to 2015. Higher levels of use were observed in Victoria compared to Western Australia or Queensland. Multivariate analyses identified reductions in favourable parent attitudes and lower availability of substances as direct contributors to reducing alcohol use trends. Indicators of school and family adjustment did not show similar trend reductions., Discussion and Conclusions: Reductions in adolescent alcohol, tobacco and cannabis use from 1999 to 2015 were associated with similar reductions in parent favourable attitudes and availability of substances. It is plausible that a reduced tendency for parents and other adults to supply adolescent alcohol are implicated in the reductions in adolescent alcohol use observed across Australia., (© 2018 Australasian Professional Society on Alcohol and other Drugs.)

Issues: Today's teenagers have been described as a sober generation and we asked: 'What is known about the recent decline in youth drinking?', Approach: A literature review (2005-2017)., Key Findings: Research from wealthier parts of the world provides solid evidence of less alcohol use by youth since the millennium shift. Some studies show that this is reflected at all levels of consumption, but there are also indications that the heaviest drinkers have not reduced their drinking. The decrease is predominately seen in underage youth, and has been larger for boys than for girls in several countries. Teenagers across social strata drink less, but some disadvantaged subgroups have not followed the downward trend. Underage drinkers have apparently not become a more deviant group as the prevalence of drinking has dropped, indicating no hardening of the group. The major gap in the literature pertains to the issue of underlying driving forces. We found no evidence in support of the widespread assumption that the digital revolution has been of importance. A decline in parenting practices that are conductive to underage drinking has occurred in several countries, but studies examining whether these changes have contributed to less alcohol use by youth are almost non-existent., Implications: To inform alcohol policy and prevention, it is imperative to find out why teenage drinking has decreased in a fairly consistent way across numerous countries., Conclusion: Future research into the issue of falling prevalence rates of youth drinking should focus on possible explanatory factors at the population level rather than at the individual level., (© 2018 Australasian Professional Society on Alcohol and other Drugs.)

Background: Early alcohol initiation is common and has been associated with the development of alcohol problems. Yet, past research on the association of age of initiation with later problem drinking has produced inconsistent findings. Using prospective data from the Australian Parental Supply of Alcohol Longitudinal Study cohort, this study examined age of alcohol initiation, and of first drunkenness, and associations with subsequent drinking in adolescence., Methods: A total of 1,673 parent-child dyads recruited through Australian secondary schools completed annual surveys for 5 years (grades 7 to 11). Limiting the sample to those adolescents who had initiated alcohol use by age 17 (n = 839), multinomial logistic regression models were used to examine associations between (i) age of initiation to alcohol use (consuming at least 1 full serve) and (ii) age of first drunkenness, and 2 outcomes: (i) binge drinking (consuming >4 standard drinks on a single occasion), and (ii) the total number of alcoholic drinks consumed in the past year, adjusted for a range of potential child, parent, family, and peer covariates., Results: Fifty percent of adolescents reported alcohol use and 36% reported bingeing at wave 5 (mean age 16.9 years), and the mean age of initiation to alcohol use for drinkers was 15.1 years. Age of initiation was significantly associated with binge drinking and total quantity of alcohol consumed in unadjusted and adjusted models. Age of first drunkenness was associated with total quantity of alcohol consumed in unadjusted models but not adjusted models and was not associated with subsequent bingeing., Conclusions: Initiating alcohol use earlier in adolescence is associated with an increased risk of binge drinking and higher quantity of consumption in late secondary school, supporting an argument for delaying alcohol initiation for as long as possible to reduce the risk for problematic use in later adolescence and the alcohol-related harms that may accompany this use., (Copyright © 2017 by the Research Society on Alcoholism.)

Background: Exposure to alcohol content in movies has been shown to be associated with adolescent use of alcohol, including earlier onset. This study examined the influence of movie alcohol exposure on subsequent alcohol onset, considering the social context (whether the movie was viewed with a friend or parent). We examined whether media's influence holds across a spectrum of early drinking milestones: sipping (but not consuming a full drink of) alcohol, consuming a full drink of alcohol, and engaging in heavy episodic drinking (HED)., Methods: Data were taken from a sample of 882 middle school youth (52% female; 24% non-White) enrolled in an ongoing study on alcohol initiation and progression. Exposure to alcohol content in films was measured using a method that combines content analysis and random assignment of movie titles to youth surveys. The hazard of initiating alcohol use (sip, full drink, HED) as a function of exposure was estimated using survival analysis. Associations were adjusted for demographic, personality, and social influence factors known to be associated with both movie exposure and alcohol use., Results: Exposure to alcohol content was common. Hours of exposure prospectively predicted earlier onset of alcohol involvement across all outcomes. Viewing movies with friends appeared to augment the media exposure effect, in contrast to viewing movies with parents, which was not a significant predictor of initiation., Conclusions: Exposure to alcohol in films is involved in the entry into early stages of alcohol involvement. Findings support further investigation into the role of the media in underage drinking, especially in the context of consuming media with friends and peers. Limiting media exposure and/or stronger Federal Trade Commission oversight of movie ratings should be a priority for preventing underage drinking., (Copyright © 2017 by the Research Society on Alcoholism.)

Background: Alcohol and marijuana are the most commonly used substances among adolescents but little is known about patterns of co-use., Objectives: This study examined patterns of concurrent (not overlapping) and simultaneous (overlapping) use of alcohol and marijuana among adolescents., Methods: Data from US-national samples of 12th graders (N = 84,805, 48.4% female) who participated in the Monitoring the Future study from 1976 to 2016 and who used alcohol and/or marijuana in the past 12 months were used to identify latent classes of alcohol use, marijuana use, and simultaneous alcohol and marijuana (SAM) use., Results: A four-class solution indicated four patterns of use among adolescents: (1) Simultaneous alcohol and marijuana (SAM) use with binge drinking and recent marijuana use (SAM-Heavier Use; 11.2%); (2) SAM use without binge drinking and with recent marijuana use (SAM-Lighter Use; 21.6%); (3) Marijuana use and alcohol use but no SAM use (Concurrent Use; 10.7%); and (4) Alcohol use but no marijuana or SAM use (Alcohol-Only Use; 56.4%). Membership in either SAM use class was associated with a higher likelihood of truancy, evenings out, and use of illicit drugs other than marijuana. SAM-Heavier Use, compared to SAM-Lighter Use, class members were more likely to report these behaviors and be male, and less likely to have college plans., Conclusions: Among 12th graders who use both alcohol and marijuana, the majority use simultaneously, although not all use heavily. Given the recognized increased public health risks associated with simultaneous use, adolescent prevention programming should include focus on particular risks of simultaneous use.

Background: Few studies examine risk to offspring who experience both parental alcohol problems and parental separation and still fewer consider gender of the affected parent. We examined interactive effects of maternal versus paternal alcohol problems and parental separation on timing of first alcoholic drink in daughters., Methods: Data were drawn from a sample of 3,539 European (or other) ancestry (EA) and 611 African ancestry (AA) female twins born between 1975 and 1985, median age 15 at first assessment. Cox proportional hazards regression models were estimated predicting age at first full drink from parental history of alcohol problems (mother only, father only, or both parents), parental separation during childhood, and the interaction of parental alcohol problems and parental separation. Cox models were estimated without and with adjustment for correlated risk factors, separately for EA and AA twins., Results: For both EA and AA twins, a significant interaction between parental separation and mother-only alcohol problems was observed, suggesting reduced risk of drinking associated with mother-only alcohol problems in separated versus intact families., Conclusions: Findings highlight parental separation as an important moderator of risk to children of mothers who have a history of problem drinking, with interactive effects observed consistently across racial group. To identify underlying processes, additional research is needed with more detailed characterization of separated families where mother only has a history of alcohol problems., (Copyright © 2017 by the Research Society on Alcoholism.)

Based on longitudinal survey data (2005, 2008, 2015), this paper investigates binge drinking among young people in Denmark. We analyse the relationship between parental alcohol rules in 2005 and the development of their children's heavy episodic drinking from age 15 to 25/26 using a multilevel approach to repeated measures. Two hypotheses are tested. The first is that young people from families with "strict" alcohol rules have a lower level of binge drinking than young people from families with lenient rules. However, given the cultural pressure on adolescents to drink heavily in Denmark, we also expect parents to face challenges when trying to limit their children's drinking. Hence, our second hypothesis is that youths with strict alcohol rules at age 15 show the steepest increase in heavy episodic drinking when going from early to late adolescence and thus gradually catch up with young people who had lenient rules. Both our hypotheses are confirmed: Strict alcohol-specific rules are associated with lower rates of binge drinking, but with time young people with strict rules close in on their peers' alcohol use., (© 2018 S. Karger AG, Basel.)