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Predicting Initiation of Adolescent Alcohol Use


Am Fam Physician. 2008 Nov 1;78(9).

Background: Alcohol use is pervasive among U.S. adolescents. Of high school students, 26 percent reported having engaged in binge drinking (i.e., more than five drinks per episode) within a given month, and nearly three fourths have experimented with alcohol. Early alcohol use has been correlated with subsequent depression and substance abuse, and it is often implicated in the most common causes of adolescent deaths (i.e., motor vehicle crashes, accidents, suicide, and homicide). Some evidence has suggested that tobacco use, exposure to alcohol advertising, and being raised in a single-parent household contribute to early alcohol use and are inversely related to academic achievement. Fisher and colleagues reviewed other predictors of adolescent alcohol use that could be useful in prevention.

The Study: The Growing Up Today Study (GUTS) is an annually updated national cohort of adolescents whose mothers are participating in the ongoing Nurses Health Study II. GUTS participants who had previously reported that they were nondrinkers received follow-up questionnaires to monitor whether their drinking status had changed. They were asked to complete the Alcohol and Expectancy Questionnaire-Adolescent version to assess how favorably they viewed alcohol consumption. They were also questioned about their social and family life. Family situation was assessed regarding the number of parents they lived with, how often they ate dinner at home with their family, and whether any adults or siblings younger than 21 years who were in their household drank alcohol. Social parameters were obtained about how many of their friends drank alcohol, awareness of alcohol advertising, and whether they possessed any alcohol promotional items. They were also asked whether they had consumed alcohol within the previous year and whether or not they smoked tobacco. Participants were also asked to rate their self-esteem in several realms, including athletic and social areas.

Results: The overall survey response rate was 70 percent. Included in the analysis were 3,283 girls and 2,228 boys, of which 611 girls and 384 boys reported initiating alcohol use within the previous year. Male and female new drinkers were significantly older (14.5 ± 1.4 years of age) and had achieved higher Tanner scores (4 or 5) than nondrinkers; they were also more likely to smoke. New alcohol use was also positively correlated with the number of their peers who drank alcohol, talking with peers about alcohol advertisements, possessing promotional items, and having more favorable opinions about alcohol. Owning promotional items (e.g., key chains) had a stronger effect on alcohol behavior than advertising awareness alone, and this effect was most notable among those who were pre-contemplative about alcohol use.

Starting to drink was positively correlated with higher social self-esteem in girls and greater athletic self-esteem in boys. Having adults who drank at home or underage siblings who drank alcohol was also positively associated with initiating alcohol use. On the other hand, girls who lived in two-parent families and who ate dinner at home with their families on a daily basis were one half as likely to initiate alcohol use than their peers. A similar, although nonsignificant, trend was observed among boys in similar situations.

Conclusion: Children whose parents drink alcohol at home may be at a higher risk of initiating alcohol use. Having family dinner together may reduce the chances of early alcohol use among teens, especially for girls. Higher self-esteem in social and athletic areas does not protect children from starting to use alcohol, and may be positively associated with early drinking. The authors also recommend that more formal marketing guidelines be implemented for the alcohol industry, becausee advertising and related promotional items are associated with early alcohol use among adolescents.


Fisher LB, et al. Predictors of initiation of alcohol use among US adolescents: findings from a prospective cohort study. Arch Pediatr Adolesc Med. October 2007;161(10):959-966.



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