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Predictors of Initiation of Alcohol Use Among US AdolescentsFindings From a Prospective Cohort Study
Laurie B. Fisher, SM;
Isa Williams Miles, ScD;
S. Bryn Austin, ScD;
Carlos A. Camargo Jr, MD, DrPH;
Graham A. Colditz, MD, DrPH
Arch Pediatr Adolesc Med. 2007;161(10):959-966.
ABSTRACT
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Objective To identify precursors of adolescent alcohol initiation and binge drinking.
Design Prospective cohort study.
Setting Self-report questionnaires.
Participants A total of 5511 Growing Up Today Study participants aged 11 to 18 years in 1998.
Main Exposures Individual, family, and social factors.
Main Outcome Measures First whole drink of alcohol and binge drinking.
Results Between 1998 and 1999, 611 girls (19%) and 384 boys (17%) initiated alcohol use. Older age, later maturational stage, smoking, adults drinking in the home, underage sibling drinking, peer drinking, possession of or willingness to use alcohol promotional items, and positive attitudes toward alcohol were associated with an increased likelihood of alcohol initiation. Girls who ate family dinner at home every day were less likely to initiate alcohol use than girls who ate family dinner only on some days or never (odds ratio, 0.66; 95% confidence interval, 0.50-0.87). Girls with higher social self-esteem and boys with higher athletic self-esteem were more likely to initiate alcohol use than those with lower self-esteem. Among teens who initiated alcohol use, 149 girls (24%) and 112 boys (29%) further engaged in binge drinking. Among girls, positive attitudes toward alcohol, underage sibling drinking, and possession of or willingness to use alcohol promotional items were associated with binge drinking; among boys, positive attitudes toward alcohol and older age were associated with binge drinking.
Conclusions Eating family dinner at home every day may delay alcohol uptake among some adolescents. Alcohol promotional items appear to encourage underage alcohol initiation and binge drinking; this may warrant marketing restrictions on the alcohol industry.
INTRODUCTION
Despite recent signs of a decline in prevalence,1 alcohol use and abuse continue to be pervasive among US adolescents. Approximately 74% of high school students report having had a whole drink of alcohol, 43% report drinking within the past 30 days, and 26% report binge drinking within the past month.2 These numbers are disturbing, as alcohol use is associated with the 4 leading causes of death among young people: motor vehicle crashes, unintentional injury, suicide, and homicide.3-7 In addition, alcohol use increases the risk of violence victimization and perpetration among adolescents.8-10 Beyond these immediate threats, early alcohol use can lead to the development of major depressive disorders, substance use disorders, and alcohol dependence in adulthood.11-14 Moreover, adolescents who initiate use at younger ages may be at greater risk for many of these alcohol-related problems.12-13,15-20 Identifying precursors of adolescent alcohol use can guide the design of innovative strategies to prevent or postpone initiation.
Previous studies6, 21-22 have identified older age, physical maturity, white race, and residing in the northeast region of the United States as individual characteristics that correlate with adolescent alcohol use. Prior studies23-25 have also highlighted the inverse association between alcohol initiation and use and higher levels of scholastic achievement, school engagement, and global self-esteem; the roles of social and athletic self-esteem are not known.
Family factors such as living in a single-parent household, parental alcohol use, and sibling alcohol use have also been found to be associated with alcohol use among adolescents.25-29 Moreover, 2 recent cross-sectional studies30-31 found that eating family dinner at home has an inverse association with adolescent drinking.
Several cross-sectional studies32-35 have shown that alcohol advertising reaches young audiences and influences their alcohol behaviors. Collins et al34 found that awareness of televised beer advertisements was associated with alcohol use among eighth-grade boys. Fleming et al32 found that increased exposure to alcohol advertising among 15- to 20-year-olds correlated with positive attitudes about alcohol, which in turn correlated with intention to drink. Using prospective data, Snyder et al36 found that past-month exposure to alcohol advertising among 15- to 20-year-olds was associated with past-month drinking. In another longitudinal study, Ellickson et al37 found that among ninth graders, exposure to magazine advertisements predicted alcohol use but exposure to television advertisements did not. Cross-sectional studies have shown a positive association between tobacco promotional items and teen smoking,38-39 and a similar relationship may exist between alcohol promotional items (APIs) and alcohol uptake. Cross-sectional analyses in a recent study40 of 2406 middle school students found that students who owned APIs were 50% more likely than their peers to initiate alcohol use.
Power et al41 found that among adolescents, predictors of movement from abstinence to non-high-risk drinking were different from predictors of movement into high-risk and problem drinking. It is also plausible that predictors vary depending on stage of behavioral adoption. This information would be useful in targeting intervention strategies.
We prospectively examined predictors of alcohol initiation and binge drinking in the Growing Up Today Study (GUTS), a large, nationwide cohort of adolescents. We compared the factors influencing alcohol uptake among younger and older adolescents and examined predictors among adolescents at varying levels of behavioral progression using a framework based on the transtheoretical model by Prochaska and Velicer,42 which posits multiple stages of change, including precontemplation and contemplation, before initiating an action.
METHODS
STUDY POPULATION
The GUTS participants were recruited in 1996 by identifying mothers from the ongoing Nurses' Health Study II who had children aged 9 to 14 years. Further details of the recruitment and establishment of the cohort are described in detail elsewhere.43 The GUTS comprises 16 882 boys and girls. Follow-up questionnaires are mailed approximately annually. This study was approved by the human subjects committees at Harvard School of Public Health and Brigham and Women's Hospital, Boston, Massachusetts.
In 1998 and 1999, an expanded section on alcohol use was included in the questionnaire, allowing for a more detailed examination of these behaviors. Approximately 75% of the girls (n = 6807) and 64% of the boys (n = 5027) who completed the baseline questionnaire in 1996 completed follow-up questionnaires in both 1998 and 1999, yielding an overall response rate of 70%. We excluded 1257 boys and 1787 girls who had initiated alcohol use by 1998, as well as those who did not respond to the 2 primary alcohol questions in both 1998 and 1999 and therefore lacked sufficient data to determine alcohol initiation status. We further excluded participants who did not respond to questions pertaining to variables of interest including Tanner stage, self-esteem, cigarette smoking, family composition, frequency of family dinners, adult alcohol use in the home, sibling alcohol use, peer alcohol use, owning or being willing to use APIs, alcohol advertising, and attitudes toward alcohol. Rates of alcohol initiation were similar among those missing data on any individual variable and those who responded, and among all of those excluded (18%) vs all of those included (18%) in the study. The final sample included 3283 girls and 2228 boys aged 11 to 18 years in 1998.
EXPOSURE MEASURES
Individual and Sociodemographic Variables
The Tanner stage of pubic hair development was assessed by a series of 5 sex-specific sketches, with stage 1 being the least developed and stage 5 being fully developed.44-45 Race was dichotomized into white and nonwhite groups. We used a modified version of the Harter Self-perception Profile for Children46 to measure self-esteem in 4 domains: social, athletic, global, and scholastic. Self-esteem scores ranged from 6 to 18 for each domain, with higher scores indicating higher levels of self-esteem. Because the 1998 question included only global and scholastic domains, we used 1997 values for social and athletic self-esteem in these analyses. Cigarette smoking was assessed with the question, "In the past year, have you smoked a cigarette, even a few puffs?"
Family Variables
Participants reported which adults they live with most of the time. Those who reported living with 2 parents (any combination of mother, father, stepmother, or stepfather) were compared with those who reported living with only 1 parent (mother or father). Participants who lived with other relatives or adults but not their mother or father were not included in the family composition variable so that a direct comparison between single- and 2-parent families could be made. To assess the frequency of family dinner at home, participants were asked, "How often do you sit down with other members of your family to eat dinner or supper?" Those who responded never or some days were compared with those who responded most days and with those who responded every day. Participants were asked whether any adults who live in their household drink alcohol and whether they have a sibling younger than 21 years who drinks alcohol.
Social Context Variables
Peer alcohol use was assessed with the question, "How many of your friends drink alcohol?" Participants who responded none were compared with those who responded 1 or a few and with those who responded most or all. Awareness of alcohol advertising was assessed with the question, "In the last month, have you talked with your friends about any advertisement or TV commercial involving alcohol?" Participants were asked whether they had ever bought or been given an API such as a hat, T-shirt, or bag with the name of an alcohol beverage on it and whether they would be willing to use such an item. Those who responded yes to either question were defined as owning or being willing to use APIs.
The Alcohol Expectancy Questionnaire–Adolescent version (AEQ-A) is a validated measure of propensity to initiate alcohol use.47-48 Shortened adaptations of this scale have been shown to be a valid indicator of the susceptibility of young people to drink alcohol.49-50 We used a shortened version of the AEQ-A to assess participants' attitudes and beliefs about alcohol. Participants indicated whether they agreed with each of 17 statements about alcohol. Total scores ranged from 0 to 17, with higher scores representing more favorable attitudes and beliefs about alcohol consumption.
OUTCOME MEASURES OF ALCOHOL BEHAVIORS
The main outcome of interest was initiation of alcohol use. Participants were asked, "Have you ever tried drinking alcohol (beer, wine, or liquor), even a few sips?" Those who responded yes were further asked, "Have you ever had a whole ‘drink’ of alcohol? (One drink means a whole glass, can, or bottle of beer; a whole glass of wine; or a whole ‘mixed drink’ or shot of liquor.)" Those who responded no to the first or second question were classified as never whole drinkers, and those who responded yes to both questions were classified as initiators of alcohol use.
To assess binge drinking, participants who had consumed a whole drink of alcohol were further asked, "Over the past year, how many times did you drink 5 or more alcohol drinks over a few hours?" Those who reported consuming 5 or more drinks on at least 1 occasion were considered to have engaged in binge drinking.
Stage of alcohol uptake42 in 1998 was assessed among those who reported never trying alcohol. These participants were further asked, "Do you think you will try drinking alcohol in the next year?" Those who responded definitely not were defined as precontemplators. Those who responded maybe or probably were categorized as contemplators. Those who reported that they had tried alcohol but never consumed a whole drink were defined as experimenters.
STATISTICAL ANALYSES
All of the analyses were stratified by sex to detect differences in factors influencing alcohol initiation between boys and girls. The association between each potential predictor and 1999 alcohol initiation status was tested, and  2 tests for proportional distributions and t tests for mean values were calculated. Predictors that retained significance in univariate logistic regressions were included in multivariate logistic regressions. For factors that appeared significant among girls but not boys or vice versa, we tested for an interaction between the variable and sex.
We examined effect modification by age to compare the influence of various factors on alcohol uptake among younger (aged < 15 years) and older (aged  15 years) adolescents. Age 15 years was selected as the age cut point for these analyses, as it is the approximate age when adolescents enter high school. We also examined effect modification by stage of alcohol uptake in 1998. Because findings for contemplators and experimenters were similar in preliminary analyses, these 2 groups were combined and compared with precontemplators. For factors that showed statistical significance among one age group or among one stage of uptake but not the other, we tested for an interaction. The categorical variables of peer drinking and family dinner were transformed into continuous variables to test for interaction.
Logistic regressions were used to compute odds ratios (ORs) for binge drinking among those adolescents who initiated alcohol use in 1999. The 90 participants who initiated alcohol use but did not respond to the question on binge drinking were excluded from this subanalysis.
RESULTS
Overall, 611 girls (19%) and 384 boys (17%) who were never drinkers in 1998 had a first whole drink of alcohol in 1999 (Table 1).
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Table 1. Distributions of Factors Among Adolescent Boys and Girls Who Were Never Whole Drinkers in 1998
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In multivariate logistic regression models, age, Tanner stage, cigarette smoking, adult drinking in the home, sibling drinking, peer drinking, owning or being willing to use APIs, and higher AEQ-A score were predictive of alcohol initiation among both girls and boys (Table 2). Higher social self-esteem among girls and higher athletic self-esteem among boys were positively associated with alcohol initiation. Among girls, living in a single-parent household was positively associated with alcohol initiation, whereas eating family dinner at home every day was inversely associated. Because social and athletic self-esteem, single-parent households, and family dinner had an association with alcohol uptake for one sex but not the other, we tested for an interaction between sex and these variables. No statistically significant interactions were found (all P > .10). As neither race nor US geographic region were statistically significant variables in univariate models (data not shown), these covariates were not included in the multivariate models.
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Table 2. Odds Ratios and 95% Confidence Intervals for Alcohol Initiation During 1 Year of Follow-up Among Adolescent Girls and Boysa
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In logistic regression models stratified by age group, we found evidence of an interaction between age group and both sibling drinking (P < .001) and peer drinking (P = .003) among girls, with stronger associations seen among those younger than 15 years compared with those aged 15 years and older (sibling drinking: OR, 2.68, 95% confidence interval (CI), 1.78-4.01 vs OR, 0.75, 95% CI, 0.42-1.34, respectively; peer drinking among 1 or a few friends: OR, 2.16, 95% CI, 1.63-2.86 vs OR, 1.30, 95% CI, 0.83-2.06, respectively; peer drinking among most or all friends: OR, 3.37, 95% CI, 1.45-7.83 vs OR, 1.32, 95% CI, 0.66-2.63, respectively). Among boys, we found an interaction between age group and Tanner stage (P = .006), with stronger effects seen among younger teens than among older teens (OR, 1.38, 95% CI, 1.15-1.67 vs OR, 0.75, 95% CI, 0.49-1.13, respectively). There was evidence of interaction with age group and both adult drinking in the home (P = .08) and owning or being willing to use APIs (P = .08) among boys, with strong influences on older adolescents as compared with younger adolescents (adult drinking in the home: OR, 1.95, 95% CI, 1.19-3.22 vs OR, 1.26, 95% CI, 0.89-1.76, respectively; APIs: OR, 2.43, 95%, CI 1.51-3.91 vs OR, 1.50, 95% CI, 1.08-2.09, respectively).
In logistic regression models stratified by stage of uptake, there was a suggestion of interaction between stage of uptake and adult drinking in the home (P = .07), family dinner (P = .06), and owning or being willing to use APIs (P = .004) among girls, with stronger associations among precontemplators compared with contemplators or experimenters (adult drinking in the home: OR, 1.79, 95% CI, 1.23-2.62 vs OR, 1.12, 95% CI, 0.82-1.54, respectively; family dinner every day: OR, 0.47, 95% CI, 0.29-0.76 vs OR, 0.86, 95% CI, 0.60-1.22, respectively; APIs: OR, 2.27, 95% CI, 1.49-3.47 vs OR, 1.24, 95% CI, 0.93-1.67, respectively). Among boys, ownership of or willingness to use APIs and awareness of alcohol advertising showed evidence of interaction with stage of uptake (P = .003 and P = .03, respectively), with stronger associations among precontemplators than contemplators or experimenters (APIs: OR, 2.63, 95% CI, 1.61-4.30 vs OR, 1.24, 95% CI, 0.88-1.76, respectively; alcohol advertising: OR, 1.70, 95% CI, 1.06-2.72 vs OR, 1.00, 95% CI, 0.71-1.40, respectively).
Among those who were never drinkers in 1998, 149 girls (5%) and 112 boys (5%) engaged in binge drinking in 1999. These 261 binge drinkers comprise 24% of girls and 29% of boys who first initiated alcohol use in 1999. Among both girls and boys, a higher AEQ-A score was positively associated with binge drinking (Table 3). For girls, sibling drinking and owning or being willing to use APIs were predictive of binge drinking. Among boys, older age was associated with binge drinking. There did not appear to be an interaction between sex and sibling drinking, owning or being willing to use APIs, or age (all P > .09).
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Table 3. Odds Ratios and 95% Confidence Intervals for Binge Drinking Among Adolescents Who Initiated Alcohol Usea
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COMMENT
One of the most striking findings of this study was the protective effect of eating family dinner every day among girls. Although the effect appears to be limited to precontemplators, these girls were more than 50% less likely to initiate alcohol use compared with those who ate family dinner some days or never. Family dinner may provide an opportunity for communication between parents and adolescents that may influence adolescent behavior, or there may be an unmeasured protective factor in families who dine together regularly that was not captured in our data. Consistent with literature that has found a greater risk of alcohol use among children living in a single-parent home,7, 25 we found that living in a single-parent household increased the risk of alcohol initiation among girls. Because we did not see a statistically significant interaction between sex and these family variables, we cannot conclude that these relationships are limited to girls.
The roles that alcohol advertising and marketing play in adolescent alcohol uptake and abuse have been explored in several studies.32-34,40 Owning or being willing to use APIs had a greater impact than advertising on alcohol behaviors, increasing risk especially among precontemplators. Owning or being willing to use APIs was further associated with binge drinking among girls. While APIs take the form of seemingly benign items such as T-shirts and key chains, our research suggests that these products contribute to underage alcohol use and abuse. A positive association between awareness of alcohol advertising and alcohol initiation was limited to boys who were precontemplators. However, our measure did not incorporate frequency and it may be that variation in advertising exposure has a broader effect.
Consistent with other prospective studies,21-22,51-53 we found that older age and greater physical maturity were associated with alcohol initiation among boys and girls. Cigarette smoking also increased the likelihood of alcohol initiation, as found in other prospective studies.54-55 However, among those who initiated alcohol use, smoking did not appear to increase the risk of binge drinking.
Among boys, greater athletic self-esteem was associated with alcohol initiation. Our findings are consistent with those of a prior longitudinal study56 of adolescents showing that boys and girls who self-identified as jocks were more likely to engage in heavier drinking and binge drinking. Although the measures of athleticism were different from our own, the consistency of the results among boys suggests that an underlying mechanism contributes to the relationship between athleticism and alcohol use. Higher athletic self-esteem among boys may indicate participation on a school sports team, and social influences associated with school teams may encourage drinking and provide increased opportunities for social activities involving alcohol. At this time, however, we can only speculate as to the reasons behind this association.
For girls, social self-esteem was predictive of alcohol initiation, especially among younger girls. A similar positive association was found in a prior cross-sectional study.57 Similar to our hypothesis about boys, girls with higher levels of social self-esteem as compared with their peers may attend more social functions that offer greater exposure and access to alcohol. Because neither social nor athletic self-esteem showed an interaction with sex, we cannot conclude that these associations are limited to either girls or boys.
Several prior studies25, 58-59 found that high scholastic self-esteem, or scholastic achievement, was inversely associated with alcohol use. Although our results suggested a similar finding, they were not statistically significant. Alcohol use may be related more directly to quantitative measures of scholastic performance than to perceived achievement.
The presence of adults drinking in the home was predictive of alcohol initiation, consistent with previous findings.60 This may result from increased access and availability of alcohol or may reflect adolescent mimicking of adult behaviors. Sibling drinking was positively associated with alcohol use and was further associated with binge drinking among girls. This highlights the influence of sibling behavior on adolescent drinking perhaps through behavior modeling, increased access to alcohol, or other mechanisms.
Consistent with previous findings, peer drinking was associated with initiation.23, 25, 28, 54, 61-65 We did not find peer drinking to be associated with binge drinking among those who had initiated alcohol use. Although we did not measure peer binge drinking, future studies should examine whether peer binge drinking predicts onset of binge drinking.
Finally, adolescents with higher AEQ-A scores, irrespective of sex, age, or stage of uptake, were more likely to initiate alcohol use and binge drink. Previous research also found that nondrinking teens who report more positive views about alcohol are more likely to initiate use during 1 year of follow-up.66 Participant AEQ-A score was further predictive of binge drinking among those who initiated alcohol use and may be a good tool for predicting this behavior.
LIMITATIONS AND STRENGTHS
This study was limited to analyzing those measures included on GUTS questionnaires and did not examine other potential predictors of adolescent alcohol initiation, such as family history of alcoholism.67-70
These findings are subject to several potential limitations. Although the GUTS cohort includes participants from across the United States, it does not represent a random sample of adolescents. Participants are predominantly white (94%) and their mothers hold nursing degrees. However, these potential limitations in generalizability of results do not negate the internal validity of the study.
The greatest potential source of misclassification of the data is the self-report nature of GUTS data. However, self-reported data from other studies of adolescent health, including the Youth Risk Behavior Surveillance System, the Longitudinal Survey of Adolescent Health, and the National Longitudinal Survey of Youth, have reasonable validity and reliability71-75 and we believe that potential misclassification in this study should be limited.
The potential limitations are offset by several strengths of this study. First, the longitudinal nature of the data allowed us to draw conclusions about the temporal effect of multiple factors on adolescent alcohol behaviors. In addition, we were able to identify predictors of alcohol use separately for girls and boys, for younger and older adolescents, and for teens at varying stages of alcohol uptake. Evaluating risk factors within these strata provides data for designing tailored interventions for adolescent alcohol initiation and binge drinking.
IMPLICATIONS
Parents should be aware that while high social and athletic self-esteem are positive attributes, they do not protect children from initiating alcohol use. Parents who drink alcohol in the home should be aware that their children are at increased risk for alcohol use and binge drinking. Having family dinner together on a regular basis may be a simple way for parents to reduce the chances that their children will initiate alcohol use.
Although federal legislation banned television advertising for tobacco products and the Master Settlement Agreement restricted tobacco promotional item distribution,76 advertising and marketing guidelines for the alcohol industry are self-regulated.77 Our findings suggest that more formalized restrictions are needed.
AUTHOR INFORMATION
Correspondence: Laurie B. Fisher, SM, Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Ave, Boston, MA 02115 (laurie.fisher{at}channing.harvard.edu).
Accepted for Publication: March 12, 2007.
Author Contributions: Study concept and design: Fisher, Miles, Austin, Camargo, and Colditz. Acquisition of data: Austin, Camargo, and Colditz. Analysis and interpretation of data: Fisher, Miles, Austin, Camargo, and Colditz. Drafting of the manuscript: Fisher and Miles. Critical revision of the manuscript for important intellectual content: Fisher, Miles, Austin, Camargo, and Colditz. Statistical analysis: Fisher. Administrative, technical, and material support: Fisher and Colditz. Study supervision: Colditz.
Financial Disclosure: None reported.
Funding/Support: Dr Austin is supported by grant 6T71-MC00009-15-01, Leadership Education in Adolescent Health project, Maternal and Child Health Bureau, Health Resources and Services Administration. Dr Colditz is an American Cancer Society Clinical Research Professor.
Additional Contributions: The GUTS Research Team provided input. We acknowledge the contribution of the thousands of adolescents who complete the GUTS surveys.
Author Affiliations: Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School (Ms Fisher and Drs Austin, Camargo, and Colditz), Departments of Epidemiology (Drs Miles and Camargo) and Health Policy and Management (Dr Colditz), Harvard School of Public Health, Division of Adolescent and Young Adult Medicine, Children's Hospital, Boston (Dr Austin), and Department of Emergency Medicine, Massachusetts General Hospital (Dr Camargo), Boston, and Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, Missouri (Dr Colditz).
REFERENCES
| |
1. Centers for Disease Control and Prevention; National Center for Chronic Disease Prevention and Health Promotion. Youth online comprehensive results: United States all years, percentage of students who had at least one drink of alcohol on one or more days during their life. http://apps.nccd.cdc.gov/yrbss/QuestYearTable.asp?path=byHT&ByVar=CI&cat=3&quest=Q39&year=Trend&loc=XX. Accessed October 25, 2006.
2. Eaton DK, Kann L, Kinchen S; et al. Youth risk behavior surveillance: United States, 2005. MMWR Surveill Summ. 2006;55(5):1-108.
PUBMED
3. Centers for Disease Control and Prevention. Alcohol involvement in fatal motor-vehicle crashes: United States, 1999-2000. MMWR Morb Mortal Wkly Rep. 2001;50(47):1064-1065.
PUBMED
4. Markowitz S, Chatterji P, Kaestner R. Estimating the impact of alcohol policies on youth suicides. J Ment Health Policy Econ. 2003;6(1):37-46.
PUBMED
5. Windle M. Suicidal behaviors and alcohol use among adolescents: a developmental psychopathology perspective. Alcohol Clin Exp Res. 2004;28(5)(suppl):29S-37S.
FULL TEXT
|
WEB OF SCIENCE
| PUBMED
6. Grunbaum JA, Kann L, Kinchen S; et al. Youth risk behavior surveillance: United States, 2003. MMWR Surveill Summ. 2004;53(2):1-96.
PUBMED
7. Hingson RW, Heeren T, Zakocs RC, Kopstein A, Wechsler H. Magnitude of alcohol-related mortality and morbidity among US college students ages 18-24. J Stud Alcohol. 2002;63(2):136-144.
WEB OF SCIENCE
| PUBMED
8. Valois RF, McKeown RE, Garrison CZ, Vincent ML. Correlates of aggressive and violent behaviors among public high school adolescents. J Adolesc Health. 1995;16(1):26-34.
FULL TEXT
|
WEB OF SCIENCE
| PUBMED
9. Swahn MH, Simon TR, Hammig BJ, Guerrero JL. Alcohol-consumption behaviors and risk for physical fighting and injuries among adolescent drinkers. Addict Behav. 2004;29(5):959-963.
FULL TEXT
|
WEB OF SCIENCE
| PUBMED
10. Hingson R, Heeren T, Winter M, Wechsler H. Magnitude of alcohol-related mortality and morbidity among US college students ages 18-24: changes from 1998-2001. Annu Rev Public Health. 2005;26:259-279.
FULL TEXT
|
WEB OF SCIENCE
| PUBMED
11. Brook DW, Brook JS, Zhang C, Cohen P, Whiteman M. Drug use and the risk of major depressive disorder, alcohol dependence, and substance use disorders. Arch Gen Psychiatry. 2002;59(11):1039-1044.
FREE FULL TEXT
12. Hingson RW, Heeren T, Winter MR. Age at drinking onset and alcohol dependence: age at onset, duration, and severity. Arch Pediatr Adolesc Med. 2006;160(7):739-746.
FREE FULL TEXT
13. Grant BF, Stinson FS, Harford TC. Age at onset of alcohol use and DSM-IV alcohol abuse and dependence: a 12-year follow-up. J Subst Abuse. 2001;13(4):493-504.
FULL TEXT
|
WEB OF SCIENCE
| PUBMED
14. Grant BF, Dawson DA. Age at onset of alcohol use and its association with DSM-IV alcohol abuse and dependence: results from the National Longitudinal Alcohol Epidemiologic Survey. J Subst Abuse. 1997;9:103-110.
FULL TEXT
|
WEB OF SCIENCE
| PUBMED
15. Hingson R, Kenkel D. Social, health, and economic consequences of underage drinking. In: Bonnie RJ, O’Connell ME, eds. Reducing Underage Drinking: A Collective Responsibility. Washington, DC: National Academies Press; 2004.16. Hingson RW, Heeren T, Jamanka A, Howland J. Age of drinking onset and unintentional injury involvement after drinking. JAMA. 2000;284(12):1527-1533.
FREE FULL TEXT
17. Hingson R, Heeren T, Zakocs R. Age of drinking onset and involvement in physical fights after drinking. Pediatrics. 2001;108(4):872-877.
FREE FULL TEXT
18. Hingson R, Heeren T, Levenson S, Jamanka A, Voas R. Age of drinking onset, driving after drinking, and involvement in alcohol related motor-vehicle crashes. Accid Anal Prev. 2002;34(1):85-92.
FULL TEXT
|
WEB OF SCIENCE
| PUBMED
19. Hingson R, Heeren T, Winter MR, Wechsler H. Early age of first drunkenness as a factor in college students' unplanned and unprotected sex attributable to drinking. Pediatrics. 2003;111(1):34-41.
FREE FULL TEXT
20. Hingson R, Heeren T, Zakocs R, Winter M, Wechsler H. Age of first intoxication, heavy drinking, driving after drinking and risk of unintentional injury among US college students. J Stud Alcohol. 2003;64(1):23-31.
WEB OF SCIENCE
| PUBMED
21. Patton GC, McMorris BJ, Toumbourou JW, Hemphill SA, Donath S, Catalano RF. Puberty and the onset of substance use and abuse. Pediatrics. 2004;114(3):e300-e306.
FREE FULL TEXT
22. O'Malley PM, Johnston LD. Drinking and driving among US high school seniors, 1984-1997. Am J Public Health. 1999;89(5):678-684.
FREE FULL TEXT
23. Warheit GJ, Biafora FA, Zimmerman RS, Gil AG, Vega WA, Apospori E. Self-rejection/derogation, peer factors, and alcohol, drug, and cigarette use among a sample of Hispanic, African-American, and white non-Hispanic adolescents. Int J Addict. 1995;30(2):97-116.
WEB OF SCIENCE
| PUBMED
24. Simons-Morton B. Prospective association of peer influence, school engagement, drinking expectancies, and parent expectations with drinking initiation among sixth graders. Addict Behav. 2004;29(2):299-309.
FULL TEXT
|
WEB OF SCIENCE
| PUBMED
25. Ritchey PN, Reid GS, Hasse LA. The relative influence of smoking on drinking and drinking on smoking among high school students in a rural tobacco-growing county. J Adolesc Health. 2001;29(6):386-394.
FULL TEXT
|
WEB OF SCIENCE
| PUBMED
26. Oman RF, Vesely S, Aspy CB, McLeroy KR, Rodine S, Marshall L. The potential protective effect of youth assets on adolescent alcohol and drug use. Am J Public Health. 2004;94(8):1425-1430.
FREE FULL TEXT
27. Blum RW, Beuhring T, Shew ML, Bearinger LH, Sieving RE, Resnick MD. The effects of race/ethnicity, income, and family structure on adolescent risk behaviors. Am J Public Health. 2000;90(12):1879-1884.
FREE FULL TEXT
28. Donovan JE. Adolescent alcohol initiation: a review of psychosocial risk factors. J Adolesc Health. 2004;35(6):529.e7-529.e18.
PUBMED
29. Deas D, Thomas S. Comorbid psychiatric factors contributing to adolescent alcohol and other drug use. Alcohol Res Health. 2002;26(2):116-121.
30. Eisenberg ME, Olson RE, Neumark-Sztainer D, Story M, Bearinger LH. Correlations between family meals and psychosocial well-being among adolescents. Arch Pediatr Adolesc Med. 2004;158(8):792-796.
FREE FULL TEXT
31. National Center on Addiction and Substance Abuse at Columbia University. The Importance of Family Dinners II. New York, NY: Columbia University; 2005.32. Fleming K, Thorson E, Atkin CK. Alcohol advertising exposure and perceptions: links with alcohol expectancies and intentions to drink or drinking in underaged youth and young adults. J Health Commun. 2004;9(1):3-29.
FULL TEXT
|
WEB OF SCIENCE
| PUBMED
33. Jernigan DH, Ostroff J, Ross C, O'Hara JA III. Sex differences in adolescent exposure to alcohol advertising in magazines. Arch Pediatr Adolesc Med. 2004;158(7):629-634.
FREE FULL TEXT
34. Collins RL, Schell T, Ellickson PL, McCaffrey D. Predictors of beer advertising awareness among eighth graders. Addiction. 2003;98(9):1297-1306.
FULL TEXT
|
WEB OF SCIENCE
| PUBMED
35. Collins RL, Ellickson PL, McCaffrey DF, Hambarsoomians K. Saturated in beer: awareness of beer advertising in late childhood and adolescence. J Adolesc Health. 2005;37(1):29-36.
FULL TEXT
|
WEB OF SCIENCE
| PUBMED
36. Snyder LB, Milici FF, Slater M, Sun H, Strizhakova Y. Effects of alcohol advertising exposure on drinking among youth. Arch Pediatr Adolesc Med. 2006;160(1):18-24.
FREE FULL TEXT
37. Ellickson PL, Collins RL, Hambarsoomians K, McCaffrey DF. Does alcohol advertising promote adolescent drinking? results from a longitudinal assessment. Addiction. 2005;100(2):235-246.
FULL TEXT
|
WEB OF SCIENCE
| PUBMED
38. Chen X, Cruz TB, Schuster DV, Unger JB, Johnson CA. Receptivity to protobacco media and its impact on cigarette smoking among ethnic minority youth in California. J Health Commun. 2002;7(2):95-111.
FULL TEXT
|
WEB OF SCIENCE
| PUBMED
39. Kaufman NJ, Castrucci BC, Mowery PD, Gerlach KK, Emont S, Orleans CT. Predictors of change on the smoking uptake continuum among adolescents. Arch Pediatr Adolesc Med. 2002;156(6):581-587.
FREE FULL TEXT
40. McClure AC, Dal Cin S, Gibson J, Sargent JD. Ownership of alcohol-branded merchandise and initiation of teen drinking. Am J Prev Med. 2006;30(4):277-283.
FULL TEXT
|
WEB OF SCIENCE
| PUBMED
41. Power TG, Stewart CD, Hughes SO, Arbona C. Predicting patterns of adolescent alcohol use: a longitudinal study. J Stud Alcohol. 2005;66(1):74-81.
WEB OF SCIENCE
| PUBMED
42. Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot. 1997;12(1):38-48.
WEB OF SCIENCE
| PUBMED
43. Berkey CS, Rockett HR, Field AE; et al. Activity, dietary intake, and weight changes in a longitudinal study of preadolescent and adolescent boys and girls. Pediatrics. 2000;105(4):E56.
FULL TEXT
| PUBMED
44. Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child. 1969;44(235):291-303.
FREE FULL TEXT
45. Marshall WA, Tanner JM. Variations in the pattern of pubertal changes in boys. Arch Dis Child. 1970;45(239):13-23.
FREE FULL TEXT
46. Harter S. Manual of the Self-perception Profile for Children. Denver, CO: University of Denver; 1985.47. Fromme K, D'Amico EJ. Measuring adolescent alcohol outcome expectancies. Psychol Addict Behav. 2000;14(2):206-212.
FULL TEXT
|
WEB OF SCIENCE
| PUBMED
48. Brown SA, Christiansen BA, Goldman MS. The Alcohol Expectancy Questionnaire: an instrument for the assessment of adolescent and adult alcohol expectancies. J Stud Alcohol. 1987;48(5):483-491.
WEB OF SCIENCE
| PUBMED
49. Aas H. Adaptation of the Alcohol Expectancy Questionnaire (AEQ-A): a short version for use among 13-year-olds in Norway. Scand J Psychol. 1993;34(2):107-118.
WEB OF SCIENCE
| PUBMED
50. Rather BC. Using the Alcohol Expectancy Questionnaire–Adolescent Form to predict college drinking: long vs short forms. Addict Behav. 1990;15(6):567-572.
FULL TEXT
|
WEB OF SCIENCE
| PUBMED
51. Kosterman R, Hawkins JD, Guo J, Catalano RF, Abbott RD. The dynamics of alcohol and marijuana initiation: patterns and predictors of first use in adolescence. Am J Public Health. 2000;90(3):360-366.
FREE FULL TEXT
52. Kandel DB, Logan JA. Patterns of drug use from adolescence to young adulthood, I: periods of risk for initiation, continued use, and discontinuation. Am J Public Health. 1984;74(7):660-666.
FREE FULL TEXT
53. Kandel DB, Yamaguchi K. Developmental patterns of the use of legal, illegal, and medically prescribed psychotropic drugs from adolescence to young adulthood. In: Jones CL, Battjes RJ, eds. Etiology of Drug Abuse: Implications for Prevention. Rockville, MD: National Institute on Drug Abuse; 1985:193-235.54. Callas PW, Flynn BS, Worden JK. Potentially modifiable psychosocial factors associated with alcohol use during early adolescence. Addict Behav. 2004;29(8):1503-1515.
FULL TEXT
|
WEB OF SCIENCE
| PUBMED
55. Krahn D, Piper D, King M, Olson L, Kurth C, Moberg DP. Dieting in sixth grade predicts alcohol use in ninth grade. J Subst Abuse. 1996;8(3):293-301.
FULL TEXT
|
WEB OF SCIENCE
| PUBMED
56. Miller KE, Hoffman JH, Barnes GM, Farrell MP, Sabo D, Melnick MJ. Jocks, gender, race, and adolescent problem drinking. J Drug Educ. 2003;33(4):445-462.
FULL TEXT
|
WEB OF SCIENCE
| PUBMED
57. Dolcini MM, Adler NE. Perceived competencies, peer group affiliation, and risk behavior among early adolescents. Health Psychol. 1994;13(6):496-506.
FULL TEXT
|
WEB OF SCIENCE
| PUBMED
58. Lifrak PD, McKay JR, Rostain A, Alterman AI, O'Brien CP. Relationship of perceived competencies, perceived social support, and gender to substance use in young adolescents. J Am Acad Child Adolesc Psychiatry. 1997;36(7):933-940.
WEB OF SCIENCE
| PUBMED
59. Schulenberg J, Bachman JG, O'Malley PM, Johnston LD. High school educational success and subsequent substance use: a panel analysis following adolescents into young adulthood. J Health Soc Behav. 1994;35(1):45-62.
FULL TEXT
|
WEB OF SCIENCE
| PUBMED
60. Ellickson PL, Hays RD. Antecedents of drinking among young adolescents with different alcohol use histories. J Stud Alcohol. 1991;52(5):398-408.
WEB OF SCIENCE
| PUBMED
61. Beal AC, Ausiello J, Perrin JM. Social influences on health-risk behaviors among minority middle school students. J Adolesc Health. 2001;28(6):474-480.
FULL TEXT
|
WEB OF SCIENCE
| PUBMED
62. Simons-Morton B, Haynie DL, Crump AD, Eitel SP, Saylor KE. Peer and parent influences on smoking and drinking among early adolescents. Health Educ Behav. 2001;28(1):95-107.
FREE FULL TEXT
63. Reifman A, Barnes GM, Dintcheff BA, Farrell MP, Uhteg L. Parental and peer influences on the onset of heavier drinking among adolescents. J Stud Alcohol. 1998;59(3):311-317.
WEB OF SCIENCE
| PUBMED
64. Epstein JA, Botvin GJ, Diaz T, Schinke SP. The role of social factors and individual characteristics in promoting alcohol use among inner-city minority youths. J Stud Alcohol. 1995;56(1):39-46.
WEB OF SCIENCE
| PUBMED
65. Sieving RE, Perry CL, Williams CL. Do friendships change behaviors, or do behaviors change friendships? examining paths of influence in young adolescents' alcohol use. J Adolesc Health. 2000;26(1):27-35.
FULL TEXT
|
WEB OF SCIENCE
| PUBMED
66. Bauman KE, Fisher LA, Bryan ES, Chenoweth RL. Relationship between subjective expected utility and behavior: a longitudinal study of adolescent drinking behavior. J Stud Alcohol. 1985;46(1):32-38.
WEB OF SCIENCE
| PUBMED
67. Kuendig H, Kuntsche E. Family bonding and adolescent alcohol use: moderating effect of living with excessive drinking parents. Alcohol Alcohol. 2006;41(4):464-471.
FREE FULL TEXT
68. Dawson DA. The link between family history and early onset alcoholism: earlier initiation of drinking or more rapid development of dependence? J Stud Alcohol. 2000;61(5):637-646.
WEB OF SCIENCE
| PUBMED
69. Hill SY, Shen S, Lowers L, Locke J. Factors predicting the onset of adolescent drinking in families at high risk for developing alcoholism. Biol Psychiatry. 2000;48(4):265-275.
FULL TEXT
|
WEB OF SCIENCE
| PUBMED
70. Seljamo S, Aromaa M, Koivusilta L; et al. Alcohol use in families: a 15-year prospective follow-up study. Addiction. 2006;101(7):984-992.
FULL TEXT
|
WEB OF SCIENCE
| PUBMED
71. Johnson TP, Mott JA. The reliability of self-reported age of onset of tobacco, alcohol and illicit drug use. Addiction. 2001;96(8):1187-1198.
FULL TEXT
|
WEB OF SCIENCE
| PUBMED
72. Kahn JA, Goodman E, Kaplowitz RA, Slap GB, Emans SJ. Validity of adolescent and young adult self-report of Papanicolaou smear results. Obstet Gynecol. 2000;96(4):625-631.
FULL TEXT
|
WEB OF SCIENCE
| PUBMED
73. Shew ML, Remafedi GJ, Bearinger LH; et al. The validity of self-reported condom use among adolescents. Sex Transm Dis. 1997;24(9):503-510.
WEB OF SCIENCE
| PUBMED
74. Hornberger LL, Rosenthal SL, Biro FM, Stanberry LR. Sexual histories of adolescent girls: comparison between interview and chart. J Adolesc Health. 1995;16(3):235-239.
FULL TEXT
|
WEB OF SCIENCE
| PUBMED
75. Brener ND, Collins JL, Kann L, Warren CW, Williams BI. Reliability of the Youth Risk Behavior Survey Questionnaire. Am J Epidemiol. 1995;141(6):575-580.
FREE FULL TEXT
76. National Association of Attorneys General. Master Settlement Agreement. Washington, DC: National Association of Attorneys General; 1998.77. Federal Trade Commission. Alcohol Marketing and Advertising: A Report to Congress. Washington, DC: Federal Trade Commission; 2003.
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