text stringlengths 59 1.12k |
|---|
age 11 predicted more likely alcohol abuse at age 27 in a study of Swedish children (Hawkins et al. 1997). Evidence of alcohol abuse was based on registration with the |
Swedish Temperance Board, arrests for drunkenness, driving-while-intoxicated charges, or treatment for alcoholism. Measures of (poor) motor development in the first year of life related to the diagnosis of alcohol dependence |
at age 30 in the Danish Longitudinal Study of Alcoholism (Manzardo et al. 2005). Motor development was measured by muscle tone at age 5 days, an inability to sit without |
support at age 7 months, and the inability to walk at 1 year. Lower math achievement scores in 1st grade, lower ratings of shyness (boys only), and mother’s regular alcohol |
use (both genders) predicted a diagnosis of adult alcohol abuse or dependence at age 42 in a followup of African-American children initially studied in the 1st grade as part of |
the Woodlawn Study (Crum et al. 2006). Psychologist ratings of extroversion/aggression at age 4 correlated with frequency of intoxication at age 25, and ratings of extroversion/ outgoing correlated with lifetime |
alcohol problems at age 36 in a Stockholm prenatal study (Wennberg and Bohman 2002). A conceptual model that integrates the following factors predicted DSM–IV alcohol abuse and dependence at age |
21: internalizing disorders, externalizing disorders, male gender, delinquency, unclear family rules, poor family monitoring, less bonding to school, living in a neighborhood with more troublemakers, having antisocial friends, having friends |
who drink frequently, bonding to antisocial friends, higher intentions to use alcohol, and more favorable attitudes toward alcohol at age 10 (Guo et al. 2001). ALCOHOL-SPECIFIC RISK FACTORS IN CHILDHOOD |
FOR FUTURE ALCOHOL INVOLVEMENT A multilevel, dynamic interplay of biological, psychological, and social processes shapes normal development as well as risk for alcohol use. Research has identified a number of |
factors in the 0–10 age-group that specifically predict risk for later alcohol use and alcohol use disorders (as compared with nonspecific risk factors that predict a spectrum of problems, including |
alcohol use). A significant alcohol-specific risk factor is the age of initiation, especially of binge drinking. Childhood and early adolescent onset of alcohol use increases the likelihood of developing both |
problem drinking in adolescence (Ellickson et al. 2003; Fergusson et al. 1994; Gruber et al. 1996; Hawkins et al. 1997) and alcohol abuse or dependence in adulthood (Grant and Dawson |
1997; Hingson et al. 2006; Pitkanen et al. 2005). It is not yet clear, however, whether childhood alcohol use (i.e., at age 12 and under) or early adolescent alcohol use |
(i.e., at age 13 or 14) is the greater risk factor. Early-onset drinking is related to a variety of problematic outcomes in addition to later alcohol involvement. Onset of drinking |
by ages 10–12, for example, is correlated with absences from school, as well as marijuana and other illicit drug use in grade 12 (Gruber et al. 1996). Onset by ages |
12–13 (7th grade) is related to more delinquent behavior, school problems, smoking, and illicit drug use in grade 12 and to smoking, illicit drug use, drug selling, and criminal behavior |
at age 23 (Ellickson et al. 2003). A follow-up study in grade 10 found that those who initiated drinking by the fall of 7th grade reported more recent drinking, drunkenness, |
and alcohol or drug problems and were more likely to have initiated sexual intercourse, to have had more than two sexual partners, and to have become pregnant or gotten someone |
pregnant compared with those who had not started drinking (Stueve and O’Donnell 2005). Development of Children’s Beliefs and Expectancies1 About Alcohol[1Expectancy is a term commonly used in the alcohol research |
literature to mean expectations.] As children develop, they become aware of alcohol as an object in their social environment through a variety of means. They observe alcohol use by parents |
and other adults in the immediate social environment, they see drinking paraphernalia (i.e., bottles, cans, six-packs, special glasses for wine and cocktails, etc.) and experience the smell of alcohol in |
its different forms. They also make observational contact via the media, seeing adolescent and adult actors on television, in movies, magazines, newspapers, advertising, and other forms of media. In the |
absence of the actual drinking experience, observational learning about alcohol is the major influence in determining children’s attitudes toward alcohol and the expectations they have about the effects of drinking. |
A number of studies show this influence is not inconsequential. As children grow older, they learn that alcohol produces changes in thinking, feeling, and behavior and that it has a |
role in social relationships. They discover who uses it and why and, ultimately, develop expectations about its use. To a significant degree, these cognitive variables influence when they will consume |
alcohol, how much they will drink, and when they will consider it appropriate to decline use. By preschool, children have learned certain norms about alcohol use, namely, that adults drink |
alcoholic beverages, children do not, and men drink more than women (Zucker et al. 1995). By ages 6.5–7.5, children understand the concept of alcohol (Fossey 1994). Their attitude toward adults |
depicted drinking alcohol basically is neutral at age 6 but becomes more negative through age 10 (Fossey 1994; Jahoda and Cramond 1972). Between ages 10 and 14, these attitudes shift |
to become more positive (Aitken 1978). Children also learn about the behavioral effects of drinking and hold definite beliefs about it by age 10 (Fossey 1994; Gaines et al. 1988; |
Miller et al. 1990). These expectations about the effects of alcohol on drinkers generally are negative in childhood (Noll et al. 1990), but they become more positive as the children |
get older (Miller et al. 1990) and as they enter adolescence (Dunn and Goldman 1998). Childhood Social Contexts That Influence Drinking In this age-group, parents are the major source of |
children’s exposure to alcohol use. Research over four decades consistently indicates that children are more likely to become drinkers at some point in their lives if their parents are drinkers. |
Self-reports of alcohol use among children correlate significantly with their perceptions of parental drinking (Jackson 1997). In fact, even preschool children are aware in some way of their parents’ level |
of drinking; this awareness translates into perceptions of the world as more or less peopled by adults who drink, such that 3- to 5-year-olds from heavier drinking homes are more |
likely to think that, when adults drink, they will be drinking alcoholic beverages (Zucker et. al., 1995). The fact that these preschoolers see men as drinking more than women, implying |
a personal knowledge of adult-cultural norms, suggests that even at very young ages, children have an acute understanding of the level of drinking around them. Thus, parents increase the likelihood |
of their child’s drinking by modeling alcohol use, by making alcohol accessible in the home, by actively encouraging their child’s experimentation with alcohol, and also by covertly teaching them that |
alcohol use is an acceptable, possibly even desirable, behavior. When children are asked to name the source of their first drink, they overwhelmingly cite their parents or their home. For |
example, the 1993–1994 Bogalusa Heart Study found that 78 percent of the children in grades 3 through 6 who had ever tried alcohol took their first drink with someone in |
the family (Johnson et al. 1997). A recent community survey of children in Oregon (Andrews et al. 2003) found that few of the children who had ever tried alcohol had |
done so without their parents’ knowledge, especially in grades 1 through 4. Children, like adolescents, also learn about alcohol use and its effects through their exposure to its portrayed use |
in movies, television, and advertisements. The alcohol industry spends over $1.6 billion a year on advertising, which it places in a variety of media, including radio, television, magazines, newspapers, and |
billboards (Bonnie and O’Connell 2004). Because magazine and radio audience data do not include children under age 12, it is not possible to measure childhood exposure to alcohol advertisements in |
these media. However, it appears likely that children under age 12 are less exposed to magazine ads because of their reading levels and their choice in reading materials. Generally, children |
favor books over magazines, or if they read magazines they prefer those with advertising restrictions. The same situation appears to exist for television advertising. A July 2005 Center on Alcohol |
Marketing and Youth report indicates that children ages 2–11 are exposed to less than half as many television alcohol advertisements as adolescents ages 12–20. As a result, they are underexposed |
relative to their prevalence in the overall population (Center on Alcohol Marketing and Youth 2005). Nonetheless, they still are exposed to some television advertising of alcohol products. Children ages 2–11 |
saw an average of 99.4 alcohol advertisements on television between January and October of 2004. Of those advertisements, 81 percent were for beer and ale, 11 percent for spirits, 5 |
percent for alcopops, and 3 percent for wine. Assuming a similar exposure rate across the years, the average child would have seen almost 1,200 television advertisements for alcohol products before |
the age of 12. In addition to alcohol advertisements, children are exposed to portrayals of alcohol use in G- and PG-rated movies and on television shows in which characters use |
alcohol, often without apparent consequences. These programs are pervasive in primetime (8–11 p.m.) television when children may be watching. An estimated 71 percent of sampled primetime episodes from the 1998–1999 |
season portrayed alcohol use (Christenson et al. 2000). Approximately 38 percent of the TV-G–rated programs considered appropriate for most children depicted alcohol use. The majority of episodes characterized drinking as |
a positive experience rather than a negative one, with adverse consequences portrayed or mentioned in only 23 percent of the episodes. Is childhood exposure to alcohol use in the media |
important? Significantly more research is necessary to determine the relationship between media exposure to drinking and children’s initiation of alcohol use. However, a greater awareness of beer advertisements was significantly |
related to greater intentions to drink as an adult in a study of 5th/6th-grade students (Grube and Wallach 1994). Awareness was defined as the ability to correctly identify brand names |
of still photographs from current television commercials. A study of 10- to 14-year-old nondrinkers found that their level of exposure to alcohol use in motion pictures predicted whether they were |
drinkers 1 to 2 years later (Sargent et al. 2006). Children in Alcoholic Families: A Special Early-Risk Population Approximately 9.7 million children age 17 or younger were living in households |
with one or more adults who were classified as having a diagnosis of alcohol abuse or dependence within the past year, according to data from the National Longitudinal Alcohol Epidemiologic |
Survey (NLAES) (Grant 2000). Approximately 70 percent of these children were biological, foster, adopted, or stepchildren. Therefore, 6.8 million children, or about 15 percent of children aged 17 or younger, |
meet the formal definition of children of alcoholics (COAs). From the standpoint of socialization risk, these numbers reflect only acute exposure (i.e., within the past year) to at least one |
alcoholic adult. According to additional data from the NLAES survey, 43 percent of the under-18 population, or slightly less than half of all children, were exposed to either a current |
or previously alcoholic adult in their household at some time in their childhood. Approximately 30 percent of COAs under the age of 18 were similarly exposed, but even this represents |
an enormous population at high risk.2 [2The apparent discrepancy between 43 percent of all children and 30 percent of children of alcoholics being exposed to an alcoholic adult in their |
household is accounted for by a variety of factors, including parental divorce where the child lives with the nonalcoholic parent or child placement outside the home because of parental alcoholism.] |
COAs have an increased risk for earlier drinking onset (Donovan 2004) and earlier progression into drinking problems (Grant and Dawson 1997). They are between 4 and 10 times as likely |
as non-COAs to become alcoholics themselves (Russell 1990). Genetic Risk Factors. Studies of children with an alcoholic biological parent who were raised by nonalcoholic adoptive parents (e.g., Sigvardsson et al. |
1996) make it possible to separate genetic and environmental influences on the development of alcoholism. In such studies, the adopted children with a biological alcoholic parent were significantly more likely |
to develop alcoholism later in life than were control children without a genetic risk for alcoholism even though alcohol abuse had not been modeled in their home. Such studies indicate |
a genetic risk for alcoholism. Additional research will be required to isolate the specific aspects of genetic risk that result in alcoholism and to identify environmental factors that moderate that |
risk. Factors Involved in Familial Transmission. The increased risk of alcohol involvement experienced by COAs is attributable to the following: Genetically transmitted differences in response to alcohol that make drinking |
more pleasurable and/or less aversive; The socialization effects of living in an alcoholic household; and Higher transmission of risky temperamental and behavioral traits that lead the COAs into greater contact |
with earlier and heavier drinking peers. Thus, familial alcoholism is a proxy for multiple risk factors, not all of which may be present for a given child. High divorce rates |
in alcoholic families makes evaluating the level of socialization risk a complex task. Quantification of that risk requires not only knowledge of the length of exposure to the actively alcoholic |
parent but also the developmental period during which that exposure took place. Some developmental periods have the potential to produce greater vulnerability than others (Caspi et al. 1996). In addition, |
a substantial number of alcoholic men marry alcoholic women (Schuckit et al. 2002). In such cases, risk exposure is multiplied and includes, in addition to genetic risk, increased socialization risk |
associated with each parent and with the risk created by impaired marital interactions (Fuller et al. 2003). Indirect socialization effects also play a role because parental psychopathology is a risk |
factor for poorer parental monitoring (Chilcoat and Anthony 1996), which, in turn, increases the probability of the COA’s involvement with a deviant peer group, including earlier exposure to alcohol- and |
other drug-using peers. The offspring of alcoholics have an increased risk for psychiatric comorbidities as well as for the development of an alcohol use disorder. Hence, COA status is a |
marker of increased risk for a variety of behavioral and cognitive problems. These include attention deficit disorder, behavioral undercontrol/conduct disorder, delinquency, lower IQ, poor school performance, low self-esteem, and others |
(West and Prinz 1987). Research strongly suggests that some of these non–alcohol-specific characteristics lead to both problem alcohol use and elevated risk for alcohol use disorders (Caspi et al. 2002; |
Donovan and Jessor 1985). For example, one community study of high-risk families (Wong et al. 2004) found that parental alcoholism was a significant predictor of early-onset alcohol use and drunkenness |
(both by age 14). Fetal Alcohol Exposure. Prenatal exposure to alcohol is a potential risk factor for early-onset drinking and for later alcohol problems. Research shows that even relatively modest |
levels of alcohol intake can have negative effects on the developing fetus. The effects of alcohol exposure on fetal development are referred to as teratogenic effects. Unfortunately, it is not |
yet clear what, if any, level of alcohol intake is safe during pregnancy, but it is known that teratogenic risks can occur at levels of alcohol intake during pregnancy that |
are not symptomatic of maternal alcoholism. Depending on the level and timing of alcohol exposure and other factors, such as nutrition and genetic vulnerability, these effects can be growth related, |
neurological, structural, and behavioral, and can reflect a spectrum of alcohol-related neurodevelopmental disorders called fetal alcohol spectrum disorders (FASD). The developmental effects of prenatal alcohol exposure have been extensively studied |
in both humans and animals (Brown et al. 1991; Donovan and Jessor 1985; Goldschmidt et al. 2004; Jacobson and Jacobson 2002; Mattson and Riley 1998; Olson et al. 1992; Rasmussen |
2005; Streissguth et al. 1995). They include effects on response inhibition, attention, executive functioning, behavior, and school achievement, all of which are risk factors for later alcohol problems. In a |
1989–1990 study involving children from 464 families in which the mothers’ drinking during pregnancy reflected a spectrum of consumption levels, the researchers followed up with the children when they were |
age 14. The mothers’ alcohol intake during pregnancy significantly predicted negative consequences of alcohol use in adolescence defined as personal and social difficulties such as fighting and neglecting responsibilities. These |
findings held even when controlling for family history of alcoholism, current parental drinking, and several parenting variables. When prenatal alcohol exposure was controlled for statistically, a family history of alcoholism |
was not a significant predictor. A later followup of this sample found that prenatal exposure to alcohol and a family history of alcoholism predicted young adult (ages 21–24) scores on |
the Alcohol Dependence Scale (Baer et al. 2003). DEVELOPMENTAL UNFOLDING OF RISK AND RESILIENCE Developmental pathways lead toward underage drinking and related problems of adolescence (risk), as well as away |
from them (resilience). Substantial evidence indicates that developmental patterns evident well before 10 years of age can be used to predict both later alcohol use and alcohol problems, suggesting that |
some children already have started down developmental paths leading toward early use and abuse of alcohol (Chilcoat and Anthony 1996; Donovan 2007; Zucker 2006). In some cases, high-risk pathways are |
so well-established that preventive interventions should be undertaken (Biglan et al. 2004). Even so, all “predictions” about the future alcohol involvement of children and adolescents more closely resemble probabilities. The |
actual pathway a given child or adolescent will take toward or away from problematic alcohol use is not certain. Many factors can intervene to change the pathway. In fact, there |
are children who appear to be on the same pathways who diverge in their decision to drink. Likewise, there are those on a developmental pathway away from problematic alcohol use |
who ultimately become involved in it. To better address underage drinking, it is important to understand the pathways that lead toward it as well as those that lead away from |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.