Exposure to alcohol starts from an early age

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Alcohol use is one of the biggest risk factors for social and physical harm and has been linked to the development of diseases including cancer, diabetes, and liver and heart disease.

Even though the legal age to buy alcohol is 18 years and above in most countries, the 2015 European School Survey Project on Alcohol and Other Drugs found that almost half of 15-16-year-old students had consumed alcohol and 8% had been drunk by the age of 13.

Exposure to alcohol starts from an early age: children as young as two years old become aware of alcohol and are able to distinguish alcoholic from non-alcoholic drinks.

From age four on, children start to understand that alcohol is usually restricted to adults and consumed in specific situations.

Many studies have connected the parent’s behaviour and the home environment with children’s alcohol use, but it is still unclear how parental attitudes influence their children’s behaviour.

In a study published today in the journal Addiction, Mariliis Tael-Oeren and colleagues at Cambridge’s Behavioural Science Group and the School of Health Sciences at the University of East Anglia (UEA) found that children whose parents had less restrictive attitudes towards their child’s alcohol use were more likely to start drinking alcohol than their peers.

They also drank – and got drunk – more frequently.

The findings come from a review of published articles examining parent-child pairs and the relationship between parental attitudes and their child’s alcohol use.

A review enables researchers to combine data from a large number of studies, sometimes with conflicting findings, to arrive at a more robust finding.

he researchers pooled information from the 29 most relevant articles and analysed all the relevant information, which included data from almost 16,500 children and more than 15,000 parents in the US and Europe.

Mariliis Tael-Oeren, Ph.D. student and lead author for the study, says:

“Our study suggests that when parents have a lenient attitude towards their children drinking alcohol, this can lead to their child drinking more frequently—and drinking too much.

“Although the data was based on children and their parents in the US and Europe, we expect that our findings will also apply here in the UK.”

Ms Tael-Oeren and colleagues also found a mismatch between what children think is their parent’s attitude towards them drinking and what the parent’s attitude actually is.

Children were no more likely to start drinking alcohol if they perceived their parent to have a lenient attitude, but once they had started drinking, they were more likely to drink often.

“This mismatch doesn’t mean that children perceive parental attitudes completely differently from their parents,” explains Ms Tael-Oeren.

“Instead, it could be that their perceptions are skewed towards thinking their parents have more lenient attitudes. This could be because their parents haven’t expressed their attitudes in a way that the children really understand.”

“Alcohol use can be problematic, particularly among young people.

It’s important that children understand the short and long term consequences of drinking.

If parents don’t want their children to drink, then our study suggests they need to be clear about the message they give out.”

Senior author Professor Stephen Sutton says that social norms could lead to confusion among children.

“Alcohol use is influenced by a variety of factors, including attitudes and social norms.

If the social norm supports parents introducing alcohol to children, children might mistakenly assume that their parents are more lenient, even when this is not the case.”

Dr. Felix Naughton, from UEA’s School of Health Sciences, adds:

“Uncovering this mismatch in perceptions is important as it may have implications for parenting programmes designed to support families in reducing childhood alcohol use and indeed for parents who just want to know what they can do to protect their children.”


Starting to drink alcohol in early adolescence or younger is associated with a greater likelihood of developing both problem drinking in adolescence (Ellickson et al., 20012003Gruber et al., 1996Hawkins et al., 1997Horton, 2007Pedersen and Skrondal, 1998Warner et al., 2007) and alcohol abuse or dependence in adulthood (DeWit et al., 2000Grant and Dawson, 1997Hingson et al., 2006).

Early initiation of drinking is also associated with a variety of other problematic outcomes later in adolescence and in young adulthood, including academic problems, dropping out of high school, delinquent behavior, fighting after drinking, illicit drug use, prescription drug misuse, substance use disorders, employment problems, risky sexual behavior, pregnancy, unintentional injuries, drinking and driving, and alcohol- and other drug-related motor vehicle crashes (Ellickson et al., 2003Gruber et al., 1996Hermos et al., 2008Hingson et al., 20002001200220082009Hingson and Zha, 2009McCluskey et al., 2002Stueve and O’Donnell, 2005Zakrajsek and Shope, 2006).

Given these linkages with multiple later problems, it is crucial to develop a better understanding of the risk factors that predict the early initiation of alcohol use.

Prevalence of child and adolescent alcohol use

Large-scale epidemiologic surveys of alcohol use among children ages 12 and younger are rare.

According to the 1999 Partnership Attitude Tracking Study (sponsored by the Partnership for a Drug-Free America), which surveyed a national probability sample of nearly 2,400 U.S. elementary school students, 9.8% of 4th graders, 16.1% of 5th graders, and 29.4% of 6th graders had had more than just a sip of alcohol in their lives (see Donovan, 2007).

Recent data on the use of alcohol in the past year (rather than lifetime) is reported annually by Pride Surveys. According to the 2008–2009 summary of school district surveys performed across the United States, 3.7% of 4th graders, 4.6% of 5th graders, and 7.6% of 6th graders had drunk alcohol in the past year (Pride Surveys, 2009).

Among adolescents, the most recent Monitoring the Future survey of U.S. students in 2009 shows that 36.6% of 8th graders, 59.1% of 10th graders, and 72.3% of 12th graders have had some experience with alcohol (Johnston et al., 2010).

Somewhat higher rates of adolescent alcohol experience were reported in the 2009 Youth Risk Behavior Survey (Eaton et al., 2010): 63.4%, 9th grade; 71.1%, 10th grade; 77.8%, 11th grade; and 79.7%, 12th grade.

Definition of early-onset drinking

The definition of early-onset drinking is still evolving. Studies have adopted cut-points for early onset of age 12 or younger (De Genna et al., 2009), age 13 or younger (Bau-meister and Tossmann, 2005; Bossarte and Swahn, 2008King and Chassin, 2007), age 14 or younger (Hingson et al., 2000McGue and Iacono, 2005Sartor et al., 2009), and age 15 or younger (Humphrey and Friedman, 1986).

In the present analyses, early initiation of alcohol use is defined as drinking at age 14 or younger, the most common definition in this literature.Go to:

Antecedents of early alcohol use initiation

A number of prospective studies have focused on the childhood predictors of the initiation of drinking by age 14 (see review by Zucker et al., 2008).

Only a few studies have examined the psychosocial antecedents of starting to drink in childhood (Andrews et al., 2003Baumrind, 1985Bush and Iannotti, 1992Long and Boik, 1993Macleod et al., 2008).

Among the variables predicting childhood onset were alcohol use intentions, beliefs about alcohol, self-esteem, less social assertiveness, negative school attitudes, depression, less parental encouragement, parental smoking, maternal cannabis use, male gender, and lower social class.

When early onset is defined as initiation before age 14 or 15, a number of additional variables figure as risk factors.

Antecedent personality variables found to predict early initiation of drinking include lower levels of behavioral control and lower levels of resiliency (Wong et al., 2006), greater rebelliousness and sensation seeking (Sargent et al., 2006), less bonding to school (Hawkins et al., 1997), greater depression (Crum et al., 2008Kaplow et al., 2001), and less separation anxiety and greater generalized anxiety (Kaplow et al., 2001).

Antecedent social environment variables predicting early-onset drinking are parental alcoholism (King and Chassin, 2007Wong et al., 2004), greater parental drinking (Hawkins et al., 1997), maternal drinking and smoking (Hayatbakhsh et al., 2008), lower parental monitoring (Hayatbakhsh et al., 2008Rose et al., 2001), worse home environment (Rose et al., 2001), family disruption (Hayatbakhsh et al., 2008), having more friends who drink (Hawkins et al., 1997), and greater exposure to alcohol use in the movies (Sargent et al., 2006).

Behavior variables predictive of starting to drink before age 14 are conduct disorder, oppositional defiant disorder or any externalizing disorder (McGue et al., 2001), conduct problems (Lynskey and Fergusson, 1995), smoking (Sargent et al., 2006), greater behavior problems and fewer emotional problems (Rose et al., 2001), and sleep problems (Wong et al., 20042009). Last, sociodemographic predictors include male gender (Rose et al., 2001) and White ethnicity (Hawkins et al., 1997).:

Problem Behavior Theory

The social–psychological framework of Problem Behavior Theory (Donovan, 2005Jessor and Jessor, 1977Jessor et al., 1991) encompasses a number of the variables noted above as predictors of early-onset drinking, as well as other personality, social environment, and behavior system variables.

Within each of the three systems comprising the framework, the explanatory variables reflect either instigations for problem behavior or controls against it, and together they generate a dynamic state of proneness that specifies the likelihood of occurrence of normative transgression or problem behavior.

The component variables comprising the personality, social environment, and behavior systems are described in the Method section.

Previous research has shown the utility of the framework for the explanation of variation in adolescent and young adult involvement in drinking, problem drinking, marijuana use, sexual behavior, and risky and drinking driving (Costa et al., 1995Donovan, 19931996Donovan et al., 1999Jessor and Jessor, 1977Jessor et al., 1991).

Greater psychosocial proneness for problem behavior ought to relate to early-onset drinking because initiation of alcohol use at a young age violates both legal and social norms for acceptable behavior (Prins et al., 2011).


More information: Mariliis Tael‐Öeren et al, The relationship between parental attitudes and children’s alcohol use: a systematic review and meta‐analysis, Addiction (2019). DOI: 10.1111/add.14615

Journal information: Addiction
Provided by University of Cambridge

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