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Psychosocial Risk Factors

Parenting, Family Environment, and Peers. Parents' drinking behavior and favorable attitudes about drinking have been positively associated with adolescents' initiating and continuing drinking (41,42). Early initiation of drinking has been identified as an important risk factor for later alcohol-related problems (43). Children who were warned about alcohol by their parents and children who reported being closer to their parents were less likely to start drinking (42,44,45).

Lack of parental support, monitoring, and communication have been significantly related to frequency of drinking (46), heavy drinking, and drunkenness among adolescents (47). Harsh, inconsistent discipline and hostility or rejection toward children have also been found to significantly predict adolescent drinking and alcohol-related problems (46).

Peer drinking and peer acceptance of drinking have been associated with adolescent drinking (48,49). While both peer influences and parental influences are important, their relative impact on adolescent drinking is unclear.

Expectancies. Positive alcohol-related expectancies have been identified as risk factors for adolescent drinking. Positive expectancies about alcohol have been found to increase with age (50) and to predict the onset of drinking and problem drinking among adolescents (51-53).

Trauma. Child abuse and other traumas have been proposed as risk factors for subsequent alcohol problems. Adolescents in treatment for alcohol abuse or dependence reported higher rates of physical abuse, sexual abuse, violent victimization, witnessing violence, and other traumas compared with controls (54). The adolescents in treatment were at least 6 times more likely than controls to have ever been abused physically and at least 18 times more likely to have ever been abused sexually. In most cases, the physical or sexual abuse preceded the alcohol use. Thirteen percent of the alcohol dependent adolescents had experienced posttraumatic stress disorder, compared with 10 percent of those who abused alcohol and 1 percent of controls.

Advertising. Research on the effects of alcohol advertising on adolescent alcohol-related beliefs and behaviors has been limited (55). While earlier studies measured the effects of exposure to advertising (56), more recent research has assessed the effects of alcohol advertising awareness on intentions to drink. In a study of fifth- and sixth-grade students' awareness, measured by the ability to identify products in commercials with the product name blocked out, awareness had a small but statistically significant relationship to positive expectancies about alcohol and to intention to drink as adults (57). This suggests that alcohol advertising may influence adolescents to be more favorably predisposed to drinking (57).

Consequences of Adolescent Alcohol Use

Drinking and Driving. Of the nearly 8,000 drivers ages 15-20 involved in fatal crashes in 1995, 20 percent had blood alcohol concentrations above zero (58). For more information about young drivers' increased crash risk and the factors that contribute to this risk, see Alcohol Alert No. 31: Drinking and Driving (59).

Sexual Behavior. Surveys of adolescents suggest that alcohol use is associated with risky sexual behavior and increased vulnerability to coercive sexual activity. Among adolescents surveyed in New Zealand, alcohol misuse was significantly associated with unprotected intercourse and sexual activity before age 16 (60). Forty-four percent of sexually active Massachusetts teenagers said they were more likely to have sexual intercourse if they had been drinking, and 17 percent said they were less likely to use condoms after drinking (61).

Risky Behavior and Victimization. Survey results from a nationally representative sample of 8th and 10th graders indicated that alcohol use was significantly associated with both risky behavior and victimization and that this relationship was strongest among the 8th-grade males, compared with other students (62).

Puberty and Bone Growth. High doses of alcohol have been found to delay puberty in female (63) and male rats (64), and large quantities of alcohol consumed by young rats can slow bone growth and result in weaker bones (65). However, the implications of these findings for young people are not clear.

Prevention of Adolescent Alcohol Use

Measures to prevent adolescent alcohol use include policy interventions and community and educational programs. Alcohol Alert No. 34: Preventing Alcohol Abuse and Related Problems (66) covers these topics in detail. See the National Institute on Alcohol Abuse and Alcoholism's (NIAAA's) World Wide Web site at http://www.niaaa.nih.gov.

Youth Drinking: Risk Factors and Consequences--A Commentary by
NIAAA Director Enoch Gordis, M.D.

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