Excessive drinking and alcohol related harms in Adulthood: ALSPAC at 24
Lead Research Organisation:
University of Bristol
Department Name: Social Medicine
Abstract
Reducing harm caused by alcohol is a key public health and policy priority. Liver disease deaths have increases over 4-fold in last 40 years. Over 1 in 3 young adults, both women and men, aged 20-24 drink excessively. These adverse patterns of drinking can originate in adolescence - with 50% of adolescents reporting binge drinking by aged 16. Several key alcohol related harms emerge in young adulthood, while others may persist into adulthood because of continued excessive drinking. The evidence on the relationship between patterns of excessive drinking and these key harms, especially how important early onset excessive drinking in adolescence is, needs to be strengthened. We aim to provide evidence on the proportion of young people who show signs of liver fibrosis/damage and the risk conferred by different patterns of alcohol use; the risk of poor cognitive and emotional processing associated with binge drinking; whether harmful alcohol use leads to depression in young adults; whether excessive alcohol use prevents people "maturing" out of antisocial behaviour; and amount of injury in young people associated with adverse patterns of alcohol use.
In addition, harmful alcohol use or alcohol dependence also emerges in young adulthood. Further evidence is required on the relative contribution of different pathways to alcohol dependence. We plan to focus on three key pathways: the role of early behavioural or conduct problems; the impact of depressed mood and anxiety in early life and adolescence; and the potential effect of physiological response to alcohol (assessed in terms of the average amount of alcohol it takes to elicit an effect).
Longitudinal data - which measures alcohol use over time, and social, environmental factors before and during alcohol use - are required to assess both of these issues - the influence of types of alcohol consumption on harm in young adulthood and pathways to problem alcohol use in young adulthood.
The ALSPAC birth cohort (Children of the 90s) is the most extensively followed birth cohort in the world with detailed biological and behavioural data from before birth to late adolescence and early adulthood. We propose to take the unique opportunity provided by ALSPAC to measure alcohol related harms and outcomes in 5000 young people aged 24/25. Testing the robustness and strength of the association between alcohol and harm or the importance of different pathways to alcohol dependence will be important. Two key problems are confounding (where an association maybe explained by another factor) and missing data (which is higher in people from lower socio-economic groups with the greater early behavioural problems). We will utilize a range of sophisticated statistical techniques that seek to address these problems, including the use where possible of genetic markers of alcohol consumption (which are unrelated to other factors) and can strengthen evidence on causation.
We are a multi-disciplinary team including leading experts in methodology, alcohol and related harms. The evidence we gather and data we collect will be beneficial to other academics working in the field, and critically to public and patient groups, clinicians and policy-makers with an interest in preventing alcohol related harm.
In addition, harmful alcohol use or alcohol dependence also emerges in young adulthood. Further evidence is required on the relative contribution of different pathways to alcohol dependence. We plan to focus on three key pathways: the role of early behavioural or conduct problems; the impact of depressed mood and anxiety in early life and adolescence; and the potential effect of physiological response to alcohol (assessed in terms of the average amount of alcohol it takes to elicit an effect).
Longitudinal data - which measures alcohol use over time, and social, environmental factors before and during alcohol use - are required to assess both of these issues - the influence of types of alcohol consumption on harm in young adulthood and pathways to problem alcohol use in young adulthood.
The ALSPAC birth cohort (Children of the 90s) is the most extensively followed birth cohort in the world with detailed biological and behavioural data from before birth to late adolescence and early adulthood. We propose to take the unique opportunity provided by ALSPAC to measure alcohol related harms and outcomes in 5000 young people aged 24/25. Testing the robustness and strength of the association between alcohol and harm or the importance of different pathways to alcohol dependence will be important. Two key problems are confounding (where an association maybe explained by another factor) and missing data (which is higher in people from lower socio-economic groups with the greater early behavioural problems). We will utilize a range of sophisticated statistical techniques that seek to address these problems, including the use where possible of genetic markers of alcohol consumption (which are unrelated to other factors) and can strengthen evidence on causation.
We are a multi-disciplinary team including leading experts in methodology, alcohol and related harms. The evidence we gather and data we collect will be beneficial to other academics working in the field, and critically to public and patient groups, clinicians and policy-makers with an interest in preventing alcohol related harm.
Technical Summary
We will measure key alcohol related harms on 5000 ALSPAC participants aged 24/25 and test the association between patterns of alcohol use and risk/level of harm in young adults. These include:- liver fibrosis measured using biomarkers and fibroscan/ultrasound; three broad domains of neurocognitive function - executive function, emotion processing, and impulsivity - assessed using three specific tasks (n-back working memory task, the emotion recognition task, and the stop-signal task); depression and depressive symptoms measured by clinical interview (Clinical Interview Schedule-Revised CIS-R and Moods & Feeling Questionnaire MFQ); antisocial behaviour and offending measured by Edinburgh Youth Transitions Study Questionnaire and record linkage with Police National Computer; and Injury measured by record linkage and self-report questionnaire. Excessive and harmful alcohol use also will be measured at age 24/25 as an outcome - and three key pathways to these outcomes assessed based on the rich phenotypic data available within ALSPAC (externalising, internalising and low response to alcohol).
Latent class and latent growth modelling will be used to develop a range of alcohol phenotypes required for the different hypotheses raised. Statistical analysis will be based on Directed Acyclic Graphs (DAGs) to specify clearly the hypothesised causal pathways and effect of confounders. Missing data will be modelled, and where possible Mendelian Randomisation using genetic markers of alcohol consumption will provide a further test of the hypotheses.
Latent class and latent growth modelling will be used to develop a range of alcohol phenotypes required for the different hypotheses raised. Statistical analysis will be based on Directed Acyclic Graphs (DAGs) to specify clearly the hypothesised causal pathways and effect of confounders. Missing data will be modelled, and where possible Mendelian Randomisation using genetic markers of alcohol consumption will provide a further test of the hypotheses.
Planned Impact
The research outlined will provide robust evidence on the relationship between excessive drinking in adolescence and adult consumption, and the key consequences in early adulthood. The research outputs will inform the development and evaluation of interventions to prevent substance misuse. As such, the direct beneficiaries of this research will include researchers working on the development and evaluation of interventions to prevent substance misuse in adolescents as well as public health policy makers. Other beneficiaries include young people, their parents, teachers and youth group leaders as well as policy makers and the wider society.
Multidisciplinary research teams working to develop and evaluate interventions for adolescence substance misuse will benefit directly from access to the basic research that will inform and guide their work. Results will be shared with these groups through the classical pathways of scientific publications in peer reviewed journals, communications at national and international meetings, press releases and more targeted presentations.
Voluntary sector organisations provide a diversity of materials, advice and training to a range of engaged parties, including young people, parents of young people and health practitioners. The findings of this research will have the potential to directly inform these organisations, and enable them to further develop and target their efforts.
We anticipate the interest of policy makers, including central government and public health commissioners, who will use the outputs of the research to inform their current practice. Looking further into the future, improved and better targeted interventions can be anticipated, which these groups will be able to act upon.
Young people, parents and youth group workers will experience immediate impact from the research, as the direct findings of the research are reported through the media and other channels. Media coverage of research can be powerful in raising the awareness of issues, influences and consequences, and for stimulating debate and discussion. However, there is limited scope to change behaviours through communication alone, and for that reason it is through informing the development and evaluation of interventions that the impact of this research will be most strongly felt.
We are dedicated to disseminate information regarding our research to both direct beneficiaries and those able to influence policy within the UK. Utilising the network of contact between the investigators and many of the beneficiaries mentioned here, we will ensure the engagement of these stakeholders throughout the project and beyond it. The benefits of the research are likely to be realised very soon after completion of the project, due to our approach to stakeholder engagement, and will ensure the rapid mobilisation of research outcomes into further research and practice
Multidisciplinary research teams working to develop and evaluate interventions for adolescence substance misuse will benefit directly from access to the basic research that will inform and guide their work. Results will be shared with these groups through the classical pathways of scientific publications in peer reviewed journals, communications at national and international meetings, press releases and more targeted presentations.
Voluntary sector organisations provide a diversity of materials, advice and training to a range of engaged parties, including young people, parents of young people and health practitioners. The findings of this research will have the potential to directly inform these organisations, and enable them to further develop and target their efforts.
We anticipate the interest of policy makers, including central government and public health commissioners, who will use the outputs of the research to inform their current practice. Looking further into the future, improved and better targeted interventions can be anticipated, which these groups will be able to act upon.
Young people, parents and youth group workers will experience immediate impact from the research, as the direct findings of the research are reported through the media and other channels. Media coverage of research can be powerful in raising the awareness of issues, influences and consequences, and for stimulating debate and discussion. However, there is limited scope to change behaviours through communication alone, and for that reason it is through informing the development and evaluation of interventions that the impact of this research will be most strongly felt.
We are dedicated to disseminate information regarding our research to both direct beneficiaries and those able to influence policy within the UK. Utilising the network of contact between the investigators and many of the beneficiaries mentioned here, we will ensure the engagement of these stakeholders throughout the project and beyond it. The benefits of the research are likely to be realised very soon after completion of the project, due to our approach to stakeholder engagement, and will ensure the rapid mobilisation of research outcomes into further research and practice
Publications
Abeysekera KWM
(2020)
Prevalence of steatosis and fibrosis in young adults in the UK: a population-based study.
in The lancet. Gastroenterology & hepatology
Wright C
(2020)
Adolescent multiple risk behaviours cluster by number of risks rather than distinct risk profiles in the ALSPAC cohort.
in BMC public health
Galloway J
(2020)
Multilevel Analysis of the Influence of Maternal Smoking and Alcohol Consumption on the Facial Shape of English Adolescents.
in Journal of imaging
Padmanathan P
(2020)
Prevention of suicide and reduction of self-harm among people with substance use disorder: A systematic review and meta-analysis of randomised controlled trials.
in Comprehensive psychiatry
Hines LA
(2020)
Association of High-Potency Cannabis Use With Mental Health and Substance Use in Adolescence.
in JAMA psychiatry
Fernandes GS
(2020)
Alcohol consumption and internalising disorders in young adults of ALSPAC: a population-based study.
in Journal of epidemiology and community health
Dyer ML
(2020)
State anxiety and alcohol choice: Evidence from experimental and online observational studies.
in Journal of psychopharmacology (Oxford, England)
Bugianesi E
(2020)
Fatty liver disease: putting the spotlight on a silent menace for young adults
in The Lancet Gastroenterology & Hepatology
Hammerton G
(2020)
Externalising pathways to alcohol-related problems in emerging adulthood.
in Journal of child psychology and psychiatry, and allied disciplines
Colledge S
(2020)
Depression, post-traumatic stress disorder, suicidality and self-harm among people who inject drugs: A systematic review and meta-analysis.
in Drug and alcohol dependence
Hickman M
(2020)
Assessing the public health effects of cannabis use: can legalization improve the evidence base?
in World psychiatry : official journal of the World Psychiatric Association (WPA)
Hammerton G
(2019)
Childhood Behavioural Problems and Adverse Outcomes in Early Adulthood: a Comparison of Brazilian and British Birth Cohorts.
in Journal of developmental and life-course criminology
Lassi G
(2019)
Locus of control is associated with tobacco and alcohol consumption in young adults of the Avon Longitudinal Study of Parents and Children
in Royal Society Open Science
Dantchev S
(2019)
The Independent and Cumulative Effects of Sibling and Peer Bullying in Childhood on Depression, Anxiety, Suicidal Ideation, and Self-Harm in Adulthood.
in Frontiers in psychiatry
Dyer ML
(2019)
Associations of child and adolescent anxiety with later alcohol use and disorders: a systematic review and meta-analysis of prospective cohort studies.
in Addiction (Abingdon, England)
Riglin L
(2019)
Developmental Contributions of Schizophrenia Risk Alleles and Childhood Peer Victimization to Early-Onset Mental Health Trajectories.
in The American journal of psychiatry
Edwards AC
(2019)
Long-Chain ?-3 Levels Are Associated With Increased Alcohol Sensitivity in a Population-Based Sample of Adolescents.
in Alcoholism, clinical and experimental research
Hughes RA
(2019)
Accounting for missing data in statistical analyses: multiple imputation is not always the answer.
in International journal of epidemiology
Dyer ML
(2019)
Alcohol use in late adolescence and early adulthood: The role of generalized anxiety disorder and drinking to cope motives.
in Drug and alcohol dependence
Er V
(2019)
The relative importance of perceived substance misuse use by different peers on smoking, alcohol and illicit drug use in adolescence.
in Drug and alcohol dependence
Jones HJ
(2018)
Association of Combined Patterns of Tobacco and Cannabis Use in Adolescence With Psychotic Experiences.
in JAMA psychiatry
Savage JE
(2018)
Polygenic Risk Score Prediction of Alcohol Dependence Symptoms Across Population-Based and Clinically Ascertained Samples.
in Alcoholism, clinical and experimental research
Tinner L
(2018)
Examining subgroup effects by socioeconomic status of public health interventions targeting multiple risk behaviour in adolescence.
in BMC public health
De Vocht F
(2018)
DNA methylation from birth to late adolescence and development of multiple-risk behaviours.
in Journal of affective disorders
Mahedy L
(2018)
Alcohol Use in Adolescence and Later Working Memory: Findings From a Large Population-Based Birth Cohort.
in Alcohol and alcoholism (Oxford, Oxfordshire)
Garnett CV
(2018)
Behavior Change Techniques Used in Digital Behavior Change Interventions to Reduce Excessive Alcohol Consumption: A Meta-regression.
in Annals of behavioral medicine : a publication of the Society of Behavioral Medicine
Troy DM
(2018)
Effect of glass shape on the pouring accuracy of liquid volume.
in PloS one
Cooper M
(2018)
Investigating late-onset ADHD: a population cohort investigation.
in Journal of child psychology and psychiatry, and allied disciplines
Peacock A
(2018)
Global statistics on alcohol, tobacco and illicit drug use: 2017 status report.
in Addiction (Abingdon, England)
Edwards AC
(2018)
Meta-Analysis of Genetic Influences on Initial Alcohol Sensitivity.
in Alcoholism, clinical and experimental research
Taylor M
(2018)
Is smoking heaviness causally associated with alcohol use? A Mendelian randomization study in four European cohorts.
in International journal of epidemiology
Mahedy L
(2018)
Corrigendum: Alcohol Use in Adolescence and Later Working Memory: Findings From a Large Population-Based Birth Cohort.
in Alcohol and alcoholism (Oxford, Oxfordshire)
Garnett C
(2018)
Reported Theory Use by Digital Interventions for Hazardous and Harmful Alcohol Consumption, and Association With Effectiveness: Meta-Regression.
in Journal of medical Internet research
MacArthur G
(2018)
Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people.
in The Cochrane database of systematic reviews
De Vocht F
(2018)
Motivation to reduce alcohol consumption and subsequent attempts at reduction and changes in consumption in increasing and higher-risk drinkers in England: a prospective population survey.
in Addiction (Abingdon, England)
Kendler KS
(2018)
Childhood Risk Factors for Heavy Episodic Alcohol Use and Alcohol Problems in Late Adolescence: A Marginal Structural Model Analysis.
in Journal of studies on alcohol and drugs
Hammerton G
(2018)
Low resting heart rate, sensation seeking and the course of antisocial behaviour across adolescence and young adulthood.
in Psychological medicine
Derges J
(2018)
'DrinkThink' alcohol screening and brief intervention for young people: a qualitative evaluation of training and implementation.
in Journal of public health (Oxford, England)
Mahedy L
(2018)
The effect of parental drinking on alcohol use in young adults: the mediating role of parental monitoring and peer deviance.
in Addiction (Abingdon, England)
Minica CC
(2018)
Genome-wide association meta-analysis of age at first cannabis use.
in Addiction (Abingdon, England)
McGovern R
(2018)
Promoting Alcohol Reduction in Non-Treatment Seeking parents (PAReNTS): a protocol for a pilot feasibility cluster randomised controlled trial of alcohol screening and brief interventions to reduce parental alcohol use disorders in vulnerable families.
in Pilot and feasibility studies
Howe L
(2017)
Body mass index, body dissatisfaction and adolescent smoking initiation
in Drug and Alcohol Dependence