Adult consequences of late adolescent alcohol consumption: a systematic review of cohort studies.
Adult consequences of late adolescent alcohol consumption: a systematic review of cohort studies.
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DOI：
10.1371/journal.pmed.1000413
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发表时间：
2011-02-08
期刊：
影响因子：
15.8
通讯作者：
Rowe R
中科院分区：
文献类型：
--
作者：
McCambridge J;McAlaney J;Rowe R
在对青少年饮酒及其后来结果的队列研究的系统回顾中，吉姆·麦坎布里奇（Jim McCambridge）和他的同事们表明，尽管研究表明饮酒与成人身心健康状况恶化和社会后果有关，但现有证据的质量很差。尽管对公共政策很重要，但目前还没有严格的证据综合说明青少年晚期饮酒的长期后果。本系统综述总结了来自一般人群队列研究的证据，这些研究涉及15-19岁的饮酒以及20岁或以上的任何后续结果，并进行了至少3年的随访研究。纳入54项研究，其中35项被评估为易受偏倚和/或混淆的影响。主要发现是：(1)有一致的证据表明，青春期晚期的高饮酒量会持续到成年，并且还与酒精依赖等酒精问题有关；(2)虽然一些研究表明与成人身心健康和社会后果有关，但现有证据质量不足，无法在现阶段作出因果推论。迫切需要进行高质量的长期前瞻性队列研究，以便更好地了解青少年晚期饮酒所造成的公共卫生负担，无论是与成人饮酒还是更广泛的饮酒有关。在青春期后期减少饮酒对于预防长期不良后果以及防止更直接的伤害可能很重要。酒精中毒（醉酒）、依赖（习惯性、强迫性和长期饮酒）以及相关的生化变化的影响具有广泛的健康和社会后果，其中一些可能是致命的。在世界范围内，酒精导致250万人死亡（占总数的3.8%）和6940万人（占总数的4.5%）残疾调整生命年。在250万例死亡中，仅意外伤害就占了三分之一左右，而神经精神疾病占了近40%。饮酒与60多种疾病和伤害之间也存在因果关系；据估计，在世界范围内，大约20%-30%的食道癌、肝癌、肝硬化、凶杀、癫痫和机动车碰撞病例是由酒精引起的。越来越多的证据表明，除了饮酒量之外，饮酒方式对健康也有影响，酗酒尤其有害。由于酗酒的大多数人是青少年，这一群体可能特别容易受到酒精对健康的破坏性影响，导致全球关注年轻人的饮酒趋势和模式。尽管有许多已发表的队列研究报告了与青少年饮酒有关的长期危害，但这些证据的强度仍不清楚，这对干预的目标有影响。例如，如果青少年饮酒不会造成后来的困难，那么早期干预和管理饮酒的严重后果，如反社会行为和意外伤害，可能是最适当的社区安全和公共卫生对策。然而，如果存在因果关系，则需要另一种方法来解决酒精的累积有害影响。研究人员对队列研究进行了系统回顾，因为这种方法提供了最有力的观察性研究设计来评估因果关系的证据。研究人员进行了全面的文献综述，以确定符合其纳入标准的相关研究，这些研究的标准是：(1)数据收集至少来自两个时间点，间隔至少3年，来自同一队列；(2)收集15至19岁之间饮酒的数据；(3)包括至少一项定量衡量影响的报告，例如在酒精参与与20岁或更大年龄时评估的任何后续结果之间的优势比。这些研究中的大多数是来自10个队列的多个报告，大约一半来自美国。然后，研究人员通过评估是否考虑了所有可能的影响因素（混杂因素）来评估这些研究中可能的因果推断的强度，确定随访率为80%或更高，样本量为1000人或更多的研究。通过这些方法，研究人员发现，总的来说，有一致的证据表明，青春期晚期的高饮酒量会持续到成年，而且还与酒精问题有关，包括酒精依赖。例如，一项基于人群的队列研究表明，青少年晚期饮酒会导致男性过早死亡，主要是车祸和自杀，而且有大量证据支持青少年晚期饮酒对成年饮酒行为的持续影响——尽管这些研究中的大多数由于设计薄弱，无法强有力地支持因果推论。研究人员还得出结论，尽管许多研究表明青少年晚期饮酒与成年后的身心健康和社会后果有关，但这些证据通常质量较差，不足以推断因果关系。这项研究的结果表明，关于青少年晚期饮酒的长期后果的证据基础并不像它需要的那样广泛或令人信服。研究人员强调，迫切需要进行高质量的长期前瞻性队列研究，以便更好地了解与青少年饮酒相关的公共卫生负担以及与成人饮酒相关的公共卫生负担。然而，有足够的证据表明，在青春期后期减少饮酒对于预防长期不良后果以及防止更直接的有害后果伤害可能很重要。请通过本摘要的在线版本http://dx.doi.org/10.1371/journal.pmed.1000413访问这些网站。世界卫生组织有关于全球酒精消费量的信息，美国马林研究所有关于酒精和年轻人的信息，英国广播公司也有一个关于青少年晚期饮酒的网站
In a systematic review of cohort studies of adolescent drinking and later outcomes, Jim McCambridge and colleagues show that although studies suggest links to worse adult physical and mental health and social consequences, existing evidence is of poor quality. Although important to public policy, there have been no rigorous evidence syntheses of the long-term consequences of late adolescent drinking. This systematic review summarises evidence from general population cohort studies of drinking between 15–19 years old and any subsequent outcomes aged 20 or greater, with at least 3 years of follow-up study. Fifty-four studies were included, of which 35 were assessed to be vulnerable to bias and/or confounding. The principal findings are: (1) There is consistent evidence that higher alcohol consumption in late adolescence continues into adulthood and is also associated with alcohol problems including dependence; (2) Although a number of studies suggest links to adult physical and mental health and social consequences, existing evidence is of insufficient quality to warrant causal inferences at this stage. There is an urgent need for high quality long-term prospective cohort studies in order to better understand the public health burden that is consequent on late adolescent drinking, both in relation to adult drinking and more broadly. Reducing drinking during late adolescence is likely to be important for preventing long-term adverse consequences as well as protecting against more immediate harms. Please see later in the article for the Editors' Summary The effects of alcohol intoxication (drunkenness), dependence (habitual, compulsive, and long-term drinking), and the associated biochemical changes, have wide-ranging health and social consequences, some of which can be lethal. Worldwide, alcohol causes 2.5 million deaths (3.8% of total) and 69.4 million (4.5% of total) of disability-adjusted life years (DALYs). Unintentional injuries alone account for about one-third of the 2.5 million deaths, whereas neuro-psychiatric conditions account for almost 40%. There is also a causal relationship between alcohol consumption and more than 60 types of disease and injury; worldwide, alcohol is estimated to cause about 20%–30% cases of esophageal cancer, liver cancer, cirrhosis of the liver, homicide, epilepsy, and motor vehicle crashes. There is increasing evidence that, in addition to the volume of alcohol consumed, the pattern of drinking has an effect on health outcomes, with binge drinking found to be particularly harmful. As the majority of people who binge drink are teenagers, this group may be particularly vulnerable to the damaging health effects of alcohol, leading to global concern about the drinking trends and patterns among young people. Although there have been many published cohort studies reporting the longer term harms associated with adolescent drinking, the strength of this evidence remains unclear, which has implications for the objectives of interventions. For example, if adolescent drinking does not cause later difficulties, early intervention on, and management of, the acute consequences of alcohol consumption, such as antisocial behaviour and unintentional injuries, may be the most appropriate community safety and public health responses. However, if there is a causal relationship, there needs to be an additional approach that addresses the cumulative harmful effects of alcohol. The researchers conducted this systematic review of cohort studies, as this method provides the strongest observational study design to evaluate evidence of causality. The researchers conducted a comprehensive literature review to identify relevant studies that met their inclusion criteria, which were: (1) data collection from at least two points in time, at least 3 years apart, from the same cohort; (2) data collection regarding alcohol consumption between the ages of 15 and 19 years old; and (3) inclusion of a report of at least one quantitative measure of effect, such as an odds ratio, between alcohol involvement and any later outcome assessed at age 20 or greater. The majority of these studies were multiple reports from ten cohorts and approximately half were from the US. The researchers then evaluated the strength of causal inference possible in these studies by assessing whether all possible contributing factors(confounders) had been taken into account, identifying studies that had follow-up rates of 80% or greater, and which had sample sizes of 1,000 participants or more. Using these methods, the researchers found that, overall, there is consistent evidence that higher alcohol consumption in late adolescence continues into adulthood and is also associated with alcohol problems, including dependence. For example, one population-based cohort showed that late adolescent drinking can cause early death among men, mainly through car crashes and suicides, and there was a large evidence base supporting the ongoing impacts of late adolescent drinking on adult drinking behaviours—although most of these studies could not strongly support causal inferences because of their weak designs. The researchers also concluded that although a number of studies suggested links with late adolescent drinking to adult physical and mental health and social consequences, this evidence is generally of poor quality and insufficient to infer causality. The results of this study show that that the evidence-base on the long-term consequences of late adolescent drinking is not as extensive or compelling as it needs to be. The researchers stress that there is an urgent need for high quality long-term prospective cohort studies in order to better understand the public health burden associated with adolescent drinking in general and in relation to adult drinking. However, there is sufficient evidence to suggest that reducing drinking during late adolescence is likely to be important for preventing long-term adverse consequences as well as protecting against more immediate harmful consequences harms. Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1000413. The World Health Organization has information about the global incidence of alcohol consumption The US-based Marin Institute has information about alcohol and young people The BBC also has a site on late adolescent drinking
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通讯作者：
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DOI：
10.15288/jsa.2005.66.729
发表时间：
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