Initiation and Progression through Early Drinking Milestones in Underage Drinkers

描述（由申请人提供）：虽然美国的法定饮酒年龄是21岁，但未成年人饮酒非常普遍。早开始饮酒与随后的一些不良后果的风险增加有关，包括后来的大量饮酒或问题饮酒，发展为酒精使用障碍的可能性，其他物质参与和行为问题。然而，我们对第一次喝酒和出现酒精相关问题之间发生了什么还知之甚少。大多数研究都没有描述出酗酒的早期过程。这项研究的目的是探索早期饮酒生涯的特征，包括我们所说的“饮酒相关里程碑”的顺序、实现和进展。这些包括具有里程碑意义的事件，如曾经饮酒、感觉亢奋或喝醉、经常饮酒、酗酒以及不同严重程度的酒精相关问题的经历。通过早期饮酒里程碑的规范顺序和进展将被描述，考虑到个体间和个体内的可变性。由于给定风险因素和调节影响的重要性可能根据个体饮酒轨迹的阶段而变化，我们将通过确定个体（例如，行为调节，期望，休闲活动）和环境（例如，家庭和同伴影响，酒精的可得性）风险因素对发病和进展的影响来解释个体内部变化中的个体间差异。对这些风险因素的审查将以一个总体理论模型为指导，该模型借鉴了物质使用和健康行为的理论。此外，我们将探讨早期开始使用酒精和以快速进展为特征的过程与各种结果（如学业成绩、物质使用和酒精问题）的关联程度。为了实现这些目标，从罗德岛中学招募的1000名六年级到八年级学生将在三年的时间内接受评估，评估方法包括相对密集（即频繁）的狭窄重点评估，以及较少频率的内容更广泛的评估。样本将通过对有饮酒风险的年轻人进行过采样来充实。具体目标将主要使用项目反应理论建模、多层次建模、生存分析、潜在增长建模和潜在转变分析等技术来解决。当具体目标达到时，我们将能够更好地理解首次饮酒年龄的预后意义，我们将能够分离出早期饮酒过程对不良后果的独特影响。这项拟议的研究将使研究人员能够准确地确定青少年首次表现出饮酒问题风险的阶段。目前的应用程序提供了一个更细致的研究，将精细地绘制出在开始和后来使用之间发生的事情。我们的研究结果将通过确定青春期饮酒的进展、维持和消退（或停止）的可改变的阶段特定风险因素，为预防工作提供信息。公共卫生相关性：早期饮酒与随后一系列不良后果的风险增加有关，包括大量饮酒或问题性饮酒、发展为酒精使用障碍的可能性、其他物质介入和行为问题。只有了解酒精使用的早期过程，我们才能实施成功的预防策略，以减少未成年人饮酒，并最终改善我们人口的身心健康。

DESCRIPTION (provided by applicant): Although the legal drinking age in the United States is age 21, underage drinking is highly prevalent. Early onset of alcohol use is associated with increased risk of a number of subsequent adverse outcomes, including later heavy or problem drinking, likelihood of developing an alcohol use disorder, other substance involvement, and behavioral problems. Yet, there is a gap in our knowledge regarding what happens between first drink and the development of alcohol-related problems. Most research fails to characterize the very early course of alcohol involvement as it unfolds. The goal of the proposed study is to explore characteristics of the early drinking career including sequencing of, attainment of, and progression through what we term "drinking-related milestones." These include landmark events such as ever drinking, feeling high or drunk, regular drinking, binge drinking, and experience of alcohol-related problems of varying severity. The normative ordering of and progression through early drinking milestones will be described, with consideration of inter- and intra-individual variability. Because the importance of given risk factors and moderating influences may vary according to the stage of an individual's drinking trajectory, we will explain inter-individual differences in intra-individual change by determining the influence of individual (e.g., behavior regulation, expectancies, leisure activity) and contextual (e.g., family and peer influence, availability of alcohol) risk factors on onset and progression. Examination of these risk factors will be guided by an overarching theoretical model that draws on theories of substance use and health behavior. In addition, we will explore the extent to which both early initiation of alcohol use and a course characterized by rapid progression are associated with various outcomes such as academic achievement, substance use, and alcohol problems. To address these aims, 1,000 6th through 8th graders recruited from Rhode Island secondary schools will be assessed over a three-year period using a combination of relatively intensive (i.e., frequent) assessments of a narrow focus complemented by less frequent assessments that are broader in terms of content. The sample will be enriched by oversampling youth at risk for drinking. Specific aims will be addressed primarily using techniques of item response theory modeling, multilevel modeling, survival analysis, latent growth modeling, and latent transition analysis. When the specific aims are met, we will better be able to understand the prognostic significance of age of first drink and we will be able to isolate the unique influence of early drinking course on adverse outcomes. The proposed study will permit researchers to accurately pinpoint the stage at which an adolescent first exhibits risk for problematic drinking. The current application offers a more nuanced study that will finely map what happens between initiation and later use. Our findings will inform prevention efforts by identifying modifiable stage- specific risk factors for progression, maintenance, and regression (or desistence) of drinking during adolescence. Public Health Relevance: Early use of alcohol is associated with increased risk of a number of subsequent adverse outcomes, including heavy or problem drinking, likelihood of developing an alcohol use disorder, other substance involvement, and behavioral problems. It is only by understanding the early course of alcohol use that we can implement successful prevention strategies to reduce underage drinking and ultimately improve the mental and physical health of our population.