Initiation and Progression through Early Drinking Milestones in Underage Drinkers

描述(申请人提供)：虽然美国法定饮酒年龄为21岁，但未成年人饮酒非常普遍。早期开始饮酒与随后出现一系列不良后果的风险增加有关，包括后来大量饮酒或问题饮酒、患酒精使用障碍的可能性、其他物质参与和行为问题。然而，关于第一次饮酒和酒精相关问题的发展之间发生了什么，我们的知识存在差距。大多数研究未能描述酒精参与的早期过程，因为它正在展开。这项拟议研究的目标是探索早期饮酒生涯的特征，包括我们所称的“与饮酒有关的里程碑”的排序、实现和进展。这些事件包括标志性事件，如曾经饮酒、感觉兴奋或醉酒、经常饮酒、酗酒以及经历不同严重程度的酒精相关问题。将描述早期饮酒里程碑的标准顺序和进展，并考虑个体间和个体内的差异。由于特定风险因素和缓和影响的重要性可能会因个人饮酒轨迹的不同阶段而有所不同，因此我们将通过确定个人(例如行为规范、预期、休闲活动)和环境(例如家庭和同伴的影响、酒精的可获得性)风险因素对发病和进展的影响来解释个人内部变化的个体差异。对这些风险因素的检查将以一个以物质使用和健康行为理论为基础的总体理论模型为指导。此外，我们将探索早期开始饮酒和以快速发展为特征的过程与各种结果(如学业成绩、药物使用和酒精问题)之间的关联程度。为了实现这些目标，将在三年内对从罗德岛中学招聘的1,000名6至8年级学生进行评估，评估方法是对范围较窄的重点进行相对密集(即频繁)的评估，并辅之以内容较广的较不频繁的评估。样本将通过对有饮酒风险的青少年进行过度抽样来丰富。具体目标将主要使用项目反应理论模型、多水平模型、生存分析、潜在增长模型和潜在转变分析等技术来解决。当具体目标达到时，我们将能够更好地了解首次饮酒年龄对预后的意义，我们将能够分离出早期饮酒病程对不良结局的独特影响。这项拟议的研究将使研究人员能够准确地确定青少年最初表现出问题饮酒风险的阶段。目前的应用程序提供了一项更细微的研究，将精细地描绘在开始使用和以后使用之间发生了什么。我们的发现将通过确定青春期饮酒进展、维持和回归(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：早期饮酒会增加随后出现一系列不良后果的风险，包括大量饮酒或问题饮酒、发生酒精使用障碍的可能性、其他物质参与以及行为问题。只有通过了解酒精使用的早期过程，我们才能实施成功的预防战略，以减少未成年人饮酒，并最终改善我国人口的身心健康。

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.