Excessive drinking and alcohol related harms in Adulthood: ALSPAC at 24

减少酒精造成的危害是一项关键的公共卫生和政策优先事项。在过去的40年里，肝病死亡人数增加了4倍以上。超过1/3的年轻人，包括男女，年龄在20-24岁之间过度饮酒。这些不良饮酒模式可能起源于青春期--50%的青少年报告在16岁之前过度饮酒。几种与酒精相关的关键危害出现在青年时期，而其他一些人可能会因为持续过度饮酒而持续到成年。关于过度饮酒模式和这些关键危害之间关系的证据，特别是青春期早期过度饮酒的重要性，需要得到加强。我们的目标是提供证据，说明出现肝纤维化/损害迹象的年轻人的比例以及不同饮酒模式带来的风险；与酗酒有关的认知和情绪处理不良的风险；有害饮酒是否会导致年轻人抑郁；过度饮酒是否会阻止人们因反社会行为而“成熟”；以及年轻人因不良饮酒模式而受到的伤害程度。此外，有害的酒精使用或酒精依赖也出现在青年时期。关于不同途径对酒精依赖的相对贡献还需要进一步的证据。我们计划将重点放在三个关键途径上：早期行为或品行问题的作用；早期生活和青春期抑郁情绪和焦虑的影响；以及对酒精的生理反应的潜在影响(根据引发影响的平均酒精量进行评估)。需要纵向数据--衡量随时间推移的酒精使用量，以及饮酒前和饮酒期间的社会、环境因素--来评估这两个问题--酒精消费类型对青年时期危害的影响，以及青年时期酒精使用问题的途径。ALSPAC出生队列(90年代儿童)是世界上最受关注的出生队列，具有从出生前到青春期后期和成年期早期的详细生物学和行为数据。我们建议利用ALSPAC提供的独特机会，对5000名24/25岁的年轻人进行与酒精相关的伤害和结果评估。测试酒精和伤害之间的联系的稳健性和强度，或者不同途径对酒精依赖的重要性将是重要的。两个关键问题是混淆(这种关联可能由另一个因素来解释)和数据缺失(来自较低社会经济群体、早期行为问题较严重的人更容易出现这种情况)。我们将利用一系列复杂的统计技术来解决这些问题，包括在可能的情况下使用酒精消费的遗传标记(与其他因素无关)，并可以加强因果关系的证据。我们是一个多学科的团队，包括方法学、酒精和相关危害方面的领先专家。我们收集的证据和数据将有益于该领域的其他学者，尤其是对公众和患者群体、临床医生和政策制定者来说，他们有兴趣防止与酒精有关的伤害。

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.