Adolescent Alcohol Abuse: A Twin-Study Perspective

描述（由申请人提供）：青少年酒精滥用与成年后持续的药物滥用有关，青少年饮酒的公共卫生负担与酒驾、不想要的和危险的性行为、学业成就的中断、生活轨迹的改变和过早死亡有关。为了通过适当的干预措施减轻公共卫生负担，我们必须了解为什么这些成人结果与青少年酒精暴露有关。从观测数据中得出因果推论的障碍是众所周知的；青少年饮酒与成人不良后果之间的关联存在许多潜在的混淆，现有的数据不允许有信心的因果推论。利用数十年来对芬兰双胞胎进行的纵向研究提供的不同寻常的资源，我们提出了旨在记录青春期酒精使用在整个生命周期中的后果的研究，比较暴露不一致的双胞胎的结果，以解决青春期饮酒的成人后果本质上是因果关系，还是相反，它们是由选择过程和相关责任引起的。暴露不一致的同卵双胞胎，关键是包括足够数量的暴露不一致的同卵双胞胎，可以产生深刻的信息来评估这个问题。我们将获得并分析来自四个大型芬兰队列的数据，从12-22岁开始对药物使用进行纵向研究，跟踪成人结果至25-59岁。我们的研究计划将为基于22,000个人的个体分析提供翔实的数据，并对1,250对双胞胎的暴露不一致的同卵双胞胎进行稳健的分析，包括最翔实的一部分：青春期酒精暴露不一致的同卵双胞胎。这项创新研究的结果将为成人与青少年酒精滥用的长期联系提供重要信息，为干预工作提供信息，并解决一个主要的公共卫生负担。

DESCRIPTION (provided by applicant): Adolescent alcohol abuse is associated with continued substance abuse into adulthood, and the public health burden of adolescent drinking is evident in its association with drunk driving, unwanted and risky sexual behavior, truncated educational achievement, altered life trajectories, and premature death. To reduce that public health burden with appropriate interventions, we must understand why these adult outcomes associate with adolescent alcohol exposure. The obstacles in drawing causal inferences from observational data are well-known; potential confounds in the association of adolescent drinking with adverse adult outcomes are many, and the available data do not permit confident causal inferences. Using the unusual resources available to us from decades of longitudinal research with Finnish twins, we propose studies designed to document the consequences of adolescent alcohol use across the lifespan, comparing outcomes in exposure-discordant twin pairs to address the question of whether adult consequences of adolescent drinking are causal in nature, or whether, instead, they arise from selection processes and correlated liabilities. Exposure-discordant co-twins, critically including adequate numbers of exposure-discordant monozygotic co-twins, can yield incisive information with which to evaluate this question. We will obtain and analyze data from four large Finnish cohorts longitudinally studied for substance use from entry ages 12-22, tracking adult outcomes to ages 25-59. Our research plan will yield informative data for individual-based analyses on 22,000 individuals and robust analyses of exposure-discordant co-twins on 1,250 twin pairs, including a substantial subset of the most informative: monozygotic co-twins who are discordant for their alcohol exposure in adolescence. Results of this innovative research will provide important information on the meaning of long-term adult associations with adolescent alcohol abuse, inform intervention efforts, and address a major public health burden.