Aims To determine if associations of alcohol consumption with all-cause mortality replicate in discordant monozygotic twin comparisons that control for familial and genetic confounds.
Design A 30-year prospective follow-up.Setting Population-based older Finnish twin cohort. Participants Same-sex twins, aged 24–60 years at the end of 1981, without overt comorbidities, completed questionnaires in 1975 and 1981 with response rates of 89 and 84%. A total of 15 607 twins were available for mortality follow-up from the date of returned 1981 questionnaires to 31 December 2011; 14 787 twins with complete information were analysed. Measurements Self-reported monthly alcohol consumption, heavy drinking occasions (HDO) and alcohol-induced blackouts. Adjustments for age, gender, marital and smoking status, physical activity, obesity, education and social class. Findings Among twins as individuals, high levels of monthly alcohol consumption (≥ 259 g/month) associated with earlier mortality [hazard ratio (HR) = 1.63, 95% confidence interval (CI) = 1.47–1.81]. That association was replicated in comparisons of all informatively drinking-discordant twin pairs (HR = 1.91, 95% CI = 1.49–2.45) and within discordant monozygotic (MZ) twin pairs (HR = 2.24, 95% CI = 1.31–3.85), with comparable effect size. Smaller samples of MZ twins discordant for HDO and blackouts limited power; a significant association with mortality was found for multiple blackouts (HR = 2.82, 95% CI = 1.30–6.08), but not for HDO.
Conclusions The associations of high levels of monthly alcohol consumption and alcohol-induced blackouts with increased all-cause mortality among Finnish twins cannot be explained by familial or genetic confounds; the explanation appears to be causal.
ALCOHOL PARENTING 16. Does parental drinking influence children's drinking? A systematic review of prospective cohort studies
Ingeborg Rossow, Patrick Keating, Lambert Felix and Jim McCambridge
Aims To evaluate evidence of the capacity for causal inference in studies of associations between parental and offspring alcohol consumption in the general population.
Methods A systematic search for, and narrative analysis of, prospective cohort studies of the consequences of drinking, except where assessed prenatally only, or with clinically derived instruments. Primary outcome measures were alcohol use or related problems in offspring, which were collected at least 3 years after exposure measures of parental drinking. The systematic review included 21 studies comprising 26 354 families or parent–child dyads with quantitative effect measures available for each study. Criteria for capacity of causal inference included (1) theory-driven approach and analysis; (2) analytical rigour; and (3) minimization of sources of bias. Results Four of the 21 included studies filled several, but not all, criteria and were assessed to have some capacity for causal inference. These four studies found some evidence that parental drinking predicted drinking behaviour in adolescent offspring. The remaining 17 studies had little or no such capacity. Conclusions There is a fairly large and consistent literature demonstrating that more parental drinking is associated with more drinking in offspring. Despite this, existing evidence is insufficient to warrant causal inferences at this stage.
17. Does promoting parents’ negative attitudes to underage drinking reduce adolescents’ drinking? The mediating process and moderators of the effects of the Örebro Prevention Programme
Metin Özdemir and Nikolaus Koutakis
Background and aims The Örebro Prevention Programme (ÖPP) was found previously to be effective in reducing drunkenness among adolescents [Cohen's d = 0.35, number needed to treat (NNT) = 7.7]. The current study tested the mediating role of parents’ restrictive attitudes to underage drinking in explaining the effectiveness of the ÖPP, and the potential moderating role of gender, immigration status, peers’ and parents’ drinking and parent–adolescent relationship quality. Design A quasi-experimental matched-control group study with assessments at baseline, and at 18- and 30-month follow-ups. Participants Of the 895 target youths at ages 12–13 years, 811 youths and 651 parents at baseline, 653 youths and 524 parents at 18-month and 705 youths and 506 parents at 30-month follow-up participated in the study. Measurements Youths reported on their past month drunkenness, their parents’ and peers’ alcohol use and the quality of their relationship with parents. Parents reported on their attitudes to underage drinking. Findings The mediation analyses, using latent growth curve modeling, showed that changes in parents’ restrictive attitudes to underage drinking explained the impact of the ÖPP on changes in youth drunkenness, which was reduced, and onset of monthly drunkenness, which was delayed, relative to controls. Mediation effect explained 57 and 45% of the effects on drunkenness and onset of monthly drunkenness, respectively. The programme effects on both parents’ attitudes and youth drunkenness were similar across gender, immigrant status, parents’ and peers’ alcohol use and parent–youth relationship quality. Conclusions Increasing parents’ restrictive attitudes to youth drinking appears to be an effective and robust strategy for reducing heavy underage drinking regardless of the adolescents’ gender, cultural origin, peers’ and parents’ drinking and relationship quality with parents.
Keywords: Adolescents; heavy drinking; mediation; moderation; parental attitudes; prevention
18. Developing and delivering local level partnership schemes with the alcohol trade
Fizz Annand Drugs: Education, Prevention and Policy 2016:23(1);62-72 Abstract
This analysis of local partnership projects involving the alcohol trade draws on the work of Michel Foucault to consider the extent to which these projects “responsibilise” the alcohol trade and contribute to a reduction of problems in the night time economy. The key aims of the research were: (1) to identify the multiple realities of the research subjects from their own perspectives, about what works in local alcohol-related partnership schemes, and (2) to identify the key drivers of change and understand the forces that influenced views of success or failure of local public sector/alcohol trade partnership schemes. Interviews (n = 28) were carried out in London boroughs (n = 8), over a two-year period between 2009 and 2011. Partners included police, licensing teams, local authority staff, pub, club and bar managers and a central government official. Post hoc “theories of change” diagrams illustrate the way interviewees thought their projects worked and made links between activities, assumptions and outcomes. In schemes thought of as successful there was a clear understanding of what interviewees thought made them work. The essential common factor was “engagement”. Partnership activities provided a vehicle through which partners could build trusting relationships. Efforts to promote engagement incorporated enforcement actions, positive publicity and generating a sense of competition. The priority of the trade to maximise profits was found to over-ride the impact of some projects.
19. Policy-Relevant Behaviors Predict Heavier Drinking in Both On and Off Premises and Mediate the Relationship Between Heavier Alcohol Consumption and Age, Gender, and Socioeconomic Status—Analysis from the International Alcohol Control Study
Sally Casswell, Taisia Huckle, Martin Wall and Karl Parker