Families, Friends, Schools And Neighborhoods Contribute To Adolescent Alcohol Misuse

Characteristics present in the four social environments in which young people live—families, peers, schools, and neighborhoods—contribute both positively and negatively to whether teens misuse alcohol, with risk from one area possibly being magnified or decreased by attributes of another.

That's the finding of a new longitudinal study conducted by researchers at the University of North Carolina at Chapel Hill, the University of California at Davis, and the University of California at Irvine.

Previous research on teen drinking has focused mostly on individuals' ties to friends and family members. This study suggests the need for a more inclusive view of the social world of adolescents and highlights the importance of examining the connections between all of the social environments in which they live.

The researchers used data from 6,544 teens ages 11 to 17 enrolled in three public school systems in North Carolina, surveying them every six months for a total of five times. The adolescents were in grades 6, 7, and 8 when they were first surveyed, and in grades 8, 9, and 10 at the end of the study. The study used information from the teens to measure their misuse of alcohol, including heavy drinking, and to gauge negative consequences associated with drinking, such as getting into fights.

The study also collected information by telephone from parents of the teens and data from the U.S. Census. The information was used to describe the family, peer, school, and neighborhood environments of the adolescents in four areas: whether they had role models who used alcohol; how close the teens were to others in their social environments; social constraints on alcohol misuse, such as parental supervision; and the stressors in each adolescent's social environment.

The researchers found that characteristics present in all four social environments—family, peers, schools, and neighborhoods—played a role in whether teens misused alcohol. They also found that the adolescents generally were more likely to misuse alcohol the more they were exposed to alcohol use by others in their social environments.

Other characteristics of those environments tended to increase or decrease the risk associated with alcohol misuse. For example, the risk for teens of being exposed to drinking by schoolmates weakened when parents supervised their children. On the other hand, the risk of exposure to drinking by schoolmates grew when there was conflict in the family and when more family members drank. These findings underscore the important role played by families in teens' use of alcohol, throughout adolescence.

"Our findings affirm what social ecological theories suggest: Adolescents are embedded in a social world of family, friends, schoolmates, and neighbors, all of whom matter to adolescent development," according to Susan T. Ennett, associate professor of health behavior and health education at the University of North Carolina at Chapel Hill and the study's lead author. "And adolescent alcohol misuse is socially conditioned behavior."

Mom's Beliefs May Impact Their Kids' Alcohol Use

Mothers, take note. If you really want to curb your teens' chances of using alcohol, help them develop a self-view that doesn't include drinking. According to a new Iowa State University study, the power of positive thinking by moms may limit their children's alcohol use.

But beware. The opposite is also true.

"When mothers overestimated their teens' future use of alcohol, the teens developed the self-view that they were likely to drink alcohol in the future, which ultimately led them to drink more," said Stephanie Madon, an ISU associate professor of psychology and lead author of the study.

Madon collaborated on the study with ISU graduate students Ashley Buller, Kyle Scherr and Jennifer Willard; Max Guyll, an assistant professor of psychology; and Richard Spoth, director of the Partnerships in Prevention Science Institute at Iowa State. They analyzed data obtained from a series of interviews with nearly 800 Iowa mothers and their children over three to five years.

Their paper, "The Mediation of Mothers' Self-Fulfilling Effects on Their Children's Alcohol Use: Self-Verification, Informational Conformity, and Modeling Processes," was recently published in the Journal of Personality and Social Psychology, a professional journal of the American Psychological Association.

Previous research found self-fulfilling prophecy link

The team's previous research had found a link between a mother's belief about her child's likelihood of using alcohol and her child's actual use in junior high school and high school.

"We previously found that mothers' beliefs about their teen's future use of alcohol were about 50 percent correct and 50 percent incorrect, and that the incorrect portion of mothers' beliefs created a self-fulfilling prophecy -- teens behaved like their mothers had incorrectly expected them to," Madon said.

Their latest study builds upon those results.

"What we were trying to do in this paper was understand the mechanisms involved in the self-fulfilling prophecy process," Madon said. "We know that mothers have self-fulfilling effects on their kids' alcohol use through the past work that we've done. What we wanted to do here was understand 'How is that happening? What are the mechanisms that are creating that?'

"We derived our hypothesis from three large, well-known theories in the social/psychological literature -- self-verification theory, research on conformity and social learning theory as it pertains to modeling processes," she said.

According to Madon, self-verification theory proposes that people are motivated to confirm what they already believe to be true about themselves. The study found strong evidence that a mother's beliefs regarding her child's likelihood of using alcohol altered her child's self-view in either a positive or negative direction. The child then validated that new self-view by acting consistently with it later on.

"What people believe ultimately has an impact on what actually occurs," Madon said. "But it's not just because they believe it. It's not magic. When we believe something -- even if we're wrong -- when we believe it's true, we act as though it is. And sometimes when you act as though something's true, your behaviors will cause the belief to become true.

"So I think the moral here is to help children develop positive and pro-social self-concepts about themselves, because children are likely to make choices that match how they view themselves," she said.

Kids model their friends' drinking behavior

The study also found some evidence that modeling -- a tendency for people to learn by watching others -- may alter a child's alcohol use. Madon says they had a little bit of support for modeling as it related to friends' alcohol use.

"We hypothesized that mothers may influence who their children are friends with and that children may learn how to behave by watching what their friends do," she said.

But there was no evidence that children conformed their own belief to their mothers' on how acceptable it was for adolescents, in general, to use alcohol.

"How acceptable children thought it was for adolescents to drink alcohol was explained by their own self-views, not by their mothers' beliefs about them. And that's not surprising given that what you think about yourself is going to be strongly tied to what you think is acceptable behavior," Madon said.

She says that it's still a good idea for mothers to instill in their children the belief that adolescent alcohol use is unacceptable, since the study did show a direct effect of teens' perceptions regarding the acceptability of alcohol use on their own drinking.

"The more acceptable teens believed adolescent alcohol use was, the more alcohol they tended to drink themselves," Madon said.

Outdoor Alcohol Ads Boost Kids' Urge To Drink

In the world depicted in an alcohol billboard, bikini-clad babes clutch icy bottles, frothy beer flows over frosty mugs and the slogan reads, "Life is good." Ads like these may target adults, but children are getting the message too, a University of Florida and University of Minnesota study shows.

Adolescents attending schools in neighborhoods where alcohol ads litter the landscape tend to want to drink more and, compared with other children, have more positive views of alcohol, researchers report in this month's issue of the Journal of Studies on Alcohol and Drugs.

UF and UM researchers counted the number of alcohol ads within a two-block radius of 63 Chicago schools and compared students' opinions on drinking when they were in sixth grade and again two years later. The result? The more ads for alcohol there were in a neighborhood, the more students were interested in drinking alcohol, the findings show.

Most of the ads researchers found were beer signs in storefronts, although they also counted billboards, bus stop signs and other types of ads. In total, there were about 931 ads for alcohol around the schools. On average, there were about 28 ads in each neighborhood, after excluding 22 schools where there were no ads. One school had more than 100.

"The majority of the ads were just brand information only," said UF epidemiologist Kelli A. Komro, Ph.D., who studied these more subtle logo-only signs as well as more elaborate, image-laden billboards. "Sometimes we think that those as are not so powerful, but the majority of the ads we found were those kinds of ads and still we found the association with increased intentions to use alcohol."

About half of all teens sample their first alcoholic drink by the time they are 15, according to the U.S. Surgeon General, which released a report on teen drinking earlier this year. Teens who start drinking this early are more likely to have trouble in school, become addicted to alcohol, smoke cigarettes and use drugs than adolescents who don't drink, the report states.

Prior research has shown that adolescents' intentions and attitudes about alcohol generally predict their later behavior, said Komro, an associate professor of epidemiology and child health policy in the UF College of Medicine. To gauge students' thoughts on drinking, the researchers asked them a series of questions, such as whether they planned on drinking in high school or if they thought drinking made teens popular.

By eighth grade, the students who attended schools with more alcohol advertising in the surrounding neighborhood had more intentions to drink alcohol and gave fewer reasons for not drinking when researchers surveyed them, the study shows.

The ads also seemed to have the same effect on teens who were already drinking in sixth grade and those who had not yet imbibed, Komro said.

"A lot of times advertisers say ads are targeted to people who are already drinking, so we looked at kids who were already drinking in sixth grade and kids who were not," she said. "Among those kids who were not drinking, we still found the association between exposure to the outdoor ads and increased intentions to use alcohol. The ads are working even for the kids who are not drinking."

Ads like these influence children by changing their perceptions of what is normal, said Steven Thomsen, Ph.D., a professor of communication at Brigham Young University who studies the effects of advertising on children. If kids believe that most people drink and all their peers drink, the chances are greater they will also drink, Thomsen said.

"The importance of this (study) is they determined that these messages have an impact on normative beliefs, which are the assumptions we make about how the world works," Thomsen said. "It doesn't have to be a (TV) commercial (to be effective)."

Restrictions that limit or eliminate alcohol advertising around schools could help students stay alcohol-free, Komro said.

"I think results from this study and studies like this study clearly indicate that there should be policies to ban alcohol advertising near the schools," Komro said. "It clearly shows that exposure is dangerous for our children."

Kids Connect Alcohol Odors With Mom's Emotions

How children respond to the smell of alcoholic beverages is related to their mothers' reasons for drinking, according to a new study from the Monell Chemical Senses Center. When asked to choose between the odor of beer and an unpleasant odor, children of mothers classified as 'Escape drinkers' were more likely than children of Non-escape drinkers to choose the unpleasant odor.

"Children's responses to odors provide us with a window into their emotions," says study lead author Julie Mennella, PhD, a Monell biopsychologist. "When given a choice between beer and pyridine -- the smell of rotten eggs -- children of mothers who drink to relieve tension and worry choose pyridine as smelling better. That's pretty powerful."

In the study, which appears in the journal Alcohol, 145 children between the ages of 5 and 8 years were presented with seven pairs of odors. One of the odors was always beer; the others were bubblegum, chocolate, cola, coffee, green tea, pyridine, and cigarette smoke. For each pair, the children indicated which odor they liked better.

Mennella notes that because odor information travels directly to areas of the brain that deal with non-verbal aspects of emotion and memory, studying children's responses to odors provides insights into their emotional worlds.

"Like adults, children are not very good at identifying odors," she says. "However, they are good at telling us whether they like an odor or not. This study shows that whether they like the odor of beer depends not just on how often their mother drinks, but on why she drinks."

The children's mothers completed a questionnaire about their drinking habits, including their reasons for drinking; 35 were classified as 'Escape drinkers,' based on their indicating having at least two escape reasons for drinking. These included: helps to relax, need when tense and nervous, helps to cheer up when in a bad mood, helps to forget worries, and helps to forget everything.

Mothers' reasons for drinking influenced how children responded to the odor of beer. Relative to children of Non-escape drinkers, children whose mothers were Escape drinkers showed greater dislike for the odor of beer, even when beer was compared with unpleasant odors such as pyridine and cigarette smoke.

Questionnaires also revealed that Escape drinkers drink more often than Non-escape drinkers. Because of this, children of Escape drinkers were exposed to alcohol odors more often. These children also experienced alcohol in a different emotional context, as the questionnaires revealed that their mothers were more tense and more likely to worry and feel guilty about their drinking.

"Even before their first taste, young children are learning about alcohol and about why their parents drink. They do this by seeing people drink and hearing them talk about it," says Mennella. "Our findings show that children are also processing the smell of alcohol with the emotional reasons their mothers, and perhaps fathers, drink."

Mennella comments that additional research is needed to determine whether children who dislike the odor of alcohol and experience it in a negative emotional context are more or less likely as adolescents or adults to seek out alcohol when stressed.

Ultrasounds Show Mothers' Drinking Shrinks Fetal Brain

Routine ultrasounds show that heavy drinkers who continue to imbibe after learning they are pregnant may carry fetuses with reduced skull and brain growth compared to those of abstainers or quitters, says a new study.

Although the alcohol-exposed babies' growth remained within normal range, the findings reveal effects of drinking on the developing human brain. The study will appear in the May issue of Alcoholism: Clinical and Experimental Research.

"What this tells us is that the earlier you abstain in a pregnancy, the better the outcome," said lead author Nancy Handmaker, a University of New Mexico clinical psychologist with expertise in maternal-fetal health.

Alcohol use during pregnancy is a leading preventable cause of birth defects and developmental disabilities in the United States, according to the Centers for Disease Control and Prevention. Fetal Alcohol Spectrum Disorder -- which includes a range of cognitive, emotional and behavioral problems -- may be present in as many as one of every 100 births.

The study authors obtained routine ultrasound data from 167 pregnant women who had reported a history of hazardous drinking before pregnancy. Of these, 97 were classified as heavy drinkers. The study compared the fetal growth measures among drinkers who quit after learning of their impending motherhood to those among women who continued to drink.

Within the heavy drinking group, the ultrasounds revealed that fetuses of the continuing drinkers had a smaller ratio of head-to-abdominal circumference, which indicates reduced skull growth. They also had smaller measures of the cerebellum, a region of the brain involved in many mental, motor and sensory tasks.

Fetal growth measures were essentially the same among nondrinkers and those who quit when they learned of their pregnancy. "There may have been measures that were not part of routine ultrasound examinations that would have been more sensitive to the pre-recognition drinking," said Handmaker.

The authors say that while women's own reports of their drinking habits may not be entirely accurate, the study findings are consistent with other research on fetal alcohol exposure in animals and humans.

"The provision of feedback on fetal development as revealed in ultrasonography may be a strategy to encourage heavy drinkers to seek treatment during pregnancy," concludes the study.

CDC would like to see intervention efforts start even earlier. "The best opportunity to identify and intervene with women at high-risk for an alcohol-exposed pregnancy is prior to pregnancy," says Louise Floyd of the Fetal Alcohol Prevention Team. "What we are hoping to see is a major shift in looking at a healthy pregnancy as something that we start to support in the preconception period."

Combined Measures Of Maternal Drinking Can Predict Resulting Problems In Children

ScienceDaily (Feb. 8, 2009) — While many people are aware that drinking during pregnancy can lead to a range of Fetal Alcohol Spectrum Disorders (FASDs), including the serious Fetal Alcohol Syndrome (FAS), linkages between maternal-drinking measures and child outcomes have been inconsistent. Researchers have now designed a "metric" or combination of measures that appear better able than individual measures to predict prenatal neurobehavioral dysfunction and deficits in children.

"The number of children being born with FAS remains unnecessarily high," said Lisa M. Chiodo, a researcher at Wayne State University and corresponding author for the study. "In part this is because it is difficult to identify patterns of drinking during pregnancy that put women's children at risk for FAS and other FASDs."

Chiodo said that although there are several measures of maternal drinking during pregnancy, their ability to predict child outcomes – particularly cognitive and behavioral problems – has been inconsistent. "We thought that combining many of the clinical and research measures of alcohol drinking into a single metric might help us find every child in our study who had been exposed to levels of alcohol that put them at risk," she said.

Only one other group has constructed a composite metric meant to identify women who were at risk of having a child with FASDs, Chiodo added, and the current metric differs from that one by focusing on problems related to alcohol drinking and not including other health concerns or risky behaviors.

The author of that other metric was Claire D. Coles, professor of psychiatry and behavioral sciences at the Emory University School of Medicine. "It is imperative that health-care professionals ask pregnant women about their alcohol and drug use in order to provide appropriate care for the women, and to provide anticipatory guidance for their children," she said. "Knowing that a woman has a substance-abuse problem or is an alcoholic is likely to be highly related to later developmental problems in the children."

Researchers examined a sample of 75 African-American mothers as well as their four- to five-year-old offspring. The mothers self-reported peri-conceptional and repeated in-pregnancy maternal drinking in response to a number of semi-structured interviews and standard screening instruments, which were then used to construct a metric of "maternal prenatal risk drinking." The offspring were tested for IQ, attention, memory, visual-motor integration, fine motor skills, and behavior. The metric was then assessed against these outcomes.

The metric identified more than 62 percent of the mothers as drinking at risk levels; 23 percent more than the individual selection criterion identified.

"We had good reason to think that risk drinking was more common than thought," said Chiodo, "so detecting more risk drinkers was not that surprising. The real surprise was how successful the metric was in predicting deficits and problems in the children. In fact, our metric predicted poor child cognition and behavior problems better than any of the individual measures of maternal alcohol consumption or screens for problem drinking alone."

"These combined measures of substance abuse were more predictive than alcohol-volume metrics," observed Coles. "Generally, alcohol-volume measures are less effective probably … due to self-reporting issues. I think that the strength of this paper is its reinforcement of the idea that alcohol use, particularly at levels that would define a woman as an alcohol abuser or alcoholic, is dangerous during pregnancy. For the clinician, it reinforces the idea that pregnant women should be questioned about their drug and alcohol use and that there are reliable and quick methods for identification of those at risk."

"Clinicians must be able to identify risk levels of drinking in their pregnant patients because that is a critical time for possible treatment and prevention," said Chiodo. "After the children are born, we also need to be able to identify which children were exposed to 'risky' alcohol levels during pregnancy to allow correct diagnosis of, and early intervention with, children with FASDs. We do not know how or if our current metric might be adapted in practice for clinicians. However, our results suggest that it might be useful for health-care providers to use more than one measure of drinking in a more thorough examination of risk patterns and problem drinking."