Association of parental supply of alcohol with adolescent drinking, alcohol-related harms, and alcohol use disorder symptoms: a prospective cohort study
Association of parental supply of alcohol with adolescent drinking, alcohol-related harms, and alcohol use disorder symptoms: a prospective cohort study
Summary
Background
Some parents supply alcohol to their children, reportedly to reduce harm, yet longitudinal research on risks associated with such supply is compromised by short periods of observation and potential confounding. We aimed to investigate associations between parental supply and supply from other (non-parental) sources, with subsequent drinking outcomes over a 6-year period of adolescence, adjusting for child, parent, family, and peer variables.
Methods
We did this prospective cohort study using data from the Australian Parental Supply of Alcohol Longitudinal Study cohort of adolescents. Children in grade 7 (mean age 12 years), and their parents, were recruited between 2010 and 2011 from secondary schools in Sydney, Perth, and Hobart, Australia, and were surveyed annually between 2010 and 2016. We examined the association of exposure to parental supply and other sources of alcohol in 1 year with five outcomes in the subsequent year: binge drinking (more than four standard drinks on a drinking occasion); alcohol-related harms; and symptoms of alcohol abuse (as defined by Diagnostic and Statistical Manual of Mental Disorders, 4th edition [DSM-IV]), alcohol dependence, and alcohol use disorder (as defined by DSM-5). This trial is registered with ClinicalTrials.gov, number NCT02280551.
Findings
Between September, 2010, and June, 2011, we recruited 1927 eligible parents and adolescents (mean age 12·9 years [SD 0·52]). Participants were followed up until 2016, during which time binge drinking and experience of alcohol-related harms increased. Adolescents who were supplied alcohol only by parents had higher odds of subsequent binge consumption (odds ratio [OR] 2·58, 95% CI 1·96–3·41; p<0·0001), alcohol-related harm (2·53, 1·99–3·24; p<0·0001), and symptoms of alcohol use disorder (2·51, 1·46–4·29; p=0·0008) than did those reporting no supply. Parental supply of alcohol was not significantly associated with the odds of reporting symptoms of either alcohol abuse or dependence, compared with no supply from any source. Supply from other sources was associated with significant risks of all adverse outcomes, compared with no supply, with an even greater increased risk of adverse outcomes.
Interpretation
Providing alcohol to children is associated with alcohol-related harms. There is no evidence to support the view that parental supply protects from adverse drinking outcomes by providing alcohol to their child. Parents should be advised that this practice is associated with risk, both directly and indirectly through increased access to alcohol from other sources.
Funding
Australian Research Council, Australian Rotary Health, Foundation for Alcohol Research and Education, National Drug and Alcohol Research Centre.
Introduction
Alcohol use is an important public health issue associated with increased disease burden, and is of special concern in late adolescence and young adulthood, when alcohol use disorders have their peak age of onset.1, 2, 3 In many countries (such as the UK), parents are an important provider of alcohol to adolescents before they reach the legal age of purchase.4 Parents reportedly provide alcohol to mitigate harm,5 but evidence about the associated risks of such parental provision is absent—partly because of the dearth of any prospective studies spanning more than a 2–3-year period, and substantially because of the failure to adequately adjust for confounders in the handful of available cohort studies.6
Our previous Australian adolescent cohort study7 found that between ages 12 and 15 years, parental supply of alcohol was associated with increased risk of consuming standard drinks, but not of binge drinking.7 Although there was no protective effect associated with early parental supply, parentally supplied children did consume fewer alcohol beverages on a typical drinking occasion than did children who obtained their alcohol from other, non-parental sources. Adolescents who sourced their alcohol from non-parental sources (eg, peers, other relatives, themselves) had greater odds both of drinking standard drinks and of binge drinking. No longitudinal research has examined the development of alcohol use disorder symptoms associated with parental supply. In view of the associations between supply of alcohol and adverse drinking behaviours in our cohort to date, it is important to examine whether these patterns continue (possibly more moderated drinking associated with parental supply compared with more excessive drinking associated with accessing alcohol from non-parental sources), and to examine risk of alcohol-related harm and alcohol use disorders symptoms.
Research in context
Evidence before this study
We did a systematic review, searching eight electronic databases on Sept 10, 2016 (Medline, MEDLINE In-Process and Other Non-Indexed Citations, EMBASE, PsycINFO, CINAHL, Scopus, Dissertations and Theses, and Cochrane Library), with the search terms “parental provision”, “social hosting”, “parental source of alcohol”, “youth”, “student”, teenage”, “underage”, “minor”, “risky drinking”, “excessive drinking”, and “binge drinking”. Inclusion criteria were that studies must be peer-reviewed, prospective, longitudinal studies, and analyse parental supply on the basis of reports from adolescent, parent, or both, and were from any publication year. We found seven cohort studies of parental supply of alcohol; the results of these showed that parental supply of alcohol was associated with subsequent risky drinking (pooled estimate odds ratio 2·00, 95% CI 1·72–2·32), but there was substantial risk of confounding bias and publication bias (assessed with the Newcastle–Ottawa scale). In all studies, measurement of exposure was problematic, follow-up times were short, and confounding was poorly controlled. Our cohort study has previously shown that, between age 12–15 years, parental supply of alcohol was associated with increased risk of consuming standard drinks (a standard drink being equal to 10 g of alcohol), but not of binge drinking. Parentally supplied children consumed fewer alcohol beverages on a typical drinking occasion than those who obtained their alcohol from non-parental sources. No study has reported on prospective associations between parental and other sources of supply of alcohol and subsequent adolescent drinking outcomes, harms, and symptoms of abuse, dependence, or alcohol use disorders, taking into account important potential confounders of any observed association.
Added value of this study
To the best of our knowledge, this is the first study to examine, over a long period of time, prospective associations between both parental supply of alcohol and supply from other sources, and subsequent adolescent drinking outcomes, and to adjust for known covariates. We found a developing pattern of harm associated with parental supply, such that by the sixth follow-up (mean age 17·8 years), parental supply during previous years was associated with binge drinking, alcohol-related harms, and alcohol use disorder symptoms. The findings also showed that parental supply of alcohol not only risks adverse outcomes itself, it also risks increasing supply from other non-parental sources. Non-parental supply was associated with an even greater increased risk of adverse outcomes.
Implications of all the available evidence
Parental provision of alcohol to adolescents is associated with subsequent binge drinking, alcohol-related harm, alcohol use disorder symptoms, and increased access to alcohol from non-parental sources, and these associations persist after controlling for confounding variables. These findings have importance for parents, policy makers, and clinicians, and highlight parents as an important target for prevention.
We aimed to study parental and non-parental supply of alcohol and adjusted associations with five primary outcome variables in adolescents: binge drinking, alcohol-related harms, and the experience of symptoms of alcohol abuse, alcohol dependence, and alcohol use disorder.
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