HAZARDOUS ALCOHOL USE ACROSS GENERATIONS: Parental and offspring hazardous alcohol use in the Nord-Trøndelag Health Study
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Background Adolescent alcohol use is prevalent and associated with an increased risk of adverse consequences both in terms of acute injury and later and long-term problems. Adolescents with parents that misuse alcohol seem to be more vulnerable to developing hazardous drinking patterns. Many studies on parental alcohol misusers and their offspring have been based on clinical samples, and findings regarding possible gender effects on the relationship between parental and offspring alcohol use have shown inconclusive results. Heavy episodic drinking among parents is far more prevalent than parental alcohol misuse, but fewer studies have investigated the relationship between these kinds of hazardous drinking patterns among parents and offspring. Factors from area of residence may also influence the development of adolescent drinking patterns. Some studies have demonstrated that area-level adult alcohol use and socioeconomic status influence adolescent alcohol use, but few studies have had the possibility to investigate adolescent hazardous drinking pattern within the context of both parental drinking practices and area factors. Main aims This thesis mainly aimed to investigate whether, and to what extent, adolescent hazardous alcohol use in the general population was associated with parental hazardous alcohol use, and whether the possible coincidence of hazardous alcohol use was gender specific. An additional aim was to investigate whether adolescent hazardous alcohol use was associated with area-level factors when parental hazardous alcohol use and other factors on individual- and family-levels were taken into account. Material and method All inhabitants in the county of Nord-Trøndelag aged 13 years or older were invited to participate in the adult or the adolescent part of the Nord-Trøndelag Health Survey (HUNT and Young-HUNT). The studies in this thesis applied data from 1) adolescent participants from Young-HUNT1 and 2 (N = 2399), 2) adolescent participants from Young-HUNT3 that could be linked to data from biological mother and/or father participating in HUNT3 (N = 5032), 3) adolescent participants from Young-HUNT3 that could be linked to data from both biological mother and father participating in HUNT3 (N = 2306). Adolescent hazardous drinking measures were based on measures of frequency of drinking, frequency of heavy episodic drinking/intoxication, and alcohol consumption in terms of volume. Parental alcohol misuse and heavy episodic drinking were applied as measures of parental hazardous alcohol use. Measures of area factors were based on aggregated data from HUNT 3 (adult HED) and data from Statistics Norway (proportion of inhabitants with higher education). Multivariate analyses were performed by using logistic regression and generalized estimating equation (GEE), and results were presented as odds ratios with 95% confidence intervals. Main findings Adolescent hazardous alcohol use was associated with both alcohol misuse and heavy episodic drinking among parents. However, results varied depending on gender and the actual drinking behaviors investigated. Hazardous drinking among both boys and girls was associated with paternal alcohol misuse and HED. While hazardous drinking among girls was associated with both maternal misuse and maternal HED, this was not found among boys. On the contrary, findings revealed evidence of an aversive transmission regarding the associations between maternal alcohol misuse and high alcohol consumption among boys. Living in an area with a higher level of adult HED increased the risk of HED among girls, and this applied even when parental HED was included in the model. Results also showed a protective effect of living in the areas with higher SES, and this applied to both boys and girls. Conclusions Adolescent hazardous alcohol use was associated with both alcohol misuse and heavy episodic drinking among parents. Associations varied to some extent by type of/measures of drinking behaviors investigated, and by parental and offspring gender. Adolescent hazardous alcohol use was associated with area SES and area HED even though parental hazardous drinking was taken into account.