Personal and social correlates of alcoholconsumption among mid-adolescents

John Marsden1 Annabel Boys1 Michael Farrell1 Garry Stillwell1Kevin Hutchings2 Jennifer Hillebrand1 and Paul Griffiths1

1Division of Psychological Medicine Institute of PsychiatryKingrsquos College London UK2School of Education University of Sussex UK

A prospective cohort survey of 540 mid-adolescent students was conducted to identifypersonal family and social correlates of alcohol use A structured questionnairerecorded alcohol involvement other substance use perceived parental alcohol use andrelated factors alcohol-related attitudes and beliefs psychological well-being social andpeer behaviours and school conduct problems Participants drank on 175 days in thepast 3 months on a typical drinking day they consumed 47 units with 285 reporteddrinking six or more units More frequent drinking was independently correlated withbeing male perceiving that parents encouraged drinking drinking without parentalknowledge drinking to alter mood buying alcoholic beverages spending more timewith friends who drink perceiving social pressure to drink and being excluded fromschool and truanting Parental discouragement for alcohol was related to morefrequent drinking in females and less frequent drinking in males Drinking moreintensively was associated with use of cannabis parental encouragement to drinkspending more time with friends who drink school exclusion and being in trouble withteachers These results highlight multidimensional correlates of drinking duringmid-adolescence and underline the importance of addressing personal family peer andschool conduct factors in school-based alcohol education programmes

Around 98 of the United Kingdom (UK) population drink alcoholic beverages on

a regular basis and social drinking is the norm for young people from their mid-

adolescent years onwards Population surveys in England show that most young people

have consumed a whole alcoholic drink at around 13 years of age (Marsh Dobbs amp

White 1986 Blenkinsop Boreham McManus Natarajan amp Prescott 2003) By the mid-adolescent period (aged 15ndash16) two-fifths of boys and girls drink every week and 1 boy

in 20 and 1 girl in 100 report drinking almost every day (Becher et al 2001) The

prevalence of other substance use in the UK is also high At 15 years around one in four

Correspondence should be addressed to Dr John Marsden Division of Psychological Medicine Institute of Psychiatry KingrsquosCollege London Addiction Sciences Building 4 Windsor Walk London SE5 8AF UK (e-mail JMarsdeniopkclacuk)

TheBritishPsychologicalSociety

427

British Journal of Developmental Psychology (2005) 23 427ndash450

q 2005 The British Psychological Society

wwwbpsjournalscouk

DOI101348026151005X26020

females and one in five males admit to regular tobacco smoking and about one in three

report using cannabis in the past year (Becher et al 2001) Substance use behaviours

covary such that young regular drinkers are more likely to be regular smokers and

cannabis users than those who drink infrequently or not at all (Anderson Plant amp Plant

1998)

Alcohol consumption appears to have been rising steadily among young people inthe UK In Scotland for example the proportion of 13-year-olds reporting drinking in the

past week has more than doubled from 10 in 1990 to 23 in 2002 (Currie Fairgrave

Akhtar amp Currie 2003) In England 40 of 15 year olds in 1990 reported drinking at

least once a week and this increased to 49 by 2000 Between 1992 and 2000 the

overall average weekly alcohol consumption levels among 15-year-olds rose from 81 to

128 standard units (1 unit frac14 8 g ethanol or 10 ml by volume Becher et al 2001) and

for girls this figure almost doubled (from 6 units in 1992 to 112 units in 2000) Most

adolescents initiate alcohol use by trying beerlager or cider but marked differencesbetween boys and girls soon appear in their usual choice of beverage Boys show a

consistent preference for beer while girls are more likely to choose spirits and pre-

mixed fruit juice and spirit products (sometimes called lsquoalcopopsrsquo Marsh et al 1986

Sutherland amp Willner 1998)

There is evidence that while young people drink less frequently than adults they are

more likely to drink equally or more intensively than adults when they do drink (Lowe

Foxcroft amp Sibley 1993) In 1999 the European School Survey Project on Alcohol and

other Drugs (ESPAD) showed that among 15- to 16-year-olds some 40 of UK studentsexperience drunkenness by the time they reach 13 years of age and more than one in

five admit to being intoxicated three times or more every month (Hibbell et al 2000)

These data ranked the UK among the highest of the 30 countries surveyed There are

also signs that regular intoxication has increased since an earlier wave of the ESPAD

survey in 1995 estimated that around one in five UK students were regularly drinking to

intoxication (Hibbell et al 1997)

There is no consensus about what amount of alcohol consumed constitutes lsquobingersquo

drinking Among adults a criterion of five or more standard drinks in one session hasbeen suggested (Midanik 1999) and a higher estimate of drinking one half of the

recommended weekly total in one session (11 or more drinks for men and 7 or more for

women Webb Ashton Kelly amp Kamali 1996) Nevertheless there is now a substantial

concern in the UK about a growing visible social phenomenon of excessive single

occasion or binge drinking among youth (Murgraft Parrott amp Bennett 1999 Honess

Seymour amp Webster 2000) Public health concerns focus on excessive binge drinking

and consequences that are indirectly linked including antisocial behaviour and public

disorder with males identified as being more likely to commit and be the victim of theseoffences (Harnett Thom Herring amp Kelly 2000 Bonomo et al 2001 Strategy Unit

2004) In terms of overall public health there has also been a fourfold increase in liver

cirrhosis among adults aged 25ndash34 since 1970 (Department of Health 2001) and the

majority of these cases are likely to be caused by long-term excessive drinking that

started at an early age

To date no comprehensive developmental theory has been developed that has

successfully partitioned genetic and environmental influences on adolescent drinking

behaviour However cross-sectional and some longitudinal studies have identified awide range of individual familial and social variables that are associated with

increased likelihood of adolescent drinking (Poikolainen 2002) It is common to

report early initiation to drinking and other substance use is associated with

John Marsden et al428

problematic alcohol use in adulthood (Chou amp Pickering 1992 Grant 1998) For early

onset drinkers it is believed that this is not simply a function of a greater exposure to

drinking but rather one consequence arising from how heavy alcohol consumption

can become progressively embedded within personal relationships and leisure

activities (DeWit Adlaf Offord amp Ogborne 2000) Research studies have looked at

individual family peer and school influences The influence of parents on theiroffspring has been a focus of the majority of the major survey work undertaken in the

USA (Barnes 1990 Denton amp Kampfe 1994) Studies have reported that there is a

close association between how often parents drink and how often their adolescent

offspring drink (Fergusson Horwood amp Lynskey 1995 Wilks Callan amp Austin 1989)

Other research has shown that the parentsrsquo attitudes and beliefs about alcohol affect

adolescentsrsquo drinking both at home and outside (Hundleby amp Mercer 1987 Foxcroft

Lowe amp May 1994 Miller amp Plant 2003) For example a study of families determined

to be of high-risk for alcoholism found that alcohol expectances of early-adolescents

(13-year-olds) were closer to their parents than those from low-risk families whodisplayed significant negative correlations (Shen Lock-Wellman amp Hill 2001)

Similarly adolescents from families at high risk of developing drinking problems have

been found to drink more frequently and intensely than adolescents from low risk

families (Hill amp Yaun 1999) In contrast there is some evidence that early parental

disapproval of alcohol may deter later adolescent drinking (Ary Tildesley Hops

amp Andrews 1993 Ellickson amp Hays 1991 Ellickson Tucker Klein amp McGuigan 2001

Monshouwer Smit De Zwart Spruit amp Van Ameijden 2003) Research has also looked

for influences on drinking from outside the family particularly within the peer group

(same age friends) It is clear that the influence of this group can be seen at an early

age in one study of 10- to 13-year-olds whether drinking was common among friendswas the most important predictor of individual behavioural expectations to drink

(Marcoux amp Shope 1997) Jackson (1997) also found that a high perceived prevalence

of alcohol use in the peer group and also having a best friend who had tried alcohol

predicted experimentation with alcohol use in a sample of 9- to 11-year-olds Other

work has examined what happens to young people as they reach mid-adolescence

During this period young people attain greater levels of independence from the family

individual and peer group drinking norms tend to converge (Kandel amp Andrews 1987

Graham et al 1987 Lowe et al 1993) Studies show that a high level of peer

involvement in drinking is reflected in increased levels of personal drinkinginvolvement (Duncan Tildesley Duncan amp Hops 1995 Swadi amp Zeitlin 1988)

Fergusson and colleagues found that having substance-using peers at 15 years of age

was one of the strongest predictors of hazardous drinking 1 year later (Fergusson et al

1995) In addition there is evidence that young drinkers are influenced to drink more

regularly if they affiliate with older peers who are likely to have more favourable

drinking norms and established drinking patterns (Keefe 1994)

Studies have also sought to describe the personal motivations for drinking that may

influence drinking involvement National household survey data from the USA show

that adolescents aged 12 to 14 are more likely to believe that positive benefits are morelikely to occur than negative effects (Substance Abuse and Mental health Services

Administration 1999) In the terms of personal reasons and motives for drinking several

research studies have looked at the different reasons that young people endorse for

drinking alcohol (or the specific functions that use is intended to serve) and how these

relate to consumption patterns These consistently report a positive relationship

between the number of reasons for alcohol use and drinking frequency in both young

Adolescent drinking 429

males and females (Windle amp Barnes 1988 Beck amp Treiman 1996 Boys et al 1999

Bradizza Reifman amp Barnes 1999) In one study of 16- to 19-year-olds Foxcroft and

Lowe (1997) found that the heavier drinkers were more likely to endorse drinking

because they liked the effects because they wished to get intoxicated or they were

motivated to improve their mood General population survey research in the US

suggests that among 12- to 17-year-olds who have drunk alcohol in the last year 8

report psychological problems although the temporal and causal relationship between

drinking and mood is unclear

A fourth potential area of influence concerns problem behaviours at school

Attendance and behavioural problems at school appear to be linked to drinking as well as

smoking and other substance use In a survey of 11000 young students in the US the

strongest predictors of drinking frequency were frequent problems at school and the

number of close friends who drank at least once a month (Blum Beuhring amp Rinehart

2000) Miller and Plant found an association between poorer school performance and

higher levels of smoking and illicit drug use in a cross-sectional survey of eight thousand

15- to 16-year-olds (Miller amp Plant 1996) There is also evidence that young people who

truant or are excluded from school are at greater risk of drinking at harmful levels

(Graham amp Bowling 1995 Goulden amp Sondhi 2001) The 2001 English Department of

Healthrsquos School survey found that among 15-year-olds those who had ever truanted were

more likely to drink once a week have taken drugs in the last year and to be a regular

smoker (Boreham amp Shaw 2002) There is no clear temporal relationship between school

problems and drinking but it is likely that school performance problems are for some an

indirect consequence of drinking and other substance involvement

To date most studies of adolescent drinking have looked at a single factor that may

relate to drinking behaviour and relatively little is known about where these influences

act differently on males and females While there continue to be major cross-sectional

population surveys of adolescent drinking in the UK detailed examinations of drinking

influences between males and females and changes in drinking behaviours over time

remain rare The argument that efforts should focus on characterizing patterns of

hazardous alcohol use and predicting negative outcomes has been advanced in a number

of reports (Reifman Barnes Dintcheff Farrell amp Uhteg 1998 Peterson Hawkins

Abbott amp Catalano 1994) Understanding of these influences can achieve valuable

insights for the design and delivery of education programmes which schools are now

obliged to include as part of the national curriculum (Department for Education and

Employment 1998a)

Aims and hypotheses of the studyThe study was designed to explore personal and social correlates of alcohol use and how

these change over time The mid- to late-adolescent period (from 15 to 17 years) was

judged to be the most appropriate phase to study the development of patterns of alcohol

use The selection of research instruments and measures was guided by a social

ecological framework for studying adolescent behaviour (Bronfenbrenner 1986

Chassin Pillow Curran Molina amp Barrera 1993) This suggests that adolescent drinkingbehaviour should be understood in terms of the interpersonal social and

environmental influences that exist in the drinkerrsquos natural ecosystem (Reed 1996)

Social ecological approaches that combine models of individual and social behaviour

change have been successfully used in health education programmes (Glanz Lewis amp

Rimer 2002)

John Marsden et al430

A core set of measures for the study was identified based on a review of the research

literature and our grouprsquos previous work on modelling substance use motivations These

variables constitute a repeated measures set of correlates which are recorded at baseline

and at follow-ups The personaldemographic background family and social correlates

constituted a set of distal (ie lifetime behaviours and events) and more proximal

influences on drinking (behaviours and events that occurred in the past year or the past

3 months) In this first report of findings from the study the aim was to examine the

correlates of alcohol use among adolescents in the 3 months before recruitment Results

are presented using data gathered from the baseline questionnaires and analysed to test

the hypothesis that increased alcohol involvement would be

(1) Negatively related to age of first drink and the lifetime experience of being

intoxicated on alcohol

(2) Positively related to lifetime experience of cannabis use and smoking

(3) Positively related to parental drinking parental encouragement to drink and

drinking with and without parental knowledge and negatively related to parentaldiscouragement to drink

(4) Positively related to more reasons for drinking and favourable drinking attitudes

and negatively related to psychological well-being and unfavourable drinking

attitudes

(5) Positively related to purchasing drinks and peersrsquo alcohol involvement and

(6) Positively related to school conduct problems

These hypotheses were tested against a null hypothesis for contrasts with males and

females No predictions were made concerning the relative strength of associations

between individual covariates and alcohol involvement

Method

Design and school selectionThe study is a prospective cohort survey of alcohol use and related attitudes and

behaviours of mid-adolescents (15ndash16 years old) recruited and interviewed from thestate school population in a single county in the south of England Two follow-up

questionnaires were administered at 9 and 18 months following recruitment In the UK

schooling is compulsory until the age of 16 years and an efficient means of recruiting a

general population sample of 15- to 16-year-olds is to sample from those in Year 11 from

educational establishments

Study resources precluded a probability sampling design and for practical reasons a

purposive non-probability method was used for recruitment of schools and

participants Schools were recruited from the countyrsquos main metropolitan area and

from other locations to yield a mix of inner-city and satellite town locations and from

schools that fell above and below standardized educational performance averages for

the county Five coeducational comprehensive schools were selected based on their

catchment area (urban or rural) educational achievements and size All of the five

schools approached agreed to participate They comprised two schools in inner-city

locations and three in satellite towns Two schools achieved above average educational

performance two were below average and one average (Department for Education and

Employment 1998b)

Adolescent drinking 431

Sample size planningGiven the available resources for the study an initial feasibility assessment suggested

that approximately 500 participants could be recruited and followed-up Statistical

power estimates suggested a sample of this size would be sufficient to detect behaviours

with rates as low as 5 with a relative standard error of 19 (95 CI frac14 32 68) The

smallest detectable effect that could be reliably measured (based on a two-tailed t testwith a frac14 05 and b frac14 020) for gender comparisons of for example drinking

involvement (using a measure of days of alcohol use and estimating for 50 female)

would be 026 which corresponds to a small effect size (Cohen 1988) The potential

design effects due to recruiting participants from different schools were assessed by

including these sites as a term in the analyses of the data Power calculations informing

follow-ups and change analyses are presented in subsequent reports

ProcedureThe Research Ethics committee of the Institute of Psychiatry and Maudsley Hospital

approved the study A detailed description of the research procedure has been reported

elsewhere (Boys et al 2003) and only the essential features are described here

Participation in the research was obtained by mailing a letter explaining the purpose and

format of the study to parents of all Year 11 students in each school at least a week in

advance of the scheduled recruitmentbaseline interviews This letter included a

detachable reply form asking parents to indicate if they did not wish their child to takepart in the study None of these student lsquoopt-outrsquo forms were returned to us and no

participant declined to take part during recruitment

A team of 24 second and third year undergraduate students (aged 19ndash24) were

recruited and trained to administer the recruitment protocol and baseline interviews All

interviewers completed a 6 hour group-based study protocol induction and training

session This was facilitated by four members of the author group and included plenary

presentation and discussion and supervised role-play experience in the administration

of the research questionnaire The recruitment of the school students took place over 20days between November and December 1998 during a 2 hour period at the end of the

school day Three members of the research team supervised each recruitment session

Interviewers were assigned a list of participants to interview in a private corner of a

classroom no more than four interviews were conducted in a room at any one time and

no teachers were present

Baseline data were collected using a personal interview of between 20 and 40

minutes duration (completion time varied according to the extent of the participantrsquos

experience with alcohol) and a self-completion questionnaire of around 20 minutesduration The self-completion instrument recorded the lifetime experience of substance

use psychological scales and questions concerning school conduct It was judged that

self-administration of these items would increase the veracity and reliability of reporting

All participants were given a pound10 retail music-store gift voucher in recognition of the

time taken to participate in the recruitment session

MeasuresThe present report utilizes a set of measures comprising standardized scales and several

indicator items developed specifically for the study The response burden on

participants was kept to a minimum and the selected measures represent a core set

that were needed to address the research hypotheses Recall periods for these measures

John Marsden et al432

spanned lifetime occurrences the past 12 months and the past 3 months (90 days) The

nature and coding structure of measures is described below while information about the

internal reliability of scales is presented in the results

Personaldemographic information and background factorsEight measures were used to characterize the personaldemographic background of

each participant (a) age (b) gender (coded male frac14 1 and female frac14 0) (c) school

recruitment site (dummy coded using school 1 as a nominal reference) (d) age of first

drink (e) whether ever intoxicated on alcohol (coded as no frac14 0 yes frac14 1) and (f) age

first intoxicated on alcohol (defined for the participants as lsquofeeling unsteady on your

feet or slurring your words or feeling dizzy or unwellrsquo) (g) lifetime use of cigarettes

and (h) lifetime use of cannabis (both coded no frac14 0 yes frac14 1)

Recent alcohol involvementIt was judged important to record both how often the participants recalled drinking in

the past 3 months and how much they consumed on a day when they consumed

alcohol (drinking intensity) These two measures which serve as the dependent

variables for the present report were not significantly correlated ( r frac14 15 ns) and

capture different and distinct alcohol use behaviours which are important when

characterizing drinking patterns and how these change over time Researchers in thisfield generally use 24 hour (day) intervals to serve as basic units of drinking frequency

The method of recording drinking frequency and intensity was adapted from the

Maudsley Addiction Profile a standardized multidimensional research instrument for

assessing substance-related behaviours (Marsden et al 1998) Each participant was first

asked to estimate the number of days on which they had consumed alcohol during the

past 3 months assisted by a prompt card listing nine categories (never less than once

every 2 months once every 2 months once every month two times a month 1 day per

week 2ndash3 days a week 4ndash5 days a week 6ndash7 days a week scored 0ndash8 and subsequentlymultiplied to total the number of days out of 90) If none of these categories closely

matched experience the participant was helped to calculate the specific number of

drinking days This can sometimes happen when a research respondent has a more

episodic pattern of drinking Then drinking intensity was estimated by recording the

number of drinks consumed during an average or typical drinking day in the past 3

months Responses to this question were recorded as verbatim reports of the number of

drinks consumed by beverage and brand type and were then converted as standard units

of alcohol at the data management stage

Family factorsQuestions on family factors that might influence adolescent drinking related to the

participantsrsquo estimates of parentsrsquo drinking the extent to which their parents

sanctioned their drinking and the extent that participants reported unsupervised

drinking without their parentsrsquo knowledge Five measures were recorded (a) two

7-point summary indices of the perceived usual frequency of the motherrsquos and fatherrsquosdrinking frequency (never to every day scored 0ndash6) (B) a 5-item scale to assess the

extent to which parents encouraged the participant to drink in the past year (offered

sondaughter a drink at home bought alcohol at a restaurant or another establishment

drunk an alcoholic drink with sondaughter at home drunk an alcoholic drink with

Adolescent drinking 433

sondaughter at another setting and allowed drinking at home) using a 5-point Likert-

type response (never to very often scored 0ndash4) (c) a 5-item scale coded to assess the

extent to which parents discouraged drinking in the past year (warning sondaughter of

the health risks of drinking parents saying they should not drink being punished by

parents for drinking parents saying that sondaughter cannot drink at home and being

reprimanded for buying alcohol (never to very often scored 0ndash4) and (d) a 9-pointindex of the number of occasions the participant recalled consuming an alcoholic drink

without their parentrsquos knowledge (never once twice 3ndash5 times 6ndash12 times 13ndash23

times 24ndash50 times 51ndash100 times and more than 100 times scored 0ndash8)

Psychological factorsQuestions in the block of psychological factors focused on personal influences and

correlates on alcohol use and included specific reasons for drinking generalpsychological health and alcohol-related attitudes Four measures were taken (a) a

6-item mood alteration functions scale developed by Boys et al (1999) was used to

assess how often participants had consumed alcohol in the past year for the following

personal reasons to relax to feel better when low or depressed to feel closer to

someone to stop worrying about a problem to get to sleep and simply to get drunk

(never to always scored 0ndash4) (B) a 5-item social functions scale also developed by

Boys et al to assess the extent that the participant had used alcohol in the past year for

the following social reasons to let go of inhibitions when socializing to feel moreconfident in a social situation to make an activity more enjoyable to help enjoy the

company of friends and to feel more confident when having sex (scored as above)

(c) the 12-item form of the General Health Questionnaire to assess psychological well-

being with each question scored using the Likert scale response coding (GHQ-12

Goldberg amp Williams 1988) and (d) two 9-item attitude scales adapted from items

used by Plant Peck and Samuel (1985) to assess positive drinking attitudes (eg young

people who drink regularly are attractive to the opposite sex coded as strongly agree

to strongly disagree scored 1ndash5)

Social and peer factorsFive measures were developed for the study to examine the relationships between

purchasing drinks and the influence of peers on alcohol involvement Five measures

were used (a) whether the participant had ever bought alcohol for personal use from a

shop or a barpub (scored no frac14 0 yes frac14 1) (b) the proportion of the participants

current friends who were older by 1 or more years (none to all scored 0ndash4) (c) theproportion of friends who were believed to drink alcohol (none to all scored 0ndash4)

(d) an index of how often the participant had spent time with friends and acquaintances

who were drinking in the past 3 months (never to 6ndash7 days a week scored 0ndash9) and

(e) an index of the extent that the participant perceived that they had felt under social

pressure to drink (coded as strongly agree to strongly disagree scored 1ndash5)

School conduct problemsFinally a block of four measures to record school conduct problems in the past year

A block of four items recording aspects of school life was taken from the youth form of

the Life Stressors and Social Resources Inventory (Moos amp Moos 1994) as follows (a) the

frequency that the participant had been in trouble with teachers and had been detained

John Marsden et al434

after school or received other sorts of punishment (never to every day scored 0ndash8)

(b) whether the participant had been in a fight with a student at school (scored no frac14 0

yes frac14 1) (c) the number of times the participant had truanted from school (defined as

not attending for a whole school day or leaving immediately after the morning class

registration) and (d) whether or not the respondent had been temporarily excluded

from school for disciplinary problems (scored no frac14 0 yes frac14 1)

Statistical analysisThe relationship between alcohol involvement and background family social and peer

and school conduct factors was investigated using multiple linear regression in twostages First two standard regression analyses were computed for drinking frequency and

intensity using the 26 items and scale measures described above in the five domains and

were regressed separately on the dependent variables in each domain and then again

simultaneously to assess overall levels of variance accounted for (Tabachnik amp Fidell

2001) This analysis was used to test the research hypotheses Second two stepwise

regression analyses with backwards elimination of covariates were computed to isolate a

set of independent predictors of drinking frequency and intensity and to explore the

strength of association for adjusted covariates and any identified gender interactions

Results

Sample characteristicsA cohort of 540 students was recruited (515 male) The average age was 154 years(381 [706] were 15 and 159 [294] were 16 years) There were no differences in the

proportion of males and females ( x2 frac14 515 p frac14 272) or number in the 15 and 16 year

age groups (x2 frac14 453 p frac14 340) between the samples from the five schools There

were also no differences in the proportion of males and females recruited compared

with the remainder of the Year 11 cohort in each school (x2 ranged from 003 to 116

p frac14 89ndash 28)

The majority of the sample described themselves as White-UK (954) while 19

were Caribbean or Black British 13 were South Asian and the remainder were MiddleEastern South East Asian or described themselves to be of mixed race Approximately

half (485) considered that they had no religious affiliation 157 reported they were

affiliated to the Church of England and 281 described themselves as Christian with no

specification Two-thirds (687) were living with both of their natural parents In terms

of living arrangements four-fifths (809) reported that their parents or guardians

owned their residence 111 were living in local authority owned housing and the

remainder were living in privately rented premises (74)

Prevalence of alcohol and other substance useThe majority of the sample (943) had consumed a whole alcoholic drink at some point

in their lives Lifetime use of tobacco products (cigarettes) was high (377 698)

particularly among females (748 vs 651 x2 frac14 602 p frac14 014) Some 404 (218) ofthe cohort reported using cannabis at some point in their lives but less than 1 in 10

reported lifetime use of other illegal drugs On average the participants estimated that

they were 124 years old when they first drank a whole alcoholic drink

( SD frac14 19 range frac14 3ndash16 years) Four-fifths of the drinkers (N frac14 407) reported that

Adolescent drinking 435

they had had experience of being intoxicated by alcohol Males reported an earlier age

of first being intoxicated after drinking than females (136 vs 138 years t frac14 2229

p 05) All of the drinkers reported that they had drunk alcohol without the

knowledge of their parents on at least one occasion On average they were 14 years old

( SD frac14 721 range frac14 7ndash16 years) when they first drank without parental knowledge

Over half of the drinkers estimated that they had drunk alcohol without their parentsrsquoknowledge on at least 13 separate occasions in total

Alcohol involvementThe majority of the lifetime drinkers (N frac14 467 917) had consumed alcohol during

the past 90 days and a third of the sample (175 324) reported that they had

purchased alcohol themselves from a bar or club during this period Table 1 summarizes

the frequency of drinking and scores on the dependent variables by gender In terms of

drinking frequency participants estimated that they had drunk alcohol on an average of175 days ( SD frac14 147) in the past 3 months with males tending to report frequent

drinking than females (187 days vs 16 days t frac14 204 p frac14 042) On average

participants consumed 47 units (47 ml by volume) on a typical drinking day and there

were no differences in drinking intensity between males and females (49 units vs 45

units respectively t frac14 0103 p frac14 302) As can be seen 285 of the cohort recalled

drinking six or more units on a typical day

In general beerlager was the most commonly used beverage (by 434) followed

by spirits (200) liqueurs (96) alcopops (88) and wine (59) Males tended to

prefer beerlager (691 vs 146 x2 frac14 15370 p 000) while females preferred

spirits (321 vs 93 x2 frac14 4111 p 000) liqueurs (175 vs 26 x2 frac14 3236

p 000) alcopops (133 vs 33 x2 frac14 1708 p 000) and wine (104 vs

19 x2 frac14 1675 p 000) In the past 3 months a similar profile of beverage

Table 1 Frequency and intensity of alcohol use in the past 90 days by gender (N frac14 467)

Males ()(N frac14 251)

Females()(N frac14 216)

Total()

Frequency of alcohol use in past 90 daysLess than monthly 17 (68) 19 (88) 36 (77)1ndash3 days per month 79 (315) 76 (352) 155 (332)One day per week 58 (231) 52 (241) 110 (236)2ndash3 days per week 82 (327) 64 (296) 146 (313)4ndash6 days per week 14 (56) 4 (19) 18 (39)Everyday 1 (04) 1 (05) 2 (04)

Units consumed on a typical drinking dayUp to 10 unit 11 (44) 15 (69) 26 (56)1ndash19 units 31 (124) 33 (153) 64 (137)2ndash39 units 78 (311) 59 (273) 137 (293)4ndash59 units 44 (175) 35 (162) 79 (169)6ndash99 units 56 (223) 38 (176) 94 (201)10 or more 20 (80) 19 (88) 39 (84)Number of drinking days90 (meanSD) 187 (155) 160 (137) 175 (147)Amount drunk on typical day (meanSD) 49 (36) 45 (38) 47 (37)

p 05

John Marsden et al436

preferences was recorded When asked what type of alcohol they had consumed

most often during the time 60 said beerlager 143 said spirits 18 said wine

and 58 said alcopops

Family factorsHalf of the sample (271 502) estimated that their mother generally drank alcohol at

least once a week and 704 (380) estimated that their father drank at least once a

week In terms of parental encouragement to drink around one quarter of the

sample estimated that they had often drunk alcohol at home with their parents in the

past year (129 239) although only 161 said that their parents had often bought

them an alcoholic drink at a restaurant or other establishment Conversely just 138

(255) of the sample said that their parents had actively discouraged them from

drinking in the past year The two 5-item scales assessing the extent to which parentsencouraged or discouraged drinking were approximately normally distributed and

had acceptable internal reliability The average total score on the parental

encouragement scale was 1363 ( SD frac14 501 Cronbachrsquos a frac14 77) and the average

total score on the parental discouragement scale was 888 ( SD frac14 367 a frac14 77)

While a fifth (203) of the sample reported that in the past 3 months they had never

drunk alcohol without the knowledge of their parents a quarter (N frac14 139) reported

that when they had recently drunk alcohol it was often or always without their

parentsrsquo knowledge

Psychological factorsThe average total score for the mood alteration function scale was 122

(median frac14 120) and it had acceptable internal reliability (a frac14 71) The most

commonly endorsed mood alteration function was drinking to relax (51 reporting

that they drank sometimes or more frequently for this reason) followed by drinking in

order to forget about a problem (endorsed by 34) The average total score for thesocial facilitation function scale was 114 (median frac14 110 a frac14 70) and the most

commonly endorsed social item was drinking to enjoy the company of friends (by 63)

followed by drinking to lose inhibitions (endorsed by 48) Scores on the GHQ-12

ranged from 0 to 34 with a mean of 121 (median frac14 110 a frac14 85) The sample were

equally likely to report positive and negative alcohol-related attitudes The mean scores

on these scales were 228 and 238 respectively (range frac14 13ndash39 and 13ndash34 a frac14 68

and a frac14 73)

Social and peer factorsJust under one half (246 483) estimated that a few of their friends were older than

them and a minority 64 (126) of the drinkers estimated that all or most of their

friends were at least 1 year older than them Two-fifths (N frac14 202) said that all of their

friends drank alcohol and a further 391 said that they believed most did so In the past

3 months two-thirds of the drinkers (338 664) reported that they typically spent time

with friendsacquaintances who were drinking at least once a week Just 68 individuals(134) estimated that this generally occurred less than once a month and a further

17 (33) said that they never spent time with friendsacquaintances who

were drinking A small proportion of the drinkers (79) considered that they

felt pressure from their peers to drink alcohol but the majority (578) did not feel

Adolescent drinking 437

this way and a further 193 indicated that they strongly disagreed that such pressure

was present in their social network

School conduct problemsIn the past year the majority of the drinkers (356 76) had received a detention afterschool or some other minor punishment There was also a minority (95 187) who

estimated that they found themselves in trouble with teachers once or twice each

month and a further small group who said that they received some form of disciplinary

action at school once a week (57 112) A quarter (138 256) reported that they had

had a fight with another student in the past year Just over a third (187 367) admitted

that they had been absent from school without authorization (truanted) at least once in

the past year and the average number of occasions on which this had occurred was 78

days ( SD frac14 150 days range frac14 05ndash80) Sixty-six students (122) had beentemporarily excluded from school in the past year

Regression of covariates of alcohol involvementThe two dependent variables were judged to be reasonably normally distributed and

were not transformed Following negative screening for multicollinearity within the

covariate set multiple regression analysis was performed separately for each of thefive blocks of covariates to assess their individual contribution to explaining variance in

the dependent variables A further regression was then performed in which all 26

covariates were entered simultaneously to calculate the overall level of variance

accounted for Table 2 presents the standardized regression coefficients (b) and the

overall R 2 for each block for these analyses

There was no significant association between age of first drink and recent drinking

although as predicted there was a positive association between feeling intoxicated after

drinking alcohol and both recent drinking frequency and intensity As predicted therewas a positive correlation between lifetime smoking and cannabis use and alcohol

involvement and this association was stronger for cannabis Among the set of

predictions concerning parents there was evidence for an association between the

frequency of parentsrsquo drinking for drinking intensity but this was in the anticipated

direction for the motherrsquos drinking only ( p 01) The frequency of the fatherrsquos

drinking was associated with drinking of lower intensity ( p 05)

As predicted there were significant positive associations between the extent that

parents encouraged drinking and both drinking frequency ( p 001) and intensity( p 01) Contrary to prediction there was a weak but positive relationship between

the extent that parents discouraged drinking and recent alcohol involvement ( p 05)

For the psychological factors there was support for the predicted association between

alcohol involvement and drinking for mood alteration functions ( p 001) but not to

fulfil social functions Higher scores on the GHQ-12 indicative of poorer psychological

well-being were negatively associated with drinking frequency only ( p 001)

Contrary to prediction there were no associations between the positive and negative

alcohol-related attitude scales with the exception of a significant association betweenpositive attitudes and recent drinking intensity ( p 05)

In the social and peer factors block there was evidence that personally buying

alcohol was associated with higher drinking intensity ( p 01) and drinking frequency

( p 001) There was rather weak supporting evidence for the relationship between

having older friends and more frequent drinking ( p 05) There were mixed findings

John Marsden et al438

concerning having more friends who drink spending time with friends who drink and

feeling under social pressure to drink The proportion of friends who drink was related

to intensity ( p 05) but not frequency There was a strong positive and consistent

relationship between spending time with friends who drink and drinking ( p 001)

and there were significant associations between perceived social pressure to drink and

Table 2 Standard multiple regression of background family psychological social and school factors on

recent alcohol involvement (N frac14 467)

Drinking frequency Drinking intensity

1 Background R 2 frac14 0211 R 2 frac14 0192Age 0100 0079Gender 098 0025School 1 100 100School 2 20024 20073School 3 0065 0012School 4 20065 20128School 5 0077 0101Age of first drink 20076 20044Ever intoxicated from alcohol 0591 1092Age first intoxicated on alcohol 20396 20899Ever smoked cigarettes 0155 0076Ever used cannabis 0160 0140

2 Family R 2 frac14 0141 R 2 frac14 0060Frequency of motherrsquos drinking 0052 0153Frequency of fatherrsquos drinking 0041 20121Extent parents encourage drinking 0231 0156Extent parents discourage drinking 0109 0094Drinking without parents knowledge 0280 0137

3 Psychological R 2 frac14 0156 R 2 frac14 0095Mood functions for drinking 0385 0307Social functions for drinking 20002 20068Psychological well-being 20116 20062Positive drinking attitudes 20050 0102Negative drinking attitudes 20014 0001

4 Social R 2 frac14 0322 R 2 frac14 0210Personally bought alcohol 0150 0131Proportion of older friends 0074 0090Proportion of friends who drink 0083 0094Time with friends drinking 0387 0307Perceived social pressure to drink 0148 0062

5 School R 2 frac14 0121 R 2 frac14 0144Been in trouble with teachers 0213 0212Had a fight with student at school 0054 0090Times truanted in past year 0155 0120Temporarily excluded in past year 0090 0152Overall R 2 frac14 0418 R 2 frac14 0339Adjusted R 2 frac14 0381 R 2 frac14 0290

frac14 p 05 frac14 p 01 frac14 p 001

Adolescent drinking 439

drinking frequency but not recent intensity There was a positive correlation between

more positive alcohol-related attitudes and high drinking intensity only ( p 05)

There were also mixed associations relating to school conduct problems and

drinking Being temporarily excluded from school and the number of times truanted

were positively related to recent frequency ( p 05 and p 001 respectively) and

recent intensity ( p 01) Having had a fight with another student with associated withrecent drinking intensity only ( p 05) while there was a strong positive and

consistent relationship between being in trouble with teachers and the both drinking

measures ( p 001)

In total the five blocks of factors explained 42 (38 adjusted) of the variance in

frequency of drinking scores and 34 (29 adjusted) of the variance in typical intensity

Taking the covariate blocks in turn the regression analysis indicated that the social and

peer factors had the strongest correlations (accounting for 32 and 21 of the variance

in drinking frequency and intensity respectively) For drinking frequency the strengthof association for the remaining factors was as follows background variables (21)

psychological factors (16) family factors (14) and school conduct problems (12)

The regression analysis for recent typical drinking intensity revealed a somewhat

contrasting pattern of predictors background variables (19) school conduct

problems (14) psychological factors (10) and family factors (6)

The dataset was then screened for the presence of moderation effects between

gender and each covariate Those variables (gender the covariate and their interaction)

that emerged as statistically significant were then entered into two regression equationsusing each of the dependent variables If the interaction term exerted a significant effect

on the dependent variable in this equation when its constituent parts were controlled

for this was taken as evidence of a moderation effect by gender The single interaction

term that was identified in this way was added to the covariate set in a backwards

stepwise regression equation controlling for gender and age This process resulted in a

final lsquotrimmed downrsquo regression model for the two dependent variables and is shown in

Table 3 The total proportions of variance in the dependent variables explained by the

final models were as follows 40 (38 adjusted) for drinking frequency( F12 441 frac14 2690 p 001) and 27 (26 adjusted) for drinking intensity

( F7 441 frac14 2316 p 001)

Drinking frequencyEleven covariates were retained in the model as significantly associated with recent

drinking frequency As can be seen most were from the family factors and social and

peer factors blocks Males tended to be more frequent drinkers than females(b frac14 0272) However the strongest predictor of frequency of alcohol use in the model

was the amount of time spent with friends who are drinking (b frac14 0316) Other

influential variables included the extent to which parents encourage (b frac14 0155) and

discourage (b frac14 20223) alcohol use with the latter association moderated by gender

More frequent parental discouragement to drink was related to more frequent drinking

in females and less frequent drinking frequency in males In a post hoc analysis the

parental discouragement scale items were entered into a regression equation This

showed that two items exerted an effect over and above the others lsquomy parents havetold me off because of drinking or buying alcoholrsquo and lsquomy parents have said that

I cannot drink alcohol at homersquo A positive relationship was also observed between

drinking more frequently without parentsrsquo knowledge and recent frequency of use

(b frac14 0110) Other independent influences on drinking frequency were higher mood

John Marsden et al440

alteration function scores (b frac14 0113) greater perceived social pressure to drink

alcohol (b frac14 0155) a history of temporary school exclusion (b frac14 0121) and more

frequent occasions of truanting from school in the past year (b frac14 0086)

Drinking intensityIn common with the final model for drinking frequency just five covariates were

retained in the regression equation for drinking intensity The amount of time spent with

friends who are drinking alcohol was the strongest predictor (b frac14 0319) This was

followed by having a history of school exclusion (b frac14 0197) and more frequently being

in trouble with teachers in the past year (b frac14 0142) Greater parental encouragement

to drink was associated with higher actual drinking intensity (b frac14 0124) Finally a

single background factor ndash lifetime use of cannabis ndash was associated with higher

drinking intensity (b frac14 0113)

Discussion

This report has presented first results from a cohort follow-up study of alcohol use

among a sample of mid-adolescents in England Baseline data on personal backgroundand demographics family psychological social factors and school conduct problems

were correlated with reports of recent drinking frequency and intensity As expected

regular drinking was the norm among the cohort 19 in 20 of the cohort had consumed a

whole alcoholic drink at some point in their lives and approximately 17 in 20 were

current drinkers This prevalence of alcohol use is comparable to that reported for the

Table 3 Stepwise multiple regression of background family psychological social and school factors on

recent alcohol involvement (N frac14 467)

Drinking frequencyR 2 frac14 0396

Drinking intensityR 2 frac14 0273

1 BackgroundAge 0033 0046Gender 0272 0004Ever smoked cannabis ndash 0113

2 FamilyExtent parents encourage drinking 0155 0124Extent parents discourage drinking 0223 ndashGender pound extent parents discourage drinkinga 0302 ndashDrinking without parents knowledge 0113 ndash

3 PsychologicalMood functions for drinking 0113 ndash

4 SocialPersonally bought alcohol 0118 ndashTime with friends who are drinking 0316 0319Perceived social pressure to drink 0155 ndash

5 SchoolIn trouble with teachers in past year ndash 0142Times truanted in past year 0086 ndashTemporarily excluded in past year 0121 0197

a frac14 interaction term frac14 p 05 frac14 p 01 frac14 p 001

Adolescent drinking 441

general adult population in the UK (Singleton Bumpstead OrsquoBrien Lee amp Meltzer

2001) and is also comparable to drinking levels reported for 15-year-olds in other

countries (eg Casswell Stewart Conolly amp Silva 1991 for New Zealand) In terms of

typical drinking intensity study participants estimated that they drank about five

standard units of alcohol on a typical day Although the government has not issued

recommended drinking levels for the under-18 s this level exceeds the safer drinkinglevels for adults as recommended by the English Department of Health (Department of

Health 1995) and is therefore a cause for concern A substantial proportion of the

sample also reported lifetime tobacco smoking (70) and use of cannabis (40) Despite

the fact that the study cohort was not generated using probability sampling techniques

it is reasonable to believe that it is unbiased The levels of drinking smoking and

cannabis use reported fell remarkably close to population estimates for this age group in

England (Goddard amp Higgins 2001 Becher et al 2001 Currie Hurrelmann

Settertobulte Smith amp Todd 2000) On school conduct characteristics the samplewas also broadly comparable to reports from national surveys (Miller amp Plant 1999)

The cohort was also comparable to the general population on school conduct problems

Thirty-seven percent admitted that they had truanted at least once in the past year and

this compares to 33 of boys who admitted truanting in the latest Office for National

Statistics school survey (Boreham amp Shaw 2001)

Drinking was well established within the social networks of the cohort The majority

reported that most or all of their friends drank alcohol and two-thirds of the drinkers

said that they typically spent time with friendsacquaintances who were drinking atleast once a week Two-thirds did not consider that they were under any peer pressure

to drink

In the UK alcopop beverages are well established in the drinks market (Clarke

2000) and concerns have been raised about the marketing of these products to younger

drinkers (Hughes et al 1997 McKeganey 1998) In our study males reported a limited

preference for these drinks and tended to favour beer and lager whereas females had a

greater preference for spirits alcopops wine and liqueurs Males were more frequent

drinkers but there were no gender differences in the amount of alcohol consumed ontypical day Previous studies on alcohol use have found that males drink more heavily

than their female peers (Goddard amp Higgins 2001 Miller amp Plant 1996) However as

alcohol use among school-age students approximately doubled between 1990 and 2000

(from 53 units in 1990 to 104 units in 2000) the gender gap in consumption has

narrowed (Goddard amp Higgins 2001) The drinking patterns of young females are of

concern given their greater vulnerability to alcohol-related harms (Goist amp Sutker 1985

Plant amp Plant 2001)

Correlates of drinking frequencyThe regression analyses were able to account for approximately 40 of the variance in

scores on the measure of drinking frequency There was no evidence for the hypothesized

negative relationship between age of first drink and recent drinking frequency although

there was a positive association with feeling intoxicated after drinking alcohol It is

however possible that the effect of earlier initiation to drinking is not seen until drinking

patterns have further developed This was observed in a longitudinal study in the USAreported by Hawkins et al (1997) In this study of a cohort of students who were

followed-up annually from age 10ndash11 to age 17ndash18 a younger age of alcohol initiation was

strongly related to a higher level of alcohol misuse at age 17ndash18 Consequently we will

assess the influence of age of alcohol initiation in further follow-ups

John Marsden et al442

Studies examining the putative relationship between lifetime smoking cannabis use

and recent drinking frequency suggest that earlier initiation to substance use mediates

peers alcohol involvement and parental drinking risk factors (eg Hawkins et al 1997)

However findings from research using twins suggests that the association between age

of onset of alcohol use and later problematic drinking may not be directly causal but

that age of onset and problematic drinking in later life are both associated with anunderlying vulnerability to behavioural problems (Prescott amp Kendler 1999)

There was no support for the predicted relationship between the frequency of

parental drinking and adolescent drinking frequency It must be acknowledged that

influence of parental drinking parental alcohol use norms and family environment and

relations are complex (Peterson et al 1994) Foxcroft and Lowe (1997) found that

increased drinking levels among 11ndash17-year-olds were linked to regular perceived

parental drinking while Casswell and her colleagues noted a positive association

between the frequency of drinking in early- to mid-adolescents and the frequency of

their mother and fatherrsquos drinking (Casswell et al 1991) Peterson et al showed thatclear communication by parents about their expectations of their childrenrsquos drinking

together with positive reinforcement for desired behaviours can reduce the impact of

parentrsquos drinking on adolescent alcohol use

Several studies have also noted a negative relationship between parental support

a positive family environment and feelings of connectedness and adolescent substance

use (Resnick et al 1997 Hops Davis amp Lewin 1999) The role that parental approval of

drinking has in predicting intensity of alcohol use in their children has also been

explored (eg Barnes amp Welte 1986) Wilks Callan and Austin (1989) found that the

fatherrsquos approval or disapproval of drinking behaviour predicted self-perception as adrinker in young males yet found no normative influences for females A gender

interaction in the present study also suggests a differential effect for discouraging

drinking More frequent parental discouragement to drink was related to more frequent

drinking in females and less frequent drinking in males This finding could indicate that

parents are more likely to disapprove of drinking in their daughters (and therefore

discourage alcohol use more strongly) than in their sons Alternatively it could point to a

tendency for girls to rebel more strongly against their parentsrsquo attitudes towards alcohol

use The direction of this relationship cannot be judged from the baseline data but our

post hoc item analysis does suggest that this effect may be due to parental reactions todrinking and proscriptions about drinking at home Future analyses of the longitudinal

data collected during the course of this study will examine this issue more closely

In the present analyses although frequency of mother and fathersrsquo alcohol use was

significantly related to drinking frequency these variables were not retained in the

regression analysis This suggests that other variables explain the relationship between

these factors Zhang Welte and Wieczorek (1999) found that the drinking behaviour of

each parent has a differential effect on their male offspring (aged 16ndash19 years) In their

study the fatherrsquos drinking but not their motherrsquos drinking affects their sons drinking

and closeness to the mother was a protective factor against adolescent drinking On theother hand male adolescent drinking increases if closeness to the mother is low and she

drinks excessively There appears to be no comparable effect for closeness to the father

and the fatherrsquos drinking

For the analysis of psychological measures there was an association in the predicted

direction between alcohol involvement and drinking for mood alteration functions but

not drinking to fulfil social functions Poorer psychological well-being was negatively

associated with drinking frequency only and contrary to our hypothesis there were no

Adolescent drinking 443

associations between the positive and negative alcohol-related attitude scales The

present results provide further evidence for the link between reasons or motives for

alcohol use and consumption patterns A strong relationship was observed between

increased frequency of drinking to serve mood alteration functions and increased

drinking frequency Our research group has also observed this effect among young

alcohol cannabis and ecstasy users (Boys et al 1999) These findings are consistentwith previous studies which have found a positive relationship between the number of

reasons for alcohol use and drinking frequency (Cooper Frone Russell amp Mudar 1995

Beck amp Treiman 1996 Bradizza Reifman amp Barnes 1999) For the social and peer

factors buying alcohol was as predicted associated with increased alcohol

involvement but there was only weak supporting evidence for an association with

having older friends There was a strong positive and consistent relationship between

spending time with friends who drink and perceived social pressure to drink and more

frequent drinking These independent social influences are interpreted in the context ofdeveloping peer relations and peer norms in which the majority of adolescents report

spending time with friends who are drinking as a recreational activity and where there

may be expectations to drink with the group sometimes to excessive levels (Iannotti

amp Bush 1992 Bahr Marcos amp Maughan 1995) Finally school conduct problems were

independently associated with drinking frequency with the number of times truanted

and being temporarily excluded having the strongest correlations Drinking more often

than other peers has been linked to more frequent unauthorized absences from school

(Currie et al 2000) Drinking smoking and drug use is also much more prevalentamong 12- to 15-year-olds who had ever truanted compared to those who had never

done so (Becher et al 2001)

Correlates of drinking intensityOverall 285 of the cohort typically drank six or more units on a drinking day which

can be taken to be a conservative indicator of underage binge drinking The regression

analyses were able to account for approximately 30 of the variance in drinkingintensity Age of first alcohol intoxication and lifetime smoking and cannabis use was

associated with more intense recent drinking For the family factors in contrast to

drinking frequency there was evidence for a positive association between how often

the mother usually drank alcohol and how much the adolescent drank on a drinking day

but contrary to prediction there was a negative association with the fatherrsquos drinking

It is possible that more frequent drinking by the father serves to discourage binge

drinking among mid-adolescents Nonetheless this effect was weak and was not

retained in the stepwise regression As predicted drinking to alter mood was associatedwith more intensive drinking but not with drinking for social facilitation functions This

effect however was not sufficiently strong to be retained in the stepwise regression

There was also a positive association between more favourable attitudes towards

alcohol and drinking intensity Among the social and peer factors a similar set of

associations was seen with the exception of perceived social pressure to drink

suggesting that mid-adolescents do not feel that the amount they consume is influenced

by their peers Finally the school conduct factors were quite strongly associated with

more intensive drinking and being in trouble with teachers and having beingtemporarily excluded had the strongest associations

The links between binge drinking and school conduct problems are a concern and

elsewhere studies have shown that binge drinking is related to poorer actual educational

performance (Newcomb Measham amp Parker 1995) Clinical diagnostic criteria for

John Marsden et al444

alcohol abuse recognize that recurrent drinking can result in school performance

problems and expulsions (American Psychiatric Association 1994) and the trajectory of

those experiencing school problems will be a focus of subsequent analyses of further

follow-up in the study The finding that lifetime use of cannabis was independently

associated with more intensive drinking is supportive of other work that argues that

those adolescents who use substances tend to have other attributes that increase therisk of poor psychosocial adjustment and school performance For example Jessor

Chase and Donovan (1980) argued that the reason that cannabis users tend to be less

well adjusted is that cannabis use is a general characteristic of individuals who are

predisposed to behavioural problems Furthermore Fergusson Lynskey and Horwood

(1997) suggested that instead of early cannabis use having a causal link with poor

psychosocial adjustment this association could be explained by family and other factors

that related to cannabis use Other alternative explanations include those proposed by

Kandel and colleagues They argue that early substance use sets into motion a chain ofevents which result in greater subsequent drug involvement and a range of other

negative psychosocial consequences (Kandel Davies Karus amp Yamaguchi 1986)

Again the causal direction of this relationship cannot be judged from the baseline data

but will be examined in more detail in subsequent reports on the longitudinal data

Strengths and limitations of the studyThe main strength of the present study was the analysis of the multiple influences on

drinking behaviour Studies of this kind have been rare in the UK but are encouraged as

good opportunities to gain an understanding of how early use of alcohol smoking and

other substance involvement evolves across the adolescent years (Edwards et al 1994

Duncan Duncan amp Hops 1998) Several limitations of the present study are also

acknowledged Given the reliance on self-report it is difficult to judge the reliability ofthe data and the findings should be interpreted with caution Nevertheless steps were

taken to maximize the privacy of the recruitment interviews to emphasize the

confidentiality of the study and the interviews were all conducted by young adults

Overall it has been argued that it is better to collect social survey data on this age group

at school than in the home (Becher et al 2001)

Implications for school-based alcohol educationThese results underline the importance of addressing personal family peer and school

conduct factors as part of alcohol education and problem prevention initiatives Theidentified correlates of drinking involvement in the present study could be usefully

taken up and discussed with students as part of alcohol education and prevention

programmes Elsewhere it has been argued that the main goal of school prevention

programmes should be to delay alcohol initiation (DeWit et al 2000 Griffin Botvin

Epstein Doyle amp Diaz 2000) However the very early age of onset in the UK suggests

that educational approaches based on harm minimization may be more realistic Recent

work in Australia has indicated that a harm minimization approach to alcohol education

together with adult supervision of initial drinking experiences can help to reduce theharms associated with alcohol use in young people (McBride Midford Farringdon amp

Phillips 2000b) Research into the merits of adopting a harm minimization approach to

alcohol education in schools has highlighted the importance of ensuring that

programme content and materials are relevant to local patterns of behaviour and are

Adolescent drinking 445

based on experiences that are relevant to the target audience (McBride Farringdon amp

Midford 2000a Dusenbury amp Falco 1995)

The potential feasibility and benefits of including parents as part of education

programmes in school should be examined The possibility of encouraging parents to

consider how their own behaviour and attitudes towards drinking might influence the

choices regarding alcohol use that are made by their offspring should be explored

Given the high prevalence of drinking involvement in mid-adolescence understanding

the influences on the further development of drinking attitudes and behaviours is of

critical importance Further reports from the study will describe the associations

between risky and heavy drinking patterns and alcohol-related problems and

developmental transitions to heavier consumption patterns as the cohort reaches the

period of late-adolescence

Acknowledgements

We would like to thank the students and staff from each school for their kind and enthusiastic

participation in the study The study was supported by a research grant from the LloydsTSB

charitable trust and conducted in association with Alcohol Concern

References

American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders

(4th ed) Washington DC APA

Anderson K Plant M amp Plant M (1998) Associations between drinking smoking and illicit

drug use among adolescents in the Western Isles of Scotland Implications for harm

minimization Journal of Substance Misuse 3 13ndash20

Ary D V Tildesley E Hops H amp Andrews J (1993) The influence of parent sibling and peer

modelling and attitudes on adolescent use of alcohol International Journal of Addiction 28

853ndash880

Bahr S J Marcos A C amp Maughan S L (1995) Family educational and peer influences on the

alcohol use of female and male adolescents Journal of Studies on Alcohol 56 457ndash469

Barnes G (1990) Impact of the family on adolescent drinking patterns In R Collins K Leonard

amp J Searles (Eds) Alcohol and the family Research and clinical perspectives (pp 137ndash161)

New York Guilford Press

Barnes G amp Welte J (1986) Patterns and predictors of alcohol use among 7ndash12th grade students

in New York State Journal of Studies on Alcohol 47 53ndash62

Becher H Boreham R Emery P Hinds K Jamison J amp Schagen I (2001) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Beck K H amp Treiman K A (1996) The relationship of social context of drinking perceived

social norms and parental influence to various drinking patterns of adolescents Addictive

Behaviors 21 633ndash644

Blenkinsop S Boreham R McManus S Natarajan L amp Prescott A (2003) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Blum R W Beuhring T amp Rinehart P M (2000) Protecting teens Beyond race income and

family structure Minneapolis MN Center for Adolescent Health University of Minnesota

Bonomo Y Coffey C Wolfe R Lynskey M Bowes G amp Patton G (2001) Adverse outcomes

of alcohol use in adolescents Addiction 96 1485ndash1496

Boreham R amp Shaw (2001) Smoking drinking and drug use among young people in England

in 2000 London The Stationery Office

John Marsden et al446

problematic alcohol use in adulthood (Chou amp Pickering 1992 Grant 1998) For early

onset drinkers it is believed that this is not simply a function of a greater exposure to

drinking but rather one consequence arising from how heavy alcohol consumption

can become progressively embedded within personal relationships and leisure

activities (DeWit Adlaf Offord amp Ogborne 2000) Research studies have looked at

individual family peer and school influences The influence of parents on theiroffspring has been a focus of the majority of the major survey work undertaken in the

USA (Barnes 1990 Denton amp Kampfe 1994) Studies have reported that there is a

close association between how often parents drink and how often their adolescent

offspring drink (Fergusson Horwood amp Lynskey 1995 Wilks Callan amp Austin 1989)

Other research has shown that the parentsrsquo attitudes and beliefs about alcohol affect

adolescentsrsquo drinking both at home and outside (Hundleby amp Mercer 1987 Foxcroft

Lowe amp May 1994 Miller amp Plant 2003) For example a study of families determined

to be of high-risk for alcoholism found that alcohol expectances of early-adolescents

(13-year-olds) were closer to their parents than those from low-risk families whodisplayed significant negative correlations (Shen Lock-Wellman amp Hill 2001)

Similarly adolescents from families at high risk of developing drinking problems have

been found to drink more frequently and intensely than adolescents from low risk

families (Hill amp Yaun 1999) In contrast there is some evidence that early parental

disapproval of alcohol may deter later adolescent drinking (Ary Tildesley Hops

amp Andrews 1993 Ellickson amp Hays 1991 Ellickson Tucker Klein amp McGuigan 2001

Monshouwer Smit De Zwart Spruit amp Van Ameijden 2003) Research has also looked

for influences on drinking from outside the family particularly within the peer group

(same age friends) It is clear that the influence of this group can be seen at an early

age in one study of 10- to 13-year-olds whether drinking was common among friendswas the most important predictor of individual behavioural expectations to drink

(Marcoux amp Shope 1997) Jackson (1997) also found that a high perceived prevalence

of alcohol use in the peer group and also having a best friend who had tried alcohol

predicted experimentation with alcohol use in a sample of 9- to 11-year-olds Other

work has examined what happens to young people as they reach mid-adolescence

During this period young people attain greater levels of independence from the family

individual and peer group drinking norms tend to converge (Kandel amp Andrews 1987

Graham et al 1987 Lowe et al 1993) Studies show that a high level of peer

involvement in drinking is reflected in increased levels of personal drinkinginvolvement (Duncan Tildesley Duncan amp Hops 1995 Swadi amp Zeitlin 1988)

Fergusson and colleagues found that having substance-using peers at 15 years of age

was one of the strongest predictors of hazardous drinking 1 year later (Fergusson et al

1995) In addition there is evidence that young drinkers are influenced to drink more

regularly if they affiliate with older peers who are likely to have more favourable

drinking norms and established drinking patterns (Keefe 1994)

Studies have also sought to describe the personal motivations for drinking that may

influence drinking involvement National household survey data from the USA show

that adolescents aged 12 to 14 are more likely to believe that positive benefits are morelikely to occur than negative effects (Substance Abuse and Mental health Services

Administration 1999) In the terms of personal reasons and motives for drinking several

research studies have looked at the different reasons that young people endorse for

drinking alcohol (or the specific functions that use is intended to serve) and how these

relate to consumption patterns These consistently report a positive relationship

between the number of reasons for alcohol use and drinking frequency in both young

Adolescent drinking 429

males and females (Windle amp Barnes 1988 Beck amp Treiman 1996 Boys et al 1999

Bradizza Reifman amp Barnes 1999) In one study of 16- to 19-year-olds Foxcroft and

Lowe (1997) found that the heavier drinkers were more likely to endorse drinking

because they liked the effects because they wished to get intoxicated or they were

motivated to improve their mood General population survey research in the US

suggests that among 12- to 17-year-olds who have drunk alcohol in the last year 8

report psychological problems although the temporal and causal relationship between

drinking and mood is unclear

A fourth potential area of influence concerns problem behaviours at school

Attendance and behavioural problems at school appear to be linked to drinking as well as

smoking and other substance use In a survey of 11000 young students in the US the

strongest predictors of drinking frequency were frequent problems at school and the

number of close friends who drank at least once a month (Blum Beuhring amp Rinehart

2000) Miller and Plant found an association between poorer school performance and

higher levels of smoking and illicit drug use in a cross-sectional survey of eight thousand

15- to 16-year-olds (Miller amp Plant 1996) There is also evidence that young people who

truant or are excluded from school are at greater risk of drinking at harmful levels

(Graham amp Bowling 1995 Goulden amp Sondhi 2001) The 2001 English Department of

Healthrsquos School survey found that among 15-year-olds those who had ever truanted were

more likely to drink once a week have taken drugs in the last year and to be a regular

smoker (Boreham amp Shaw 2002) There is no clear temporal relationship between school

problems and drinking but it is likely that school performance problems are for some an

indirect consequence of drinking and other substance involvement

To date most studies of adolescent drinking have looked at a single factor that may

relate to drinking behaviour and relatively little is known about where these influences

act differently on males and females While there continue to be major cross-sectional

population surveys of adolescent drinking in the UK detailed examinations of drinking

influences between males and females and changes in drinking behaviours over time

remain rare The argument that efforts should focus on characterizing patterns of

hazardous alcohol use and predicting negative outcomes has been advanced in a number

of reports (Reifman Barnes Dintcheff Farrell amp Uhteg 1998 Peterson Hawkins

Abbott amp Catalano 1994) Understanding of these influences can achieve valuable

insights for the design and delivery of education programmes which schools are now

obliged to include as part of the national curriculum (Department for Education and

Employment 1998a)

Aims and hypotheses of the studyThe study was designed to explore personal and social correlates of alcohol use and how

these change over time The mid- to late-adolescent period (from 15 to 17 years) was

judged to be the most appropriate phase to study the development of patterns of alcohol

use The selection of research instruments and measures was guided by a social

ecological framework for studying adolescent behaviour (Bronfenbrenner 1986

Chassin Pillow Curran Molina amp Barrera 1993) This suggests that adolescent drinkingbehaviour should be understood in terms of the interpersonal social and

environmental influences that exist in the drinkerrsquos natural ecosystem (Reed 1996)

Social ecological approaches that combine models of individual and social behaviour

change have been successfully used in health education programmes (Glanz Lewis amp

Rimer 2002)

John Marsden et al430

A core set of measures for the study was identified based on a review of the research

literature and our grouprsquos previous work on modelling substance use motivations These

variables constitute a repeated measures set of correlates which are recorded at baseline

and at follow-ups The personaldemographic background family and social correlates

constituted a set of distal (ie lifetime behaviours and events) and more proximal

influences on drinking (behaviours and events that occurred in the past year or the past

3 months) In this first report of findings from the study the aim was to examine the

correlates of alcohol use among adolescents in the 3 months before recruitment Results

are presented using data gathered from the baseline questionnaires and analysed to test

the hypothesis that increased alcohol involvement would be

(1) Negatively related to age of first drink and the lifetime experience of being

intoxicated on alcohol

(2) Positively related to lifetime experience of cannabis use and smoking

(3) Positively related to parental drinking parental encouragement to drink and

drinking with and without parental knowledge and negatively related to parentaldiscouragement to drink

(4) Positively related to more reasons for drinking and favourable drinking attitudes

and negatively related to psychological well-being and unfavourable drinking

attitudes

(5) Positively related to purchasing drinks and peersrsquo alcohol involvement and

(6) Positively related to school conduct problems

These hypotheses were tested against a null hypothesis for contrasts with males and

females No predictions were made concerning the relative strength of associations

between individual covariates and alcohol involvement

Method

Design and school selectionThe study is a prospective cohort survey of alcohol use and related attitudes and

behaviours of mid-adolescents (15ndash16 years old) recruited and interviewed from thestate school population in a single county in the south of England Two follow-up

questionnaires were administered at 9 and 18 months following recruitment In the UK

schooling is compulsory until the age of 16 years and an efficient means of recruiting a

general population sample of 15- to 16-year-olds is to sample from those in Year 11 from

educational establishments

Study resources precluded a probability sampling design and for practical reasons a

purposive non-probability method was used for recruitment of schools and

participants Schools were recruited from the countyrsquos main metropolitan area and

from other locations to yield a mix of inner-city and satellite town locations and from

schools that fell above and below standardized educational performance averages for

the county Five coeducational comprehensive schools were selected based on their

catchment area (urban or rural) educational achievements and size All of the five

schools approached agreed to participate They comprised two schools in inner-city

locations and three in satellite towns Two schools achieved above average educational

performance two were below average and one average (Department for Education and

Employment 1998b)

Adolescent drinking 431

Sample size planningGiven the available resources for the study an initial feasibility assessment suggested

that approximately 500 participants could be recruited and followed-up Statistical

power estimates suggested a sample of this size would be sufficient to detect behaviours

with rates as low as 5 with a relative standard error of 19 (95 CI frac14 32 68) The

smallest detectable effect that could be reliably measured (based on a two-tailed t testwith a frac14 05 and b frac14 020) for gender comparisons of for example drinking

involvement (using a measure of days of alcohol use and estimating for 50 female)

would be 026 which corresponds to a small effect size (Cohen 1988) The potential

design effects due to recruiting participants from different schools were assessed by

including these sites as a term in the analyses of the data Power calculations informing

follow-ups and change analyses are presented in subsequent reports

ProcedureThe Research Ethics committee of the Institute of Psychiatry and Maudsley Hospital

approved the study A detailed description of the research procedure has been reported

elsewhere (Boys et al 2003) and only the essential features are described here

Participation in the research was obtained by mailing a letter explaining the purpose and

format of the study to parents of all Year 11 students in each school at least a week in

advance of the scheduled recruitmentbaseline interviews This letter included a

detachable reply form asking parents to indicate if they did not wish their child to takepart in the study None of these student lsquoopt-outrsquo forms were returned to us and no

participant declined to take part during recruitment

A team of 24 second and third year undergraduate students (aged 19ndash24) were

recruited and trained to administer the recruitment protocol and baseline interviews All

interviewers completed a 6 hour group-based study protocol induction and training

session This was facilitated by four members of the author group and included plenary

presentation and discussion and supervised role-play experience in the administration

of the research questionnaire The recruitment of the school students took place over 20days between November and December 1998 during a 2 hour period at the end of the

school day Three members of the research team supervised each recruitment session

Interviewers were assigned a list of participants to interview in a private corner of a

classroom no more than four interviews were conducted in a room at any one time and

no teachers were present

Baseline data were collected using a personal interview of between 20 and 40

minutes duration (completion time varied according to the extent of the participantrsquos

experience with alcohol) and a self-completion questionnaire of around 20 minutesduration The self-completion instrument recorded the lifetime experience of substance

use psychological scales and questions concerning school conduct It was judged that

self-administration of these items would increase the veracity and reliability of reporting

All participants were given a pound10 retail music-store gift voucher in recognition of the

time taken to participate in the recruitment session

MeasuresThe present report utilizes a set of measures comprising standardized scales and several

indicator items developed specifically for the study The response burden on

participants was kept to a minimum and the selected measures represent a core set

that were needed to address the research hypotheses Recall periods for these measures

John Marsden et al432

spanned lifetime occurrences the past 12 months and the past 3 months (90 days) The

nature and coding structure of measures is described below while information about the

internal reliability of scales is presented in the results

Personaldemographic information and background factorsEight measures were used to characterize the personaldemographic background of

each participant (a) age (b) gender (coded male frac14 1 and female frac14 0) (c) school

recruitment site (dummy coded using school 1 as a nominal reference) (d) age of first

drink (e) whether ever intoxicated on alcohol (coded as no frac14 0 yes frac14 1) and (f) age

first intoxicated on alcohol (defined for the participants as lsquofeeling unsteady on your

feet or slurring your words or feeling dizzy or unwellrsquo) (g) lifetime use of cigarettes

and (h) lifetime use of cannabis (both coded no frac14 0 yes frac14 1)

Recent alcohol involvementIt was judged important to record both how often the participants recalled drinking in

the past 3 months and how much they consumed on a day when they consumed

alcohol (drinking intensity) These two measures which serve as the dependent

variables for the present report were not significantly correlated ( r frac14 15 ns) and

capture different and distinct alcohol use behaviours which are important when

characterizing drinking patterns and how these change over time Researchers in thisfield generally use 24 hour (day) intervals to serve as basic units of drinking frequency

The method of recording drinking frequency and intensity was adapted from the

Maudsley Addiction Profile a standardized multidimensional research instrument for

assessing substance-related behaviours (Marsden et al 1998) Each participant was first

asked to estimate the number of days on which they had consumed alcohol during the

past 3 months assisted by a prompt card listing nine categories (never less than once

every 2 months once every 2 months once every month two times a month 1 day per

week 2ndash3 days a week 4ndash5 days a week 6ndash7 days a week scored 0ndash8 and subsequentlymultiplied to total the number of days out of 90) If none of these categories closely

matched experience the participant was helped to calculate the specific number of

drinking days This can sometimes happen when a research respondent has a more

episodic pattern of drinking Then drinking intensity was estimated by recording the

number of drinks consumed during an average or typical drinking day in the past 3

months Responses to this question were recorded as verbatim reports of the number of

drinks consumed by beverage and brand type and were then converted as standard units

of alcohol at the data management stage

Family factorsQuestions on family factors that might influence adolescent drinking related to the

participantsrsquo estimates of parentsrsquo drinking the extent to which their parents

sanctioned their drinking and the extent that participants reported unsupervised

drinking without their parentsrsquo knowledge Five measures were recorded (a) two

7-point summary indices of the perceived usual frequency of the motherrsquos and fatherrsquosdrinking frequency (never to every day scored 0ndash6) (B) a 5-item scale to assess the

extent to which parents encouraged the participant to drink in the past year (offered

sondaughter a drink at home bought alcohol at a restaurant or another establishment

drunk an alcoholic drink with sondaughter at home drunk an alcoholic drink with

Adolescent drinking 433

sondaughter at another setting and allowed drinking at home) using a 5-point Likert-

type response (never to very often scored 0ndash4) (c) a 5-item scale coded to assess the

extent to which parents discouraged drinking in the past year (warning sondaughter of

the health risks of drinking parents saying they should not drink being punished by

parents for drinking parents saying that sondaughter cannot drink at home and being

reprimanded for buying alcohol (never to very often scored 0ndash4) and (d) a 9-pointindex of the number of occasions the participant recalled consuming an alcoholic drink

without their parentrsquos knowledge (never once twice 3ndash5 times 6ndash12 times 13ndash23

times 24ndash50 times 51ndash100 times and more than 100 times scored 0ndash8)

Psychological factorsQuestions in the block of psychological factors focused on personal influences and

correlates on alcohol use and included specific reasons for drinking generalpsychological health and alcohol-related attitudes Four measures were taken (a) a

6-item mood alteration functions scale developed by Boys et al (1999) was used to

assess how often participants had consumed alcohol in the past year for the following

personal reasons to relax to feel better when low or depressed to feel closer to

someone to stop worrying about a problem to get to sleep and simply to get drunk

(never to always scored 0ndash4) (B) a 5-item social functions scale also developed by

Boys et al to assess the extent that the participant had used alcohol in the past year for

the following social reasons to let go of inhibitions when socializing to feel moreconfident in a social situation to make an activity more enjoyable to help enjoy the

company of friends and to feel more confident when having sex (scored as above)

(c) the 12-item form of the General Health Questionnaire to assess psychological well-

being with each question scored using the Likert scale response coding (GHQ-12

Goldberg amp Williams 1988) and (d) two 9-item attitude scales adapted from items

used by Plant Peck and Samuel (1985) to assess positive drinking attitudes (eg young

people who drink regularly are attractive to the opposite sex coded as strongly agree

to strongly disagree scored 1ndash5)

Social and peer factorsFive measures were developed for the study to examine the relationships between

purchasing drinks and the influence of peers on alcohol involvement Five measures

were used (a) whether the participant had ever bought alcohol for personal use from a

shop or a barpub (scored no frac14 0 yes frac14 1) (b) the proportion of the participants

current friends who were older by 1 or more years (none to all scored 0ndash4) (c) theproportion of friends who were believed to drink alcohol (none to all scored 0ndash4)

(d) an index of how often the participant had spent time with friends and acquaintances

who were drinking in the past 3 months (never to 6ndash7 days a week scored 0ndash9) and

(e) an index of the extent that the participant perceived that they had felt under social

pressure to drink (coded as strongly agree to strongly disagree scored 1ndash5)

School conduct problemsFinally a block of four measures to record school conduct problems in the past year

A block of four items recording aspects of school life was taken from the youth form of

the Life Stressors and Social Resources Inventory (Moos amp Moos 1994) as follows (a) the

frequency that the participant had been in trouble with teachers and had been detained

John Marsden et al434

after school or received other sorts of punishment (never to every day scored 0ndash8)

(b) whether the participant had been in a fight with a student at school (scored no frac14 0

yes frac14 1) (c) the number of times the participant had truanted from school (defined as

not attending for a whole school day or leaving immediately after the morning class

registration) and (d) whether or not the respondent had been temporarily excluded

from school for disciplinary problems (scored no frac14 0 yes frac14 1)

Statistical analysisThe relationship between alcohol involvement and background family social and peer

and school conduct factors was investigated using multiple linear regression in twostages First two standard regression analyses were computed for drinking frequency and

intensity using the 26 items and scale measures described above in the five domains and

were regressed separately on the dependent variables in each domain and then again

simultaneously to assess overall levels of variance accounted for (Tabachnik amp Fidell

2001) This analysis was used to test the research hypotheses Second two stepwise

regression analyses with backwards elimination of covariates were computed to isolate a

set of independent predictors of drinking frequency and intensity and to explore the

strength of association for adjusted covariates and any identified gender interactions

Results

Sample characteristicsA cohort of 540 students was recruited (515 male) The average age was 154 years(381 [706] were 15 and 159 [294] were 16 years) There were no differences in the

proportion of males and females ( x2 frac14 515 p frac14 272) or number in the 15 and 16 year

age groups (x2 frac14 453 p frac14 340) between the samples from the five schools There

were also no differences in the proportion of males and females recruited compared

with the remainder of the Year 11 cohort in each school (x2 ranged from 003 to 116

p frac14 89ndash 28)

The majority of the sample described themselves as White-UK (954) while 19

were Caribbean or Black British 13 were South Asian and the remainder were MiddleEastern South East Asian or described themselves to be of mixed race Approximately

half (485) considered that they had no religious affiliation 157 reported they were

affiliated to the Church of England and 281 described themselves as Christian with no

specification Two-thirds (687) were living with both of their natural parents In terms

of living arrangements four-fifths (809) reported that their parents or guardians

owned their residence 111 were living in local authority owned housing and the

remainder were living in privately rented premises (74)

Prevalence of alcohol and other substance useThe majority of the sample (943) had consumed a whole alcoholic drink at some point

in their lives Lifetime use of tobacco products (cigarettes) was high (377 698)

particularly among females (748 vs 651 x2 frac14 602 p frac14 014) Some 404 (218) ofthe cohort reported using cannabis at some point in their lives but less than 1 in 10

reported lifetime use of other illegal drugs On average the participants estimated that

they were 124 years old when they first drank a whole alcoholic drink

( SD frac14 19 range frac14 3ndash16 years) Four-fifths of the drinkers (N frac14 407) reported that

Adolescent drinking 435

they had had experience of being intoxicated by alcohol Males reported an earlier age

of first being intoxicated after drinking than females (136 vs 138 years t frac14 2229

p 05) All of the drinkers reported that they had drunk alcohol without the

knowledge of their parents on at least one occasion On average they were 14 years old

( SD frac14 721 range frac14 7ndash16 years) when they first drank without parental knowledge

Over half of the drinkers estimated that they had drunk alcohol without their parentsrsquoknowledge on at least 13 separate occasions in total

Alcohol involvementThe majority of the lifetime drinkers (N frac14 467 917) had consumed alcohol during

the past 90 days and a third of the sample (175 324) reported that they had

purchased alcohol themselves from a bar or club during this period Table 1 summarizes

the frequency of drinking and scores on the dependent variables by gender In terms of

drinking frequency participants estimated that they had drunk alcohol on an average of175 days ( SD frac14 147) in the past 3 months with males tending to report frequent

drinking than females (187 days vs 16 days t frac14 204 p frac14 042) On average

participants consumed 47 units (47 ml by volume) on a typical drinking day and there

were no differences in drinking intensity between males and females (49 units vs 45

units respectively t frac14 0103 p frac14 302) As can be seen 285 of the cohort recalled

drinking six or more units on a typical day

In general beerlager was the most commonly used beverage (by 434) followed

by spirits (200) liqueurs (96) alcopops (88) and wine (59) Males tended to

prefer beerlager (691 vs 146 x2 frac14 15370 p 000) while females preferred

spirits (321 vs 93 x2 frac14 4111 p 000) liqueurs (175 vs 26 x2 frac14 3236

p 000) alcopops (133 vs 33 x2 frac14 1708 p 000) and wine (104 vs

19 x2 frac14 1675 p 000) In the past 3 months a similar profile of beverage

Table 1 Frequency and intensity of alcohol use in the past 90 days by gender (N frac14 467)

Males ()(N frac14 251)

Females()(N frac14 216)

Total()

Frequency of alcohol use in past 90 daysLess than monthly 17 (68) 19 (88) 36 (77)1ndash3 days per month 79 (315) 76 (352) 155 (332)One day per week 58 (231) 52 (241) 110 (236)2ndash3 days per week 82 (327) 64 (296) 146 (313)4ndash6 days per week 14 (56) 4 (19) 18 (39)Everyday 1 (04) 1 (05) 2 (04)

Units consumed on a typical drinking dayUp to 10 unit 11 (44) 15 (69) 26 (56)1ndash19 units 31 (124) 33 (153) 64 (137)2ndash39 units 78 (311) 59 (273) 137 (293)4ndash59 units 44 (175) 35 (162) 79 (169)6ndash99 units 56 (223) 38 (176) 94 (201)10 or more 20 (80) 19 (88) 39 (84)Number of drinking days90 (meanSD) 187 (155) 160 (137) 175 (147)Amount drunk on typical day (meanSD) 49 (36) 45 (38) 47 (37)

p 05

John Marsden et al436

preferences was recorded When asked what type of alcohol they had consumed

most often during the time 60 said beerlager 143 said spirits 18 said wine

and 58 said alcopops

Family factorsHalf of the sample (271 502) estimated that their mother generally drank alcohol at

least once a week and 704 (380) estimated that their father drank at least once a

week In terms of parental encouragement to drink around one quarter of the

sample estimated that they had often drunk alcohol at home with their parents in the

past year (129 239) although only 161 said that their parents had often bought

them an alcoholic drink at a restaurant or other establishment Conversely just 138

(255) of the sample said that their parents had actively discouraged them from

drinking in the past year The two 5-item scales assessing the extent to which parentsencouraged or discouraged drinking were approximately normally distributed and

had acceptable internal reliability The average total score on the parental

encouragement scale was 1363 ( SD frac14 501 Cronbachrsquos a frac14 77) and the average

total score on the parental discouragement scale was 888 ( SD frac14 367 a frac14 77)

While a fifth (203) of the sample reported that in the past 3 months they had never

drunk alcohol without the knowledge of their parents a quarter (N frac14 139) reported

that when they had recently drunk alcohol it was often or always without their

parentsrsquo knowledge

Psychological factorsThe average total score for the mood alteration function scale was 122

(median frac14 120) and it had acceptable internal reliability (a frac14 71) The most

commonly endorsed mood alteration function was drinking to relax (51 reporting

that they drank sometimes or more frequently for this reason) followed by drinking in

order to forget about a problem (endorsed by 34) The average total score for thesocial facilitation function scale was 114 (median frac14 110 a frac14 70) and the most

commonly endorsed social item was drinking to enjoy the company of friends (by 63)

followed by drinking to lose inhibitions (endorsed by 48) Scores on the GHQ-12

ranged from 0 to 34 with a mean of 121 (median frac14 110 a frac14 85) The sample were

equally likely to report positive and negative alcohol-related attitudes The mean scores

on these scales were 228 and 238 respectively (range frac14 13ndash39 and 13ndash34 a frac14 68

and a frac14 73)

Social and peer factorsJust under one half (246 483) estimated that a few of their friends were older than

them and a minority 64 (126) of the drinkers estimated that all or most of their

friends were at least 1 year older than them Two-fifths (N frac14 202) said that all of their

friends drank alcohol and a further 391 said that they believed most did so In the past

3 months two-thirds of the drinkers (338 664) reported that they typically spent time

with friendsacquaintances who were drinking at least once a week Just 68 individuals(134) estimated that this generally occurred less than once a month and a further

17 (33) said that they never spent time with friendsacquaintances who

were drinking A small proportion of the drinkers (79) considered that they

felt pressure from their peers to drink alcohol but the majority (578) did not feel

Adolescent drinking 437

this way and a further 193 indicated that they strongly disagreed that such pressure

was present in their social network

School conduct problemsIn the past year the majority of the drinkers (356 76) had received a detention afterschool or some other minor punishment There was also a minority (95 187) who

estimated that they found themselves in trouble with teachers once or twice each

month and a further small group who said that they received some form of disciplinary

action at school once a week (57 112) A quarter (138 256) reported that they had

had a fight with another student in the past year Just over a third (187 367) admitted

that they had been absent from school without authorization (truanted) at least once in

the past year and the average number of occasions on which this had occurred was 78

days ( SD frac14 150 days range frac14 05ndash80) Sixty-six students (122) had beentemporarily excluded from school in the past year

Regression of covariates of alcohol involvementThe two dependent variables were judged to be reasonably normally distributed and

were not transformed Following negative screening for multicollinearity within the

covariate set multiple regression analysis was performed separately for each of thefive blocks of covariates to assess their individual contribution to explaining variance in

the dependent variables A further regression was then performed in which all 26

covariates were entered simultaneously to calculate the overall level of variance

accounted for Table 2 presents the standardized regression coefficients (b) and the

overall R 2 for each block for these analyses

There was no significant association between age of first drink and recent drinking

although as predicted there was a positive association between feeling intoxicated after

drinking alcohol and both recent drinking frequency and intensity As predicted therewas a positive correlation between lifetime smoking and cannabis use and alcohol

involvement and this association was stronger for cannabis Among the set of

predictions concerning parents there was evidence for an association between the

frequency of parentsrsquo drinking for drinking intensity but this was in the anticipated

direction for the motherrsquos drinking only ( p 01) The frequency of the fatherrsquos

drinking was associated with drinking of lower intensity ( p 05)

As predicted there were significant positive associations between the extent that

parents encouraged drinking and both drinking frequency ( p 001) and intensity( p 01) Contrary to prediction there was a weak but positive relationship between

the extent that parents discouraged drinking and recent alcohol involvement ( p 05)

For the psychological factors there was support for the predicted association between

alcohol involvement and drinking for mood alteration functions ( p 001) but not to

fulfil social functions Higher scores on the GHQ-12 indicative of poorer psychological

well-being were negatively associated with drinking frequency only ( p 001)

Contrary to prediction there were no associations between the positive and negative

alcohol-related attitude scales with the exception of a significant association betweenpositive attitudes and recent drinking intensity ( p 05)

In the social and peer factors block there was evidence that personally buying

alcohol was associated with higher drinking intensity ( p 01) and drinking frequency

( p 001) There was rather weak supporting evidence for the relationship between

having older friends and more frequent drinking ( p 05) There were mixed findings

John Marsden et al438

concerning having more friends who drink spending time with friends who drink and

feeling under social pressure to drink The proportion of friends who drink was related

to intensity ( p 05) but not frequency There was a strong positive and consistent

relationship between spending time with friends who drink and drinking ( p 001)

and there were significant associations between perceived social pressure to drink and

Table 2 Standard multiple regression of background family psychological social and school factors on

recent alcohol involvement (N frac14 467)

Drinking frequency Drinking intensity

1 Background R 2 frac14 0211 R 2 frac14 0192Age 0100 0079Gender 098 0025School 1 100 100School 2 20024 20073School 3 0065 0012School 4 20065 20128School 5 0077 0101Age of first drink 20076 20044Ever intoxicated from alcohol 0591 1092Age first intoxicated on alcohol 20396 20899Ever smoked cigarettes 0155 0076Ever used cannabis 0160 0140

2 Family R 2 frac14 0141 R 2 frac14 0060Frequency of motherrsquos drinking 0052 0153Frequency of fatherrsquos drinking 0041 20121Extent parents encourage drinking 0231 0156Extent parents discourage drinking 0109 0094Drinking without parents knowledge 0280 0137

3 Psychological R 2 frac14 0156 R 2 frac14 0095Mood functions for drinking 0385 0307Social functions for drinking 20002 20068Psychological well-being 20116 20062Positive drinking attitudes 20050 0102Negative drinking attitudes 20014 0001

4 Social R 2 frac14 0322 R 2 frac14 0210Personally bought alcohol 0150 0131Proportion of older friends 0074 0090Proportion of friends who drink 0083 0094Time with friends drinking 0387 0307Perceived social pressure to drink 0148 0062

5 School R 2 frac14 0121 R 2 frac14 0144Been in trouble with teachers 0213 0212Had a fight with student at school 0054 0090Times truanted in past year 0155 0120Temporarily excluded in past year 0090 0152Overall R 2 frac14 0418 R 2 frac14 0339Adjusted R 2 frac14 0381 R 2 frac14 0290

frac14 p 05 frac14 p 01 frac14 p 001

Adolescent drinking 439

drinking frequency but not recent intensity There was a positive correlation between

more positive alcohol-related attitudes and high drinking intensity only ( p 05)

There were also mixed associations relating to school conduct problems and

drinking Being temporarily excluded from school and the number of times truanted

were positively related to recent frequency ( p 05 and p 001 respectively) and

recent intensity ( p 01) Having had a fight with another student with associated withrecent drinking intensity only ( p 05) while there was a strong positive and

consistent relationship between being in trouble with teachers and the both drinking

measures ( p 001)

In total the five blocks of factors explained 42 (38 adjusted) of the variance in

frequency of drinking scores and 34 (29 adjusted) of the variance in typical intensity

Taking the covariate blocks in turn the regression analysis indicated that the social and

peer factors had the strongest correlations (accounting for 32 and 21 of the variance

in drinking frequency and intensity respectively) For drinking frequency the strengthof association for the remaining factors was as follows background variables (21)

psychological factors (16) family factors (14) and school conduct problems (12)

The regression analysis for recent typical drinking intensity revealed a somewhat

contrasting pattern of predictors background variables (19) school conduct

problems (14) psychological factors (10) and family factors (6)

The dataset was then screened for the presence of moderation effects between

gender and each covariate Those variables (gender the covariate and their interaction)

that emerged as statistically significant were then entered into two regression equationsusing each of the dependent variables If the interaction term exerted a significant effect

on the dependent variable in this equation when its constituent parts were controlled

for this was taken as evidence of a moderation effect by gender The single interaction

term that was identified in this way was added to the covariate set in a backwards

stepwise regression equation controlling for gender and age This process resulted in a

final lsquotrimmed downrsquo regression model for the two dependent variables and is shown in

Table 3 The total proportions of variance in the dependent variables explained by the

final models were as follows 40 (38 adjusted) for drinking frequency( F12 441 frac14 2690 p 001) and 27 (26 adjusted) for drinking intensity

( F7 441 frac14 2316 p 001)

Drinking frequencyEleven covariates were retained in the model as significantly associated with recent

drinking frequency As can be seen most were from the family factors and social and

peer factors blocks Males tended to be more frequent drinkers than females(b frac14 0272) However the strongest predictor of frequency of alcohol use in the model

was the amount of time spent with friends who are drinking (b frac14 0316) Other

influential variables included the extent to which parents encourage (b frac14 0155) and

discourage (b frac14 20223) alcohol use with the latter association moderated by gender

More frequent parental discouragement to drink was related to more frequent drinking

in females and less frequent drinking frequency in males In a post hoc analysis the

parental discouragement scale items were entered into a regression equation This

showed that two items exerted an effect over and above the others lsquomy parents havetold me off because of drinking or buying alcoholrsquo and lsquomy parents have said that

I cannot drink alcohol at homersquo A positive relationship was also observed between

drinking more frequently without parentsrsquo knowledge and recent frequency of use

(b frac14 0110) Other independent influences on drinking frequency were higher mood

John Marsden et al440

alteration function scores (b frac14 0113) greater perceived social pressure to drink

alcohol (b frac14 0155) a history of temporary school exclusion (b frac14 0121) and more

frequent occasions of truanting from school in the past year (b frac14 0086)

Drinking intensityIn common with the final model for drinking frequency just five covariates were

retained in the regression equation for drinking intensity The amount of time spent with

friends who are drinking alcohol was the strongest predictor (b frac14 0319) This was

followed by having a history of school exclusion (b frac14 0197) and more frequently being

in trouble with teachers in the past year (b frac14 0142) Greater parental encouragement

to drink was associated with higher actual drinking intensity (b frac14 0124) Finally a

single background factor ndash lifetime use of cannabis ndash was associated with higher

drinking intensity (b frac14 0113)

Discussion

This report has presented first results from a cohort follow-up study of alcohol use

among a sample of mid-adolescents in England Baseline data on personal backgroundand demographics family psychological social factors and school conduct problems

were correlated with reports of recent drinking frequency and intensity As expected

regular drinking was the norm among the cohort 19 in 20 of the cohort had consumed a

whole alcoholic drink at some point in their lives and approximately 17 in 20 were

current drinkers This prevalence of alcohol use is comparable to that reported for the

Table 3 Stepwise multiple regression of background family psychological social and school factors on

recent alcohol involvement (N frac14 467)

Drinking frequencyR 2 frac14 0396

Drinking intensityR 2 frac14 0273

1 BackgroundAge 0033 0046Gender 0272 0004Ever smoked cannabis ndash 0113

2 FamilyExtent parents encourage drinking 0155 0124Extent parents discourage drinking 0223 ndashGender pound extent parents discourage drinkinga 0302 ndashDrinking without parents knowledge 0113 ndash

3 PsychologicalMood functions for drinking 0113 ndash

4 SocialPersonally bought alcohol 0118 ndashTime with friends who are drinking 0316 0319Perceived social pressure to drink 0155 ndash

5 SchoolIn trouble with teachers in past year ndash 0142Times truanted in past year 0086 ndashTemporarily excluded in past year 0121 0197

a frac14 interaction term frac14 p 05 frac14 p 01 frac14 p 001

Adolescent drinking 441

general adult population in the UK (Singleton Bumpstead OrsquoBrien Lee amp Meltzer

2001) and is also comparable to drinking levels reported for 15-year-olds in other

countries (eg Casswell Stewart Conolly amp Silva 1991 for New Zealand) In terms of

typical drinking intensity study participants estimated that they drank about five

standard units of alcohol on a typical day Although the government has not issued

recommended drinking levels for the under-18 s this level exceeds the safer drinkinglevels for adults as recommended by the English Department of Health (Department of

Health 1995) and is therefore a cause for concern A substantial proportion of the

sample also reported lifetime tobacco smoking (70) and use of cannabis (40) Despite

the fact that the study cohort was not generated using probability sampling techniques

it is reasonable to believe that it is unbiased The levels of drinking smoking and

cannabis use reported fell remarkably close to population estimates for this age group in

England (Goddard amp Higgins 2001 Becher et al 2001 Currie Hurrelmann

Settertobulte Smith amp Todd 2000) On school conduct characteristics the samplewas also broadly comparable to reports from national surveys (Miller amp Plant 1999)

The cohort was also comparable to the general population on school conduct problems

Thirty-seven percent admitted that they had truanted at least once in the past year and

this compares to 33 of boys who admitted truanting in the latest Office for National

Statistics school survey (Boreham amp Shaw 2001)

Drinking was well established within the social networks of the cohort The majority

reported that most or all of their friends drank alcohol and two-thirds of the drinkers

said that they typically spent time with friendsacquaintances who were drinking atleast once a week Two-thirds did not consider that they were under any peer pressure

to drink

In the UK alcopop beverages are well established in the drinks market (Clarke

2000) and concerns have been raised about the marketing of these products to younger

drinkers (Hughes et al 1997 McKeganey 1998) In our study males reported a limited

preference for these drinks and tended to favour beer and lager whereas females had a

greater preference for spirits alcopops wine and liqueurs Males were more frequent

drinkers but there were no gender differences in the amount of alcohol consumed ontypical day Previous studies on alcohol use have found that males drink more heavily

than their female peers (Goddard amp Higgins 2001 Miller amp Plant 1996) However as

alcohol use among school-age students approximately doubled between 1990 and 2000

(from 53 units in 1990 to 104 units in 2000) the gender gap in consumption has

narrowed (Goddard amp Higgins 2001) The drinking patterns of young females are of

concern given their greater vulnerability to alcohol-related harms (Goist amp Sutker 1985

Plant amp Plant 2001)

Correlates of drinking frequencyThe regression analyses were able to account for approximately 40 of the variance in

scores on the measure of drinking frequency There was no evidence for the hypothesized

negative relationship between age of first drink and recent drinking frequency although

there was a positive association with feeling intoxicated after drinking alcohol It is

however possible that the effect of earlier initiation to drinking is not seen until drinking

patterns have further developed This was observed in a longitudinal study in the USAreported by Hawkins et al (1997) In this study of a cohort of students who were

followed-up annually from age 10ndash11 to age 17ndash18 a younger age of alcohol initiation was

strongly related to a higher level of alcohol misuse at age 17ndash18 Consequently we will

assess the influence of age of alcohol initiation in further follow-ups

John Marsden et al442

Studies examining the putative relationship between lifetime smoking cannabis use

and recent drinking frequency suggest that earlier initiation to substance use mediates

peers alcohol involvement and parental drinking risk factors (eg Hawkins et al 1997)

However findings from research using twins suggests that the association between age

of onset of alcohol use and later problematic drinking may not be directly causal but

that age of onset and problematic drinking in later life are both associated with anunderlying vulnerability to behavioural problems (Prescott amp Kendler 1999)

There was no support for the predicted relationship between the frequency of

parental drinking and adolescent drinking frequency It must be acknowledged that

influence of parental drinking parental alcohol use norms and family environment and

relations are complex (Peterson et al 1994) Foxcroft and Lowe (1997) found that

increased drinking levels among 11ndash17-year-olds were linked to regular perceived

parental drinking while Casswell and her colleagues noted a positive association

between the frequency of drinking in early- to mid-adolescents and the frequency of

their mother and fatherrsquos drinking (Casswell et al 1991) Peterson et al showed thatclear communication by parents about their expectations of their childrenrsquos drinking

together with positive reinforcement for desired behaviours can reduce the impact of

parentrsquos drinking on adolescent alcohol use

Several studies have also noted a negative relationship between parental support

a positive family environment and feelings of connectedness and adolescent substance

use (Resnick et al 1997 Hops Davis amp Lewin 1999) The role that parental approval of

drinking has in predicting intensity of alcohol use in their children has also been

explored (eg Barnes amp Welte 1986) Wilks Callan and Austin (1989) found that the

fatherrsquos approval or disapproval of drinking behaviour predicted self-perception as adrinker in young males yet found no normative influences for females A gender

interaction in the present study also suggests a differential effect for discouraging

drinking More frequent parental discouragement to drink was related to more frequent

drinking in females and less frequent drinking in males This finding could indicate that

parents are more likely to disapprove of drinking in their daughters (and therefore

discourage alcohol use more strongly) than in their sons Alternatively it could point to a

tendency for girls to rebel more strongly against their parentsrsquo attitudes towards alcohol

use The direction of this relationship cannot be judged from the baseline data but our

post hoc item analysis does suggest that this effect may be due to parental reactions todrinking and proscriptions about drinking at home Future analyses of the longitudinal

data collected during the course of this study will examine this issue more closely

In the present analyses although frequency of mother and fathersrsquo alcohol use was

significantly related to drinking frequency these variables were not retained in the

regression analysis This suggests that other variables explain the relationship between

these factors Zhang Welte and Wieczorek (1999) found that the drinking behaviour of

each parent has a differential effect on their male offspring (aged 16ndash19 years) In their

study the fatherrsquos drinking but not their motherrsquos drinking affects their sons drinking

and closeness to the mother was a protective factor against adolescent drinking On theother hand male adolescent drinking increases if closeness to the mother is low and she

drinks excessively There appears to be no comparable effect for closeness to the father

and the fatherrsquos drinking

For the analysis of psychological measures there was an association in the predicted

direction between alcohol involvement and drinking for mood alteration functions but

not drinking to fulfil social functions Poorer psychological well-being was negatively

associated with drinking frequency only and contrary to our hypothesis there were no

Adolescent drinking 443

associations between the positive and negative alcohol-related attitude scales The

present results provide further evidence for the link between reasons or motives for

alcohol use and consumption patterns A strong relationship was observed between

increased frequency of drinking to serve mood alteration functions and increased

drinking frequency Our research group has also observed this effect among young

alcohol cannabis and ecstasy users (Boys et al 1999) These findings are consistentwith previous studies which have found a positive relationship between the number of

reasons for alcohol use and drinking frequency (Cooper Frone Russell amp Mudar 1995

Beck amp Treiman 1996 Bradizza Reifman amp Barnes 1999) For the social and peer

factors buying alcohol was as predicted associated with increased alcohol

involvement but there was only weak supporting evidence for an association with

having older friends There was a strong positive and consistent relationship between

spending time with friends who drink and perceived social pressure to drink and more

frequent drinking These independent social influences are interpreted in the context ofdeveloping peer relations and peer norms in which the majority of adolescents report

spending time with friends who are drinking as a recreational activity and where there

may be expectations to drink with the group sometimes to excessive levels (Iannotti

amp Bush 1992 Bahr Marcos amp Maughan 1995) Finally school conduct problems were

independently associated with drinking frequency with the number of times truanted

and being temporarily excluded having the strongest correlations Drinking more often

than other peers has been linked to more frequent unauthorized absences from school

(Currie et al 2000) Drinking smoking and drug use is also much more prevalentamong 12- to 15-year-olds who had ever truanted compared to those who had never

done so (Becher et al 2001)

Correlates of drinking intensityOverall 285 of the cohort typically drank six or more units on a drinking day which

can be taken to be a conservative indicator of underage binge drinking The regression

analyses were able to account for approximately 30 of the variance in drinkingintensity Age of first alcohol intoxication and lifetime smoking and cannabis use was

associated with more intense recent drinking For the family factors in contrast to

drinking frequency there was evidence for a positive association between how often

the mother usually drank alcohol and how much the adolescent drank on a drinking day

but contrary to prediction there was a negative association with the fatherrsquos drinking

It is possible that more frequent drinking by the father serves to discourage binge

drinking among mid-adolescents Nonetheless this effect was weak and was not

retained in the stepwise regression As predicted drinking to alter mood was associatedwith more intensive drinking but not with drinking for social facilitation functions This

effect however was not sufficiently strong to be retained in the stepwise regression

There was also a positive association between more favourable attitudes towards

alcohol and drinking intensity Among the social and peer factors a similar set of

associations was seen with the exception of perceived social pressure to drink

suggesting that mid-adolescents do not feel that the amount they consume is influenced

by their peers Finally the school conduct factors were quite strongly associated with

more intensive drinking and being in trouble with teachers and having beingtemporarily excluded had the strongest associations

The links between binge drinking and school conduct problems are a concern and

elsewhere studies have shown that binge drinking is related to poorer actual educational

performance (Newcomb Measham amp Parker 1995) Clinical diagnostic criteria for

John Marsden et al444

alcohol abuse recognize that recurrent drinking can result in school performance

problems and expulsions (American Psychiatric Association 1994) and the trajectory of

those experiencing school problems will be a focus of subsequent analyses of further

follow-up in the study The finding that lifetime use of cannabis was independently

associated with more intensive drinking is supportive of other work that argues that

those adolescents who use substances tend to have other attributes that increase therisk of poor psychosocial adjustment and school performance For example Jessor

Chase and Donovan (1980) argued that the reason that cannabis users tend to be less

well adjusted is that cannabis use is a general characteristic of individuals who are

predisposed to behavioural problems Furthermore Fergusson Lynskey and Horwood

(1997) suggested that instead of early cannabis use having a causal link with poor

psychosocial adjustment this association could be explained by family and other factors

that related to cannabis use Other alternative explanations include those proposed by

Kandel and colleagues They argue that early substance use sets into motion a chain ofevents which result in greater subsequent drug involvement and a range of other

negative psychosocial consequences (Kandel Davies Karus amp Yamaguchi 1986)

Again the causal direction of this relationship cannot be judged from the baseline data

but will be examined in more detail in subsequent reports on the longitudinal data

Strengths and limitations of the studyThe main strength of the present study was the analysis of the multiple influences on

drinking behaviour Studies of this kind have been rare in the UK but are encouraged as

good opportunities to gain an understanding of how early use of alcohol smoking and

other substance involvement evolves across the adolescent years (Edwards et al 1994

Duncan Duncan amp Hops 1998) Several limitations of the present study are also

acknowledged Given the reliance on self-report it is difficult to judge the reliability ofthe data and the findings should be interpreted with caution Nevertheless steps were

taken to maximize the privacy of the recruitment interviews to emphasize the

confidentiality of the study and the interviews were all conducted by young adults

Overall it has been argued that it is better to collect social survey data on this age group

at school than in the home (Becher et al 2001)

Implications for school-based alcohol educationThese results underline the importance of addressing personal family peer and school

conduct factors as part of alcohol education and problem prevention initiatives Theidentified correlates of drinking involvement in the present study could be usefully

taken up and discussed with students as part of alcohol education and prevention

programmes Elsewhere it has been argued that the main goal of school prevention

programmes should be to delay alcohol initiation (DeWit et al 2000 Griffin Botvin

Epstein Doyle amp Diaz 2000) However the very early age of onset in the UK suggests

that educational approaches based on harm minimization may be more realistic Recent

work in Australia has indicated that a harm minimization approach to alcohol education

together with adult supervision of initial drinking experiences can help to reduce theharms associated with alcohol use in young people (McBride Midford Farringdon amp

Phillips 2000b) Research into the merits of adopting a harm minimization approach to

alcohol education in schools has highlighted the importance of ensuring that

programme content and materials are relevant to local patterns of behaviour and are

Adolescent drinking 445

based on experiences that are relevant to the target audience (McBride Farringdon amp

Midford 2000a Dusenbury amp Falco 1995)

The potential feasibility and benefits of including parents as part of education

programmes in school should be examined The possibility of encouraging parents to

consider how their own behaviour and attitudes towards drinking might influence the

choices regarding alcohol use that are made by their offspring should be explored

Given the high prevalence of drinking involvement in mid-adolescence understanding

the influences on the further development of drinking attitudes and behaviours is of

critical importance Further reports from the study will describe the associations

between risky and heavy drinking patterns and alcohol-related problems and

developmental transitions to heavier consumption patterns as the cohort reaches the

period of late-adolescence

Acknowledgements

We would like to thank the students and staff from each school for their kind and enthusiastic

participation in the study The study was supported by a research grant from the LloydsTSB

charitable trust and conducted in association with Alcohol Concern

References

American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders

(4th ed) Washington DC APA

Anderson K Plant M amp Plant M (1998) Associations between drinking smoking and illicit

drug use among adolescents in the Western Isles of Scotland Implications for harm

minimization Journal of Substance Misuse 3 13ndash20

Ary D V Tildesley E Hops H amp Andrews J (1993) The influence of parent sibling and peer

modelling and attitudes on adolescent use of alcohol International Journal of Addiction 28

853ndash880

Bahr S J Marcos A C amp Maughan S L (1995) Family educational and peer influences on the

alcohol use of female and male adolescents Journal of Studies on Alcohol 56 457ndash469

Barnes G (1990) Impact of the family on adolescent drinking patterns In R Collins K Leonard

amp J Searles (Eds) Alcohol and the family Research and clinical perspectives (pp 137ndash161)

New York Guilford Press

Barnes G amp Welte J (1986) Patterns and predictors of alcohol use among 7ndash12th grade students

in New York State Journal of Studies on Alcohol 47 53ndash62

Becher H Boreham R Emery P Hinds K Jamison J amp Schagen I (2001) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Beck K H amp Treiman K A (1996) The relationship of social context of drinking perceived

social norms and parental influence to various drinking patterns of adolescents Addictive

Behaviors 21 633ndash644

Blenkinsop S Boreham R McManus S Natarajan L amp Prescott A (2003) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Blum R W Beuhring T amp Rinehart P M (2000) Protecting teens Beyond race income and

family structure Minneapolis MN Center for Adolescent Health University of Minnesota

Bonomo Y Coffey C Wolfe R Lynskey M Bowes G amp Patton G (2001) Adverse outcomes

of alcohol use in adolescents Addiction 96 1485ndash1496

Boreham R amp Shaw (2001) Smoking drinking and drug use among young people in England

in 2000 London The Stationery Office

John Marsden et al446

males and females (Windle amp Barnes 1988 Beck amp Treiman 1996 Boys et al 1999

Bradizza Reifman amp Barnes 1999) In one study of 16- to 19-year-olds Foxcroft and

Lowe (1997) found that the heavier drinkers were more likely to endorse drinking

because they liked the effects because they wished to get intoxicated or they were

motivated to improve their mood General population survey research in the US

suggests that among 12- to 17-year-olds who have drunk alcohol in the last year 8

report psychological problems although the temporal and causal relationship between

drinking and mood is unclear

A fourth potential area of influence concerns problem behaviours at school

Attendance and behavioural problems at school appear to be linked to drinking as well as

smoking and other substance use In a survey of 11000 young students in the US the

strongest predictors of drinking frequency were frequent problems at school and the

number of close friends who drank at least once a month (Blum Beuhring amp Rinehart

2000) Miller and Plant found an association between poorer school performance and

higher levels of smoking and illicit drug use in a cross-sectional survey of eight thousand

15- to 16-year-olds (Miller amp Plant 1996) There is also evidence that young people who

truant or are excluded from school are at greater risk of drinking at harmful levels

(Graham amp Bowling 1995 Goulden amp Sondhi 2001) The 2001 English Department of

Healthrsquos School survey found that among 15-year-olds those who had ever truanted were

more likely to drink once a week have taken drugs in the last year and to be a regular

smoker (Boreham amp Shaw 2002) There is no clear temporal relationship between school

problems and drinking but it is likely that school performance problems are for some an

indirect consequence of drinking and other substance involvement

To date most studies of adolescent drinking have looked at a single factor that may

relate to drinking behaviour and relatively little is known about where these influences

act differently on males and females While there continue to be major cross-sectional

population surveys of adolescent drinking in the UK detailed examinations of drinking

influences between males and females and changes in drinking behaviours over time

remain rare The argument that efforts should focus on characterizing patterns of

hazardous alcohol use and predicting negative outcomes has been advanced in a number

of reports (Reifman Barnes Dintcheff Farrell amp Uhteg 1998 Peterson Hawkins

Abbott amp Catalano 1994) Understanding of these influences can achieve valuable

insights for the design and delivery of education programmes which schools are now

obliged to include as part of the national curriculum (Department for Education and

Employment 1998a)

Aims and hypotheses of the studyThe study was designed to explore personal and social correlates of alcohol use and how

these change over time The mid- to late-adolescent period (from 15 to 17 years) was

judged to be the most appropriate phase to study the development of patterns of alcohol

use The selection of research instruments and measures was guided by a social

ecological framework for studying adolescent behaviour (Bronfenbrenner 1986

Chassin Pillow Curran Molina amp Barrera 1993) This suggests that adolescent drinkingbehaviour should be understood in terms of the interpersonal social and

environmental influences that exist in the drinkerrsquos natural ecosystem (Reed 1996)

Social ecological approaches that combine models of individual and social behaviour

change have been successfully used in health education programmes (Glanz Lewis amp

Rimer 2002)

John Marsden et al430

A core set of measures for the study was identified based on a review of the research

literature and our grouprsquos previous work on modelling substance use motivations These

variables constitute a repeated measures set of correlates which are recorded at baseline

and at follow-ups The personaldemographic background family and social correlates

constituted a set of distal (ie lifetime behaviours and events) and more proximal

influences on drinking (behaviours and events that occurred in the past year or the past

3 months) In this first report of findings from the study the aim was to examine the

correlates of alcohol use among adolescents in the 3 months before recruitment Results

are presented using data gathered from the baseline questionnaires and analysed to test

the hypothesis that increased alcohol involvement would be

(1) Negatively related to age of first drink and the lifetime experience of being

intoxicated on alcohol

(2) Positively related to lifetime experience of cannabis use and smoking

(3) Positively related to parental drinking parental encouragement to drink and

drinking with and without parental knowledge and negatively related to parentaldiscouragement to drink

(4) Positively related to more reasons for drinking and favourable drinking attitudes

and negatively related to psychological well-being and unfavourable drinking

attitudes

(5) Positively related to purchasing drinks and peersrsquo alcohol involvement and

(6) Positively related to school conduct problems

These hypotheses were tested against a null hypothesis for contrasts with males and

females No predictions were made concerning the relative strength of associations

between individual covariates and alcohol involvement

Method

Design and school selectionThe study is a prospective cohort survey of alcohol use and related attitudes and

behaviours of mid-adolescents (15ndash16 years old) recruited and interviewed from thestate school population in a single county in the south of England Two follow-up

questionnaires were administered at 9 and 18 months following recruitment In the UK

schooling is compulsory until the age of 16 years and an efficient means of recruiting a

general population sample of 15- to 16-year-olds is to sample from those in Year 11 from

educational establishments

Study resources precluded a probability sampling design and for practical reasons a

purposive non-probability method was used for recruitment of schools and

participants Schools were recruited from the countyrsquos main metropolitan area and

from other locations to yield a mix of inner-city and satellite town locations and from

schools that fell above and below standardized educational performance averages for

the county Five coeducational comprehensive schools were selected based on their

catchment area (urban or rural) educational achievements and size All of the five

schools approached agreed to participate They comprised two schools in inner-city

locations and three in satellite towns Two schools achieved above average educational

performance two were below average and one average (Department for Education and

Employment 1998b)

Adolescent drinking 431

Sample size planningGiven the available resources for the study an initial feasibility assessment suggested

that approximately 500 participants could be recruited and followed-up Statistical

power estimates suggested a sample of this size would be sufficient to detect behaviours

with rates as low as 5 with a relative standard error of 19 (95 CI frac14 32 68) The

smallest detectable effect that could be reliably measured (based on a two-tailed t testwith a frac14 05 and b frac14 020) for gender comparisons of for example drinking

involvement (using a measure of days of alcohol use and estimating for 50 female)

would be 026 which corresponds to a small effect size (Cohen 1988) The potential

design effects due to recruiting participants from different schools were assessed by

including these sites as a term in the analyses of the data Power calculations informing

follow-ups and change analyses are presented in subsequent reports

ProcedureThe Research Ethics committee of the Institute of Psychiatry and Maudsley Hospital

approved the study A detailed description of the research procedure has been reported

elsewhere (Boys et al 2003) and only the essential features are described here

Participation in the research was obtained by mailing a letter explaining the purpose and

format of the study to parents of all Year 11 students in each school at least a week in

advance of the scheduled recruitmentbaseline interviews This letter included a

detachable reply form asking parents to indicate if they did not wish their child to takepart in the study None of these student lsquoopt-outrsquo forms were returned to us and no

participant declined to take part during recruitment

A team of 24 second and third year undergraduate students (aged 19ndash24) were

recruited and trained to administer the recruitment protocol and baseline interviews All

interviewers completed a 6 hour group-based study protocol induction and training

session This was facilitated by four members of the author group and included plenary

presentation and discussion and supervised role-play experience in the administration

of the research questionnaire The recruitment of the school students took place over 20days between November and December 1998 during a 2 hour period at the end of the

school day Three members of the research team supervised each recruitment session

Interviewers were assigned a list of participants to interview in a private corner of a

classroom no more than four interviews were conducted in a room at any one time and

no teachers were present

Baseline data were collected using a personal interview of between 20 and 40

minutes duration (completion time varied according to the extent of the participantrsquos

experience with alcohol) and a self-completion questionnaire of around 20 minutesduration The self-completion instrument recorded the lifetime experience of substance

use psychological scales and questions concerning school conduct It was judged that

self-administration of these items would increase the veracity and reliability of reporting

All participants were given a pound10 retail music-store gift voucher in recognition of the

time taken to participate in the recruitment session

MeasuresThe present report utilizes a set of measures comprising standardized scales and several

indicator items developed specifically for the study The response burden on

participants was kept to a minimum and the selected measures represent a core set

that were needed to address the research hypotheses Recall periods for these measures

John Marsden et al432

spanned lifetime occurrences the past 12 months and the past 3 months (90 days) The

nature and coding structure of measures is described below while information about the

internal reliability of scales is presented in the results

Personaldemographic information and background factorsEight measures were used to characterize the personaldemographic background of

each participant (a) age (b) gender (coded male frac14 1 and female frac14 0) (c) school

recruitment site (dummy coded using school 1 as a nominal reference) (d) age of first

drink (e) whether ever intoxicated on alcohol (coded as no frac14 0 yes frac14 1) and (f) age

first intoxicated on alcohol (defined for the participants as lsquofeeling unsteady on your

feet or slurring your words or feeling dizzy or unwellrsquo) (g) lifetime use of cigarettes

and (h) lifetime use of cannabis (both coded no frac14 0 yes frac14 1)

Recent alcohol involvementIt was judged important to record both how often the participants recalled drinking in

the past 3 months and how much they consumed on a day when they consumed

alcohol (drinking intensity) These two measures which serve as the dependent

variables for the present report were not significantly correlated ( r frac14 15 ns) and

capture different and distinct alcohol use behaviours which are important when

characterizing drinking patterns and how these change over time Researchers in thisfield generally use 24 hour (day) intervals to serve as basic units of drinking frequency

The method of recording drinking frequency and intensity was adapted from the

Maudsley Addiction Profile a standardized multidimensional research instrument for

assessing substance-related behaviours (Marsden et al 1998) Each participant was first

asked to estimate the number of days on which they had consumed alcohol during the

past 3 months assisted by a prompt card listing nine categories (never less than once

every 2 months once every 2 months once every month two times a month 1 day per

week 2ndash3 days a week 4ndash5 days a week 6ndash7 days a week scored 0ndash8 and subsequentlymultiplied to total the number of days out of 90) If none of these categories closely

matched experience the participant was helped to calculate the specific number of

drinking days This can sometimes happen when a research respondent has a more

episodic pattern of drinking Then drinking intensity was estimated by recording the

number of drinks consumed during an average or typical drinking day in the past 3

months Responses to this question were recorded as verbatim reports of the number of

drinks consumed by beverage and brand type and were then converted as standard units

of alcohol at the data management stage

Family factorsQuestions on family factors that might influence adolescent drinking related to the

participantsrsquo estimates of parentsrsquo drinking the extent to which their parents

sanctioned their drinking and the extent that participants reported unsupervised

drinking without their parentsrsquo knowledge Five measures were recorded (a) two

7-point summary indices of the perceived usual frequency of the motherrsquos and fatherrsquosdrinking frequency (never to every day scored 0ndash6) (B) a 5-item scale to assess the

extent to which parents encouraged the participant to drink in the past year (offered

sondaughter a drink at home bought alcohol at a restaurant or another establishment

drunk an alcoholic drink with sondaughter at home drunk an alcoholic drink with

Adolescent drinking 433

sondaughter at another setting and allowed drinking at home) using a 5-point Likert-

type response (never to very often scored 0ndash4) (c) a 5-item scale coded to assess the

extent to which parents discouraged drinking in the past year (warning sondaughter of

the health risks of drinking parents saying they should not drink being punished by

parents for drinking parents saying that sondaughter cannot drink at home and being

reprimanded for buying alcohol (never to very often scored 0ndash4) and (d) a 9-pointindex of the number of occasions the participant recalled consuming an alcoholic drink

without their parentrsquos knowledge (never once twice 3ndash5 times 6ndash12 times 13ndash23

times 24ndash50 times 51ndash100 times and more than 100 times scored 0ndash8)

Psychological factorsQuestions in the block of psychological factors focused on personal influences and

correlates on alcohol use and included specific reasons for drinking generalpsychological health and alcohol-related attitudes Four measures were taken (a) a

6-item mood alteration functions scale developed by Boys et al (1999) was used to

assess how often participants had consumed alcohol in the past year for the following

personal reasons to relax to feel better when low or depressed to feel closer to

someone to stop worrying about a problem to get to sleep and simply to get drunk

(never to always scored 0ndash4) (B) a 5-item social functions scale also developed by

Boys et al to assess the extent that the participant had used alcohol in the past year for

the following social reasons to let go of inhibitions when socializing to feel moreconfident in a social situation to make an activity more enjoyable to help enjoy the

company of friends and to feel more confident when having sex (scored as above)

(c) the 12-item form of the General Health Questionnaire to assess psychological well-

being with each question scored using the Likert scale response coding (GHQ-12

Goldberg amp Williams 1988) and (d) two 9-item attitude scales adapted from items

used by Plant Peck and Samuel (1985) to assess positive drinking attitudes (eg young

people who drink regularly are attractive to the opposite sex coded as strongly agree

to strongly disagree scored 1ndash5)

Social and peer factorsFive measures were developed for the study to examine the relationships between

purchasing drinks and the influence of peers on alcohol involvement Five measures

were used (a) whether the participant had ever bought alcohol for personal use from a

shop or a barpub (scored no frac14 0 yes frac14 1) (b) the proportion of the participants

current friends who were older by 1 or more years (none to all scored 0ndash4) (c) theproportion of friends who were believed to drink alcohol (none to all scored 0ndash4)

(d) an index of how often the participant had spent time with friends and acquaintances

who were drinking in the past 3 months (never to 6ndash7 days a week scored 0ndash9) and

(e) an index of the extent that the participant perceived that they had felt under social

pressure to drink (coded as strongly agree to strongly disagree scored 1ndash5)

School conduct problemsFinally a block of four measures to record school conduct problems in the past year

A block of four items recording aspects of school life was taken from the youth form of

the Life Stressors and Social Resources Inventory (Moos amp Moos 1994) as follows (a) the

frequency that the participant had been in trouble with teachers and had been detained

John Marsden et al434

after school or received other sorts of punishment (never to every day scored 0ndash8)

(b) whether the participant had been in a fight with a student at school (scored no frac14 0

yes frac14 1) (c) the number of times the participant had truanted from school (defined as

not attending for a whole school day or leaving immediately after the morning class

registration) and (d) whether or not the respondent had been temporarily excluded

from school for disciplinary problems (scored no frac14 0 yes frac14 1)

Statistical analysisThe relationship between alcohol involvement and background family social and peer

and school conduct factors was investigated using multiple linear regression in twostages First two standard regression analyses were computed for drinking frequency and

intensity using the 26 items and scale measures described above in the five domains and

were regressed separately on the dependent variables in each domain and then again

simultaneously to assess overall levels of variance accounted for (Tabachnik amp Fidell

2001) This analysis was used to test the research hypotheses Second two stepwise

regression analyses with backwards elimination of covariates were computed to isolate a

set of independent predictors of drinking frequency and intensity and to explore the

strength of association for adjusted covariates and any identified gender interactions

Results

Sample characteristicsA cohort of 540 students was recruited (515 male) The average age was 154 years(381 [706] were 15 and 159 [294] were 16 years) There were no differences in the

proportion of males and females ( x2 frac14 515 p frac14 272) or number in the 15 and 16 year

age groups (x2 frac14 453 p frac14 340) between the samples from the five schools There

were also no differences in the proportion of males and females recruited compared

with the remainder of the Year 11 cohort in each school (x2 ranged from 003 to 116

p frac14 89ndash 28)

The majority of the sample described themselves as White-UK (954) while 19

were Caribbean or Black British 13 were South Asian and the remainder were MiddleEastern South East Asian or described themselves to be of mixed race Approximately

half (485) considered that they had no religious affiliation 157 reported they were

affiliated to the Church of England and 281 described themselves as Christian with no

specification Two-thirds (687) were living with both of their natural parents In terms

of living arrangements four-fifths (809) reported that their parents or guardians

owned their residence 111 were living in local authority owned housing and the

remainder were living in privately rented premises (74)

Prevalence of alcohol and other substance useThe majority of the sample (943) had consumed a whole alcoholic drink at some point

in their lives Lifetime use of tobacco products (cigarettes) was high (377 698)

particularly among females (748 vs 651 x2 frac14 602 p frac14 014) Some 404 (218) ofthe cohort reported using cannabis at some point in their lives but less than 1 in 10

reported lifetime use of other illegal drugs On average the participants estimated that

they were 124 years old when they first drank a whole alcoholic drink

( SD frac14 19 range frac14 3ndash16 years) Four-fifths of the drinkers (N frac14 407) reported that

Adolescent drinking 435

they had had experience of being intoxicated by alcohol Males reported an earlier age

of first being intoxicated after drinking than females (136 vs 138 years t frac14 2229

p 05) All of the drinkers reported that they had drunk alcohol without the

knowledge of their parents on at least one occasion On average they were 14 years old

( SD frac14 721 range frac14 7ndash16 years) when they first drank without parental knowledge

Over half of the drinkers estimated that they had drunk alcohol without their parentsrsquoknowledge on at least 13 separate occasions in total

Alcohol involvementThe majority of the lifetime drinkers (N frac14 467 917) had consumed alcohol during

the past 90 days and a third of the sample (175 324) reported that they had

purchased alcohol themselves from a bar or club during this period Table 1 summarizes

the frequency of drinking and scores on the dependent variables by gender In terms of

drinking frequency participants estimated that they had drunk alcohol on an average of175 days ( SD frac14 147) in the past 3 months with males tending to report frequent

drinking than females (187 days vs 16 days t frac14 204 p frac14 042) On average

participants consumed 47 units (47 ml by volume) on a typical drinking day and there

were no differences in drinking intensity between males and females (49 units vs 45

units respectively t frac14 0103 p frac14 302) As can be seen 285 of the cohort recalled

drinking six or more units on a typical day

In general beerlager was the most commonly used beverage (by 434) followed

by spirits (200) liqueurs (96) alcopops (88) and wine (59) Males tended to

prefer beerlager (691 vs 146 x2 frac14 15370 p 000) while females preferred

spirits (321 vs 93 x2 frac14 4111 p 000) liqueurs (175 vs 26 x2 frac14 3236

p 000) alcopops (133 vs 33 x2 frac14 1708 p 000) and wine (104 vs

19 x2 frac14 1675 p 000) In the past 3 months a similar profile of beverage

Table 1 Frequency and intensity of alcohol use in the past 90 days by gender (N frac14 467)

Males ()(N frac14 251)

Females()(N frac14 216)

Total()

Frequency of alcohol use in past 90 daysLess than monthly 17 (68) 19 (88) 36 (77)1ndash3 days per month 79 (315) 76 (352) 155 (332)One day per week 58 (231) 52 (241) 110 (236)2ndash3 days per week 82 (327) 64 (296) 146 (313)4ndash6 days per week 14 (56) 4 (19) 18 (39)Everyday 1 (04) 1 (05) 2 (04)

Units consumed on a typical drinking dayUp to 10 unit 11 (44) 15 (69) 26 (56)1ndash19 units 31 (124) 33 (153) 64 (137)2ndash39 units 78 (311) 59 (273) 137 (293)4ndash59 units 44 (175) 35 (162) 79 (169)6ndash99 units 56 (223) 38 (176) 94 (201)10 or more 20 (80) 19 (88) 39 (84)Number of drinking days90 (meanSD) 187 (155) 160 (137) 175 (147)Amount drunk on typical day (meanSD) 49 (36) 45 (38) 47 (37)

p 05

John Marsden et al436

preferences was recorded When asked what type of alcohol they had consumed

most often during the time 60 said beerlager 143 said spirits 18 said wine

and 58 said alcopops

Family factorsHalf of the sample (271 502) estimated that their mother generally drank alcohol at

least once a week and 704 (380) estimated that their father drank at least once a

week In terms of parental encouragement to drink around one quarter of the

sample estimated that they had often drunk alcohol at home with their parents in the

past year (129 239) although only 161 said that their parents had often bought

them an alcoholic drink at a restaurant or other establishment Conversely just 138

(255) of the sample said that their parents had actively discouraged them from

drinking in the past year The two 5-item scales assessing the extent to which parentsencouraged or discouraged drinking were approximately normally distributed and

had acceptable internal reliability The average total score on the parental

encouragement scale was 1363 ( SD frac14 501 Cronbachrsquos a frac14 77) and the average

total score on the parental discouragement scale was 888 ( SD frac14 367 a frac14 77)

While a fifth (203) of the sample reported that in the past 3 months they had never

drunk alcohol without the knowledge of their parents a quarter (N frac14 139) reported

that when they had recently drunk alcohol it was often or always without their

parentsrsquo knowledge

Psychological factorsThe average total score for the mood alteration function scale was 122

(median frac14 120) and it had acceptable internal reliability (a frac14 71) The most

commonly endorsed mood alteration function was drinking to relax (51 reporting

that they drank sometimes or more frequently for this reason) followed by drinking in

order to forget about a problem (endorsed by 34) The average total score for thesocial facilitation function scale was 114 (median frac14 110 a frac14 70) and the most

commonly endorsed social item was drinking to enjoy the company of friends (by 63)

followed by drinking to lose inhibitions (endorsed by 48) Scores on the GHQ-12

ranged from 0 to 34 with a mean of 121 (median frac14 110 a frac14 85) The sample were

equally likely to report positive and negative alcohol-related attitudes The mean scores

on these scales were 228 and 238 respectively (range frac14 13ndash39 and 13ndash34 a frac14 68

and a frac14 73)

Social and peer factorsJust under one half (246 483) estimated that a few of their friends were older than

them and a minority 64 (126) of the drinkers estimated that all or most of their

friends were at least 1 year older than them Two-fifths (N frac14 202) said that all of their

friends drank alcohol and a further 391 said that they believed most did so In the past

3 months two-thirds of the drinkers (338 664) reported that they typically spent time

with friendsacquaintances who were drinking at least once a week Just 68 individuals(134) estimated that this generally occurred less than once a month and a further

17 (33) said that they never spent time with friendsacquaintances who

were drinking A small proportion of the drinkers (79) considered that they

felt pressure from their peers to drink alcohol but the majority (578) did not feel

Adolescent drinking 437

this way and a further 193 indicated that they strongly disagreed that such pressure

was present in their social network

School conduct problemsIn the past year the majority of the drinkers (356 76) had received a detention afterschool or some other minor punishment There was also a minority (95 187) who

estimated that they found themselves in trouble with teachers once or twice each

month and a further small group who said that they received some form of disciplinary

action at school once a week (57 112) A quarter (138 256) reported that they had

had a fight with another student in the past year Just over a third (187 367) admitted

that they had been absent from school without authorization (truanted) at least once in

the past year and the average number of occasions on which this had occurred was 78

days ( SD frac14 150 days range frac14 05ndash80) Sixty-six students (122) had beentemporarily excluded from school in the past year

Regression of covariates of alcohol involvementThe two dependent variables were judged to be reasonably normally distributed and

were not transformed Following negative screening for multicollinearity within the

covariate set multiple regression analysis was performed separately for each of thefive blocks of covariates to assess their individual contribution to explaining variance in

the dependent variables A further regression was then performed in which all 26

covariates were entered simultaneously to calculate the overall level of variance

accounted for Table 2 presents the standardized regression coefficients (b) and the

overall R 2 for each block for these analyses

There was no significant association between age of first drink and recent drinking

although as predicted there was a positive association between feeling intoxicated after

drinking alcohol and both recent drinking frequency and intensity As predicted therewas a positive correlation between lifetime smoking and cannabis use and alcohol

involvement and this association was stronger for cannabis Among the set of

predictions concerning parents there was evidence for an association between the

frequency of parentsrsquo drinking for drinking intensity but this was in the anticipated

direction for the motherrsquos drinking only ( p 01) The frequency of the fatherrsquos

drinking was associated with drinking of lower intensity ( p 05)

As predicted there were significant positive associations between the extent that

parents encouraged drinking and both drinking frequency ( p 001) and intensity( p 01) Contrary to prediction there was a weak but positive relationship between

the extent that parents discouraged drinking and recent alcohol involvement ( p 05)

For the psychological factors there was support for the predicted association between

alcohol involvement and drinking for mood alteration functions ( p 001) but not to

fulfil social functions Higher scores on the GHQ-12 indicative of poorer psychological

well-being were negatively associated with drinking frequency only ( p 001)

Contrary to prediction there were no associations between the positive and negative

alcohol-related attitude scales with the exception of a significant association betweenpositive attitudes and recent drinking intensity ( p 05)

In the social and peer factors block there was evidence that personally buying

alcohol was associated with higher drinking intensity ( p 01) and drinking frequency

( p 001) There was rather weak supporting evidence for the relationship between

having older friends and more frequent drinking ( p 05) There were mixed findings

John Marsden et al438

concerning having more friends who drink spending time with friends who drink and

feeling under social pressure to drink The proportion of friends who drink was related

to intensity ( p 05) but not frequency There was a strong positive and consistent

relationship between spending time with friends who drink and drinking ( p 001)

and there were significant associations between perceived social pressure to drink and

Table 2 Standard multiple regression of background family psychological social and school factors on

recent alcohol involvement (N frac14 467)

Drinking frequency Drinking intensity

1 Background R 2 frac14 0211 R 2 frac14 0192Age 0100 0079Gender 098 0025School 1 100 100School 2 20024 20073School 3 0065 0012School 4 20065 20128School 5 0077 0101Age of first drink 20076 20044Ever intoxicated from alcohol 0591 1092Age first intoxicated on alcohol 20396 20899Ever smoked cigarettes 0155 0076Ever used cannabis 0160 0140

2 Family R 2 frac14 0141 R 2 frac14 0060Frequency of motherrsquos drinking 0052 0153Frequency of fatherrsquos drinking 0041 20121Extent parents encourage drinking 0231 0156Extent parents discourage drinking 0109 0094Drinking without parents knowledge 0280 0137

3 Psychological R 2 frac14 0156 R 2 frac14 0095Mood functions for drinking 0385 0307Social functions for drinking 20002 20068Psychological well-being 20116 20062Positive drinking attitudes 20050 0102Negative drinking attitudes 20014 0001

4 Social R 2 frac14 0322 R 2 frac14 0210Personally bought alcohol 0150 0131Proportion of older friends 0074 0090Proportion of friends who drink 0083 0094Time with friends drinking 0387 0307Perceived social pressure to drink 0148 0062

5 School R 2 frac14 0121 R 2 frac14 0144Been in trouble with teachers 0213 0212Had a fight with student at school 0054 0090Times truanted in past year 0155 0120Temporarily excluded in past year 0090 0152Overall R 2 frac14 0418 R 2 frac14 0339Adjusted R 2 frac14 0381 R 2 frac14 0290

frac14 p 05 frac14 p 01 frac14 p 001

Adolescent drinking 439

drinking frequency but not recent intensity There was a positive correlation between

more positive alcohol-related attitudes and high drinking intensity only ( p 05)

There were also mixed associations relating to school conduct problems and

drinking Being temporarily excluded from school and the number of times truanted

were positively related to recent frequency ( p 05 and p 001 respectively) and

recent intensity ( p 01) Having had a fight with another student with associated withrecent drinking intensity only ( p 05) while there was a strong positive and

consistent relationship between being in trouble with teachers and the both drinking

measures ( p 001)

In total the five blocks of factors explained 42 (38 adjusted) of the variance in

frequency of drinking scores and 34 (29 adjusted) of the variance in typical intensity

Taking the covariate blocks in turn the regression analysis indicated that the social and

peer factors had the strongest correlations (accounting for 32 and 21 of the variance

in drinking frequency and intensity respectively) For drinking frequency the strengthof association for the remaining factors was as follows background variables (21)

psychological factors (16) family factors (14) and school conduct problems (12)

The regression analysis for recent typical drinking intensity revealed a somewhat

contrasting pattern of predictors background variables (19) school conduct

problems (14) psychological factors (10) and family factors (6)

The dataset was then screened for the presence of moderation effects between

gender and each covariate Those variables (gender the covariate and their interaction)

that emerged as statistically significant were then entered into two regression equationsusing each of the dependent variables If the interaction term exerted a significant effect

on the dependent variable in this equation when its constituent parts were controlled

for this was taken as evidence of a moderation effect by gender The single interaction

term that was identified in this way was added to the covariate set in a backwards

stepwise regression equation controlling for gender and age This process resulted in a

final lsquotrimmed downrsquo regression model for the two dependent variables and is shown in

Table 3 The total proportions of variance in the dependent variables explained by the

final models were as follows 40 (38 adjusted) for drinking frequency( F12 441 frac14 2690 p 001) and 27 (26 adjusted) for drinking intensity

( F7 441 frac14 2316 p 001)

Drinking frequencyEleven covariates were retained in the model as significantly associated with recent

drinking frequency As can be seen most were from the family factors and social and

peer factors blocks Males tended to be more frequent drinkers than females(b frac14 0272) However the strongest predictor of frequency of alcohol use in the model

was the amount of time spent with friends who are drinking (b frac14 0316) Other

influential variables included the extent to which parents encourage (b frac14 0155) and

discourage (b frac14 20223) alcohol use with the latter association moderated by gender

More frequent parental discouragement to drink was related to more frequent drinking

in females and less frequent drinking frequency in males In a post hoc analysis the

parental discouragement scale items were entered into a regression equation This

showed that two items exerted an effect over and above the others lsquomy parents havetold me off because of drinking or buying alcoholrsquo and lsquomy parents have said that

I cannot drink alcohol at homersquo A positive relationship was also observed between

drinking more frequently without parentsrsquo knowledge and recent frequency of use

(b frac14 0110) Other independent influences on drinking frequency were higher mood

John Marsden et al440

alteration function scores (b frac14 0113) greater perceived social pressure to drink

alcohol (b frac14 0155) a history of temporary school exclusion (b frac14 0121) and more

frequent occasions of truanting from school in the past year (b frac14 0086)

Drinking intensityIn common with the final model for drinking frequency just five covariates were

retained in the regression equation for drinking intensity The amount of time spent with

friends who are drinking alcohol was the strongest predictor (b frac14 0319) This was

followed by having a history of school exclusion (b frac14 0197) and more frequently being

in trouble with teachers in the past year (b frac14 0142) Greater parental encouragement

to drink was associated with higher actual drinking intensity (b frac14 0124) Finally a

single background factor ndash lifetime use of cannabis ndash was associated with higher

drinking intensity (b frac14 0113)

Discussion

This report has presented first results from a cohort follow-up study of alcohol use

among a sample of mid-adolescents in England Baseline data on personal backgroundand demographics family psychological social factors and school conduct problems

were correlated with reports of recent drinking frequency and intensity As expected

regular drinking was the norm among the cohort 19 in 20 of the cohort had consumed a

whole alcoholic drink at some point in their lives and approximately 17 in 20 were

current drinkers This prevalence of alcohol use is comparable to that reported for the

Table 3 Stepwise multiple regression of background family psychological social and school factors on

recent alcohol involvement (N frac14 467)

Drinking frequencyR 2 frac14 0396

Drinking intensityR 2 frac14 0273

1 BackgroundAge 0033 0046Gender 0272 0004Ever smoked cannabis ndash 0113

2 FamilyExtent parents encourage drinking 0155 0124Extent parents discourage drinking 0223 ndashGender pound extent parents discourage drinkinga 0302 ndashDrinking without parents knowledge 0113 ndash

3 PsychologicalMood functions for drinking 0113 ndash

4 SocialPersonally bought alcohol 0118 ndashTime with friends who are drinking 0316 0319Perceived social pressure to drink 0155 ndash

5 SchoolIn trouble with teachers in past year ndash 0142Times truanted in past year 0086 ndashTemporarily excluded in past year 0121 0197

a frac14 interaction term frac14 p 05 frac14 p 01 frac14 p 001

Adolescent drinking 441

general adult population in the UK (Singleton Bumpstead OrsquoBrien Lee amp Meltzer

2001) and is also comparable to drinking levels reported for 15-year-olds in other

countries (eg Casswell Stewart Conolly amp Silva 1991 for New Zealand) In terms of

typical drinking intensity study participants estimated that they drank about five

standard units of alcohol on a typical day Although the government has not issued

recommended drinking levels for the under-18 s this level exceeds the safer drinkinglevels for adults as recommended by the English Department of Health (Department of

Health 1995) and is therefore a cause for concern A substantial proportion of the

sample also reported lifetime tobacco smoking (70) and use of cannabis (40) Despite

the fact that the study cohort was not generated using probability sampling techniques

it is reasonable to believe that it is unbiased The levels of drinking smoking and

cannabis use reported fell remarkably close to population estimates for this age group in

England (Goddard amp Higgins 2001 Becher et al 2001 Currie Hurrelmann

Settertobulte Smith amp Todd 2000) On school conduct characteristics the samplewas also broadly comparable to reports from national surveys (Miller amp Plant 1999)

The cohort was also comparable to the general population on school conduct problems

Thirty-seven percent admitted that they had truanted at least once in the past year and

this compares to 33 of boys who admitted truanting in the latest Office for National

Statistics school survey (Boreham amp Shaw 2001)

Drinking was well established within the social networks of the cohort The majority

reported that most or all of their friends drank alcohol and two-thirds of the drinkers

said that they typically spent time with friendsacquaintances who were drinking atleast once a week Two-thirds did not consider that they were under any peer pressure

to drink

In the UK alcopop beverages are well established in the drinks market (Clarke

2000) and concerns have been raised about the marketing of these products to younger

drinkers (Hughes et al 1997 McKeganey 1998) In our study males reported a limited

preference for these drinks and tended to favour beer and lager whereas females had a

greater preference for spirits alcopops wine and liqueurs Males were more frequent

drinkers but there were no gender differences in the amount of alcohol consumed ontypical day Previous studies on alcohol use have found that males drink more heavily

than their female peers (Goddard amp Higgins 2001 Miller amp Plant 1996) However as

alcohol use among school-age students approximately doubled between 1990 and 2000

(from 53 units in 1990 to 104 units in 2000) the gender gap in consumption has

narrowed (Goddard amp Higgins 2001) The drinking patterns of young females are of

concern given their greater vulnerability to alcohol-related harms (Goist amp Sutker 1985

Plant amp Plant 2001)

Correlates of drinking frequencyThe regression analyses were able to account for approximately 40 of the variance in

scores on the measure of drinking frequency There was no evidence for the hypothesized

negative relationship between age of first drink and recent drinking frequency although

there was a positive association with feeling intoxicated after drinking alcohol It is

however possible that the effect of earlier initiation to drinking is not seen until drinking

patterns have further developed This was observed in a longitudinal study in the USAreported by Hawkins et al (1997) In this study of a cohort of students who were

followed-up annually from age 10ndash11 to age 17ndash18 a younger age of alcohol initiation was

strongly related to a higher level of alcohol misuse at age 17ndash18 Consequently we will

assess the influence of age of alcohol initiation in further follow-ups

John Marsden et al442

Studies examining the putative relationship between lifetime smoking cannabis use

and recent drinking frequency suggest that earlier initiation to substance use mediates

peers alcohol involvement and parental drinking risk factors (eg Hawkins et al 1997)

However findings from research using twins suggests that the association between age

of onset of alcohol use and later problematic drinking may not be directly causal but

that age of onset and problematic drinking in later life are both associated with anunderlying vulnerability to behavioural problems (Prescott amp Kendler 1999)

There was no support for the predicted relationship between the frequency of

parental drinking and adolescent drinking frequency It must be acknowledged that

influence of parental drinking parental alcohol use norms and family environment and

relations are complex (Peterson et al 1994) Foxcroft and Lowe (1997) found that

increased drinking levels among 11ndash17-year-olds were linked to regular perceived

parental drinking while Casswell and her colleagues noted a positive association

between the frequency of drinking in early- to mid-adolescents and the frequency of

their mother and fatherrsquos drinking (Casswell et al 1991) Peterson et al showed thatclear communication by parents about their expectations of their childrenrsquos drinking

together with positive reinforcement for desired behaviours can reduce the impact of

parentrsquos drinking on adolescent alcohol use

Several studies have also noted a negative relationship between parental support

a positive family environment and feelings of connectedness and adolescent substance

use (Resnick et al 1997 Hops Davis amp Lewin 1999) The role that parental approval of

drinking has in predicting intensity of alcohol use in their children has also been

explored (eg Barnes amp Welte 1986) Wilks Callan and Austin (1989) found that the

fatherrsquos approval or disapproval of drinking behaviour predicted self-perception as adrinker in young males yet found no normative influences for females A gender

interaction in the present study also suggests a differential effect for discouraging

drinking More frequent parental discouragement to drink was related to more frequent

drinking in females and less frequent drinking in males This finding could indicate that

parents are more likely to disapprove of drinking in their daughters (and therefore

discourage alcohol use more strongly) than in their sons Alternatively it could point to a

tendency for girls to rebel more strongly against their parentsrsquo attitudes towards alcohol

use The direction of this relationship cannot be judged from the baseline data but our

post hoc item analysis does suggest that this effect may be due to parental reactions todrinking and proscriptions about drinking at home Future analyses of the longitudinal

data collected during the course of this study will examine this issue more closely

In the present analyses although frequency of mother and fathersrsquo alcohol use was

significantly related to drinking frequency these variables were not retained in the

regression analysis This suggests that other variables explain the relationship between

these factors Zhang Welte and Wieczorek (1999) found that the drinking behaviour of

each parent has a differential effect on their male offspring (aged 16ndash19 years) In their

study the fatherrsquos drinking but not their motherrsquos drinking affects their sons drinking

and closeness to the mother was a protective factor against adolescent drinking On theother hand male adolescent drinking increases if closeness to the mother is low and she

drinks excessively There appears to be no comparable effect for closeness to the father

and the fatherrsquos drinking

For the analysis of psychological measures there was an association in the predicted

direction between alcohol involvement and drinking for mood alteration functions but

not drinking to fulfil social functions Poorer psychological well-being was negatively

associated with drinking frequency only and contrary to our hypothesis there were no

Adolescent drinking 443

associations between the positive and negative alcohol-related attitude scales The

present results provide further evidence for the link between reasons or motives for

alcohol use and consumption patterns A strong relationship was observed between

increased frequency of drinking to serve mood alteration functions and increased

drinking frequency Our research group has also observed this effect among young

alcohol cannabis and ecstasy users (Boys et al 1999) These findings are consistentwith previous studies which have found a positive relationship between the number of

reasons for alcohol use and drinking frequency (Cooper Frone Russell amp Mudar 1995

Beck amp Treiman 1996 Bradizza Reifman amp Barnes 1999) For the social and peer

factors buying alcohol was as predicted associated with increased alcohol

involvement but there was only weak supporting evidence for an association with

having older friends There was a strong positive and consistent relationship between

spending time with friends who drink and perceived social pressure to drink and more

frequent drinking These independent social influences are interpreted in the context ofdeveloping peer relations and peer norms in which the majority of adolescents report

spending time with friends who are drinking as a recreational activity and where there

may be expectations to drink with the group sometimes to excessive levels (Iannotti

amp Bush 1992 Bahr Marcos amp Maughan 1995) Finally school conduct problems were

independently associated with drinking frequency with the number of times truanted

and being temporarily excluded having the strongest correlations Drinking more often

than other peers has been linked to more frequent unauthorized absences from school

(Currie et al 2000) Drinking smoking and drug use is also much more prevalentamong 12- to 15-year-olds who had ever truanted compared to those who had never

done so (Becher et al 2001)

Correlates of drinking intensityOverall 285 of the cohort typically drank six or more units on a drinking day which

can be taken to be a conservative indicator of underage binge drinking The regression

analyses were able to account for approximately 30 of the variance in drinkingintensity Age of first alcohol intoxication and lifetime smoking and cannabis use was

associated with more intense recent drinking For the family factors in contrast to

drinking frequency there was evidence for a positive association between how often

the mother usually drank alcohol and how much the adolescent drank on a drinking day

but contrary to prediction there was a negative association with the fatherrsquos drinking

It is possible that more frequent drinking by the father serves to discourage binge

drinking among mid-adolescents Nonetheless this effect was weak and was not

retained in the stepwise regression As predicted drinking to alter mood was associatedwith more intensive drinking but not with drinking for social facilitation functions This

effect however was not sufficiently strong to be retained in the stepwise regression

There was also a positive association between more favourable attitudes towards

alcohol and drinking intensity Among the social and peer factors a similar set of

associations was seen with the exception of perceived social pressure to drink

suggesting that mid-adolescents do not feel that the amount they consume is influenced

by their peers Finally the school conduct factors were quite strongly associated with

more intensive drinking and being in trouble with teachers and having beingtemporarily excluded had the strongest associations

The links between binge drinking and school conduct problems are a concern and

elsewhere studies have shown that binge drinking is related to poorer actual educational

performance (Newcomb Measham amp Parker 1995) Clinical diagnostic criteria for

John Marsden et al444

alcohol abuse recognize that recurrent drinking can result in school performance

problems and expulsions (American Psychiatric Association 1994) and the trajectory of

those experiencing school problems will be a focus of subsequent analyses of further

follow-up in the study The finding that lifetime use of cannabis was independently

associated with more intensive drinking is supportive of other work that argues that

those adolescents who use substances tend to have other attributes that increase therisk of poor psychosocial adjustment and school performance For example Jessor

Chase and Donovan (1980) argued that the reason that cannabis users tend to be less

well adjusted is that cannabis use is a general characteristic of individuals who are

predisposed to behavioural problems Furthermore Fergusson Lynskey and Horwood

(1997) suggested that instead of early cannabis use having a causal link with poor

psychosocial adjustment this association could be explained by family and other factors

that related to cannabis use Other alternative explanations include those proposed by

Kandel and colleagues They argue that early substance use sets into motion a chain ofevents which result in greater subsequent drug involvement and a range of other

negative psychosocial consequences (Kandel Davies Karus amp Yamaguchi 1986)

Again the causal direction of this relationship cannot be judged from the baseline data

but will be examined in more detail in subsequent reports on the longitudinal data

Strengths and limitations of the studyThe main strength of the present study was the analysis of the multiple influences on

drinking behaviour Studies of this kind have been rare in the UK but are encouraged as

good opportunities to gain an understanding of how early use of alcohol smoking and

other substance involvement evolves across the adolescent years (Edwards et al 1994

Duncan Duncan amp Hops 1998) Several limitations of the present study are also

acknowledged Given the reliance on self-report it is difficult to judge the reliability ofthe data and the findings should be interpreted with caution Nevertheless steps were

taken to maximize the privacy of the recruitment interviews to emphasize the

confidentiality of the study and the interviews were all conducted by young adults

Overall it has been argued that it is better to collect social survey data on this age group

at school than in the home (Becher et al 2001)

Implications for school-based alcohol educationThese results underline the importance of addressing personal family peer and school

conduct factors as part of alcohol education and problem prevention initiatives Theidentified correlates of drinking involvement in the present study could be usefully

taken up and discussed with students as part of alcohol education and prevention

programmes Elsewhere it has been argued that the main goal of school prevention

programmes should be to delay alcohol initiation (DeWit et al 2000 Griffin Botvin

Epstein Doyle amp Diaz 2000) However the very early age of onset in the UK suggests

that educational approaches based on harm minimization may be more realistic Recent

work in Australia has indicated that a harm minimization approach to alcohol education

together with adult supervision of initial drinking experiences can help to reduce theharms associated with alcohol use in young people (McBride Midford Farringdon amp

Phillips 2000b) Research into the merits of adopting a harm minimization approach to

alcohol education in schools has highlighted the importance of ensuring that

programme content and materials are relevant to local patterns of behaviour and are

Adolescent drinking 445

based on experiences that are relevant to the target audience (McBride Farringdon amp

Midford 2000a Dusenbury amp Falco 1995)

The potential feasibility and benefits of including parents as part of education

programmes in school should be examined The possibility of encouraging parents to

consider how their own behaviour and attitudes towards drinking might influence the

choices regarding alcohol use that are made by their offspring should be explored

Given the high prevalence of drinking involvement in mid-adolescence understanding

the influences on the further development of drinking attitudes and behaviours is of

critical importance Further reports from the study will describe the associations

between risky and heavy drinking patterns and alcohol-related problems and

developmental transitions to heavier consumption patterns as the cohort reaches the

period of late-adolescence

Acknowledgements

We would like to thank the students and staff from each school for their kind and enthusiastic

participation in the study The study was supported by a research grant from the LloydsTSB

charitable trust and conducted in association with Alcohol Concern

References

American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders

(4th ed) Washington DC APA

Anderson K Plant M amp Plant M (1998) Associations between drinking smoking and illicit

drug use among adolescents in the Western Isles of Scotland Implications for harm

minimization Journal of Substance Misuse 3 13ndash20

Ary D V Tildesley E Hops H amp Andrews J (1993) The influence of parent sibling and peer

modelling and attitudes on adolescent use of alcohol International Journal of Addiction 28

853ndash880

Bahr S J Marcos A C amp Maughan S L (1995) Family educational and peer influences on the

alcohol use of female and male adolescents Journal of Studies on Alcohol 56 457ndash469

Barnes G (1990) Impact of the family on adolescent drinking patterns In R Collins K Leonard

amp J Searles (Eds) Alcohol and the family Research and clinical perspectives (pp 137ndash161)

New York Guilford Press

Barnes G amp Welte J (1986) Patterns and predictors of alcohol use among 7ndash12th grade students

in New York State Journal of Studies on Alcohol 47 53ndash62

Becher H Boreham R Emery P Hinds K Jamison J amp Schagen I (2001) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Beck K H amp Treiman K A (1996) The relationship of social context of drinking perceived

social norms and parental influence to various drinking patterns of adolescents Addictive

Behaviors 21 633ndash644

Blenkinsop S Boreham R McManus S Natarajan L amp Prescott A (2003) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Blum R W Beuhring T amp Rinehart P M (2000) Protecting teens Beyond race income and

family structure Minneapolis MN Center for Adolescent Health University of Minnesota

Bonomo Y Coffey C Wolfe R Lynskey M Bowes G amp Patton G (2001) Adverse outcomes

of alcohol use in adolescents Addiction 96 1485ndash1496

Boreham R amp Shaw (2001) Smoking drinking and drug use among young people in England

in 2000 London The Stationery Office

John Marsden et al446

A core set of measures for the study was identified based on a review of the research

literature and our grouprsquos previous work on modelling substance use motivations These

variables constitute a repeated measures set of correlates which are recorded at baseline

and at follow-ups The personaldemographic background family and social correlates

constituted a set of distal (ie lifetime behaviours and events) and more proximal

influences on drinking (behaviours and events that occurred in the past year or the past

3 months) In this first report of findings from the study the aim was to examine the

correlates of alcohol use among adolescents in the 3 months before recruitment Results

are presented using data gathered from the baseline questionnaires and analysed to test

the hypothesis that increased alcohol involvement would be

(1) Negatively related to age of first drink and the lifetime experience of being

intoxicated on alcohol

(2) Positively related to lifetime experience of cannabis use and smoking

(3) Positively related to parental drinking parental encouragement to drink and

drinking with and without parental knowledge and negatively related to parentaldiscouragement to drink

(4) Positively related to more reasons for drinking and favourable drinking attitudes

and negatively related to psychological well-being and unfavourable drinking

attitudes

(5) Positively related to purchasing drinks and peersrsquo alcohol involvement and

(6) Positively related to school conduct problems

These hypotheses were tested against a null hypothesis for contrasts with males and

females No predictions were made concerning the relative strength of associations

between individual covariates and alcohol involvement

Method

Design and school selectionThe study is a prospective cohort survey of alcohol use and related attitudes and

behaviours of mid-adolescents (15ndash16 years old) recruited and interviewed from thestate school population in a single county in the south of England Two follow-up

questionnaires were administered at 9 and 18 months following recruitment In the UK

schooling is compulsory until the age of 16 years and an efficient means of recruiting a

general population sample of 15- to 16-year-olds is to sample from those in Year 11 from

educational establishments

Study resources precluded a probability sampling design and for practical reasons a

purposive non-probability method was used for recruitment of schools and

participants Schools were recruited from the countyrsquos main metropolitan area and

from other locations to yield a mix of inner-city and satellite town locations and from

schools that fell above and below standardized educational performance averages for

the county Five coeducational comprehensive schools were selected based on their

catchment area (urban or rural) educational achievements and size All of the five

schools approached agreed to participate They comprised two schools in inner-city

locations and three in satellite towns Two schools achieved above average educational

performance two were below average and one average (Department for Education and

Employment 1998b)

Adolescent drinking 431

Sample size planningGiven the available resources for the study an initial feasibility assessment suggested

that approximately 500 participants could be recruited and followed-up Statistical

power estimates suggested a sample of this size would be sufficient to detect behaviours

with rates as low as 5 with a relative standard error of 19 (95 CI frac14 32 68) The

smallest detectable effect that could be reliably measured (based on a two-tailed t testwith a frac14 05 and b frac14 020) for gender comparisons of for example drinking

involvement (using a measure of days of alcohol use and estimating for 50 female)

would be 026 which corresponds to a small effect size (Cohen 1988) The potential

design effects due to recruiting participants from different schools were assessed by

including these sites as a term in the analyses of the data Power calculations informing

follow-ups and change analyses are presented in subsequent reports

ProcedureThe Research Ethics committee of the Institute of Psychiatry and Maudsley Hospital

approved the study A detailed description of the research procedure has been reported

elsewhere (Boys et al 2003) and only the essential features are described here

Participation in the research was obtained by mailing a letter explaining the purpose and

format of the study to parents of all Year 11 students in each school at least a week in

advance of the scheduled recruitmentbaseline interviews This letter included a

detachable reply form asking parents to indicate if they did not wish their child to takepart in the study None of these student lsquoopt-outrsquo forms were returned to us and no

participant declined to take part during recruitment

A team of 24 second and third year undergraduate students (aged 19ndash24) were

recruited and trained to administer the recruitment protocol and baseline interviews All

interviewers completed a 6 hour group-based study protocol induction and training

session This was facilitated by four members of the author group and included plenary

presentation and discussion and supervised role-play experience in the administration

of the research questionnaire The recruitment of the school students took place over 20days between November and December 1998 during a 2 hour period at the end of the

school day Three members of the research team supervised each recruitment session

Interviewers were assigned a list of participants to interview in a private corner of a

classroom no more than four interviews were conducted in a room at any one time and

no teachers were present

Baseline data were collected using a personal interview of between 20 and 40

minutes duration (completion time varied according to the extent of the participantrsquos

experience with alcohol) and a self-completion questionnaire of around 20 minutesduration The self-completion instrument recorded the lifetime experience of substance

use psychological scales and questions concerning school conduct It was judged that

self-administration of these items would increase the veracity and reliability of reporting

All participants were given a pound10 retail music-store gift voucher in recognition of the

time taken to participate in the recruitment session

MeasuresThe present report utilizes a set of measures comprising standardized scales and several

indicator items developed specifically for the study The response burden on

participants was kept to a minimum and the selected measures represent a core set

that were needed to address the research hypotheses Recall periods for these measures

John Marsden et al432

spanned lifetime occurrences the past 12 months and the past 3 months (90 days) The

nature and coding structure of measures is described below while information about the

internal reliability of scales is presented in the results

Personaldemographic information and background factorsEight measures were used to characterize the personaldemographic background of

each participant (a) age (b) gender (coded male frac14 1 and female frac14 0) (c) school

recruitment site (dummy coded using school 1 as a nominal reference) (d) age of first

drink (e) whether ever intoxicated on alcohol (coded as no frac14 0 yes frac14 1) and (f) age

first intoxicated on alcohol (defined for the participants as lsquofeeling unsteady on your

feet or slurring your words or feeling dizzy or unwellrsquo) (g) lifetime use of cigarettes

and (h) lifetime use of cannabis (both coded no frac14 0 yes frac14 1)

Recent alcohol involvementIt was judged important to record both how often the participants recalled drinking in

the past 3 months and how much they consumed on a day when they consumed

alcohol (drinking intensity) These two measures which serve as the dependent

variables for the present report were not significantly correlated ( r frac14 15 ns) and

capture different and distinct alcohol use behaviours which are important when

characterizing drinking patterns and how these change over time Researchers in thisfield generally use 24 hour (day) intervals to serve as basic units of drinking frequency

The method of recording drinking frequency and intensity was adapted from the

Maudsley Addiction Profile a standardized multidimensional research instrument for

assessing substance-related behaviours (Marsden et al 1998) Each participant was first

asked to estimate the number of days on which they had consumed alcohol during the

past 3 months assisted by a prompt card listing nine categories (never less than once

every 2 months once every 2 months once every month two times a month 1 day per

week 2ndash3 days a week 4ndash5 days a week 6ndash7 days a week scored 0ndash8 and subsequentlymultiplied to total the number of days out of 90) If none of these categories closely

matched experience the participant was helped to calculate the specific number of

drinking days This can sometimes happen when a research respondent has a more

episodic pattern of drinking Then drinking intensity was estimated by recording the

number of drinks consumed during an average or typical drinking day in the past 3

months Responses to this question were recorded as verbatim reports of the number of

drinks consumed by beverage and brand type and were then converted as standard units

of alcohol at the data management stage

Family factorsQuestions on family factors that might influence adolescent drinking related to the

participantsrsquo estimates of parentsrsquo drinking the extent to which their parents

sanctioned their drinking and the extent that participants reported unsupervised

drinking without their parentsrsquo knowledge Five measures were recorded (a) two

7-point summary indices of the perceived usual frequency of the motherrsquos and fatherrsquosdrinking frequency (never to every day scored 0ndash6) (B) a 5-item scale to assess the

extent to which parents encouraged the participant to drink in the past year (offered

sondaughter a drink at home bought alcohol at a restaurant or another establishment

drunk an alcoholic drink with sondaughter at home drunk an alcoholic drink with

Adolescent drinking 433

sondaughter at another setting and allowed drinking at home) using a 5-point Likert-

type response (never to very often scored 0ndash4) (c) a 5-item scale coded to assess the

extent to which parents discouraged drinking in the past year (warning sondaughter of

the health risks of drinking parents saying they should not drink being punished by

parents for drinking parents saying that sondaughter cannot drink at home and being

reprimanded for buying alcohol (never to very often scored 0ndash4) and (d) a 9-pointindex of the number of occasions the participant recalled consuming an alcoholic drink

without their parentrsquos knowledge (never once twice 3ndash5 times 6ndash12 times 13ndash23

times 24ndash50 times 51ndash100 times and more than 100 times scored 0ndash8)

Psychological factorsQuestions in the block of psychological factors focused on personal influences and

correlates on alcohol use and included specific reasons for drinking generalpsychological health and alcohol-related attitudes Four measures were taken (a) a

6-item mood alteration functions scale developed by Boys et al (1999) was used to

assess how often participants had consumed alcohol in the past year for the following

personal reasons to relax to feel better when low or depressed to feel closer to

someone to stop worrying about a problem to get to sleep and simply to get drunk

(never to always scored 0ndash4) (B) a 5-item social functions scale also developed by

Boys et al to assess the extent that the participant had used alcohol in the past year for

the following social reasons to let go of inhibitions when socializing to feel moreconfident in a social situation to make an activity more enjoyable to help enjoy the

company of friends and to feel more confident when having sex (scored as above)

(c) the 12-item form of the General Health Questionnaire to assess psychological well-

being with each question scored using the Likert scale response coding (GHQ-12

Goldberg amp Williams 1988) and (d) two 9-item attitude scales adapted from items

used by Plant Peck and Samuel (1985) to assess positive drinking attitudes (eg young

people who drink regularly are attractive to the opposite sex coded as strongly agree

to strongly disagree scored 1ndash5)

Social and peer factorsFive measures were developed for the study to examine the relationships between

purchasing drinks and the influence of peers on alcohol involvement Five measures

were used (a) whether the participant had ever bought alcohol for personal use from a

shop or a barpub (scored no frac14 0 yes frac14 1) (b) the proportion of the participants

current friends who were older by 1 or more years (none to all scored 0ndash4) (c) theproportion of friends who were believed to drink alcohol (none to all scored 0ndash4)

(d) an index of how often the participant had spent time with friends and acquaintances

who were drinking in the past 3 months (never to 6ndash7 days a week scored 0ndash9) and

(e) an index of the extent that the participant perceived that they had felt under social

pressure to drink (coded as strongly agree to strongly disagree scored 1ndash5)

School conduct problemsFinally a block of four measures to record school conduct problems in the past year

A block of four items recording aspects of school life was taken from the youth form of

the Life Stressors and Social Resources Inventory (Moos amp Moos 1994) as follows (a) the

frequency that the participant had been in trouble with teachers and had been detained

John Marsden et al434

after school or received other sorts of punishment (never to every day scored 0ndash8)

(b) whether the participant had been in a fight with a student at school (scored no frac14 0

yes frac14 1) (c) the number of times the participant had truanted from school (defined as

not attending for a whole school day or leaving immediately after the morning class

registration) and (d) whether or not the respondent had been temporarily excluded

from school for disciplinary problems (scored no frac14 0 yes frac14 1)

Statistical analysisThe relationship between alcohol involvement and background family social and peer

and school conduct factors was investigated using multiple linear regression in twostages First two standard regression analyses were computed for drinking frequency and

intensity using the 26 items and scale measures described above in the five domains and

were regressed separately on the dependent variables in each domain and then again

simultaneously to assess overall levels of variance accounted for (Tabachnik amp Fidell

2001) This analysis was used to test the research hypotheses Second two stepwise

regression analyses with backwards elimination of covariates were computed to isolate a

set of independent predictors of drinking frequency and intensity and to explore the

strength of association for adjusted covariates and any identified gender interactions

Results

Sample characteristicsA cohort of 540 students was recruited (515 male) The average age was 154 years(381 [706] were 15 and 159 [294] were 16 years) There were no differences in the

proportion of males and females ( x2 frac14 515 p frac14 272) or number in the 15 and 16 year

age groups (x2 frac14 453 p frac14 340) between the samples from the five schools There

were also no differences in the proportion of males and females recruited compared

with the remainder of the Year 11 cohort in each school (x2 ranged from 003 to 116

p frac14 89ndash 28)

The majority of the sample described themselves as White-UK (954) while 19

were Caribbean or Black British 13 were South Asian and the remainder were MiddleEastern South East Asian or described themselves to be of mixed race Approximately

half (485) considered that they had no religious affiliation 157 reported they were

affiliated to the Church of England and 281 described themselves as Christian with no

specification Two-thirds (687) were living with both of their natural parents In terms

of living arrangements four-fifths (809) reported that their parents or guardians

owned their residence 111 were living in local authority owned housing and the

remainder were living in privately rented premises (74)

Prevalence of alcohol and other substance useThe majority of the sample (943) had consumed a whole alcoholic drink at some point

in their lives Lifetime use of tobacco products (cigarettes) was high (377 698)

particularly among females (748 vs 651 x2 frac14 602 p frac14 014) Some 404 (218) ofthe cohort reported using cannabis at some point in their lives but less than 1 in 10

reported lifetime use of other illegal drugs On average the participants estimated that

they were 124 years old when they first drank a whole alcoholic drink

( SD frac14 19 range frac14 3ndash16 years) Four-fifths of the drinkers (N frac14 407) reported that

Adolescent drinking 435

they had had experience of being intoxicated by alcohol Males reported an earlier age

of first being intoxicated after drinking than females (136 vs 138 years t frac14 2229

p 05) All of the drinkers reported that they had drunk alcohol without the

knowledge of their parents on at least one occasion On average they were 14 years old

( SD frac14 721 range frac14 7ndash16 years) when they first drank without parental knowledge

Over half of the drinkers estimated that they had drunk alcohol without their parentsrsquoknowledge on at least 13 separate occasions in total

Alcohol involvementThe majority of the lifetime drinkers (N frac14 467 917) had consumed alcohol during

the past 90 days and a third of the sample (175 324) reported that they had

purchased alcohol themselves from a bar or club during this period Table 1 summarizes

the frequency of drinking and scores on the dependent variables by gender In terms of

drinking frequency participants estimated that they had drunk alcohol on an average of175 days ( SD frac14 147) in the past 3 months with males tending to report frequent

drinking than females (187 days vs 16 days t frac14 204 p frac14 042) On average

participants consumed 47 units (47 ml by volume) on a typical drinking day and there

were no differences in drinking intensity between males and females (49 units vs 45

units respectively t frac14 0103 p frac14 302) As can be seen 285 of the cohort recalled

drinking six or more units on a typical day

In general beerlager was the most commonly used beverage (by 434) followed

by spirits (200) liqueurs (96) alcopops (88) and wine (59) Males tended to

prefer beerlager (691 vs 146 x2 frac14 15370 p 000) while females preferred

spirits (321 vs 93 x2 frac14 4111 p 000) liqueurs (175 vs 26 x2 frac14 3236

p 000) alcopops (133 vs 33 x2 frac14 1708 p 000) and wine (104 vs

19 x2 frac14 1675 p 000) In the past 3 months a similar profile of beverage

Table 1 Frequency and intensity of alcohol use in the past 90 days by gender (N frac14 467)

Males ()(N frac14 251)

Females()(N frac14 216)

Total()

Frequency of alcohol use in past 90 daysLess than monthly 17 (68) 19 (88) 36 (77)1ndash3 days per month 79 (315) 76 (352) 155 (332)One day per week 58 (231) 52 (241) 110 (236)2ndash3 days per week 82 (327) 64 (296) 146 (313)4ndash6 days per week 14 (56) 4 (19) 18 (39)Everyday 1 (04) 1 (05) 2 (04)

Units consumed on a typical drinking dayUp to 10 unit 11 (44) 15 (69) 26 (56)1ndash19 units 31 (124) 33 (153) 64 (137)2ndash39 units 78 (311) 59 (273) 137 (293)4ndash59 units 44 (175) 35 (162) 79 (169)6ndash99 units 56 (223) 38 (176) 94 (201)10 or more 20 (80) 19 (88) 39 (84)Number of drinking days90 (meanSD) 187 (155) 160 (137) 175 (147)Amount drunk on typical day (meanSD) 49 (36) 45 (38) 47 (37)

p 05

John Marsden et al436

preferences was recorded When asked what type of alcohol they had consumed

most often during the time 60 said beerlager 143 said spirits 18 said wine

and 58 said alcopops

Family factorsHalf of the sample (271 502) estimated that their mother generally drank alcohol at

least once a week and 704 (380) estimated that their father drank at least once a

week In terms of parental encouragement to drink around one quarter of the

sample estimated that they had often drunk alcohol at home with their parents in the

past year (129 239) although only 161 said that their parents had often bought

them an alcoholic drink at a restaurant or other establishment Conversely just 138

(255) of the sample said that their parents had actively discouraged them from

drinking in the past year The two 5-item scales assessing the extent to which parentsencouraged or discouraged drinking were approximately normally distributed and

had acceptable internal reliability The average total score on the parental

encouragement scale was 1363 ( SD frac14 501 Cronbachrsquos a frac14 77) and the average

total score on the parental discouragement scale was 888 ( SD frac14 367 a frac14 77)

While a fifth (203) of the sample reported that in the past 3 months they had never

drunk alcohol without the knowledge of their parents a quarter (N frac14 139) reported

that when they had recently drunk alcohol it was often or always without their

parentsrsquo knowledge

Psychological factorsThe average total score for the mood alteration function scale was 122

(median frac14 120) and it had acceptable internal reliability (a frac14 71) The most

commonly endorsed mood alteration function was drinking to relax (51 reporting

that they drank sometimes or more frequently for this reason) followed by drinking in

order to forget about a problem (endorsed by 34) The average total score for thesocial facilitation function scale was 114 (median frac14 110 a frac14 70) and the most

commonly endorsed social item was drinking to enjoy the company of friends (by 63)

followed by drinking to lose inhibitions (endorsed by 48) Scores on the GHQ-12

ranged from 0 to 34 with a mean of 121 (median frac14 110 a frac14 85) The sample were

equally likely to report positive and negative alcohol-related attitudes The mean scores

on these scales were 228 and 238 respectively (range frac14 13ndash39 and 13ndash34 a frac14 68

and a frac14 73)

Social and peer factorsJust under one half (246 483) estimated that a few of their friends were older than

them and a minority 64 (126) of the drinkers estimated that all or most of their

friends were at least 1 year older than them Two-fifths (N frac14 202) said that all of their

friends drank alcohol and a further 391 said that they believed most did so In the past

3 months two-thirds of the drinkers (338 664) reported that they typically spent time

with friendsacquaintances who were drinking at least once a week Just 68 individuals(134) estimated that this generally occurred less than once a month and a further

17 (33) said that they never spent time with friendsacquaintances who

were drinking A small proportion of the drinkers (79) considered that they

felt pressure from their peers to drink alcohol but the majority (578) did not feel

Adolescent drinking 437

this way and a further 193 indicated that they strongly disagreed that such pressure

was present in their social network

School conduct problemsIn the past year the majority of the drinkers (356 76) had received a detention afterschool or some other minor punishment There was also a minority (95 187) who

estimated that they found themselves in trouble with teachers once or twice each

month and a further small group who said that they received some form of disciplinary

action at school once a week (57 112) A quarter (138 256) reported that they had

had a fight with another student in the past year Just over a third (187 367) admitted

that they had been absent from school without authorization (truanted) at least once in

the past year and the average number of occasions on which this had occurred was 78

days ( SD frac14 150 days range frac14 05ndash80) Sixty-six students (122) had beentemporarily excluded from school in the past year

Regression of covariates of alcohol involvementThe two dependent variables were judged to be reasonably normally distributed and

were not transformed Following negative screening for multicollinearity within the

covariate set multiple regression analysis was performed separately for each of thefive blocks of covariates to assess their individual contribution to explaining variance in

the dependent variables A further regression was then performed in which all 26

covariates were entered simultaneously to calculate the overall level of variance

accounted for Table 2 presents the standardized regression coefficients (b) and the

overall R 2 for each block for these analyses

There was no significant association between age of first drink and recent drinking

although as predicted there was a positive association between feeling intoxicated after

drinking alcohol and both recent drinking frequency and intensity As predicted therewas a positive correlation between lifetime smoking and cannabis use and alcohol

involvement and this association was stronger for cannabis Among the set of

predictions concerning parents there was evidence for an association between the

frequency of parentsrsquo drinking for drinking intensity but this was in the anticipated

direction for the motherrsquos drinking only ( p 01) The frequency of the fatherrsquos

drinking was associated with drinking of lower intensity ( p 05)

As predicted there were significant positive associations between the extent that

parents encouraged drinking and both drinking frequency ( p 001) and intensity( p 01) Contrary to prediction there was a weak but positive relationship between

the extent that parents discouraged drinking and recent alcohol involvement ( p 05)

For the psychological factors there was support for the predicted association between

alcohol involvement and drinking for mood alteration functions ( p 001) but not to

fulfil social functions Higher scores on the GHQ-12 indicative of poorer psychological

well-being were negatively associated with drinking frequency only ( p 001)

Contrary to prediction there were no associations between the positive and negative

alcohol-related attitude scales with the exception of a significant association betweenpositive attitudes and recent drinking intensity ( p 05)

In the social and peer factors block there was evidence that personally buying

alcohol was associated with higher drinking intensity ( p 01) and drinking frequency

( p 001) There was rather weak supporting evidence for the relationship between

having older friends and more frequent drinking ( p 05) There were mixed findings

John Marsden et al438

concerning having more friends who drink spending time with friends who drink and

feeling under social pressure to drink The proportion of friends who drink was related

to intensity ( p 05) but not frequency There was a strong positive and consistent

relationship between spending time with friends who drink and drinking ( p 001)

and there were significant associations between perceived social pressure to drink and

Table 2 Standard multiple regression of background family psychological social and school factors on

recent alcohol involvement (N frac14 467)

Drinking frequency Drinking intensity

1 Background R 2 frac14 0211 R 2 frac14 0192Age 0100 0079Gender 098 0025School 1 100 100School 2 20024 20073School 3 0065 0012School 4 20065 20128School 5 0077 0101Age of first drink 20076 20044Ever intoxicated from alcohol 0591 1092Age first intoxicated on alcohol 20396 20899Ever smoked cigarettes 0155 0076Ever used cannabis 0160 0140

2 Family R 2 frac14 0141 R 2 frac14 0060Frequency of motherrsquos drinking 0052 0153Frequency of fatherrsquos drinking 0041 20121Extent parents encourage drinking 0231 0156Extent parents discourage drinking 0109 0094Drinking without parents knowledge 0280 0137

3 Psychological R 2 frac14 0156 R 2 frac14 0095Mood functions for drinking 0385 0307Social functions for drinking 20002 20068Psychological well-being 20116 20062Positive drinking attitudes 20050 0102Negative drinking attitudes 20014 0001

4 Social R 2 frac14 0322 R 2 frac14 0210Personally bought alcohol 0150 0131Proportion of older friends 0074 0090Proportion of friends who drink 0083 0094Time with friends drinking 0387 0307Perceived social pressure to drink 0148 0062

5 School R 2 frac14 0121 R 2 frac14 0144Been in trouble with teachers 0213 0212Had a fight with student at school 0054 0090Times truanted in past year 0155 0120Temporarily excluded in past year 0090 0152Overall R 2 frac14 0418 R 2 frac14 0339Adjusted R 2 frac14 0381 R 2 frac14 0290

frac14 p 05 frac14 p 01 frac14 p 001

Adolescent drinking 439

drinking frequency but not recent intensity There was a positive correlation between

more positive alcohol-related attitudes and high drinking intensity only ( p 05)

There were also mixed associations relating to school conduct problems and

drinking Being temporarily excluded from school and the number of times truanted

were positively related to recent frequency ( p 05 and p 001 respectively) and

recent intensity ( p 01) Having had a fight with another student with associated withrecent drinking intensity only ( p 05) while there was a strong positive and

consistent relationship between being in trouble with teachers and the both drinking

measures ( p 001)

In total the five blocks of factors explained 42 (38 adjusted) of the variance in

frequency of drinking scores and 34 (29 adjusted) of the variance in typical intensity

Taking the covariate blocks in turn the regression analysis indicated that the social and

peer factors had the strongest correlations (accounting for 32 and 21 of the variance

in drinking frequency and intensity respectively) For drinking frequency the strengthof association for the remaining factors was as follows background variables (21)

psychological factors (16) family factors (14) and school conduct problems (12)

The regression analysis for recent typical drinking intensity revealed a somewhat

contrasting pattern of predictors background variables (19) school conduct

problems (14) psychological factors (10) and family factors (6)

The dataset was then screened for the presence of moderation effects between

gender and each covariate Those variables (gender the covariate and their interaction)

that emerged as statistically significant were then entered into two regression equationsusing each of the dependent variables If the interaction term exerted a significant effect

on the dependent variable in this equation when its constituent parts were controlled

for this was taken as evidence of a moderation effect by gender The single interaction

term that was identified in this way was added to the covariate set in a backwards

stepwise regression equation controlling for gender and age This process resulted in a

final lsquotrimmed downrsquo regression model for the two dependent variables and is shown in

Table 3 The total proportions of variance in the dependent variables explained by the

final models were as follows 40 (38 adjusted) for drinking frequency( F12 441 frac14 2690 p 001) and 27 (26 adjusted) for drinking intensity

( F7 441 frac14 2316 p 001)

Drinking frequencyEleven covariates were retained in the model as significantly associated with recent

drinking frequency As can be seen most were from the family factors and social and

peer factors blocks Males tended to be more frequent drinkers than females(b frac14 0272) However the strongest predictor of frequency of alcohol use in the model

was the amount of time spent with friends who are drinking (b frac14 0316) Other

influential variables included the extent to which parents encourage (b frac14 0155) and

discourage (b frac14 20223) alcohol use with the latter association moderated by gender

More frequent parental discouragement to drink was related to more frequent drinking

in females and less frequent drinking frequency in males In a post hoc analysis the

parental discouragement scale items were entered into a regression equation This

showed that two items exerted an effect over and above the others lsquomy parents havetold me off because of drinking or buying alcoholrsquo and lsquomy parents have said that

I cannot drink alcohol at homersquo A positive relationship was also observed between

drinking more frequently without parentsrsquo knowledge and recent frequency of use

(b frac14 0110) Other independent influences on drinking frequency were higher mood

John Marsden et al440

alteration function scores (b frac14 0113) greater perceived social pressure to drink

alcohol (b frac14 0155) a history of temporary school exclusion (b frac14 0121) and more

frequent occasions of truanting from school in the past year (b frac14 0086)

Drinking intensityIn common with the final model for drinking frequency just five covariates were

retained in the regression equation for drinking intensity The amount of time spent with

friends who are drinking alcohol was the strongest predictor (b frac14 0319) This was

followed by having a history of school exclusion (b frac14 0197) and more frequently being

in trouble with teachers in the past year (b frac14 0142) Greater parental encouragement

to drink was associated with higher actual drinking intensity (b frac14 0124) Finally a

single background factor ndash lifetime use of cannabis ndash was associated with higher

drinking intensity (b frac14 0113)

Discussion

This report has presented first results from a cohort follow-up study of alcohol use

among a sample of mid-adolescents in England Baseline data on personal backgroundand demographics family psychological social factors and school conduct problems

were correlated with reports of recent drinking frequency and intensity As expected

regular drinking was the norm among the cohort 19 in 20 of the cohort had consumed a

whole alcoholic drink at some point in their lives and approximately 17 in 20 were

current drinkers This prevalence of alcohol use is comparable to that reported for the

Table 3 Stepwise multiple regression of background family psychological social and school factors on

recent alcohol involvement (N frac14 467)

Drinking frequencyR 2 frac14 0396

Drinking intensityR 2 frac14 0273

1 BackgroundAge 0033 0046Gender 0272 0004Ever smoked cannabis ndash 0113

2 FamilyExtent parents encourage drinking 0155 0124Extent parents discourage drinking 0223 ndashGender pound extent parents discourage drinkinga 0302 ndashDrinking without parents knowledge 0113 ndash

3 PsychologicalMood functions for drinking 0113 ndash

4 SocialPersonally bought alcohol 0118 ndashTime with friends who are drinking 0316 0319Perceived social pressure to drink 0155 ndash

5 SchoolIn trouble with teachers in past year ndash 0142Times truanted in past year 0086 ndashTemporarily excluded in past year 0121 0197

a frac14 interaction term frac14 p 05 frac14 p 01 frac14 p 001

Adolescent drinking 441

general adult population in the UK (Singleton Bumpstead OrsquoBrien Lee amp Meltzer

2001) and is also comparable to drinking levels reported for 15-year-olds in other

countries (eg Casswell Stewart Conolly amp Silva 1991 for New Zealand) In terms of

typical drinking intensity study participants estimated that they drank about five

standard units of alcohol on a typical day Although the government has not issued

recommended drinking levels for the under-18 s this level exceeds the safer drinkinglevels for adults as recommended by the English Department of Health (Department of

Health 1995) and is therefore a cause for concern A substantial proportion of the

sample also reported lifetime tobacco smoking (70) and use of cannabis (40) Despite

the fact that the study cohort was not generated using probability sampling techniques

it is reasonable to believe that it is unbiased The levels of drinking smoking and

cannabis use reported fell remarkably close to population estimates for this age group in

England (Goddard amp Higgins 2001 Becher et al 2001 Currie Hurrelmann

Settertobulte Smith amp Todd 2000) On school conduct characteristics the samplewas also broadly comparable to reports from national surveys (Miller amp Plant 1999)

The cohort was also comparable to the general population on school conduct problems

Thirty-seven percent admitted that they had truanted at least once in the past year and

this compares to 33 of boys who admitted truanting in the latest Office for National

Statistics school survey (Boreham amp Shaw 2001)

Drinking was well established within the social networks of the cohort The majority

reported that most or all of their friends drank alcohol and two-thirds of the drinkers

said that they typically spent time with friendsacquaintances who were drinking atleast once a week Two-thirds did not consider that they were under any peer pressure

to drink

In the UK alcopop beverages are well established in the drinks market (Clarke

2000) and concerns have been raised about the marketing of these products to younger

drinkers (Hughes et al 1997 McKeganey 1998) In our study males reported a limited

preference for these drinks and tended to favour beer and lager whereas females had a

greater preference for spirits alcopops wine and liqueurs Males were more frequent

drinkers but there were no gender differences in the amount of alcohol consumed ontypical day Previous studies on alcohol use have found that males drink more heavily

than their female peers (Goddard amp Higgins 2001 Miller amp Plant 1996) However as

alcohol use among school-age students approximately doubled between 1990 and 2000

(from 53 units in 1990 to 104 units in 2000) the gender gap in consumption has

narrowed (Goddard amp Higgins 2001) The drinking patterns of young females are of

concern given their greater vulnerability to alcohol-related harms (Goist amp Sutker 1985

Plant amp Plant 2001)

Correlates of drinking frequencyThe regression analyses were able to account for approximately 40 of the variance in

scores on the measure of drinking frequency There was no evidence for the hypothesized

negative relationship between age of first drink and recent drinking frequency although

there was a positive association with feeling intoxicated after drinking alcohol It is

however possible that the effect of earlier initiation to drinking is not seen until drinking

patterns have further developed This was observed in a longitudinal study in the USAreported by Hawkins et al (1997) In this study of a cohort of students who were

followed-up annually from age 10ndash11 to age 17ndash18 a younger age of alcohol initiation was

strongly related to a higher level of alcohol misuse at age 17ndash18 Consequently we will

assess the influence of age of alcohol initiation in further follow-ups

John Marsden et al442

Studies examining the putative relationship between lifetime smoking cannabis use

and recent drinking frequency suggest that earlier initiation to substance use mediates

peers alcohol involvement and parental drinking risk factors (eg Hawkins et al 1997)

However findings from research using twins suggests that the association between age

of onset of alcohol use and later problematic drinking may not be directly causal but

that age of onset and problematic drinking in later life are both associated with anunderlying vulnerability to behavioural problems (Prescott amp Kendler 1999)

There was no support for the predicted relationship between the frequency of

parental drinking and adolescent drinking frequency It must be acknowledged that

influence of parental drinking parental alcohol use norms and family environment and

relations are complex (Peterson et al 1994) Foxcroft and Lowe (1997) found that

increased drinking levels among 11ndash17-year-olds were linked to regular perceived

parental drinking while Casswell and her colleagues noted a positive association

between the frequency of drinking in early- to mid-adolescents and the frequency of

their mother and fatherrsquos drinking (Casswell et al 1991) Peterson et al showed thatclear communication by parents about their expectations of their childrenrsquos drinking

together with positive reinforcement for desired behaviours can reduce the impact of

parentrsquos drinking on adolescent alcohol use

Several studies have also noted a negative relationship between parental support

a positive family environment and feelings of connectedness and adolescent substance

use (Resnick et al 1997 Hops Davis amp Lewin 1999) The role that parental approval of

drinking has in predicting intensity of alcohol use in their children has also been

explored (eg Barnes amp Welte 1986) Wilks Callan and Austin (1989) found that the

fatherrsquos approval or disapproval of drinking behaviour predicted self-perception as adrinker in young males yet found no normative influences for females A gender

interaction in the present study also suggests a differential effect for discouraging

drinking More frequent parental discouragement to drink was related to more frequent

drinking in females and less frequent drinking in males This finding could indicate that

parents are more likely to disapprove of drinking in their daughters (and therefore

discourage alcohol use more strongly) than in their sons Alternatively it could point to a

tendency for girls to rebel more strongly against their parentsrsquo attitudes towards alcohol

use The direction of this relationship cannot be judged from the baseline data but our

post hoc item analysis does suggest that this effect may be due to parental reactions todrinking and proscriptions about drinking at home Future analyses of the longitudinal

data collected during the course of this study will examine this issue more closely

In the present analyses although frequency of mother and fathersrsquo alcohol use was

significantly related to drinking frequency these variables were not retained in the

regression analysis This suggests that other variables explain the relationship between

these factors Zhang Welte and Wieczorek (1999) found that the drinking behaviour of

each parent has a differential effect on their male offspring (aged 16ndash19 years) In their

study the fatherrsquos drinking but not their motherrsquos drinking affects their sons drinking

and closeness to the mother was a protective factor against adolescent drinking On theother hand male adolescent drinking increases if closeness to the mother is low and she

drinks excessively There appears to be no comparable effect for closeness to the father

and the fatherrsquos drinking

For the analysis of psychological measures there was an association in the predicted

direction between alcohol involvement and drinking for mood alteration functions but

not drinking to fulfil social functions Poorer psychological well-being was negatively

associated with drinking frequency only and contrary to our hypothesis there were no

Adolescent drinking 443

associations between the positive and negative alcohol-related attitude scales The

present results provide further evidence for the link between reasons or motives for

alcohol use and consumption patterns A strong relationship was observed between

increased frequency of drinking to serve mood alteration functions and increased

drinking frequency Our research group has also observed this effect among young

alcohol cannabis and ecstasy users (Boys et al 1999) These findings are consistentwith previous studies which have found a positive relationship between the number of

reasons for alcohol use and drinking frequency (Cooper Frone Russell amp Mudar 1995

Beck amp Treiman 1996 Bradizza Reifman amp Barnes 1999) For the social and peer

factors buying alcohol was as predicted associated with increased alcohol

involvement but there was only weak supporting evidence for an association with

having older friends There was a strong positive and consistent relationship between

spending time with friends who drink and perceived social pressure to drink and more

frequent drinking These independent social influences are interpreted in the context ofdeveloping peer relations and peer norms in which the majority of adolescents report

spending time with friends who are drinking as a recreational activity and where there

may be expectations to drink with the group sometimes to excessive levels (Iannotti

amp Bush 1992 Bahr Marcos amp Maughan 1995) Finally school conduct problems were

independently associated with drinking frequency with the number of times truanted

and being temporarily excluded having the strongest correlations Drinking more often

than other peers has been linked to more frequent unauthorized absences from school

(Currie et al 2000) Drinking smoking and drug use is also much more prevalentamong 12- to 15-year-olds who had ever truanted compared to those who had never

done so (Becher et al 2001)

Correlates of drinking intensityOverall 285 of the cohort typically drank six or more units on a drinking day which

can be taken to be a conservative indicator of underage binge drinking The regression

analyses were able to account for approximately 30 of the variance in drinkingintensity Age of first alcohol intoxication and lifetime smoking and cannabis use was

associated with more intense recent drinking For the family factors in contrast to

drinking frequency there was evidence for a positive association between how often

the mother usually drank alcohol and how much the adolescent drank on a drinking day

but contrary to prediction there was a negative association with the fatherrsquos drinking

It is possible that more frequent drinking by the father serves to discourage binge

drinking among mid-adolescents Nonetheless this effect was weak and was not

retained in the stepwise regression As predicted drinking to alter mood was associatedwith more intensive drinking but not with drinking for social facilitation functions This

effect however was not sufficiently strong to be retained in the stepwise regression

There was also a positive association between more favourable attitudes towards

alcohol and drinking intensity Among the social and peer factors a similar set of

associations was seen with the exception of perceived social pressure to drink

suggesting that mid-adolescents do not feel that the amount they consume is influenced

by their peers Finally the school conduct factors were quite strongly associated with

more intensive drinking and being in trouble with teachers and having beingtemporarily excluded had the strongest associations

The links between binge drinking and school conduct problems are a concern and

elsewhere studies have shown that binge drinking is related to poorer actual educational

performance (Newcomb Measham amp Parker 1995) Clinical diagnostic criteria for

John Marsden et al444

alcohol abuse recognize that recurrent drinking can result in school performance

problems and expulsions (American Psychiatric Association 1994) and the trajectory of

those experiencing school problems will be a focus of subsequent analyses of further

follow-up in the study The finding that lifetime use of cannabis was independently

associated with more intensive drinking is supportive of other work that argues that

those adolescents who use substances tend to have other attributes that increase therisk of poor psychosocial adjustment and school performance For example Jessor

Chase and Donovan (1980) argued that the reason that cannabis users tend to be less

well adjusted is that cannabis use is a general characteristic of individuals who are

predisposed to behavioural problems Furthermore Fergusson Lynskey and Horwood

(1997) suggested that instead of early cannabis use having a causal link with poor

psychosocial adjustment this association could be explained by family and other factors

that related to cannabis use Other alternative explanations include those proposed by

Kandel and colleagues They argue that early substance use sets into motion a chain ofevents which result in greater subsequent drug involvement and a range of other

negative psychosocial consequences (Kandel Davies Karus amp Yamaguchi 1986)

Again the causal direction of this relationship cannot be judged from the baseline data

but will be examined in more detail in subsequent reports on the longitudinal data

Strengths and limitations of the studyThe main strength of the present study was the analysis of the multiple influences on

drinking behaviour Studies of this kind have been rare in the UK but are encouraged as

good opportunities to gain an understanding of how early use of alcohol smoking and

other substance involvement evolves across the adolescent years (Edwards et al 1994

Duncan Duncan amp Hops 1998) Several limitations of the present study are also

acknowledged Given the reliance on self-report it is difficult to judge the reliability ofthe data and the findings should be interpreted with caution Nevertheless steps were

taken to maximize the privacy of the recruitment interviews to emphasize the

confidentiality of the study and the interviews were all conducted by young adults

Overall it has been argued that it is better to collect social survey data on this age group

at school than in the home (Becher et al 2001)

Implications for school-based alcohol educationThese results underline the importance of addressing personal family peer and school

conduct factors as part of alcohol education and problem prevention initiatives Theidentified correlates of drinking involvement in the present study could be usefully

taken up and discussed with students as part of alcohol education and prevention

programmes Elsewhere it has been argued that the main goal of school prevention

programmes should be to delay alcohol initiation (DeWit et al 2000 Griffin Botvin

Epstein Doyle amp Diaz 2000) However the very early age of onset in the UK suggests

that educational approaches based on harm minimization may be more realistic Recent

work in Australia has indicated that a harm minimization approach to alcohol education

together with adult supervision of initial drinking experiences can help to reduce theharms associated with alcohol use in young people (McBride Midford Farringdon amp

Phillips 2000b) Research into the merits of adopting a harm minimization approach to

alcohol education in schools has highlighted the importance of ensuring that

programme content and materials are relevant to local patterns of behaviour and are

Adolescent drinking 445

based on experiences that are relevant to the target audience (McBride Farringdon amp

Midford 2000a Dusenbury amp Falco 1995)

The potential feasibility and benefits of including parents as part of education

programmes in school should be examined The possibility of encouraging parents to

consider how their own behaviour and attitudes towards drinking might influence the

choices regarding alcohol use that are made by their offspring should be explored

Given the high prevalence of drinking involvement in mid-adolescence understanding

the influences on the further development of drinking attitudes and behaviours is of

critical importance Further reports from the study will describe the associations

between risky and heavy drinking patterns and alcohol-related problems and

developmental transitions to heavier consumption patterns as the cohort reaches the

period of late-adolescence

Acknowledgements

We would like to thank the students and staff from each school for their kind and enthusiastic

participation in the study The study was supported by a research grant from the LloydsTSB

charitable trust and conducted in association with Alcohol Concern

References

American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders

(4th ed) Washington DC APA

Anderson K Plant M amp Plant M (1998) Associations between drinking smoking and illicit

drug use among adolescents in the Western Isles of Scotland Implications for harm

minimization Journal of Substance Misuse 3 13ndash20

Ary D V Tildesley E Hops H amp Andrews J (1993) The influence of parent sibling and peer

modelling and attitudes on adolescent use of alcohol International Journal of Addiction 28

853ndash880

Bahr S J Marcos A C amp Maughan S L (1995) Family educational and peer influences on the

alcohol use of female and male adolescents Journal of Studies on Alcohol 56 457ndash469

Barnes G (1990) Impact of the family on adolescent drinking patterns In R Collins K Leonard

amp J Searles (Eds) Alcohol and the family Research and clinical perspectives (pp 137ndash161)

New York Guilford Press

Barnes G amp Welte J (1986) Patterns and predictors of alcohol use among 7ndash12th grade students

in New York State Journal of Studies on Alcohol 47 53ndash62

Becher H Boreham R Emery P Hinds K Jamison J amp Schagen I (2001) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Beck K H amp Treiman K A (1996) The relationship of social context of drinking perceived

social norms and parental influence to various drinking patterns of adolescents Addictive

Behaviors 21 633ndash644

Blenkinsop S Boreham R McManus S Natarajan L amp Prescott A (2003) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Blum R W Beuhring T amp Rinehart P M (2000) Protecting teens Beyond race income and

family structure Minneapolis MN Center for Adolescent Health University of Minnesota

Bonomo Y Coffey C Wolfe R Lynskey M Bowes G amp Patton G (2001) Adverse outcomes

of alcohol use in adolescents Addiction 96 1485ndash1496

Boreham R amp Shaw (2001) Smoking drinking and drug use among young people in England

in 2000 London The Stationery Office

John Marsden et al446

Sample size planningGiven the available resources for the study an initial feasibility assessment suggested

that approximately 500 participants could be recruited and followed-up Statistical

power estimates suggested a sample of this size would be sufficient to detect behaviours

with rates as low as 5 with a relative standard error of 19 (95 CI frac14 32 68) The

smallest detectable effect that could be reliably measured (based on a two-tailed t testwith a frac14 05 and b frac14 020) for gender comparisons of for example drinking

involvement (using a measure of days of alcohol use and estimating for 50 female)

would be 026 which corresponds to a small effect size (Cohen 1988) The potential

design effects due to recruiting participants from different schools were assessed by

including these sites as a term in the analyses of the data Power calculations informing

follow-ups and change analyses are presented in subsequent reports

ProcedureThe Research Ethics committee of the Institute of Psychiatry and Maudsley Hospital

approved the study A detailed description of the research procedure has been reported

elsewhere (Boys et al 2003) and only the essential features are described here

Participation in the research was obtained by mailing a letter explaining the purpose and

format of the study to parents of all Year 11 students in each school at least a week in

advance of the scheduled recruitmentbaseline interviews This letter included a

detachable reply form asking parents to indicate if they did not wish their child to takepart in the study None of these student lsquoopt-outrsquo forms were returned to us and no

participant declined to take part during recruitment

A team of 24 second and third year undergraduate students (aged 19ndash24) were

recruited and trained to administer the recruitment protocol and baseline interviews All

interviewers completed a 6 hour group-based study protocol induction and training

session This was facilitated by four members of the author group and included plenary

presentation and discussion and supervised role-play experience in the administration

of the research questionnaire The recruitment of the school students took place over 20days between November and December 1998 during a 2 hour period at the end of the

school day Three members of the research team supervised each recruitment session

Interviewers were assigned a list of participants to interview in a private corner of a

classroom no more than four interviews were conducted in a room at any one time and

no teachers were present

Baseline data were collected using a personal interview of between 20 and 40

minutes duration (completion time varied according to the extent of the participantrsquos

experience with alcohol) and a self-completion questionnaire of around 20 minutesduration The self-completion instrument recorded the lifetime experience of substance

use psychological scales and questions concerning school conduct It was judged that

self-administration of these items would increase the veracity and reliability of reporting

All participants were given a pound10 retail music-store gift voucher in recognition of the

time taken to participate in the recruitment session

MeasuresThe present report utilizes a set of measures comprising standardized scales and several

indicator items developed specifically for the study The response burden on

participants was kept to a minimum and the selected measures represent a core set

that were needed to address the research hypotheses Recall periods for these measures

John Marsden et al432

spanned lifetime occurrences the past 12 months and the past 3 months (90 days) The

nature and coding structure of measures is described below while information about the

internal reliability of scales is presented in the results

Personaldemographic information and background factorsEight measures were used to characterize the personaldemographic background of

each participant (a) age (b) gender (coded male frac14 1 and female frac14 0) (c) school

recruitment site (dummy coded using school 1 as a nominal reference) (d) age of first

drink (e) whether ever intoxicated on alcohol (coded as no frac14 0 yes frac14 1) and (f) age

first intoxicated on alcohol (defined for the participants as lsquofeeling unsteady on your

feet or slurring your words or feeling dizzy or unwellrsquo) (g) lifetime use of cigarettes

and (h) lifetime use of cannabis (both coded no frac14 0 yes frac14 1)

Recent alcohol involvementIt was judged important to record both how often the participants recalled drinking in

the past 3 months and how much they consumed on a day when they consumed

alcohol (drinking intensity) These two measures which serve as the dependent

variables for the present report were not significantly correlated ( r frac14 15 ns) and

capture different and distinct alcohol use behaviours which are important when

characterizing drinking patterns and how these change over time Researchers in thisfield generally use 24 hour (day) intervals to serve as basic units of drinking frequency

The method of recording drinking frequency and intensity was adapted from the

Maudsley Addiction Profile a standardized multidimensional research instrument for

assessing substance-related behaviours (Marsden et al 1998) Each participant was first

asked to estimate the number of days on which they had consumed alcohol during the

past 3 months assisted by a prompt card listing nine categories (never less than once

every 2 months once every 2 months once every month two times a month 1 day per

week 2ndash3 days a week 4ndash5 days a week 6ndash7 days a week scored 0ndash8 and subsequentlymultiplied to total the number of days out of 90) If none of these categories closely

matched experience the participant was helped to calculate the specific number of

drinking days This can sometimes happen when a research respondent has a more

episodic pattern of drinking Then drinking intensity was estimated by recording the

number of drinks consumed during an average or typical drinking day in the past 3

months Responses to this question were recorded as verbatim reports of the number of

drinks consumed by beverage and brand type and were then converted as standard units

of alcohol at the data management stage

Family factorsQuestions on family factors that might influence adolescent drinking related to the

participantsrsquo estimates of parentsrsquo drinking the extent to which their parents

sanctioned their drinking and the extent that participants reported unsupervised

drinking without their parentsrsquo knowledge Five measures were recorded (a) two

7-point summary indices of the perceived usual frequency of the motherrsquos and fatherrsquosdrinking frequency (never to every day scored 0ndash6) (B) a 5-item scale to assess the

extent to which parents encouraged the participant to drink in the past year (offered

sondaughter a drink at home bought alcohol at a restaurant or another establishment

drunk an alcoholic drink with sondaughter at home drunk an alcoholic drink with

Adolescent drinking 433

sondaughter at another setting and allowed drinking at home) using a 5-point Likert-

type response (never to very often scored 0ndash4) (c) a 5-item scale coded to assess the

extent to which parents discouraged drinking in the past year (warning sondaughter of

the health risks of drinking parents saying they should not drink being punished by

parents for drinking parents saying that sondaughter cannot drink at home and being

reprimanded for buying alcohol (never to very often scored 0ndash4) and (d) a 9-pointindex of the number of occasions the participant recalled consuming an alcoholic drink

without their parentrsquos knowledge (never once twice 3ndash5 times 6ndash12 times 13ndash23

times 24ndash50 times 51ndash100 times and more than 100 times scored 0ndash8)

Psychological factorsQuestions in the block of psychological factors focused on personal influences and

correlates on alcohol use and included specific reasons for drinking generalpsychological health and alcohol-related attitudes Four measures were taken (a) a

6-item mood alteration functions scale developed by Boys et al (1999) was used to

assess how often participants had consumed alcohol in the past year for the following

personal reasons to relax to feel better when low or depressed to feel closer to

someone to stop worrying about a problem to get to sleep and simply to get drunk

(never to always scored 0ndash4) (B) a 5-item social functions scale also developed by

Boys et al to assess the extent that the participant had used alcohol in the past year for

the following social reasons to let go of inhibitions when socializing to feel moreconfident in a social situation to make an activity more enjoyable to help enjoy the

company of friends and to feel more confident when having sex (scored as above)

(c) the 12-item form of the General Health Questionnaire to assess psychological well-

being with each question scored using the Likert scale response coding (GHQ-12

Goldberg amp Williams 1988) and (d) two 9-item attitude scales adapted from items

used by Plant Peck and Samuel (1985) to assess positive drinking attitudes (eg young

people who drink regularly are attractive to the opposite sex coded as strongly agree

to strongly disagree scored 1ndash5)

Social and peer factorsFive measures were developed for the study to examine the relationships between

purchasing drinks and the influence of peers on alcohol involvement Five measures

were used (a) whether the participant had ever bought alcohol for personal use from a

shop or a barpub (scored no frac14 0 yes frac14 1) (b) the proportion of the participants

current friends who were older by 1 or more years (none to all scored 0ndash4) (c) theproportion of friends who were believed to drink alcohol (none to all scored 0ndash4)

(d) an index of how often the participant had spent time with friends and acquaintances

who were drinking in the past 3 months (never to 6ndash7 days a week scored 0ndash9) and

(e) an index of the extent that the participant perceived that they had felt under social

pressure to drink (coded as strongly agree to strongly disagree scored 1ndash5)

School conduct problemsFinally a block of four measures to record school conduct problems in the past year

A block of four items recording aspects of school life was taken from the youth form of

the Life Stressors and Social Resources Inventory (Moos amp Moos 1994) as follows (a) the

frequency that the participant had been in trouble with teachers and had been detained

John Marsden et al434

after school or received other sorts of punishment (never to every day scored 0ndash8)

(b) whether the participant had been in a fight with a student at school (scored no frac14 0

yes frac14 1) (c) the number of times the participant had truanted from school (defined as

not attending for a whole school day or leaving immediately after the morning class

registration) and (d) whether or not the respondent had been temporarily excluded

from school for disciplinary problems (scored no frac14 0 yes frac14 1)

Statistical analysisThe relationship between alcohol involvement and background family social and peer

and school conduct factors was investigated using multiple linear regression in twostages First two standard regression analyses were computed for drinking frequency and

intensity using the 26 items and scale measures described above in the five domains and

were regressed separately on the dependent variables in each domain and then again

simultaneously to assess overall levels of variance accounted for (Tabachnik amp Fidell

2001) This analysis was used to test the research hypotheses Second two stepwise

regression analyses with backwards elimination of covariates were computed to isolate a

set of independent predictors of drinking frequency and intensity and to explore the

strength of association for adjusted covariates and any identified gender interactions

Results

Sample characteristicsA cohort of 540 students was recruited (515 male) The average age was 154 years(381 [706] were 15 and 159 [294] were 16 years) There were no differences in the

proportion of males and females ( x2 frac14 515 p frac14 272) or number in the 15 and 16 year

age groups (x2 frac14 453 p frac14 340) between the samples from the five schools There

were also no differences in the proportion of males and females recruited compared

with the remainder of the Year 11 cohort in each school (x2 ranged from 003 to 116

p frac14 89ndash 28)

The majority of the sample described themselves as White-UK (954) while 19

were Caribbean or Black British 13 were South Asian and the remainder were MiddleEastern South East Asian or described themselves to be of mixed race Approximately

half (485) considered that they had no religious affiliation 157 reported they were

affiliated to the Church of England and 281 described themselves as Christian with no

specification Two-thirds (687) were living with both of their natural parents In terms

of living arrangements four-fifths (809) reported that their parents or guardians

owned their residence 111 were living in local authority owned housing and the

remainder were living in privately rented premises (74)

Prevalence of alcohol and other substance useThe majority of the sample (943) had consumed a whole alcoholic drink at some point

in their lives Lifetime use of tobacco products (cigarettes) was high (377 698)

particularly among females (748 vs 651 x2 frac14 602 p frac14 014) Some 404 (218) ofthe cohort reported using cannabis at some point in their lives but less than 1 in 10

reported lifetime use of other illegal drugs On average the participants estimated that

they were 124 years old when they first drank a whole alcoholic drink

( SD frac14 19 range frac14 3ndash16 years) Four-fifths of the drinkers (N frac14 407) reported that

Adolescent drinking 435

they had had experience of being intoxicated by alcohol Males reported an earlier age

of first being intoxicated after drinking than females (136 vs 138 years t frac14 2229

p 05) All of the drinkers reported that they had drunk alcohol without the

knowledge of their parents on at least one occasion On average they were 14 years old

( SD frac14 721 range frac14 7ndash16 years) when they first drank without parental knowledge

Over half of the drinkers estimated that they had drunk alcohol without their parentsrsquoknowledge on at least 13 separate occasions in total

Alcohol involvementThe majority of the lifetime drinkers (N frac14 467 917) had consumed alcohol during

the past 90 days and a third of the sample (175 324) reported that they had

purchased alcohol themselves from a bar or club during this period Table 1 summarizes

the frequency of drinking and scores on the dependent variables by gender In terms of

drinking frequency participants estimated that they had drunk alcohol on an average of175 days ( SD frac14 147) in the past 3 months with males tending to report frequent

drinking than females (187 days vs 16 days t frac14 204 p frac14 042) On average

participants consumed 47 units (47 ml by volume) on a typical drinking day and there

were no differences in drinking intensity between males and females (49 units vs 45

units respectively t frac14 0103 p frac14 302) As can be seen 285 of the cohort recalled

drinking six or more units on a typical day

In general beerlager was the most commonly used beverage (by 434) followed

by spirits (200) liqueurs (96) alcopops (88) and wine (59) Males tended to

prefer beerlager (691 vs 146 x2 frac14 15370 p 000) while females preferred

spirits (321 vs 93 x2 frac14 4111 p 000) liqueurs (175 vs 26 x2 frac14 3236

p 000) alcopops (133 vs 33 x2 frac14 1708 p 000) and wine (104 vs

19 x2 frac14 1675 p 000) In the past 3 months a similar profile of beverage

Table 1 Frequency and intensity of alcohol use in the past 90 days by gender (N frac14 467)

Males ()(N frac14 251)

Females()(N frac14 216)

Total()

Frequency of alcohol use in past 90 daysLess than monthly 17 (68) 19 (88) 36 (77)1ndash3 days per month 79 (315) 76 (352) 155 (332)One day per week 58 (231) 52 (241) 110 (236)2ndash3 days per week 82 (327) 64 (296) 146 (313)4ndash6 days per week 14 (56) 4 (19) 18 (39)Everyday 1 (04) 1 (05) 2 (04)

Units consumed on a typical drinking dayUp to 10 unit 11 (44) 15 (69) 26 (56)1ndash19 units 31 (124) 33 (153) 64 (137)2ndash39 units 78 (311) 59 (273) 137 (293)4ndash59 units 44 (175) 35 (162) 79 (169)6ndash99 units 56 (223) 38 (176) 94 (201)10 or more 20 (80) 19 (88) 39 (84)Number of drinking days90 (meanSD) 187 (155) 160 (137) 175 (147)Amount drunk on typical day (meanSD) 49 (36) 45 (38) 47 (37)

p 05

John Marsden et al436

preferences was recorded When asked what type of alcohol they had consumed

most often during the time 60 said beerlager 143 said spirits 18 said wine

and 58 said alcopops

Family factorsHalf of the sample (271 502) estimated that their mother generally drank alcohol at

least once a week and 704 (380) estimated that their father drank at least once a

week In terms of parental encouragement to drink around one quarter of the

sample estimated that they had often drunk alcohol at home with their parents in the

past year (129 239) although only 161 said that their parents had often bought

them an alcoholic drink at a restaurant or other establishment Conversely just 138

(255) of the sample said that their parents had actively discouraged them from

drinking in the past year The two 5-item scales assessing the extent to which parentsencouraged or discouraged drinking were approximately normally distributed and

had acceptable internal reliability The average total score on the parental

encouragement scale was 1363 ( SD frac14 501 Cronbachrsquos a frac14 77) and the average

total score on the parental discouragement scale was 888 ( SD frac14 367 a frac14 77)

While a fifth (203) of the sample reported that in the past 3 months they had never

drunk alcohol without the knowledge of their parents a quarter (N frac14 139) reported

that when they had recently drunk alcohol it was often or always without their

parentsrsquo knowledge

Psychological factorsThe average total score for the mood alteration function scale was 122

(median frac14 120) and it had acceptable internal reliability (a frac14 71) The most

commonly endorsed mood alteration function was drinking to relax (51 reporting

that they drank sometimes or more frequently for this reason) followed by drinking in

order to forget about a problem (endorsed by 34) The average total score for thesocial facilitation function scale was 114 (median frac14 110 a frac14 70) and the most

commonly endorsed social item was drinking to enjoy the company of friends (by 63)

followed by drinking to lose inhibitions (endorsed by 48) Scores on the GHQ-12

ranged from 0 to 34 with a mean of 121 (median frac14 110 a frac14 85) The sample were

equally likely to report positive and negative alcohol-related attitudes The mean scores

on these scales were 228 and 238 respectively (range frac14 13ndash39 and 13ndash34 a frac14 68

and a frac14 73)

Social and peer factorsJust under one half (246 483) estimated that a few of their friends were older than

them and a minority 64 (126) of the drinkers estimated that all or most of their

friends were at least 1 year older than them Two-fifths (N frac14 202) said that all of their

friends drank alcohol and a further 391 said that they believed most did so In the past

3 months two-thirds of the drinkers (338 664) reported that they typically spent time

with friendsacquaintances who were drinking at least once a week Just 68 individuals(134) estimated that this generally occurred less than once a month and a further

17 (33) said that they never spent time with friendsacquaintances who

were drinking A small proportion of the drinkers (79) considered that they

felt pressure from their peers to drink alcohol but the majority (578) did not feel

Adolescent drinking 437

this way and a further 193 indicated that they strongly disagreed that such pressure

was present in their social network

School conduct problemsIn the past year the majority of the drinkers (356 76) had received a detention afterschool or some other minor punishment There was also a minority (95 187) who

estimated that they found themselves in trouble with teachers once or twice each

month and a further small group who said that they received some form of disciplinary

action at school once a week (57 112) A quarter (138 256) reported that they had

had a fight with another student in the past year Just over a third (187 367) admitted

that they had been absent from school without authorization (truanted) at least once in

the past year and the average number of occasions on which this had occurred was 78

days ( SD frac14 150 days range frac14 05ndash80) Sixty-six students (122) had beentemporarily excluded from school in the past year

Regression of covariates of alcohol involvementThe two dependent variables were judged to be reasonably normally distributed and

were not transformed Following negative screening for multicollinearity within the

covariate set multiple regression analysis was performed separately for each of thefive blocks of covariates to assess their individual contribution to explaining variance in

the dependent variables A further regression was then performed in which all 26

covariates were entered simultaneously to calculate the overall level of variance

accounted for Table 2 presents the standardized regression coefficients (b) and the

overall R 2 for each block for these analyses

There was no significant association between age of first drink and recent drinking

although as predicted there was a positive association between feeling intoxicated after

drinking alcohol and both recent drinking frequency and intensity As predicted therewas a positive correlation between lifetime smoking and cannabis use and alcohol

involvement and this association was stronger for cannabis Among the set of

predictions concerning parents there was evidence for an association between the

frequency of parentsrsquo drinking for drinking intensity but this was in the anticipated

direction for the motherrsquos drinking only ( p 01) The frequency of the fatherrsquos

drinking was associated with drinking of lower intensity ( p 05)

As predicted there were significant positive associations between the extent that

parents encouraged drinking and both drinking frequency ( p 001) and intensity( p 01) Contrary to prediction there was a weak but positive relationship between

the extent that parents discouraged drinking and recent alcohol involvement ( p 05)

For the psychological factors there was support for the predicted association between

alcohol involvement and drinking for mood alteration functions ( p 001) but not to

fulfil social functions Higher scores on the GHQ-12 indicative of poorer psychological

well-being were negatively associated with drinking frequency only ( p 001)

Contrary to prediction there were no associations between the positive and negative

alcohol-related attitude scales with the exception of a significant association betweenpositive attitudes and recent drinking intensity ( p 05)

In the social and peer factors block there was evidence that personally buying

alcohol was associated with higher drinking intensity ( p 01) and drinking frequency

( p 001) There was rather weak supporting evidence for the relationship between

having older friends and more frequent drinking ( p 05) There were mixed findings

John Marsden et al438

concerning having more friends who drink spending time with friends who drink and

feeling under social pressure to drink The proportion of friends who drink was related

to intensity ( p 05) but not frequency There was a strong positive and consistent

relationship between spending time with friends who drink and drinking ( p 001)

and there were significant associations between perceived social pressure to drink and

Table 2 Standard multiple regression of background family psychological social and school factors on

recent alcohol involvement (N frac14 467)

Drinking frequency Drinking intensity

1 Background R 2 frac14 0211 R 2 frac14 0192Age 0100 0079Gender 098 0025School 1 100 100School 2 20024 20073School 3 0065 0012School 4 20065 20128School 5 0077 0101Age of first drink 20076 20044Ever intoxicated from alcohol 0591 1092Age first intoxicated on alcohol 20396 20899Ever smoked cigarettes 0155 0076Ever used cannabis 0160 0140

2 Family R 2 frac14 0141 R 2 frac14 0060Frequency of motherrsquos drinking 0052 0153Frequency of fatherrsquos drinking 0041 20121Extent parents encourage drinking 0231 0156Extent parents discourage drinking 0109 0094Drinking without parents knowledge 0280 0137

3 Psychological R 2 frac14 0156 R 2 frac14 0095Mood functions for drinking 0385 0307Social functions for drinking 20002 20068Psychological well-being 20116 20062Positive drinking attitudes 20050 0102Negative drinking attitudes 20014 0001

4 Social R 2 frac14 0322 R 2 frac14 0210Personally bought alcohol 0150 0131Proportion of older friends 0074 0090Proportion of friends who drink 0083 0094Time with friends drinking 0387 0307Perceived social pressure to drink 0148 0062

5 School R 2 frac14 0121 R 2 frac14 0144Been in trouble with teachers 0213 0212Had a fight with student at school 0054 0090Times truanted in past year 0155 0120Temporarily excluded in past year 0090 0152Overall R 2 frac14 0418 R 2 frac14 0339Adjusted R 2 frac14 0381 R 2 frac14 0290

frac14 p 05 frac14 p 01 frac14 p 001

Adolescent drinking 439

drinking frequency but not recent intensity There was a positive correlation between

more positive alcohol-related attitudes and high drinking intensity only ( p 05)

There were also mixed associations relating to school conduct problems and

drinking Being temporarily excluded from school and the number of times truanted

were positively related to recent frequency ( p 05 and p 001 respectively) and

recent intensity ( p 01) Having had a fight with another student with associated withrecent drinking intensity only ( p 05) while there was a strong positive and

consistent relationship between being in trouble with teachers and the both drinking

measures ( p 001)

In total the five blocks of factors explained 42 (38 adjusted) of the variance in

frequency of drinking scores and 34 (29 adjusted) of the variance in typical intensity

Taking the covariate blocks in turn the regression analysis indicated that the social and

peer factors had the strongest correlations (accounting for 32 and 21 of the variance

in drinking frequency and intensity respectively) For drinking frequency the strengthof association for the remaining factors was as follows background variables (21)

psychological factors (16) family factors (14) and school conduct problems (12)

The regression analysis for recent typical drinking intensity revealed a somewhat

contrasting pattern of predictors background variables (19) school conduct

problems (14) psychological factors (10) and family factors (6)

The dataset was then screened for the presence of moderation effects between

gender and each covariate Those variables (gender the covariate and their interaction)

that emerged as statistically significant were then entered into two regression equationsusing each of the dependent variables If the interaction term exerted a significant effect

on the dependent variable in this equation when its constituent parts were controlled

for this was taken as evidence of a moderation effect by gender The single interaction

term that was identified in this way was added to the covariate set in a backwards

stepwise regression equation controlling for gender and age This process resulted in a

final lsquotrimmed downrsquo regression model for the two dependent variables and is shown in

Table 3 The total proportions of variance in the dependent variables explained by the

final models were as follows 40 (38 adjusted) for drinking frequency( F12 441 frac14 2690 p 001) and 27 (26 adjusted) for drinking intensity

( F7 441 frac14 2316 p 001)

Drinking frequencyEleven covariates were retained in the model as significantly associated with recent

drinking frequency As can be seen most were from the family factors and social and

peer factors blocks Males tended to be more frequent drinkers than females(b frac14 0272) However the strongest predictor of frequency of alcohol use in the model

was the amount of time spent with friends who are drinking (b frac14 0316) Other

influential variables included the extent to which parents encourage (b frac14 0155) and

discourage (b frac14 20223) alcohol use with the latter association moderated by gender

More frequent parental discouragement to drink was related to more frequent drinking

in females and less frequent drinking frequency in males In a post hoc analysis the

parental discouragement scale items were entered into a regression equation This

showed that two items exerted an effect over and above the others lsquomy parents havetold me off because of drinking or buying alcoholrsquo and lsquomy parents have said that

I cannot drink alcohol at homersquo A positive relationship was also observed between

drinking more frequently without parentsrsquo knowledge and recent frequency of use

(b frac14 0110) Other independent influences on drinking frequency were higher mood

John Marsden et al440

alteration function scores (b frac14 0113) greater perceived social pressure to drink

alcohol (b frac14 0155) a history of temporary school exclusion (b frac14 0121) and more

frequent occasions of truanting from school in the past year (b frac14 0086)

Drinking intensityIn common with the final model for drinking frequency just five covariates were

retained in the regression equation for drinking intensity The amount of time spent with

friends who are drinking alcohol was the strongest predictor (b frac14 0319) This was

followed by having a history of school exclusion (b frac14 0197) and more frequently being

in trouble with teachers in the past year (b frac14 0142) Greater parental encouragement

to drink was associated with higher actual drinking intensity (b frac14 0124) Finally a

single background factor ndash lifetime use of cannabis ndash was associated with higher

drinking intensity (b frac14 0113)

Discussion

This report has presented first results from a cohort follow-up study of alcohol use

among a sample of mid-adolescents in England Baseline data on personal backgroundand demographics family psychological social factors and school conduct problems

were correlated with reports of recent drinking frequency and intensity As expected

regular drinking was the norm among the cohort 19 in 20 of the cohort had consumed a

whole alcoholic drink at some point in their lives and approximately 17 in 20 were

current drinkers This prevalence of alcohol use is comparable to that reported for the

Table 3 Stepwise multiple regression of background family psychological social and school factors on

recent alcohol involvement (N frac14 467)

Drinking frequencyR 2 frac14 0396

Drinking intensityR 2 frac14 0273

1 BackgroundAge 0033 0046Gender 0272 0004Ever smoked cannabis ndash 0113

2 FamilyExtent parents encourage drinking 0155 0124Extent parents discourage drinking 0223 ndashGender pound extent parents discourage drinkinga 0302 ndashDrinking without parents knowledge 0113 ndash

3 PsychologicalMood functions for drinking 0113 ndash

4 SocialPersonally bought alcohol 0118 ndashTime with friends who are drinking 0316 0319Perceived social pressure to drink 0155 ndash

5 SchoolIn trouble with teachers in past year ndash 0142Times truanted in past year 0086 ndashTemporarily excluded in past year 0121 0197

a frac14 interaction term frac14 p 05 frac14 p 01 frac14 p 001

Adolescent drinking 441

general adult population in the UK (Singleton Bumpstead OrsquoBrien Lee amp Meltzer

2001) and is also comparable to drinking levels reported for 15-year-olds in other

countries (eg Casswell Stewart Conolly amp Silva 1991 for New Zealand) In terms of

typical drinking intensity study participants estimated that they drank about five

standard units of alcohol on a typical day Although the government has not issued

recommended drinking levels for the under-18 s this level exceeds the safer drinkinglevels for adults as recommended by the English Department of Health (Department of

Health 1995) and is therefore a cause for concern A substantial proportion of the

sample also reported lifetime tobacco smoking (70) and use of cannabis (40) Despite

the fact that the study cohort was not generated using probability sampling techniques

it is reasonable to believe that it is unbiased The levels of drinking smoking and

cannabis use reported fell remarkably close to population estimates for this age group in

England (Goddard amp Higgins 2001 Becher et al 2001 Currie Hurrelmann

Settertobulte Smith amp Todd 2000) On school conduct characteristics the samplewas also broadly comparable to reports from national surveys (Miller amp Plant 1999)

The cohort was also comparable to the general population on school conduct problems

Thirty-seven percent admitted that they had truanted at least once in the past year and

this compares to 33 of boys who admitted truanting in the latest Office for National

Statistics school survey (Boreham amp Shaw 2001)

Drinking was well established within the social networks of the cohort The majority

reported that most or all of their friends drank alcohol and two-thirds of the drinkers

said that they typically spent time with friendsacquaintances who were drinking atleast once a week Two-thirds did not consider that they were under any peer pressure

to drink

In the UK alcopop beverages are well established in the drinks market (Clarke

2000) and concerns have been raised about the marketing of these products to younger

drinkers (Hughes et al 1997 McKeganey 1998) In our study males reported a limited

preference for these drinks and tended to favour beer and lager whereas females had a

greater preference for spirits alcopops wine and liqueurs Males were more frequent

drinkers but there were no gender differences in the amount of alcohol consumed ontypical day Previous studies on alcohol use have found that males drink more heavily

than their female peers (Goddard amp Higgins 2001 Miller amp Plant 1996) However as

alcohol use among school-age students approximately doubled between 1990 and 2000

(from 53 units in 1990 to 104 units in 2000) the gender gap in consumption has

narrowed (Goddard amp Higgins 2001) The drinking patterns of young females are of

concern given their greater vulnerability to alcohol-related harms (Goist amp Sutker 1985

Plant amp Plant 2001)

Correlates of drinking frequencyThe regression analyses were able to account for approximately 40 of the variance in

scores on the measure of drinking frequency There was no evidence for the hypothesized

negative relationship between age of first drink and recent drinking frequency although

there was a positive association with feeling intoxicated after drinking alcohol It is

however possible that the effect of earlier initiation to drinking is not seen until drinking

patterns have further developed This was observed in a longitudinal study in the USAreported by Hawkins et al (1997) In this study of a cohort of students who were

followed-up annually from age 10ndash11 to age 17ndash18 a younger age of alcohol initiation was

strongly related to a higher level of alcohol misuse at age 17ndash18 Consequently we will

assess the influence of age of alcohol initiation in further follow-ups

John Marsden et al442

Studies examining the putative relationship between lifetime smoking cannabis use

and recent drinking frequency suggest that earlier initiation to substance use mediates

peers alcohol involvement and parental drinking risk factors (eg Hawkins et al 1997)

However findings from research using twins suggests that the association between age

of onset of alcohol use and later problematic drinking may not be directly causal but

that age of onset and problematic drinking in later life are both associated with anunderlying vulnerability to behavioural problems (Prescott amp Kendler 1999)

There was no support for the predicted relationship between the frequency of

parental drinking and adolescent drinking frequency It must be acknowledged that

influence of parental drinking parental alcohol use norms and family environment and

relations are complex (Peterson et al 1994) Foxcroft and Lowe (1997) found that

increased drinking levels among 11ndash17-year-olds were linked to regular perceived

parental drinking while Casswell and her colleagues noted a positive association

between the frequency of drinking in early- to mid-adolescents and the frequency of

their mother and fatherrsquos drinking (Casswell et al 1991) Peterson et al showed thatclear communication by parents about their expectations of their childrenrsquos drinking

together with positive reinforcement for desired behaviours can reduce the impact of

parentrsquos drinking on adolescent alcohol use

Several studies have also noted a negative relationship between parental support

a positive family environment and feelings of connectedness and adolescent substance

use (Resnick et al 1997 Hops Davis amp Lewin 1999) The role that parental approval of

drinking has in predicting intensity of alcohol use in their children has also been

explored (eg Barnes amp Welte 1986) Wilks Callan and Austin (1989) found that the

fatherrsquos approval or disapproval of drinking behaviour predicted self-perception as adrinker in young males yet found no normative influences for females A gender

interaction in the present study also suggests a differential effect for discouraging

drinking More frequent parental discouragement to drink was related to more frequent

drinking in females and less frequent drinking in males This finding could indicate that

parents are more likely to disapprove of drinking in their daughters (and therefore

discourage alcohol use more strongly) than in their sons Alternatively it could point to a

tendency for girls to rebel more strongly against their parentsrsquo attitudes towards alcohol

use The direction of this relationship cannot be judged from the baseline data but our

post hoc item analysis does suggest that this effect may be due to parental reactions todrinking and proscriptions about drinking at home Future analyses of the longitudinal

data collected during the course of this study will examine this issue more closely

In the present analyses although frequency of mother and fathersrsquo alcohol use was

significantly related to drinking frequency these variables were not retained in the

regression analysis This suggests that other variables explain the relationship between

these factors Zhang Welte and Wieczorek (1999) found that the drinking behaviour of

each parent has a differential effect on their male offspring (aged 16ndash19 years) In their

study the fatherrsquos drinking but not their motherrsquos drinking affects their sons drinking

and closeness to the mother was a protective factor against adolescent drinking On theother hand male adolescent drinking increases if closeness to the mother is low and she

drinks excessively There appears to be no comparable effect for closeness to the father

and the fatherrsquos drinking

For the analysis of psychological measures there was an association in the predicted

direction between alcohol involvement and drinking for mood alteration functions but

not drinking to fulfil social functions Poorer psychological well-being was negatively

associated with drinking frequency only and contrary to our hypothesis there were no

Adolescent drinking 443

associations between the positive and negative alcohol-related attitude scales The

present results provide further evidence for the link between reasons or motives for

alcohol use and consumption patterns A strong relationship was observed between

increased frequency of drinking to serve mood alteration functions and increased

drinking frequency Our research group has also observed this effect among young

alcohol cannabis and ecstasy users (Boys et al 1999) These findings are consistentwith previous studies which have found a positive relationship between the number of

reasons for alcohol use and drinking frequency (Cooper Frone Russell amp Mudar 1995

Beck amp Treiman 1996 Bradizza Reifman amp Barnes 1999) For the social and peer

factors buying alcohol was as predicted associated with increased alcohol

involvement but there was only weak supporting evidence for an association with

having older friends There was a strong positive and consistent relationship between

spending time with friends who drink and perceived social pressure to drink and more

frequent drinking These independent social influences are interpreted in the context ofdeveloping peer relations and peer norms in which the majority of adolescents report

spending time with friends who are drinking as a recreational activity and where there

may be expectations to drink with the group sometimes to excessive levels (Iannotti

amp Bush 1992 Bahr Marcos amp Maughan 1995) Finally school conduct problems were

independently associated with drinking frequency with the number of times truanted

and being temporarily excluded having the strongest correlations Drinking more often

than other peers has been linked to more frequent unauthorized absences from school

(Currie et al 2000) Drinking smoking and drug use is also much more prevalentamong 12- to 15-year-olds who had ever truanted compared to those who had never

done so (Becher et al 2001)

Correlates of drinking intensityOverall 285 of the cohort typically drank six or more units on a drinking day which

can be taken to be a conservative indicator of underage binge drinking The regression

analyses were able to account for approximately 30 of the variance in drinkingintensity Age of first alcohol intoxication and lifetime smoking and cannabis use was

associated with more intense recent drinking For the family factors in contrast to

drinking frequency there was evidence for a positive association between how often

the mother usually drank alcohol and how much the adolescent drank on a drinking day

but contrary to prediction there was a negative association with the fatherrsquos drinking

It is possible that more frequent drinking by the father serves to discourage binge

drinking among mid-adolescents Nonetheless this effect was weak and was not

retained in the stepwise regression As predicted drinking to alter mood was associatedwith more intensive drinking but not with drinking for social facilitation functions This

effect however was not sufficiently strong to be retained in the stepwise regression

There was also a positive association between more favourable attitudes towards

alcohol and drinking intensity Among the social and peer factors a similar set of

associations was seen with the exception of perceived social pressure to drink

suggesting that mid-adolescents do not feel that the amount they consume is influenced

by their peers Finally the school conduct factors were quite strongly associated with

more intensive drinking and being in trouble with teachers and having beingtemporarily excluded had the strongest associations

The links between binge drinking and school conduct problems are a concern and

elsewhere studies have shown that binge drinking is related to poorer actual educational

performance (Newcomb Measham amp Parker 1995) Clinical diagnostic criteria for

John Marsden et al444

alcohol abuse recognize that recurrent drinking can result in school performance

problems and expulsions (American Psychiatric Association 1994) and the trajectory of

those experiencing school problems will be a focus of subsequent analyses of further

follow-up in the study The finding that lifetime use of cannabis was independently

associated with more intensive drinking is supportive of other work that argues that

those adolescents who use substances tend to have other attributes that increase therisk of poor psychosocial adjustment and school performance For example Jessor

Chase and Donovan (1980) argued that the reason that cannabis users tend to be less

well adjusted is that cannabis use is a general characteristic of individuals who are

predisposed to behavioural problems Furthermore Fergusson Lynskey and Horwood

(1997) suggested that instead of early cannabis use having a causal link with poor

psychosocial adjustment this association could be explained by family and other factors

that related to cannabis use Other alternative explanations include those proposed by

Kandel and colleagues They argue that early substance use sets into motion a chain ofevents which result in greater subsequent drug involvement and a range of other

negative psychosocial consequences (Kandel Davies Karus amp Yamaguchi 1986)

Again the causal direction of this relationship cannot be judged from the baseline data

but will be examined in more detail in subsequent reports on the longitudinal data

Strengths and limitations of the studyThe main strength of the present study was the analysis of the multiple influences on

drinking behaviour Studies of this kind have been rare in the UK but are encouraged as

good opportunities to gain an understanding of how early use of alcohol smoking and

other substance involvement evolves across the adolescent years (Edwards et al 1994

Duncan Duncan amp Hops 1998) Several limitations of the present study are also

acknowledged Given the reliance on self-report it is difficult to judge the reliability ofthe data and the findings should be interpreted with caution Nevertheless steps were

taken to maximize the privacy of the recruitment interviews to emphasize the

confidentiality of the study and the interviews were all conducted by young adults

Overall it has been argued that it is better to collect social survey data on this age group

at school than in the home (Becher et al 2001)

Implications for school-based alcohol educationThese results underline the importance of addressing personal family peer and school

conduct factors as part of alcohol education and problem prevention initiatives Theidentified correlates of drinking involvement in the present study could be usefully

taken up and discussed with students as part of alcohol education and prevention

programmes Elsewhere it has been argued that the main goal of school prevention

programmes should be to delay alcohol initiation (DeWit et al 2000 Griffin Botvin

Epstein Doyle amp Diaz 2000) However the very early age of onset in the UK suggests

that educational approaches based on harm minimization may be more realistic Recent

work in Australia has indicated that a harm minimization approach to alcohol education

together with adult supervision of initial drinking experiences can help to reduce theharms associated with alcohol use in young people (McBride Midford Farringdon amp

Phillips 2000b) Research into the merits of adopting a harm minimization approach to

alcohol education in schools has highlighted the importance of ensuring that

programme content and materials are relevant to local patterns of behaviour and are

Adolescent drinking 445

based on experiences that are relevant to the target audience (McBride Farringdon amp

Midford 2000a Dusenbury amp Falco 1995)

The potential feasibility and benefits of including parents as part of education

programmes in school should be examined The possibility of encouraging parents to

consider how their own behaviour and attitudes towards drinking might influence the

choices regarding alcohol use that are made by their offspring should be explored

Given the high prevalence of drinking involvement in mid-adolescence understanding

the influences on the further development of drinking attitudes and behaviours is of

critical importance Further reports from the study will describe the associations

between risky and heavy drinking patterns and alcohol-related problems and

developmental transitions to heavier consumption patterns as the cohort reaches the

period of late-adolescence

Acknowledgements

We would like to thank the students and staff from each school for their kind and enthusiastic

participation in the study The study was supported by a research grant from the LloydsTSB

charitable trust and conducted in association with Alcohol Concern

References

American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders

(4th ed) Washington DC APA

Anderson K Plant M amp Plant M (1998) Associations between drinking smoking and illicit

drug use among adolescents in the Western Isles of Scotland Implications for harm

minimization Journal of Substance Misuse 3 13ndash20

Ary D V Tildesley E Hops H amp Andrews J (1993) The influence of parent sibling and peer

modelling and attitudes on adolescent use of alcohol International Journal of Addiction 28

853ndash880

Bahr S J Marcos A C amp Maughan S L (1995) Family educational and peer influences on the

alcohol use of female and male adolescents Journal of Studies on Alcohol 56 457ndash469

Barnes G (1990) Impact of the family on adolescent drinking patterns In R Collins K Leonard

amp J Searles (Eds) Alcohol and the family Research and clinical perspectives (pp 137ndash161)

New York Guilford Press

Barnes G amp Welte J (1986) Patterns and predictors of alcohol use among 7ndash12th grade students

in New York State Journal of Studies on Alcohol 47 53ndash62

Becher H Boreham R Emery P Hinds K Jamison J amp Schagen I (2001) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Beck K H amp Treiman K A (1996) The relationship of social context of drinking perceived

social norms and parental influence to various drinking patterns of adolescents Addictive

Behaviors 21 633ndash644

Blenkinsop S Boreham R McManus S Natarajan L amp Prescott A (2003) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Blum R W Beuhring T amp Rinehart P M (2000) Protecting teens Beyond race income and

family structure Minneapolis MN Center for Adolescent Health University of Minnesota

Bonomo Y Coffey C Wolfe R Lynskey M Bowes G amp Patton G (2001) Adverse outcomes

of alcohol use in adolescents Addiction 96 1485ndash1496

Boreham R amp Shaw (2001) Smoking drinking and drug use among young people in England

in 2000 London The Stationery Office

John Marsden et al446

spanned lifetime occurrences the past 12 months and the past 3 months (90 days) The

nature and coding structure of measures is described below while information about the

internal reliability of scales is presented in the results

Personaldemographic information and background factorsEight measures were used to characterize the personaldemographic background of

each participant (a) age (b) gender (coded male frac14 1 and female frac14 0) (c) school

recruitment site (dummy coded using school 1 as a nominal reference) (d) age of first

drink (e) whether ever intoxicated on alcohol (coded as no frac14 0 yes frac14 1) and (f) age

first intoxicated on alcohol (defined for the participants as lsquofeeling unsteady on your

feet or slurring your words or feeling dizzy or unwellrsquo) (g) lifetime use of cigarettes

and (h) lifetime use of cannabis (both coded no frac14 0 yes frac14 1)

Recent alcohol involvementIt was judged important to record both how often the participants recalled drinking in

the past 3 months and how much they consumed on a day when they consumed

alcohol (drinking intensity) These two measures which serve as the dependent

variables for the present report were not significantly correlated ( r frac14 15 ns) and

capture different and distinct alcohol use behaviours which are important when

characterizing drinking patterns and how these change over time Researchers in thisfield generally use 24 hour (day) intervals to serve as basic units of drinking frequency

The method of recording drinking frequency and intensity was adapted from the

Maudsley Addiction Profile a standardized multidimensional research instrument for

assessing substance-related behaviours (Marsden et al 1998) Each participant was first

asked to estimate the number of days on which they had consumed alcohol during the

past 3 months assisted by a prompt card listing nine categories (never less than once

every 2 months once every 2 months once every month two times a month 1 day per

week 2ndash3 days a week 4ndash5 days a week 6ndash7 days a week scored 0ndash8 and subsequentlymultiplied to total the number of days out of 90) If none of these categories closely

matched experience the participant was helped to calculate the specific number of

drinking days This can sometimes happen when a research respondent has a more

episodic pattern of drinking Then drinking intensity was estimated by recording the

number of drinks consumed during an average or typical drinking day in the past 3

months Responses to this question were recorded as verbatim reports of the number of

drinks consumed by beverage and brand type and were then converted as standard units

of alcohol at the data management stage

Family factorsQuestions on family factors that might influence adolescent drinking related to the

participantsrsquo estimates of parentsrsquo drinking the extent to which their parents

sanctioned their drinking and the extent that participants reported unsupervised

drinking without their parentsrsquo knowledge Five measures were recorded (a) two

7-point summary indices of the perceived usual frequency of the motherrsquos and fatherrsquosdrinking frequency (never to every day scored 0ndash6) (B) a 5-item scale to assess the

extent to which parents encouraged the participant to drink in the past year (offered

sondaughter a drink at home bought alcohol at a restaurant or another establishment

drunk an alcoholic drink with sondaughter at home drunk an alcoholic drink with

Adolescent drinking 433

sondaughter at another setting and allowed drinking at home) using a 5-point Likert-

type response (never to very often scored 0ndash4) (c) a 5-item scale coded to assess the

extent to which parents discouraged drinking in the past year (warning sondaughter of

the health risks of drinking parents saying they should not drink being punished by

parents for drinking parents saying that sondaughter cannot drink at home and being

reprimanded for buying alcohol (never to very often scored 0ndash4) and (d) a 9-pointindex of the number of occasions the participant recalled consuming an alcoholic drink

without their parentrsquos knowledge (never once twice 3ndash5 times 6ndash12 times 13ndash23

times 24ndash50 times 51ndash100 times and more than 100 times scored 0ndash8)

Psychological factorsQuestions in the block of psychological factors focused on personal influences and

correlates on alcohol use and included specific reasons for drinking generalpsychological health and alcohol-related attitudes Four measures were taken (a) a

6-item mood alteration functions scale developed by Boys et al (1999) was used to

assess how often participants had consumed alcohol in the past year for the following

personal reasons to relax to feel better when low or depressed to feel closer to

someone to stop worrying about a problem to get to sleep and simply to get drunk

(never to always scored 0ndash4) (B) a 5-item social functions scale also developed by

Boys et al to assess the extent that the participant had used alcohol in the past year for

the following social reasons to let go of inhibitions when socializing to feel moreconfident in a social situation to make an activity more enjoyable to help enjoy the

company of friends and to feel more confident when having sex (scored as above)

(c) the 12-item form of the General Health Questionnaire to assess psychological well-

being with each question scored using the Likert scale response coding (GHQ-12

Goldberg amp Williams 1988) and (d) two 9-item attitude scales adapted from items

used by Plant Peck and Samuel (1985) to assess positive drinking attitudes (eg young

people who drink regularly are attractive to the opposite sex coded as strongly agree

to strongly disagree scored 1ndash5)

Social and peer factorsFive measures were developed for the study to examine the relationships between

purchasing drinks and the influence of peers on alcohol involvement Five measures

were used (a) whether the participant had ever bought alcohol for personal use from a

shop or a barpub (scored no frac14 0 yes frac14 1) (b) the proportion of the participants

current friends who were older by 1 or more years (none to all scored 0ndash4) (c) theproportion of friends who were believed to drink alcohol (none to all scored 0ndash4)

(d) an index of how often the participant had spent time with friends and acquaintances

who were drinking in the past 3 months (never to 6ndash7 days a week scored 0ndash9) and

(e) an index of the extent that the participant perceived that they had felt under social

pressure to drink (coded as strongly agree to strongly disagree scored 1ndash5)

School conduct problemsFinally a block of four measures to record school conduct problems in the past year

A block of four items recording aspects of school life was taken from the youth form of

the Life Stressors and Social Resources Inventory (Moos amp Moos 1994) as follows (a) the

frequency that the participant had been in trouble with teachers and had been detained

John Marsden et al434

after school or received other sorts of punishment (never to every day scored 0ndash8)

(b) whether the participant had been in a fight with a student at school (scored no frac14 0

yes frac14 1) (c) the number of times the participant had truanted from school (defined as

not attending for a whole school day or leaving immediately after the morning class

registration) and (d) whether or not the respondent had been temporarily excluded

from school for disciplinary problems (scored no frac14 0 yes frac14 1)

Statistical analysisThe relationship between alcohol involvement and background family social and peer

and school conduct factors was investigated using multiple linear regression in twostages First two standard regression analyses were computed for drinking frequency and

intensity using the 26 items and scale measures described above in the five domains and

were regressed separately on the dependent variables in each domain and then again

simultaneously to assess overall levels of variance accounted for (Tabachnik amp Fidell

2001) This analysis was used to test the research hypotheses Second two stepwise

regression analyses with backwards elimination of covariates were computed to isolate a

set of independent predictors of drinking frequency and intensity and to explore the

strength of association for adjusted covariates and any identified gender interactions

Results

Sample characteristicsA cohort of 540 students was recruited (515 male) The average age was 154 years(381 [706] were 15 and 159 [294] were 16 years) There were no differences in the

proportion of males and females ( x2 frac14 515 p frac14 272) or number in the 15 and 16 year

age groups (x2 frac14 453 p frac14 340) between the samples from the five schools There

were also no differences in the proportion of males and females recruited compared

with the remainder of the Year 11 cohort in each school (x2 ranged from 003 to 116

p frac14 89ndash 28)

The majority of the sample described themselves as White-UK (954) while 19

were Caribbean or Black British 13 were South Asian and the remainder were MiddleEastern South East Asian or described themselves to be of mixed race Approximately

half (485) considered that they had no religious affiliation 157 reported they were

affiliated to the Church of England and 281 described themselves as Christian with no

specification Two-thirds (687) were living with both of their natural parents In terms

of living arrangements four-fifths (809) reported that their parents or guardians

owned their residence 111 were living in local authority owned housing and the

remainder were living in privately rented premises (74)

Prevalence of alcohol and other substance useThe majority of the sample (943) had consumed a whole alcoholic drink at some point

in their lives Lifetime use of tobacco products (cigarettes) was high (377 698)

particularly among females (748 vs 651 x2 frac14 602 p frac14 014) Some 404 (218) ofthe cohort reported using cannabis at some point in their lives but less than 1 in 10

reported lifetime use of other illegal drugs On average the participants estimated that

they were 124 years old when they first drank a whole alcoholic drink

( SD frac14 19 range frac14 3ndash16 years) Four-fifths of the drinkers (N frac14 407) reported that

Adolescent drinking 435

they had had experience of being intoxicated by alcohol Males reported an earlier age

of first being intoxicated after drinking than females (136 vs 138 years t frac14 2229

p 05) All of the drinkers reported that they had drunk alcohol without the

knowledge of their parents on at least one occasion On average they were 14 years old

( SD frac14 721 range frac14 7ndash16 years) when they first drank without parental knowledge

Over half of the drinkers estimated that they had drunk alcohol without their parentsrsquoknowledge on at least 13 separate occasions in total

Alcohol involvementThe majority of the lifetime drinkers (N frac14 467 917) had consumed alcohol during

the past 90 days and a third of the sample (175 324) reported that they had

purchased alcohol themselves from a bar or club during this period Table 1 summarizes

the frequency of drinking and scores on the dependent variables by gender In terms of

drinking frequency participants estimated that they had drunk alcohol on an average of175 days ( SD frac14 147) in the past 3 months with males tending to report frequent

drinking than females (187 days vs 16 days t frac14 204 p frac14 042) On average

participants consumed 47 units (47 ml by volume) on a typical drinking day and there

were no differences in drinking intensity between males and females (49 units vs 45

units respectively t frac14 0103 p frac14 302) As can be seen 285 of the cohort recalled

drinking six or more units on a typical day

In general beerlager was the most commonly used beverage (by 434) followed

by spirits (200) liqueurs (96) alcopops (88) and wine (59) Males tended to

prefer beerlager (691 vs 146 x2 frac14 15370 p 000) while females preferred

spirits (321 vs 93 x2 frac14 4111 p 000) liqueurs (175 vs 26 x2 frac14 3236

p 000) alcopops (133 vs 33 x2 frac14 1708 p 000) and wine (104 vs

19 x2 frac14 1675 p 000) In the past 3 months a similar profile of beverage

Table 1 Frequency and intensity of alcohol use in the past 90 days by gender (N frac14 467)

Males ()(N frac14 251)

Females()(N frac14 216)

Total()

Frequency of alcohol use in past 90 daysLess than monthly 17 (68) 19 (88) 36 (77)1ndash3 days per month 79 (315) 76 (352) 155 (332)One day per week 58 (231) 52 (241) 110 (236)2ndash3 days per week 82 (327) 64 (296) 146 (313)4ndash6 days per week 14 (56) 4 (19) 18 (39)Everyday 1 (04) 1 (05) 2 (04)

Units consumed on a typical drinking dayUp to 10 unit 11 (44) 15 (69) 26 (56)1ndash19 units 31 (124) 33 (153) 64 (137)2ndash39 units 78 (311) 59 (273) 137 (293)4ndash59 units 44 (175) 35 (162) 79 (169)6ndash99 units 56 (223) 38 (176) 94 (201)10 or more 20 (80) 19 (88) 39 (84)Number of drinking days90 (meanSD) 187 (155) 160 (137) 175 (147)Amount drunk on typical day (meanSD) 49 (36) 45 (38) 47 (37)

p 05

John Marsden et al436

preferences was recorded When asked what type of alcohol they had consumed

most often during the time 60 said beerlager 143 said spirits 18 said wine

and 58 said alcopops

Family factorsHalf of the sample (271 502) estimated that their mother generally drank alcohol at

least once a week and 704 (380) estimated that their father drank at least once a

week In terms of parental encouragement to drink around one quarter of the

sample estimated that they had often drunk alcohol at home with their parents in the

past year (129 239) although only 161 said that their parents had often bought

them an alcoholic drink at a restaurant or other establishment Conversely just 138

(255) of the sample said that their parents had actively discouraged them from

drinking in the past year The two 5-item scales assessing the extent to which parentsencouraged or discouraged drinking were approximately normally distributed and

had acceptable internal reliability The average total score on the parental

encouragement scale was 1363 ( SD frac14 501 Cronbachrsquos a frac14 77) and the average

total score on the parental discouragement scale was 888 ( SD frac14 367 a frac14 77)

While a fifth (203) of the sample reported that in the past 3 months they had never

drunk alcohol without the knowledge of their parents a quarter (N frac14 139) reported

that when they had recently drunk alcohol it was often or always without their

parentsrsquo knowledge

Psychological factorsThe average total score for the mood alteration function scale was 122

(median frac14 120) and it had acceptable internal reliability (a frac14 71) The most

commonly endorsed mood alteration function was drinking to relax (51 reporting

that they drank sometimes or more frequently for this reason) followed by drinking in

order to forget about a problem (endorsed by 34) The average total score for thesocial facilitation function scale was 114 (median frac14 110 a frac14 70) and the most

commonly endorsed social item was drinking to enjoy the company of friends (by 63)

followed by drinking to lose inhibitions (endorsed by 48) Scores on the GHQ-12

ranged from 0 to 34 with a mean of 121 (median frac14 110 a frac14 85) The sample were

equally likely to report positive and negative alcohol-related attitudes The mean scores

on these scales were 228 and 238 respectively (range frac14 13ndash39 and 13ndash34 a frac14 68

and a frac14 73)

Social and peer factorsJust under one half (246 483) estimated that a few of their friends were older than

them and a minority 64 (126) of the drinkers estimated that all or most of their

friends were at least 1 year older than them Two-fifths (N frac14 202) said that all of their

friends drank alcohol and a further 391 said that they believed most did so In the past

3 months two-thirds of the drinkers (338 664) reported that they typically spent time

with friendsacquaintances who were drinking at least once a week Just 68 individuals(134) estimated that this generally occurred less than once a month and a further

17 (33) said that they never spent time with friendsacquaintances who

were drinking A small proportion of the drinkers (79) considered that they

felt pressure from their peers to drink alcohol but the majority (578) did not feel

Adolescent drinking 437

this way and a further 193 indicated that they strongly disagreed that such pressure

was present in their social network

School conduct problemsIn the past year the majority of the drinkers (356 76) had received a detention afterschool or some other minor punishment There was also a minority (95 187) who

estimated that they found themselves in trouble with teachers once or twice each

month and a further small group who said that they received some form of disciplinary

action at school once a week (57 112) A quarter (138 256) reported that they had

had a fight with another student in the past year Just over a third (187 367) admitted

that they had been absent from school without authorization (truanted) at least once in

the past year and the average number of occasions on which this had occurred was 78

days ( SD frac14 150 days range frac14 05ndash80) Sixty-six students (122) had beentemporarily excluded from school in the past year

Regression of covariates of alcohol involvementThe two dependent variables were judged to be reasonably normally distributed and

were not transformed Following negative screening for multicollinearity within the

covariate set multiple regression analysis was performed separately for each of thefive blocks of covariates to assess their individual contribution to explaining variance in

the dependent variables A further regression was then performed in which all 26

covariates were entered simultaneously to calculate the overall level of variance

accounted for Table 2 presents the standardized regression coefficients (b) and the

overall R 2 for each block for these analyses

There was no significant association between age of first drink and recent drinking

although as predicted there was a positive association between feeling intoxicated after

drinking alcohol and both recent drinking frequency and intensity As predicted therewas a positive correlation between lifetime smoking and cannabis use and alcohol

involvement and this association was stronger for cannabis Among the set of

predictions concerning parents there was evidence for an association between the

frequency of parentsrsquo drinking for drinking intensity but this was in the anticipated

direction for the motherrsquos drinking only ( p 01) The frequency of the fatherrsquos

drinking was associated with drinking of lower intensity ( p 05)

As predicted there were significant positive associations between the extent that

parents encouraged drinking and both drinking frequency ( p 001) and intensity( p 01) Contrary to prediction there was a weak but positive relationship between

the extent that parents discouraged drinking and recent alcohol involvement ( p 05)

For the psychological factors there was support for the predicted association between

alcohol involvement and drinking for mood alteration functions ( p 001) but not to

fulfil social functions Higher scores on the GHQ-12 indicative of poorer psychological

well-being were negatively associated with drinking frequency only ( p 001)

Contrary to prediction there were no associations between the positive and negative

alcohol-related attitude scales with the exception of a significant association betweenpositive attitudes and recent drinking intensity ( p 05)

In the social and peer factors block there was evidence that personally buying

alcohol was associated with higher drinking intensity ( p 01) and drinking frequency

( p 001) There was rather weak supporting evidence for the relationship between

having older friends and more frequent drinking ( p 05) There were mixed findings

John Marsden et al438

concerning having more friends who drink spending time with friends who drink and

feeling under social pressure to drink The proportion of friends who drink was related

to intensity ( p 05) but not frequency There was a strong positive and consistent

relationship between spending time with friends who drink and drinking ( p 001)

and there were significant associations between perceived social pressure to drink and

Table 2 Standard multiple regression of background family psychological social and school factors on

recent alcohol involvement (N frac14 467)

Drinking frequency Drinking intensity

1 Background R 2 frac14 0211 R 2 frac14 0192Age 0100 0079Gender 098 0025School 1 100 100School 2 20024 20073School 3 0065 0012School 4 20065 20128School 5 0077 0101Age of first drink 20076 20044Ever intoxicated from alcohol 0591 1092Age first intoxicated on alcohol 20396 20899Ever smoked cigarettes 0155 0076Ever used cannabis 0160 0140

2 Family R 2 frac14 0141 R 2 frac14 0060Frequency of motherrsquos drinking 0052 0153Frequency of fatherrsquos drinking 0041 20121Extent parents encourage drinking 0231 0156Extent parents discourage drinking 0109 0094Drinking without parents knowledge 0280 0137

3 Psychological R 2 frac14 0156 R 2 frac14 0095Mood functions for drinking 0385 0307Social functions for drinking 20002 20068Psychological well-being 20116 20062Positive drinking attitudes 20050 0102Negative drinking attitudes 20014 0001

4 Social R 2 frac14 0322 R 2 frac14 0210Personally bought alcohol 0150 0131Proportion of older friends 0074 0090Proportion of friends who drink 0083 0094Time with friends drinking 0387 0307Perceived social pressure to drink 0148 0062

5 School R 2 frac14 0121 R 2 frac14 0144Been in trouble with teachers 0213 0212Had a fight with student at school 0054 0090Times truanted in past year 0155 0120Temporarily excluded in past year 0090 0152Overall R 2 frac14 0418 R 2 frac14 0339Adjusted R 2 frac14 0381 R 2 frac14 0290

frac14 p 05 frac14 p 01 frac14 p 001

Adolescent drinking 439

drinking frequency but not recent intensity There was a positive correlation between

more positive alcohol-related attitudes and high drinking intensity only ( p 05)

There were also mixed associations relating to school conduct problems and

drinking Being temporarily excluded from school and the number of times truanted

were positively related to recent frequency ( p 05 and p 001 respectively) and

recent intensity ( p 01) Having had a fight with another student with associated withrecent drinking intensity only ( p 05) while there was a strong positive and

consistent relationship between being in trouble with teachers and the both drinking

measures ( p 001)

In total the five blocks of factors explained 42 (38 adjusted) of the variance in

frequency of drinking scores and 34 (29 adjusted) of the variance in typical intensity

Taking the covariate blocks in turn the regression analysis indicated that the social and

peer factors had the strongest correlations (accounting for 32 and 21 of the variance

in drinking frequency and intensity respectively) For drinking frequency the strengthof association for the remaining factors was as follows background variables (21)

psychological factors (16) family factors (14) and school conduct problems (12)

The regression analysis for recent typical drinking intensity revealed a somewhat

contrasting pattern of predictors background variables (19) school conduct

problems (14) psychological factors (10) and family factors (6)

The dataset was then screened for the presence of moderation effects between

gender and each covariate Those variables (gender the covariate and their interaction)

that emerged as statistically significant were then entered into two regression equationsusing each of the dependent variables If the interaction term exerted a significant effect

on the dependent variable in this equation when its constituent parts were controlled

for this was taken as evidence of a moderation effect by gender The single interaction

term that was identified in this way was added to the covariate set in a backwards

stepwise regression equation controlling for gender and age This process resulted in a

final lsquotrimmed downrsquo regression model for the two dependent variables and is shown in

Table 3 The total proportions of variance in the dependent variables explained by the

final models were as follows 40 (38 adjusted) for drinking frequency( F12 441 frac14 2690 p 001) and 27 (26 adjusted) for drinking intensity

( F7 441 frac14 2316 p 001)

Drinking frequencyEleven covariates were retained in the model as significantly associated with recent

drinking frequency As can be seen most were from the family factors and social and

peer factors blocks Males tended to be more frequent drinkers than females(b frac14 0272) However the strongest predictor of frequency of alcohol use in the model

was the amount of time spent with friends who are drinking (b frac14 0316) Other

influential variables included the extent to which parents encourage (b frac14 0155) and

discourage (b frac14 20223) alcohol use with the latter association moderated by gender

More frequent parental discouragement to drink was related to more frequent drinking

in females and less frequent drinking frequency in males In a post hoc analysis the

parental discouragement scale items were entered into a regression equation This

showed that two items exerted an effect over and above the others lsquomy parents havetold me off because of drinking or buying alcoholrsquo and lsquomy parents have said that

I cannot drink alcohol at homersquo A positive relationship was also observed between

drinking more frequently without parentsrsquo knowledge and recent frequency of use

(b frac14 0110) Other independent influences on drinking frequency were higher mood

John Marsden et al440

alteration function scores (b frac14 0113) greater perceived social pressure to drink

alcohol (b frac14 0155) a history of temporary school exclusion (b frac14 0121) and more

frequent occasions of truanting from school in the past year (b frac14 0086)

Drinking intensityIn common with the final model for drinking frequency just five covariates were

retained in the regression equation for drinking intensity The amount of time spent with

friends who are drinking alcohol was the strongest predictor (b frac14 0319) This was

followed by having a history of school exclusion (b frac14 0197) and more frequently being

in trouble with teachers in the past year (b frac14 0142) Greater parental encouragement

to drink was associated with higher actual drinking intensity (b frac14 0124) Finally a

single background factor ndash lifetime use of cannabis ndash was associated with higher

drinking intensity (b frac14 0113)

Discussion

This report has presented first results from a cohort follow-up study of alcohol use

among a sample of mid-adolescents in England Baseline data on personal backgroundand demographics family psychological social factors and school conduct problems

were correlated with reports of recent drinking frequency and intensity As expected

regular drinking was the norm among the cohort 19 in 20 of the cohort had consumed a

whole alcoholic drink at some point in their lives and approximately 17 in 20 were

current drinkers This prevalence of alcohol use is comparable to that reported for the

Table 3 Stepwise multiple regression of background family psychological social and school factors on

recent alcohol involvement (N frac14 467)

Drinking frequencyR 2 frac14 0396

Drinking intensityR 2 frac14 0273

1 BackgroundAge 0033 0046Gender 0272 0004Ever smoked cannabis ndash 0113

2 FamilyExtent parents encourage drinking 0155 0124Extent parents discourage drinking 0223 ndashGender pound extent parents discourage drinkinga 0302 ndashDrinking without parents knowledge 0113 ndash

3 PsychologicalMood functions for drinking 0113 ndash

4 SocialPersonally bought alcohol 0118 ndashTime with friends who are drinking 0316 0319Perceived social pressure to drink 0155 ndash

5 SchoolIn trouble with teachers in past year ndash 0142Times truanted in past year 0086 ndashTemporarily excluded in past year 0121 0197

a frac14 interaction term frac14 p 05 frac14 p 01 frac14 p 001

Adolescent drinking 441

general adult population in the UK (Singleton Bumpstead OrsquoBrien Lee amp Meltzer

2001) and is also comparable to drinking levels reported for 15-year-olds in other

countries (eg Casswell Stewart Conolly amp Silva 1991 for New Zealand) In terms of

typical drinking intensity study participants estimated that they drank about five

standard units of alcohol on a typical day Although the government has not issued

recommended drinking levels for the under-18 s this level exceeds the safer drinkinglevels for adults as recommended by the English Department of Health (Department of

Health 1995) and is therefore a cause for concern A substantial proportion of the

sample also reported lifetime tobacco smoking (70) and use of cannabis (40) Despite

the fact that the study cohort was not generated using probability sampling techniques

it is reasonable to believe that it is unbiased The levels of drinking smoking and

cannabis use reported fell remarkably close to population estimates for this age group in

England (Goddard amp Higgins 2001 Becher et al 2001 Currie Hurrelmann

Settertobulte Smith amp Todd 2000) On school conduct characteristics the samplewas also broadly comparable to reports from national surveys (Miller amp Plant 1999)

The cohort was also comparable to the general population on school conduct problems

Thirty-seven percent admitted that they had truanted at least once in the past year and

this compares to 33 of boys who admitted truanting in the latest Office for National

Statistics school survey (Boreham amp Shaw 2001)

Drinking was well established within the social networks of the cohort The majority

reported that most or all of their friends drank alcohol and two-thirds of the drinkers

said that they typically spent time with friendsacquaintances who were drinking atleast once a week Two-thirds did not consider that they were under any peer pressure

to drink

In the UK alcopop beverages are well established in the drinks market (Clarke

2000) and concerns have been raised about the marketing of these products to younger

drinkers (Hughes et al 1997 McKeganey 1998) In our study males reported a limited

preference for these drinks and tended to favour beer and lager whereas females had a

greater preference for spirits alcopops wine and liqueurs Males were more frequent

drinkers but there were no gender differences in the amount of alcohol consumed ontypical day Previous studies on alcohol use have found that males drink more heavily

than their female peers (Goddard amp Higgins 2001 Miller amp Plant 1996) However as

alcohol use among school-age students approximately doubled between 1990 and 2000

(from 53 units in 1990 to 104 units in 2000) the gender gap in consumption has

narrowed (Goddard amp Higgins 2001) The drinking patterns of young females are of

concern given their greater vulnerability to alcohol-related harms (Goist amp Sutker 1985

Plant amp Plant 2001)

Correlates of drinking frequencyThe regression analyses were able to account for approximately 40 of the variance in

scores on the measure of drinking frequency There was no evidence for the hypothesized

negative relationship between age of first drink and recent drinking frequency although

there was a positive association with feeling intoxicated after drinking alcohol It is

however possible that the effect of earlier initiation to drinking is not seen until drinking

patterns have further developed This was observed in a longitudinal study in the USAreported by Hawkins et al (1997) In this study of a cohort of students who were

followed-up annually from age 10ndash11 to age 17ndash18 a younger age of alcohol initiation was

strongly related to a higher level of alcohol misuse at age 17ndash18 Consequently we will

assess the influence of age of alcohol initiation in further follow-ups

John Marsden et al442

Studies examining the putative relationship between lifetime smoking cannabis use

and recent drinking frequency suggest that earlier initiation to substance use mediates

peers alcohol involvement and parental drinking risk factors (eg Hawkins et al 1997)

However findings from research using twins suggests that the association between age

of onset of alcohol use and later problematic drinking may not be directly causal but

that age of onset and problematic drinking in later life are both associated with anunderlying vulnerability to behavioural problems (Prescott amp Kendler 1999)

There was no support for the predicted relationship between the frequency of

parental drinking and adolescent drinking frequency It must be acknowledged that

influence of parental drinking parental alcohol use norms and family environment and

relations are complex (Peterson et al 1994) Foxcroft and Lowe (1997) found that

increased drinking levels among 11ndash17-year-olds were linked to regular perceived

parental drinking while Casswell and her colleagues noted a positive association

between the frequency of drinking in early- to mid-adolescents and the frequency of

their mother and fatherrsquos drinking (Casswell et al 1991) Peterson et al showed thatclear communication by parents about their expectations of their childrenrsquos drinking

together with positive reinforcement for desired behaviours can reduce the impact of

parentrsquos drinking on adolescent alcohol use

Several studies have also noted a negative relationship between parental support

a positive family environment and feelings of connectedness and adolescent substance

use (Resnick et al 1997 Hops Davis amp Lewin 1999) The role that parental approval of

drinking has in predicting intensity of alcohol use in their children has also been

explored (eg Barnes amp Welte 1986) Wilks Callan and Austin (1989) found that the

fatherrsquos approval or disapproval of drinking behaviour predicted self-perception as adrinker in young males yet found no normative influences for females A gender

interaction in the present study also suggests a differential effect for discouraging

drinking More frequent parental discouragement to drink was related to more frequent

drinking in females and less frequent drinking in males This finding could indicate that

parents are more likely to disapprove of drinking in their daughters (and therefore

discourage alcohol use more strongly) than in their sons Alternatively it could point to a

tendency for girls to rebel more strongly against their parentsrsquo attitudes towards alcohol

use The direction of this relationship cannot be judged from the baseline data but our

post hoc item analysis does suggest that this effect may be due to parental reactions todrinking and proscriptions about drinking at home Future analyses of the longitudinal

data collected during the course of this study will examine this issue more closely

In the present analyses although frequency of mother and fathersrsquo alcohol use was

significantly related to drinking frequency these variables were not retained in the

regression analysis This suggests that other variables explain the relationship between

these factors Zhang Welte and Wieczorek (1999) found that the drinking behaviour of

each parent has a differential effect on their male offspring (aged 16ndash19 years) In their

study the fatherrsquos drinking but not their motherrsquos drinking affects their sons drinking

and closeness to the mother was a protective factor against adolescent drinking On theother hand male adolescent drinking increases if closeness to the mother is low and she

drinks excessively There appears to be no comparable effect for closeness to the father

and the fatherrsquos drinking

For the analysis of psychological measures there was an association in the predicted

direction between alcohol involvement and drinking for mood alteration functions but

not drinking to fulfil social functions Poorer psychological well-being was negatively

associated with drinking frequency only and contrary to our hypothesis there were no

Adolescent drinking 443

associations between the positive and negative alcohol-related attitude scales The

present results provide further evidence for the link between reasons or motives for

alcohol use and consumption patterns A strong relationship was observed between

increased frequency of drinking to serve mood alteration functions and increased

drinking frequency Our research group has also observed this effect among young

alcohol cannabis and ecstasy users (Boys et al 1999) These findings are consistentwith previous studies which have found a positive relationship between the number of

reasons for alcohol use and drinking frequency (Cooper Frone Russell amp Mudar 1995

Beck amp Treiman 1996 Bradizza Reifman amp Barnes 1999) For the social and peer

factors buying alcohol was as predicted associated with increased alcohol

involvement but there was only weak supporting evidence for an association with

having older friends There was a strong positive and consistent relationship between

spending time with friends who drink and perceived social pressure to drink and more

frequent drinking These independent social influences are interpreted in the context ofdeveloping peer relations and peer norms in which the majority of adolescents report

spending time with friends who are drinking as a recreational activity and where there

may be expectations to drink with the group sometimes to excessive levels (Iannotti

amp Bush 1992 Bahr Marcos amp Maughan 1995) Finally school conduct problems were

independently associated with drinking frequency with the number of times truanted

and being temporarily excluded having the strongest correlations Drinking more often

than other peers has been linked to more frequent unauthorized absences from school

(Currie et al 2000) Drinking smoking and drug use is also much more prevalentamong 12- to 15-year-olds who had ever truanted compared to those who had never

done so (Becher et al 2001)

Correlates of drinking intensityOverall 285 of the cohort typically drank six or more units on a drinking day which

can be taken to be a conservative indicator of underage binge drinking The regression

analyses were able to account for approximately 30 of the variance in drinkingintensity Age of first alcohol intoxication and lifetime smoking and cannabis use was

associated with more intense recent drinking For the family factors in contrast to

drinking frequency there was evidence for a positive association between how often

the mother usually drank alcohol and how much the adolescent drank on a drinking day

but contrary to prediction there was a negative association with the fatherrsquos drinking

It is possible that more frequent drinking by the father serves to discourage binge

drinking among mid-adolescents Nonetheless this effect was weak and was not

retained in the stepwise regression As predicted drinking to alter mood was associatedwith more intensive drinking but not with drinking for social facilitation functions This

effect however was not sufficiently strong to be retained in the stepwise regression

There was also a positive association between more favourable attitudes towards

alcohol and drinking intensity Among the social and peer factors a similar set of

associations was seen with the exception of perceived social pressure to drink

suggesting that mid-adolescents do not feel that the amount they consume is influenced

by their peers Finally the school conduct factors were quite strongly associated with

more intensive drinking and being in trouble with teachers and having beingtemporarily excluded had the strongest associations

The links between binge drinking and school conduct problems are a concern and

elsewhere studies have shown that binge drinking is related to poorer actual educational

performance (Newcomb Measham amp Parker 1995) Clinical diagnostic criteria for

John Marsden et al444

alcohol abuse recognize that recurrent drinking can result in school performance

problems and expulsions (American Psychiatric Association 1994) and the trajectory of

those experiencing school problems will be a focus of subsequent analyses of further

follow-up in the study The finding that lifetime use of cannabis was independently

associated with more intensive drinking is supportive of other work that argues that

those adolescents who use substances tend to have other attributes that increase therisk of poor psychosocial adjustment and school performance For example Jessor

Chase and Donovan (1980) argued that the reason that cannabis users tend to be less

well adjusted is that cannabis use is a general characteristic of individuals who are

predisposed to behavioural problems Furthermore Fergusson Lynskey and Horwood

(1997) suggested that instead of early cannabis use having a causal link with poor

psychosocial adjustment this association could be explained by family and other factors

that related to cannabis use Other alternative explanations include those proposed by

Kandel and colleagues They argue that early substance use sets into motion a chain ofevents which result in greater subsequent drug involvement and a range of other

negative psychosocial consequences (Kandel Davies Karus amp Yamaguchi 1986)

Again the causal direction of this relationship cannot be judged from the baseline data

but will be examined in more detail in subsequent reports on the longitudinal data

Strengths and limitations of the studyThe main strength of the present study was the analysis of the multiple influences on

drinking behaviour Studies of this kind have been rare in the UK but are encouraged as

good opportunities to gain an understanding of how early use of alcohol smoking and

other substance involvement evolves across the adolescent years (Edwards et al 1994

Duncan Duncan amp Hops 1998) Several limitations of the present study are also

acknowledged Given the reliance on self-report it is difficult to judge the reliability ofthe data and the findings should be interpreted with caution Nevertheless steps were

taken to maximize the privacy of the recruitment interviews to emphasize the

confidentiality of the study and the interviews were all conducted by young adults

Overall it has been argued that it is better to collect social survey data on this age group

at school than in the home (Becher et al 2001)

Implications for school-based alcohol educationThese results underline the importance of addressing personal family peer and school

conduct factors as part of alcohol education and problem prevention initiatives Theidentified correlates of drinking involvement in the present study could be usefully

taken up and discussed with students as part of alcohol education and prevention

programmes Elsewhere it has been argued that the main goal of school prevention

programmes should be to delay alcohol initiation (DeWit et al 2000 Griffin Botvin

Epstein Doyle amp Diaz 2000) However the very early age of onset in the UK suggests

that educational approaches based on harm minimization may be more realistic Recent

work in Australia has indicated that a harm minimization approach to alcohol education

together with adult supervision of initial drinking experiences can help to reduce theharms associated with alcohol use in young people (McBride Midford Farringdon amp

Phillips 2000b) Research into the merits of adopting a harm minimization approach to

alcohol education in schools has highlighted the importance of ensuring that

programme content and materials are relevant to local patterns of behaviour and are

Adolescent drinking 445

based on experiences that are relevant to the target audience (McBride Farringdon amp

Midford 2000a Dusenbury amp Falco 1995)

The potential feasibility and benefits of including parents as part of education

programmes in school should be examined The possibility of encouraging parents to

consider how their own behaviour and attitudes towards drinking might influence the

choices regarding alcohol use that are made by their offspring should be explored

Given the high prevalence of drinking involvement in mid-adolescence understanding

the influences on the further development of drinking attitudes and behaviours is of

critical importance Further reports from the study will describe the associations

between risky and heavy drinking patterns and alcohol-related problems and

developmental transitions to heavier consumption patterns as the cohort reaches the

period of late-adolescence

Acknowledgements

We would like to thank the students and staff from each school for their kind and enthusiastic

participation in the study The study was supported by a research grant from the LloydsTSB

charitable trust and conducted in association with Alcohol Concern

References

American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders

(4th ed) Washington DC APA

Anderson K Plant M amp Plant M (1998) Associations between drinking smoking and illicit

drug use among adolescents in the Western Isles of Scotland Implications for harm

minimization Journal of Substance Misuse 3 13ndash20

Ary D V Tildesley E Hops H amp Andrews J (1993) The influence of parent sibling and peer

modelling and attitudes on adolescent use of alcohol International Journal of Addiction 28

853ndash880

Bahr S J Marcos A C amp Maughan S L (1995) Family educational and peer influences on the

alcohol use of female and male adolescents Journal of Studies on Alcohol 56 457ndash469

Barnes G (1990) Impact of the family on adolescent drinking patterns In R Collins K Leonard

amp J Searles (Eds) Alcohol and the family Research and clinical perspectives (pp 137ndash161)

New York Guilford Press

Barnes G amp Welte J (1986) Patterns and predictors of alcohol use among 7ndash12th grade students

in New York State Journal of Studies on Alcohol 47 53ndash62

Becher H Boreham R Emery P Hinds K Jamison J amp Schagen I (2001) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Beck K H amp Treiman K A (1996) The relationship of social context of drinking perceived

social norms and parental influence to various drinking patterns of adolescents Addictive

Behaviors 21 633ndash644

Blenkinsop S Boreham R McManus S Natarajan L amp Prescott A (2003) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Blum R W Beuhring T amp Rinehart P M (2000) Protecting teens Beyond race income and

family structure Minneapolis MN Center for Adolescent Health University of Minnesota

Bonomo Y Coffey C Wolfe R Lynskey M Bowes G amp Patton G (2001) Adverse outcomes

of alcohol use in adolescents Addiction 96 1485ndash1496

Boreham R amp Shaw (2001) Smoking drinking and drug use among young people in England

in 2000 London The Stationery Office

John Marsden et al446

sondaughter at another setting and allowed drinking at home) using a 5-point Likert-

type response (never to very often scored 0ndash4) (c) a 5-item scale coded to assess the

extent to which parents discouraged drinking in the past year (warning sondaughter of

the health risks of drinking parents saying they should not drink being punished by

parents for drinking parents saying that sondaughter cannot drink at home and being

reprimanded for buying alcohol (never to very often scored 0ndash4) and (d) a 9-pointindex of the number of occasions the participant recalled consuming an alcoholic drink

without their parentrsquos knowledge (never once twice 3ndash5 times 6ndash12 times 13ndash23

times 24ndash50 times 51ndash100 times and more than 100 times scored 0ndash8)

Psychological factorsQuestions in the block of psychological factors focused on personal influences and

correlates on alcohol use and included specific reasons for drinking generalpsychological health and alcohol-related attitudes Four measures were taken (a) a

6-item mood alteration functions scale developed by Boys et al (1999) was used to

assess how often participants had consumed alcohol in the past year for the following

personal reasons to relax to feel better when low or depressed to feel closer to

someone to stop worrying about a problem to get to sleep and simply to get drunk

(never to always scored 0ndash4) (B) a 5-item social functions scale also developed by

Boys et al to assess the extent that the participant had used alcohol in the past year for

the following social reasons to let go of inhibitions when socializing to feel moreconfident in a social situation to make an activity more enjoyable to help enjoy the

company of friends and to feel more confident when having sex (scored as above)

(c) the 12-item form of the General Health Questionnaire to assess psychological well-

being with each question scored using the Likert scale response coding (GHQ-12

Goldberg amp Williams 1988) and (d) two 9-item attitude scales adapted from items

used by Plant Peck and Samuel (1985) to assess positive drinking attitudes (eg young

people who drink regularly are attractive to the opposite sex coded as strongly agree

to strongly disagree scored 1ndash5)

Social and peer factorsFive measures were developed for the study to examine the relationships between

purchasing drinks and the influence of peers on alcohol involvement Five measures

were used (a) whether the participant had ever bought alcohol for personal use from a

shop or a barpub (scored no frac14 0 yes frac14 1) (b) the proportion of the participants

current friends who were older by 1 or more years (none to all scored 0ndash4) (c) theproportion of friends who were believed to drink alcohol (none to all scored 0ndash4)

(d) an index of how often the participant had spent time with friends and acquaintances

who were drinking in the past 3 months (never to 6ndash7 days a week scored 0ndash9) and

(e) an index of the extent that the participant perceived that they had felt under social

pressure to drink (coded as strongly agree to strongly disagree scored 1ndash5)

School conduct problemsFinally a block of four measures to record school conduct problems in the past year

A block of four items recording aspects of school life was taken from the youth form of

the Life Stressors and Social Resources Inventory (Moos amp Moos 1994) as follows (a) the

frequency that the participant had been in trouble with teachers and had been detained

John Marsden et al434

after school or received other sorts of punishment (never to every day scored 0ndash8)

(b) whether the participant had been in a fight with a student at school (scored no frac14 0

yes frac14 1) (c) the number of times the participant had truanted from school (defined as

not attending for a whole school day or leaving immediately after the morning class

registration) and (d) whether or not the respondent had been temporarily excluded

from school for disciplinary problems (scored no frac14 0 yes frac14 1)

Statistical analysisThe relationship between alcohol involvement and background family social and peer

and school conduct factors was investigated using multiple linear regression in twostages First two standard regression analyses were computed for drinking frequency and

intensity using the 26 items and scale measures described above in the five domains and

were regressed separately on the dependent variables in each domain and then again

simultaneously to assess overall levels of variance accounted for (Tabachnik amp Fidell

2001) This analysis was used to test the research hypotheses Second two stepwise

regression analyses with backwards elimination of covariates were computed to isolate a

set of independent predictors of drinking frequency and intensity and to explore the

strength of association for adjusted covariates and any identified gender interactions

Results

Sample characteristicsA cohort of 540 students was recruited (515 male) The average age was 154 years(381 [706] were 15 and 159 [294] were 16 years) There were no differences in the

proportion of males and females ( x2 frac14 515 p frac14 272) or number in the 15 and 16 year

age groups (x2 frac14 453 p frac14 340) between the samples from the five schools There

were also no differences in the proportion of males and females recruited compared

with the remainder of the Year 11 cohort in each school (x2 ranged from 003 to 116

p frac14 89ndash 28)

The majority of the sample described themselves as White-UK (954) while 19

were Caribbean or Black British 13 were South Asian and the remainder were MiddleEastern South East Asian or described themselves to be of mixed race Approximately

half (485) considered that they had no religious affiliation 157 reported they were

affiliated to the Church of England and 281 described themselves as Christian with no

specification Two-thirds (687) were living with both of their natural parents In terms

of living arrangements four-fifths (809) reported that their parents or guardians

owned their residence 111 were living in local authority owned housing and the

remainder were living in privately rented premises (74)

Prevalence of alcohol and other substance useThe majority of the sample (943) had consumed a whole alcoholic drink at some point

in their lives Lifetime use of tobacco products (cigarettes) was high (377 698)

particularly among females (748 vs 651 x2 frac14 602 p frac14 014) Some 404 (218) ofthe cohort reported using cannabis at some point in their lives but less than 1 in 10

reported lifetime use of other illegal drugs On average the participants estimated that

they were 124 years old when they first drank a whole alcoholic drink

( SD frac14 19 range frac14 3ndash16 years) Four-fifths of the drinkers (N frac14 407) reported that

Adolescent drinking 435

they had had experience of being intoxicated by alcohol Males reported an earlier age

of first being intoxicated after drinking than females (136 vs 138 years t frac14 2229

p 05) All of the drinkers reported that they had drunk alcohol without the

knowledge of their parents on at least one occasion On average they were 14 years old

( SD frac14 721 range frac14 7ndash16 years) when they first drank without parental knowledge

Over half of the drinkers estimated that they had drunk alcohol without their parentsrsquoknowledge on at least 13 separate occasions in total

Alcohol involvementThe majority of the lifetime drinkers (N frac14 467 917) had consumed alcohol during

the past 90 days and a third of the sample (175 324) reported that they had

purchased alcohol themselves from a bar or club during this period Table 1 summarizes

the frequency of drinking and scores on the dependent variables by gender In terms of

drinking frequency participants estimated that they had drunk alcohol on an average of175 days ( SD frac14 147) in the past 3 months with males tending to report frequent

drinking than females (187 days vs 16 days t frac14 204 p frac14 042) On average

participants consumed 47 units (47 ml by volume) on a typical drinking day and there

were no differences in drinking intensity between males and females (49 units vs 45

units respectively t frac14 0103 p frac14 302) As can be seen 285 of the cohort recalled

drinking six or more units on a typical day

In general beerlager was the most commonly used beverage (by 434) followed

by spirits (200) liqueurs (96) alcopops (88) and wine (59) Males tended to

prefer beerlager (691 vs 146 x2 frac14 15370 p 000) while females preferred

spirits (321 vs 93 x2 frac14 4111 p 000) liqueurs (175 vs 26 x2 frac14 3236

p 000) alcopops (133 vs 33 x2 frac14 1708 p 000) and wine (104 vs

19 x2 frac14 1675 p 000) In the past 3 months a similar profile of beverage

Table 1 Frequency and intensity of alcohol use in the past 90 days by gender (N frac14 467)

Males ()(N frac14 251)

Females()(N frac14 216)

Total()

Frequency of alcohol use in past 90 daysLess than monthly 17 (68) 19 (88) 36 (77)1ndash3 days per month 79 (315) 76 (352) 155 (332)One day per week 58 (231) 52 (241) 110 (236)2ndash3 days per week 82 (327) 64 (296) 146 (313)4ndash6 days per week 14 (56) 4 (19) 18 (39)Everyday 1 (04) 1 (05) 2 (04)

Units consumed on a typical drinking dayUp to 10 unit 11 (44) 15 (69) 26 (56)1ndash19 units 31 (124) 33 (153) 64 (137)2ndash39 units 78 (311) 59 (273) 137 (293)4ndash59 units 44 (175) 35 (162) 79 (169)6ndash99 units 56 (223) 38 (176) 94 (201)10 or more 20 (80) 19 (88) 39 (84)Number of drinking days90 (meanSD) 187 (155) 160 (137) 175 (147)Amount drunk on typical day (meanSD) 49 (36) 45 (38) 47 (37)

p 05

John Marsden et al436

preferences was recorded When asked what type of alcohol they had consumed

most often during the time 60 said beerlager 143 said spirits 18 said wine

and 58 said alcopops

Family factorsHalf of the sample (271 502) estimated that their mother generally drank alcohol at

least once a week and 704 (380) estimated that their father drank at least once a

week In terms of parental encouragement to drink around one quarter of the

sample estimated that they had often drunk alcohol at home with their parents in the

past year (129 239) although only 161 said that their parents had often bought

them an alcoholic drink at a restaurant or other establishment Conversely just 138

(255) of the sample said that their parents had actively discouraged them from

drinking in the past year The two 5-item scales assessing the extent to which parentsencouraged or discouraged drinking were approximately normally distributed and

had acceptable internal reliability The average total score on the parental

encouragement scale was 1363 ( SD frac14 501 Cronbachrsquos a frac14 77) and the average

total score on the parental discouragement scale was 888 ( SD frac14 367 a frac14 77)

While a fifth (203) of the sample reported that in the past 3 months they had never

drunk alcohol without the knowledge of their parents a quarter (N frac14 139) reported

that when they had recently drunk alcohol it was often or always without their

parentsrsquo knowledge

Psychological factorsThe average total score for the mood alteration function scale was 122

(median frac14 120) and it had acceptable internal reliability (a frac14 71) The most

commonly endorsed mood alteration function was drinking to relax (51 reporting

that they drank sometimes or more frequently for this reason) followed by drinking in

order to forget about a problem (endorsed by 34) The average total score for thesocial facilitation function scale was 114 (median frac14 110 a frac14 70) and the most

commonly endorsed social item was drinking to enjoy the company of friends (by 63)

followed by drinking to lose inhibitions (endorsed by 48) Scores on the GHQ-12

ranged from 0 to 34 with a mean of 121 (median frac14 110 a frac14 85) The sample were

equally likely to report positive and negative alcohol-related attitudes The mean scores

on these scales were 228 and 238 respectively (range frac14 13ndash39 and 13ndash34 a frac14 68

and a frac14 73)

Social and peer factorsJust under one half (246 483) estimated that a few of their friends were older than

them and a minority 64 (126) of the drinkers estimated that all or most of their

friends were at least 1 year older than them Two-fifths (N frac14 202) said that all of their

friends drank alcohol and a further 391 said that they believed most did so In the past

3 months two-thirds of the drinkers (338 664) reported that they typically spent time

with friendsacquaintances who were drinking at least once a week Just 68 individuals(134) estimated that this generally occurred less than once a month and a further

17 (33) said that they never spent time with friendsacquaintances who

were drinking A small proportion of the drinkers (79) considered that they

felt pressure from their peers to drink alcohol but the majority (578) did not feel

Adolescent drinking 437

this way and a further 193 indicated that they strongly disagreed that such pressure

was present in their social network

School conduct problemsIn the past year the majority of the drinkers (356 76) had received a detention afterschool or some other minor punishment There was also a minority (95 187) who

estimated that they found themselves in trouble with teachers once or twice each

month and a further small group who said that they received some form of disciplinary

action at school once a week (57 112) A quarter (138 256) reported that they had

had a fight with another student in the past year Just over a third (187 367) admitted

that they had been absent from school without authorization (truanted) at least once in

the past year and the average number of occasions on which this had occurred was 78

days ( SD frac14 150 days range frac14 05ndash80) Sixty-six students (122) had beentemporarily excluded from school in the past year

Regression of covariates of alcohol involvementThe two dependent variables were judged to be reasonably normally distributed and

were not transformed Following negative screening for multicollinearity within the

covariate set multiple regression analysis was performed separately for each of thefive blocks of covariates to assess their individual contribution to explaining variance in

the dependent variables A further regression was then performed in which all 26

covariates were entered simultaneously to calculate the overall level of variance

accounted for Table 2 presents the standardized regression coefficients (b) and the

overall R 2 for each block for these analyses

There was no significant association between age of first drink and recent drinking

although as predicted there was a positive association between feeling intoxicated after

drinking alcohol and both recent drinking frequency and intensity As predicted therewas a positive correlation between lifetime smoking and cannabis use and alcohol

involvement and this association was stronger for cannabis Among the set of

predictions concerning parents there was evidence for an association between the

frequency of parentsrsquo drinking for drinking intensity but this was in the anticipated

direction for the motherrsquos drinking only ( p 01) The frequency of the fatherrsquos

drinking was associated with drinking of lower intensity ( p 05)

As predicted there were significant positive associations between the extent that

parents encouraged drinking and both drinking frequency ( p 001) and intensity( p 01) Contrary to prediction there was a weak but positive relationship between

the extent that parents discouraged drinking and recent alcohol involvement ( p 05)

For the psychological factors there was support for the predicted association between

alcohol involvement and drinking for mood alteration functions ( p 001) but not to

fulfil social functions Higher scores on the GHQ-12 indicative of poorer psychological

well-being were negatively associated with drinking frequency only ( p 001)

Contrary to prediction there were no associations between the positive and negative

alcohol-related attitude scales with the exception of a significant association betweenpositive attitudes and recent drinking intensity ( p 05)

In the social and peer factors block there was evidence that personally buying

alcohol was associated with higher drinking intensity ( p 01) and drinking frequency

( p 001) There was rather weak supporting evidence for the relationship between

having older friends and more frequent drinking ( p 05) There were mixed findings

John Marsden et al438

concerning having more friends who drink spending time with friends who drink and

feeling under social pressure to drink The proportion of friends who drink was related

to intensity ( p 05) but not frequency There was a strong positive and consistent

relationship between spending time with friends who drink and drinking ( p 001)

and there were significant associations between perceived social pressure to drink and

Table 2 Standard multiple regression of background family psychological social and school factors on

recent alcohol involvement (N frac14 467)

Drinking frequency Drinking intensity

1 Background R 2 frac14 0211 R 2 frac14 0192Age 0100 0079Gender 098 0025School 1 100 100School 2 20024 20073School 3 0065 0012School 4 20065 20128School 5 0077 0101Age of first drink 20076 20044Ever intoxicated from alcohol 0591 1092Age first intoxicated on alcohol 20396 20899Ever smoked cigarettes 0155 0076Ever used cannabis 0160 0140

2 Family R 2 frac14 0141 R 2 frac14 0060Frequency of motherrsquos drinking 0052 0153Frequency of fatherrsquos drinking 0041 20121Extent parents encourage drinking 0231 0156Extent parents discourage drinking 0109 0094Drinking without parents knowledge 0280 0137

3 Psychological R 2 frac14 0156 R 2 frac14 0095Mood functions for drinking 0385 0307Social functions for drinking 20002 20068Psychological well-being 20116 20062Positive drinking attitudes 20050 0102Negative drinking attitudes 20014 0001

4 Social R 2 frac14 0322 R 2 frac14 0210Personally bought alcohol 0150 0131Proportion of older friends 0074 0090Proportion of friends who drink 0083 0094Time with friends drinking 0387 0307Perceived social pressure to drink 0148 0062

5 School R 2 frac14 0121 R 2 frac14 0144Been in trouble with teachers 0213 0212Had a fight with student at school 0054 0090Times truanted in past year 0155 0120Temporarily excluded in past year 0090 0152Overall R 2 frac14 0418 R 2 frac14 0339Adjusted R 2 frac14 0381 R 2 frac14 0290

frac14 p 05 frac14 p 01 frac14 p 001

Adolescent drinking 439

drinking frequency but not recent intensity There was a positive correlation between

more positive alcohol-related attitudes and high drinking intensity only ( p 05)

There were also mixed associations relating to school conduct problems and

drinking Being temporarily excluded from school and the number of times truanted

were positively related to recent frequency ( p 05 and p 001 respectively) and

recent intensity ( p 01) Having had a fight with another student with associated withrecent drinking intensity only ( p 05) while there was a strong positive and

consistent relationship between being in trouble with teachers and the both drinking

measures ( p 001)

In total the five blocks of factors explained 42 (38 adjusted) of the variance in

frequency of drinking scores and 34 (29 adjusted) of the variance in typical intensity

Taking the covariate blocks in turn the regression analysis indicated that the social and

peer factors had the strongest correlations (accounting for 32 and 21 of the variance

in drinking frequency and intensity respectively) For drinking frequency the strengthof association for the remaining factors was as follows background variables (21)

psychological factors (16) family factors (14) and school conduct problems (12)

The regression analysis for recent typical drinking intensity revealed a somewhat

contrasting pattern of predictors background variables (19) school conduct

problems (14) psychological factors (10) and family factors (6)

The dataset was then screened for the presence of moderation effects between

gender and each covariate Those variables (gender the covariate and their interaction)

that emerged as statistically significant were then entered into two regression equationsusing each of the dependent variables If the interaction term exerted a significant effect

on the dependent variable in this equation when its constituent parts were controlled

for this was taken as evidence of a moderation effect by gender The single interaction

term that was identified in this way was added to the covariate set in a backwards

stepwise regression equation controlling for gender and age This process resulted in a

final lsquotrimmed downrsquo regression model for the two dependent variables and is shown in

Table 3 The total proportions of variance in the dependent variables explained by the

final models were as follows 40 (38 adjusted) for drinking frequency( F12 441 frac14 2690 p 001) and 27 (26 adjusted) for drinking intensity

( F7 441 frac14 2316 p 001)

Drinking frequencyEleven covariates were retained in the model as significantly associated with recent

drinking frequency As can be seen most were from the family factors and social and

peer factors blocks Males tended to be more frequent drinkers than females(b frac14 0272) However the strongest predictor of frequency of alcohol use in the model

was the amount of time spent with friends who are drinking (b frac14 0316) Other

influential variables included the extent to which parents encourage (b frac14 0155) and

discourage (b frac14 20223) alcohol use with the latter association moderated by gender

More frequent parental discouragement to drink was related to more frequent drinking

in females and less frequent drinking frequency in males In a post hoc analysis the

parental discouragement scale items were entered into a regression equation This

showed that two items exerted an effect over and above the others lsquomy parents havetold me off because of drinking or buying alcoholrsquo and lsquomy parents have said that

I cannot drink alcohol at homersquo A positive relationship was also observed between

drinking more frequently without parentsrsquo knowledge and recent frequency of use

(b frac14 0110) Other independent influences on drinking frequency were higher mood

John Marsden et al440

alteration function scores (b frac14 0113) greater perceived social pressure to drink

alcohol (b frac14 0155) a history of temporary school exclusion (b frac14 0121) and more

frequent occasions of truanting from school in the past year (b frac14 0086)

Drinking intensityIn common with the final model for drinking frequency just five covariates were

retained in the regression equation for drinking intensity The amount of time spent with

friends who are drinking alcohol was the strongest predictor (b frac14 0319) This was

followed by having a history of school exclusion (b frac14 0197) and more frequently being

in trouble with teachers in the past year (b frac14 0142) Greater parental encouragement

to drink was associated with higher actual drinking intensity (b frac14 0124) Finally a

single background factor ndash lifetime use of cannabis ndash was associated with higher

drinking intensity (b frac14 0113)

Discussion

This report has presented first results from a cohort follow-up study of alcohol use

among a sample of mid-adolescents in England Baseline data on personal backgroundand demographics family psychological social factors and school conduct problems

were correlated with reports of recent drinking frequency and intensity As expected

regular drinking was the norm among the cohort 19 in 20 of the cohort had consumed a

whole alcoholic drink at some point in their lives and approximately 17 in 20 were

current drinkers This prevalence of alcohol use is comparable to that reported for the

Table 3 Stepwise multiple regression of background family psychological social and school factors on

recent alcohol involvement (N frac14 467)

Drinking frequencyR 2 frac14 0396

Drinking intensityR 2 frac14 0273

1 BackgroundAge 0033 0046Gender 0272 0004Ever smoked cannabis ndash 0113

2 FamilyExtent parents encourage drinking 0155 0124Extent parents discourage drinking 0223 ndashGender pound extent parents discourage drinkinga 0302 ndashDrinking without parents knowledge 0113 ndash

3 PsychologicalMood functions for drinking 0113 ndash

4 SocialPersonally bought alcohol 0118 ndashTime with friends who are drinking 0316 0319Perceived social pressure to drink 0155 ndash

5 SchoolIn trouble with teachers in past year ndash 0142Times truanted in past year 0086 ndashTemporarily excluded in past year 0121 0197

a frac14 interaction term frac14 p 05 frac14 p 01 frac14 p 001

Adolescent drinking 441

general adult population in the UK (Singleton Bumpstead OrsquoBrien Lee amp Meltzer

2001) and is also comparable to drinking levels reported for 15-year-olds in other

countries (eg Casswell Stewart Conolly amp Silva 1991 for New Zealand) In terms of

typical drinking intensity study participants estimated that they drank about five

standard units of alcohol on a typical day Although the government has not issued

recommended drinking levels for the under-18 s this level exceeds the safer drinkinglevels for adults as recommended by the English Department of Health (Department of

Health 1995) and is therefore a cause for concern A substantial proportion of the

sample also reported lifetime tobacco smoking (70) and use of cannabis (40) Despite

the fact that the study cohort was not generated using probability sampling techniques

it is reasonable to believe that it is unbiased The levels of drinking smoking and

cannabis use reported fell remarkably close to population estimates for this age group in

England (Goddard amp Higgins 2001 Becher et al 2001 Currie Hurrelmann

Settertobulte Smith amp Todd 2000) On school conduct characteristics the samplewas also broadly comparable to reports from national surveys (Miller amp Plant 1999)

The cohort was also comparable to the general population on school conduct problems

Thirty-seven percent admitted that they had truanted at least once in the past year and

this compares to 33 of boys who admitted truanting in the latest Office for National

Statistics school survey (Boreham amp Shaw 2001)

Drinking was well established within the social networks of the cohort The majority

reported that most or all of their friends drank alcohol and two-thirds of the drinkers

said that they typically spent time with friendsacquaintances who were drinking atleast once a week Two-thirds did not consider that they were under any peer pressure

to drink

In the UK alcopop beverages are well established in the drinks market (Clarke

2000) and concerns have been raised about the marketing of these products to younger

drinkers (Hughes et al 1997 McKeganey 1998) In our study males reported a limited

preference for these drinks and tended to favour beer and lager whereas females had a

greater preference for spirits alcopops wine and liqueurs Males were more frequent

drinkers but there were no gender differences in the amount of alcohol consumed ontypical day Previous studies on alcohol use have found that males drink more heavily

than their female peers (Goddard amp Higgins 2001 Miller amp Plant 1996) However as

alcohol use among school-age students approximately doubled between 1990 and 2000

(from 53 units in 1990 to 104 units in 2000) the gender gap in consumption has

narrowed (Goddard amp Higgins 2001) The drinking patterns of young females are of

concern given their greater vulnerability to alcohol-related harms (Goist amp Sutker 1985

Plant amp Plant 2001)

Correlates of drinking frequencyThe regression analyses were able to account for approximately 40 of the variance in

scores on the measure of drinking frequency There was no evidence for the hypothesized

negative relationship between age of first drink and recent drinking frequency although

there was a positive association with feeling intoxicated after drinking alcohol It is

however possible that the effect of earlier initiation to drinking is not seen until drinking

patterns have further developed This was observed in a longitudinal study in the USAreported by Hawkins et al (1997) In this study of a cohort of students who were

followed-up annually from age 10ndash11 to age 17ndash18 a younger age of alcohol initiation was

strongly related to a higher level of alcohol misuse at age 17ndash18 Consequently we will

assess the influence of age of alcohol initiation in further follow-ups

John Marsden et al442

Studies examining the putative relationship between lifetime smoking cannabis use

and recent drinking frequency suggest that earlier initiation to substance use mediates

peers alcohol involvement and parental drinking risk factors (eg Hawkins et al 1997)

However findings from research using twins suggests that the association between age

of onset of alcohol use and later problematic drinking may not be directly causal but

that age of onset and problematic drinking in later life are both associated with anunderlying vulnerability to behavioural problems (Prescott amp Kendler 1999)

There was no support for the predicted relationship between the frequency of

parental drinking and adolescent drinking frequency It must be acknowledged that

influence of parental drinking parental alcohol use norms and family environment and

relations are complex (Peterson et al 1994) Foxcroft and Lowe (1997) found that

increased drinking levels among 11ndash17-year-olds were linked to regular perceived

parental drinking while Casswell and her colleagues noted a positive association

between the frequency of drinking in early- to mid-adolescents and the frequency of

their mother and fatherrsquos drinking (Casswell et al 1991) Peterson et al showed thatclear communication by parents about their expectations of their childrenrsquos drinking

together with positive reinforcement for desired behaviours can reduce the impact of

parentrsquos drinking on adolescent alcohol use

Several studies have also noted a negative relationship between parental support

a positive family environment and feelings of connectedness and adolescent substance

use (Resnick et al 1997 Hops Davis amp Lewin 1999) The role that parental approval of

drinking has in predicting intensity of alcohol use in their children has also been

explored (eg Barnes amp Welte 1986) Wilks Callan and Austin (1989) found that the

fatherrsquos approval or disapproval of drinking behaviour predicted self-perception as adrinker in young males yet found no normative influences for females A gender

interaction in the present study also suggests a differential effect for discouraging

drinking More frequent parental discouragement to drink was related to more frequent

drinking in females and less frequent drinking in males This finding could indicate that

parents are more likely to disapprove of drinking in their daughters (and therefore

discourage alcohol use more strongly) than in their sons Alternatively it could point to a

tendency for girls to rebel more strongly against their parentsrsquo attitudes towards alcohol

use The direction of this relationship cannot be judged from the baseline data but our

post hoc item analysis does suggest that this effect may be due to parental reactions todrinking and proscriptions about drinking at home Future analyses of the longitudinal

data collected during the course of this study will examine this issue more closely

In the present analyses although frequency of mother and fathersrsquo alcohol use was

significantly related to drinking frequency these variables were not retained in the

regression analysis This suggests that other variables explain the relationship between

these factors Zhang Welte and Wieczorek (1999) found that the drinking behaviour of

each parent has a differential effect on their male offspring (aged 16ndash19 years) In their

study the fatherrsquos drinking but not their motherrsquos drinking affects their sons drinking

and closeness to the mother was a protective factor against adolescent drinking On theother hand male adolescent drinking increases if closeness to the mother is low and she

drinks excessively There appears to be no comparable effect for closeness to the father

and the fatherrsquos drinking

For the analysis of psychological measures there was an association in the predicted

direction between alcohol involvement and drinking for mood alteration functions but

not drinking to fulfil social functions Poorer psychological well-being was negatively

associated with drinking frequency only and contrary to our hypothesis there were no

Adolescent drinking 443

associations between the positive and negative alcohol-related attitude scales The

present results provide further evidence for the link between reasons or motives for

alcohol use and consumption patterns A strong relationship was observed between

increased frequency of drinking to serve mood alteration functions and increased

drinking frequency Our research group has also observed this effect among young

alcohol cannabis and ecstasy users (Boys et al 1999) These findings are consistentwith previous studies which have found a positive relationship between the number of

reasons for alcohol use and drinking frequency (Cooper Frone Russell amp Mudar 1995

Beck amp Treiman 1996 Bradizza Reifman amp Barnes 1999) For the social and peer

factors buying alcohol was as predicted associated with increased alcohol

involvement but there was only weak supporting evidence for an association with

having older friends There was a strong positive and consistent relationship between

spending time with friends who drink and perceived social pressure to drink and more

frequent drinking These independent social influences are interpreted in the context ofdeveloping peer relations and peer norms in which the majority of adolescents report

spending time with friends who are drinking as a recreational activity and where there

may be expectations to drink with the group sometimes to excessive levels (Iannotti

amp Bush 1992 Bahr Marcos amp Maughan 1995) Finally school conduct problems were

independently associated with drinking frequency with the number of times truanted

and being temporarily excluded having the strongest correlations Drinking more often

than other peers has been linked to more frequent unauthorized absences from school

(Currie et al 2000) Drinking smoking and drug use is also much more prevalentamong 12- to 15-year-olds who had ever truanted compared to those who had never

done so (Becher et al 2001)

Correlates of drinking intensityOverall 285 of the cohort typically drank six or more units on a drinking day which

can be taken to be a conservative indicator of underage binge drinking The regression

analyses were able to account for approximately 30 of the variance in drinkingintensity Age of first alcohol intoxication and lifetime smoking and cannabis use was

associated with more intense recent drinking For the family factors in contrast to

drinking frequency there was evidence for a positive association between how often

the mother usually drank alcohol and how much the adolescent drank on a drinking day

but contrary to prediction there was a negative association with the fatherrsquos drinking

It is possible that more frequent drinking by the father serves to discourage binge

drinking among mid-adolescents Nonetheless this effect was weak and was not

retained in the stepwise regression As predicted drinking to alter mood was associatedwith more intensive drinking but not with drinking for social facilitation functions This

effect however was not sufficiently strong to be retained in the stepwise regression

There was also a positive association between more favourable attitudes towards

alcohol and drinking intensity Among the social and peer factors a similar set of

associations was seen with the exception of perceived social pressure to drink

suggesting that mid-adolescents do not feel that the amount they consume is influenced

by their peers Finally the school conduct factors were quite strongly associated with

more intensive drinking and being in trouble with teachers and having beingtemporarily excluded had the strongest associations

The links between binge drinking and school conduct problems are a concern and

elsewhere studies have shown that binge drinking is related to poorer actual educational

performance (Newcomb Measham amp Parker 1995) Clinical diagnostic criteria for

John Marsden et al444

alcohol abuse recognize that recurrent drinking can result in school performance

problems and expulsions (American Psychiatric Association 1994) and the trajectory of

those experiencing school problems will be a focus of subsequent analyses of further

follow-up in the study The finding that lifetime use of cannabis was independently

associated with more intensive drinking is supportive of other work that argues that

those adolescents who use substances tend to have other attributes that increase therisk of poor psychosocial adjustment and school performance For example Jessor

Chase and Donovan (1980) argued that the reason that cannabis users tend to be less

well adjusted is that cannabis use is a general characteristic of individuals who are

predisposed to behavioural problems Furthermore Fergusson Lynskey and Horwood

(1997) suggested that instead of early cannabis use having a causal link with poor

psychosocial adjustment this association could be explained by family and other factors

that related to cannabis use Other alternative explanations include those proposed by

Kandel and colleagues They argue that early substance use sets into motion a chain ofevents which result in greater subsequent drug involvement and a range of other

negative psychosocial consequences (Kandel Davies Karus amp Yamaguchi 1986)

Again the causal direction of this relationship cannot be judged from the baseline data

but will be examined in more detail in subsequent reports on the longitudinal data

Strengths and limitations of the studyThe main strength of the present study was the analysis of the multiple influences on

drinking behaviour Studies of this kind have been rare in the UK but are encouraged as

good opportunities to gain an understanding of how early use of alcohol smoking and

other substance involvement evolves across the adolescent years (Edwards et al 1994

Duncan Duncan amp Hops 1998) Several limitations of the present study are also

acknowledged Given the reliance on self-report it is difficult to judge the reliability ofthe data and the findings should be interpreted with caution Nevertheless steps were

taken to maximize the privacy of the recruitment interviews to emphasize the

confidentiality of the study and the interviews were all conducted by young adults

Overall it has been argued that it is better to collect social survey data on this age group

at school than in the home (Becher et al 2001)

Implications for school-based alcohol educationThese results underline the importance of addressing personal family peer and school

conduct factors as part of alcohol education and problem prevention initiatives Theidentified correlates of drinking involvement in the present study could be usefully

taken up and discussed with students as part of alcohol education and prevention

programmes Elsewhere it has been argued that the main goal of school prevention

programmes should be to delay alcohol initiation (DeWit et al 2000 Griffin Botvin

Epstein Doyle amp Diaz 2000) However the very early age of onset in the UK suggests

that educational approaches based on harm minimization may be more realistic Recent

work in Australia has indicated that a harm minimization approach to alcohol education

together with adult supervision of initial drinking experiences can help to reduce theharms associated with alcohol use in young people (McBride Midford Farringdon amp

Phillips 2000b) Research into the merits of adopting a harm minimization approach to

alcohol education in schools has highlighted the importance of ensuring that

programme content and materials are relevant to local patterns of behaviour and are

Adolescent drinking 445

based on experiences that are relevant to the target audience (McBride Farringdon amp

Midford 2000a Dusenbury amp Falco 1995)

The potential feasibility and benefits of including parents as part of education

programmes in school should be examined The possibility of encouraging parents to

consider how their own behaviour and attitudes towards drinking might influence the

choices regarding alcohol use that are made by their offspring should be explored

Given the high prevalence of drinking involvement in mid-adolescence understanding

the influences on the further development of drinking attitudes and behaviours is of

critical importance Further reports from the study will describe the associations

between risky and heavy drinking patterns and alcohol-related problems and

developmental transitions to heavier consumption patterns as the cohort reaches the

period of late-adolescence

Acknowledgements

We would like to thank the students and staff from each school for their kind and enthusiastic

participation in the study The study was supported by a research grant from the LloydsTSB

charitable trust and conducted in association with Alcohol Concern

References

American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders

(4th ed) Washington DC APA

Anderson K Plant M amp Plant M (1998) Associations between drinking smoking and illicit

drug use among adolescents in the Western Isles of Scotland Implications for harm

minimization Journal of Substance Misuse 3 13ndash20

Ary D V Tildesley E Hops H amp Andrews J (1993) The influence of parent sibling and peer

modelling and attitudes on adolescent use of alcohol International Journal of Addiction 28

853ndash880

Bahr S J Marcos A C amp Maughan S L (1995) Family educational and peer influences on the

alcohol use of female and male adolescents Journal of Studies on Alcohol 56 457ndash469

Barnes G (1990) Impact of the family on adolescent drinking patterns In R Collins K Leonard

amp J Searles (Eds) Alcohol and the family Research and clinical perspectives (pp 137ndash161)

New York Guilford Press

Barnes G amp Welte J (1986) Patterns and predictors of alcohol use among 7ndash12th grade students

in New York State Journal of Studies on Alcohol 47 53ndash62

Becher H Boreham R Emery P Hinds K Jamison J amp Schagen I (2001) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Beck K H amp Treiman K A (1996) The relationship of social context of drinking perceived

social norms and parental influence to various drinking patterns of adolescents Addictive

Behaviors 21 633ndash644

Blenkinsop S Boreham R McManus S Natarajan L amp Prescott A (2003) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Blum R W Beuhring T amp Rinehart P M (2000) Protecting teens Beyond race income and

family structure Minneapolis MN Center for Adolescent Health University of Minnesota

Bonomo Y Coffey C Wolfe R Lynskey M Bowes G amp Patton G (2001) Adverse outcomes

of alcohol use in adolescents Addiction 96 1485ndash1496

Boreham R amp Shaw (2001) Smoking drinking and drug use among young people in England

in 2000 London The Stationery Office

John Marsden et al446

after school or received other sorts of punishment (never to every day scored 0ndash8)

(b) whether the participant had been in a fight with a student at school (scored no frac14 0

yes frac14 1) (c) the number of times the participant had truanted from school (defined as

not attending for a whole school day or leaving immediately after the morning class

registration) and (d) whether or not the respondent had been temporarily excluded

from school for disciplinary problems (scored no frac14 0 yes frac14 1)

Statistical analysisThe relationship between alcohol involvement and background family social and peer

and school conduct factors was investigated using multiple linear regression in twostages First two standard regression analyses were computed for drinking frequency and

intensity using the 26 items and scale measures described above in the five domains and

were regressed separately on the dependent variables in each domain and then again

simultaneously to assess overall levels of variance accounted for (Tabachnik amp Fidell

2001) This analysis was used to test the research hypotheses Second two stepwise

regression analyses with backwards elimination of covariates were computed to isolate a

set of independent predictors of drinking frequency and intensity and to explore the

strength of association for adjusted covariates and any identified gender interactions

Results

Sample characteristicsA cohort of 540 students was recruited (515 male) The average age was 154 years(381 [706] were 15 and 159 [294] were 16 years) There were no differences in the

proportion of males and females ( x2 frac14 515 p frac14 272) or number in the 15 and 16 year

age groups (x2 frac14 453 p frac14 340) between the samples from the five schools There

were also no differences in the proportion of males and females recruited compared

with the remainder of the Year 11 cohort in each school (x2 ranged from 003 to 116

p frac14 89ndash 28)

The majority of the sample described themselves as White-UK (954) while 19

were Caribbean or Black British 13 were South Asian and the remainder were MiddleEastern South East Asian or described themselves to be of mixed race Approximately

half (485) considered that they had no religious affiliation 157 reported they were

affiliated to the Church of England and 281 described themselves as Christian with no

specification Two-thirds (687) were living with both of their natural parents In terms

of living arrangements four-fifths (809) reported that their parents or guardians

owned their residence 111 were living in local authority owned housing and the

remainder were living in privately rented premises (74)

Prevalence of alcohol and other substance useThe majority of the sample (943) had consumed a whole alcoholic drink at some point

in their lives Lifetime use of tobacco products (cigarettes) was high (377 698)

particularly among females (748 vs 651 x2 frac14 602 p frac14 014) Some 404 (218) ofthe cohort reported using cannabis at some point in their lives but less than 1 in 10

reported lifetime use of other illegal drugs On average the participants estimated that

they were 124 years old when they first drank a whole alcoholic drink

( SD frac14 19 range frac14 3ndash16 years) Four-fifths of the drinkers (N frac14 407) reported that

Adolescent drinking 435

they had had experience of being intoxicated by alcohol Males reported an earlier age

of first being intoxicated after drinking than females (136 vs 138 years t frac14 2229

p 05) All of the drinkers reported that they had drunk alcohol without the

knowledge of their parents on at least one occasion On average they were 14 years old

( SD frac14 721 range frac14 7ndash16 years) when they first drank without parental knowledge

Over half of the drinkers estimated that they had drunk alcohol without their parentsrsquoknowledge on at least 13 separate occasions in total

Alcohol involvementThe majority of the lifetime drinkers (N frac14 467 917) had consumed alcohol during

the past 90 days and a third of the sample (175 324) reported that they had

purchased alcohol themselves from a bar or club during this period Table 1 summarizes

the frequency of drinking and scores on the dependent variables by gender In terms of

drinking frequency participants estimated that they had drunk alcohol on an average of175 days ( SD frac14 147) in the past 3 months with males tending to report frequent

drinking than females (187 days vs 16 days t frac14 204 p frac14 042) On average

participants consumed 47 units (47 ml by volume) on a typical drinking day and there

were no differences in drinking intensity between males and females (49 units vs 45

units respectively t frac14 0103 p frac14 302) As can be seen 285 of the cohort recalled

drinking six or more units on a typical day

In general beerlager was the most commonly used beverage (by 434) followed

by spirits (200) liqueurs (96) alcopops (88) and wine (59) Males tended to

prefer beerlager (691 vs 146 x2 frac14 15370 p 000) while females preferred

spirits (321 vs 93 x2 frac14 4111 p 000) liqueurs (175 vs 26 x2 frac14 3236

p 000) alcopops (133 vs 33 x2 frac14 1708 p 000) and wine (104 vs

19 x2 frac14 1675 p 000) In the past 3 months a similar profile of beverage

Table 1 Frequency and intensity of alcohol use in the past 90 days by gender (N frac14 467)

Males ()(N frac14 251)

Females()(N frac14 216)

Total()

Frequency of alcohol use in past 90 daysLess than monthly 17 (68) 19 (88) 36 (77)1ndash3 days per month 79 (315) 76 (352) 155 (332)One day per week 58 (231) 52 (241) 110 (236)2ndash3 days per week 82 (327) 64 (296) 146 (313)4ndash6 days per week 14 (56) 4 (19) 18 (39)Everyday 1 (04) 1 (05) 2 (04)

Units consumed on a typical drinking dayUp to 10 unit 11 (44) 15 (69) 26 (56)1ndash19 units 31 (124) 33 (153) 64 (137)2ndash39 units 78 (311) 59 (273) 137 (293)4ndash59 units 44 (175) 35 (162) 79 (169)6ndash99 units 56 (223) 38 (176) 94 (201)10 or more 20 (80) 19 (88) 39 (84)Number of drinking days90 (meanSD) 187 (155) 160 (137) 175 (147)Amount drunk on typical day (meanSD) 49 (36) 45 (38) 47 (37)

p 05

John Marsden et al436

preferences was recorded When asked what type of alcohol they had consumed

most often during the time 60 said beerlager 143 said spirits 18 said wine

and 58 said alcopops

Family factorsHalf of the sample (271 502) estimated that their mother generally drank alcohol at

least once a week and 704 (380) estimated that their father drank at least once a

week In terms of parental encouragement to drink around one quarter of the

sample estimated that they had often drunk alcohol at home with their parents in the

past year (129 239) although only 161 said that their parents had often bought

them an alcoholic drink at a restaurant or other establishment Conversely just 138

(255) of the sample said that their parents had actively discouraged them from

drinking in the past year The two 5-item scales assessing the extent to which parentsencouraged or discouraged drinking were approximately normally distributed and

had acceptable internal reliability The average total score on the parental

encouragement scale was 1363 ( SD frac14 501 Cronbachrsquos a frac14 77) and the average

total score on the parental discouragement scale was 888 ( SD frac14 367 a frac14 77)

While a fifth (203) of the sample reported that in the past 3 months they had never

drunk alcohol without the knowledge of their parents a quarter (N frac14 139) reported

that when they had recently drunk alcohol it was often or always without their

parentsrsquo knowledge

Psychological factorsThe average total score for the mood alteration function scale was 122

(median frac14 120) and it had acceptable internal reliability (a frac14 71) The most

commonly endorsed mood alteration function was drinking to relax (51 reporting

that they drank sometimes or more frequently for this reason) followed by drinking in

order to forget about a problem (endorsed by 34) The average total score for thesocial facilitation function scale was 114 (median frac14 110 a frac14 70) and the most

commonly endorsed social item was drinking to enjoy the company of friends (by 63)

followed by drinking to lose inhibitions (endorsed by 48) Scores on the GHQ-12

ranged from 0 to 34 with a mean of 121 (median frac14 110 a frac14 85) The sample were

equally likely to report positive and negative alcohol-related attitudes The mean scores

on these scales were 228 and 238 respectively (range frac14 13ndash39 and 13ndash34 a frac14 68

and a frac14 73)

Social and peer factorsJust under one half (246 483) estimated that a few of their friends were older than

them and a minority 64 (126) of the drinkers estimated that all or most of their

friends were at least 1 year older than them Two-fifths (N frac14 202) said that all of their

friends drank alcohol and a further 391 said that they believed most did so In the past

3 months two-thirds of the drinkers (338 664) reported that they typically spent time

with friendsacquaintances who were drinking at least once a week Just 68 individuals(134) estimated that this generally occurred less than once a month and a further

17 (33) said that they never spent time with friendsacquaintances who

were drinking A small proportion of the drinkers (79) considered that they

felt pressure from their peers to drink alcohol but the majority (578) did not feel

Adolescent drinking 437

this way and a further 193 indicated that they strongly disagreed that such pressure

was present in their social network

School conduct problemsIn the past year the majority of the drinkers (356 76) had received a detention afterschool or some other minor punishment There was also a minority (95 187) who

estimated that they found themselves in trouble with teachers once or twice each

month and a further small group who said that they received some form of disciplinary

action at school once a week (57 112) A quarter (138 256) reported that they had

had a fight with another student in the past year Just over a third (187 367) admitted

that they had been absent from school without authorization (truanted) at least once in

the past year and the average number of occasions on which this had occurred was 78

days ( SD frac14 150 days range frac14 05ndash80) Sixty-six students (122) had beentemporarily excluded from school in the past year

Regression of covariates of alcohol involvementThe two dependent variables were judged to be reasonably normally distributed and

were not transformed Following negative screening for multicollinearity within the

covariate set multiple regression analysis was performed separately for each of thefive blocks of covariates to assess their individual contribution to explaining variance in

the dependent variables A further regression was then performed in which all 26

covariates were entered simultaneously to calculate the overall level of variance

accounted for Table 2 presents the standardized regression coefficients (b) and the

overall R 2 for each block for these analyses

There was no significant association between age of first drink and recent drinking

although as predicted there was a positive association between feeling intoxicated after

drinking alcohol and both recent drinking frequency and intensity As predicted therewas a positive correlation between lifetime smoking and cannabis use and alcohol

involvement and this association was stronger for cannabis Among the set of

predictions concerning parents there was evidence for an association between the

frequency of parentsrsquo drinking for drinking intensity but this was in the anticipated

direction for the motherrsquos drinking only ( p 01) The frequency of the fatherrsquos

drinking was associated with drinking of lower intensity ( p 05)

As predicted there were significant positive associations between the extent that

parents encouraged drinking and both drinking frequency ( p 001) and intensity( p 01) Contrary to prediction there was a weak but positive relationship between

the extent that parents discouraged drinking and recent alcohol involvement ( p 05)

For the psychological factors there was support for the predicted association between

alcohol involvement and drinking for mood alteration functions ( p 001) but not to

fulfil social functions Higher scores on the GHQ-12 indicative of poorer psychological

well-being were negatively associated with drinking frequency only ( p 001)

Contrary to prediction there were no associations between the positive and negative

alcohol-related attitude scales with the exception of a significant association betweenpositive attitudes and recent drinking intensity ( p 05)

In the social and peer factors block there was evidence that personally buying

alcohol was associated with higher drinking intensity ( p 01) and drinking frequency

( p 001) There was rather weak supporting evidence for the relationship between

having older friends and more frequent drinking ( p 05) There were mixed findings

John Marsden et al438

concerning having more friends who drink spending time with friends who drink and

feeling under social pressure to drink The proportion of friends who drink was related

to intensity ( p 05) but not frequency There was a strong positive and consistent

relationship between spending time with friends who drink and drinking ( p 001)

and there were significant associations between perceived social pressure to drink and

Table 2 Standard multiple regression of background family psychological social and school factors on

recent alcohol involvement (N frac14 467)

Drinking frequency Drinking intensity

1 Background R 2 frac14 0211 R 2 frac14 0192Age 0100 0079Gender 098 0025School 1 100 100School 2 20024 20073School 3 0065 0012School 4 20065 20128School 5 0077 0101Age of first drink 20076 20044Ever intoxicated from alcohol 0591 1092Age first intoxicated on alcohol 20396 20899Ever smoked cigarettes 0155 0076Ever used cannabis 0160 0140

2 Family R 2 frac14 0141 R 2 frac14 0060Frequency of motherrsquos drinking 0052 0153Frequency of fatherrsquos drinking 0041 20121Extent parents encourage drinking 0231 0156Extent parents discourage drinking 0109 0094Drinking without parents knowledge 0280 0137

3 Psychological R 2 frac14 0156 R 2 frac14 0095Mood functions for drinking 0385 0307Social functions for drinking 20002 20068Psychological well-being 20116 20062Positive drinking attitudes 20050 0102Negative drinking attitudes 20014 0001

4 Social R 2 frac14 0322 R 2 frac14 0210Personally bought alcohol 0150 0131Proportion of older friends 0074 0090Proportion of friends who drink 0083 0094Time with friends drinking 0387 0307Perceived social pressure to drink 0148 0062

5 School R 2 frac14 0121 R 2 frac14 0144Been in trouble with teachers 0213 0212Had a fight with student at school 0054 0090Times truanted in past year 0155 0120Temporarily excluded in past year 0090 0152Overall R 2 frac14 0418 R 2 frac14 0339Adjusted R 2 frac14 0381 R 2 frac14 0290

frac14 p 05 frac14 p 01 frac14 p 001

Adolescent drinking 439

drinking frequency but not recent intensity There was a positive correlation between

more positive alcohol-related attitudes and high drinking intensity only ( p 05)

There were also mixed associations relating to school conduct problems and

drinking Being temporarily excluded from school and the number of times truanted

were positively related to recent frequency ( p 05 and p 001 respectively) and

recent intensity ( p 01) Having had a fight with another student with associated withrecent drinking intensity only ( p 05) while there was a strong positive and

consistent relationship between being in trouble with teachers and the both drinking

measures ( p 001)

In total the five blocks of factors explained 42 (38 adjusted) of the variance in

frequency of drinking scores and 34 (29 adjusted) of the variance in typical intensity

Taking the covariate blocks in turn the regression analysis indicated that the social and

peer factors had the strongest correlations (accounting for 32 and 21 of the variance

in drinking frequency and intensity respectively) For drinking frequency the strengthof association for the remaining factors was as follows background variables (21)

psychological factors (16) family factors (14) and school conduct problems (12)

The regression analysis for recent typical drinking intensity revealed a somewhat

contrasting pattern of predictors background variables (19) school conduct

problems (14) psychological factors (10) and family factors (6)

The dataset was then screened for the presence of moderation effects between

gender and each covariate Those variables (gender the covariate and their interaction)

that emerged as statistically significant were then entered into two regression equationsusing each of the dependent variables If the interaction term exerted a significant effect

on the dependent variable in this equation when its constituent parts were controlled

for this was taken as evidence of a moderation effect by gender The single interaction

term that was identified in this way was added to the covariate set in a backwards

stepwise regression equation controlling for gender and age This process resulted in a

final lsquotrimmed downrsquo regression model for the two dependent variables and is shown in

Table 3 The total proportions of variance in the dependent variables explained by the

final models were as follows 40 (38 adjusted) for drinking frequency( F12 441 frac14 2690 p 001) and 27 (26 adjusted) for drinking intensity

( F7 441 frac14 2316 p 001)

Drinking frequencyEleven covariates were retained in the model as significantly associated with recent

drinking frequency As can be seen most were from the family factors and social and

peer factors blocks Males tended to be more frequent drinkers than females(b frac14 0272) However the strongest predictor of frequency of alcohol use in the model

was the amount of time spent with friends who are drinking (b frac14 0316) Other

influential variables included the extent to which parents encourage (b frac14 0155) and

discourage (b frac14 20223) alcohol use with the latter association moderated by gender

More frequent parental discouragement to drink was related to more frequent drinking

in females and less frequent drinking frequency in males In a post hoc analysis the

parental discouragement scale items were entered into a regression equation This

showed that two items exerted an effect over and above the others lsquomy parents havetold me off because of drinking or buying alcoholrsquo and lsquomy parents have said that

I cannot drink alcohol at homersquo A positive relationship was also observed between

drinking more frequently without parentsrsquo knowledge and recent frequency of use

(b frac14 0110) Other independent influences on drinking frequency were higher mood

John Marsden et al440

alteration function scores (b frac14 0113) greater perceived social pressure to drink

alcohol (b frac14 0155) a history of temporary school exclusion (b frac14 0121) and more

frequent occasions of truanting from school in the past year (b frac14 0086)

Drinking intensityIn common with the final model for drinking frequency just five covariates were

retained in the regression equation for drinking intensity The amount of time spent with

friends who are drinking alcohol was the strongest predictor (b frac14 0319) This was

followed by having a history of school exclusion (b frac14 0197) and more frequently being

in trouble with teachers in the past year (b frac14 0142) Greater parental encouragement

to drink was associated with higher actual drinking intensity (b frac14 0124) Finally a

single background factor ndash lifetime use of cannabis ndash was associated with higher

drinking intensity (b frac14 0113)

Discussion

This report has presented first results from a cohort follow-up study of alcohol use

among a sample of mid-adolescents in England Baseline data on personal backgroundand demographics family psychological social factors and school conduct problems

were correlated with reports of recent drinking frequency and intensity As expected

regular drinking was the norm among the cohort 19 in 20 of the cohort had consumed a

whole alcoholic drink at some point in their lives and approximately 17 in 20 were

current drinkers This prevalence of alcohol use is comparable to that reported for the

Table 3 Stepwise multiple regression of background family psychological social and school factors on

recent alcohol involvement (N frac14 467)

Drinking frequencyR 2 frac14 0396

Drinking intensityR 2 frac14 0273

1 BackgroundAge 0033 0046Gender 0272 0004Ever smoked cannabis ndash 0113

2 FamilyExtent parents encourage drinking 0155 0124Extent parents discourage drinking 0223 ndashGender pound extent parents discourage drinkinga 0302 ndashDrinking without parents knowledge 0113 ndash

3 PsychologicalMood functions for drinking 0113 ndash

4 SocialPersonally bought alcohol 0118 ndashTime with friends who are drinking 0316 0319Perceived social pressure to drink 0155 ndash

5 SchoolIn trouble with teachers in past year ndash 0142Times truanted in past year 0086 ndashTemporarily excluded in past year 0121 0197

a frac14 interaction term frac14 p 05 frac14 p 01 frac14 p 001

Adolescent drinking 441

general adult population in the UK (Singleton Bumpstead OrsquoBrien Lee amp Meltzer

2001) and is also comparable to drinking levels reported for 15-year-olds in other

countries (eg Casswell Stewart Conolly amp Silva 1991 for New Zealand) In terms of

typical drinking intensity study participants estimated that they drank about five

standard units of alcohol on a typical day Although the government has not issued

recommended drinking levels for the under-18 s this level exceeds the safer drinkinglevels for adults as recommended by the English Department of Health (Department of

Health 1995) and is therefore a cause for concern A substantial proportion of the

sample also reported lifetime tobacco smoking (70) and use of cannabis (40) Despite

the fact that the study cohort was not generated using probability sampling techniques

it is reasonable to believe that it is unbiased The levels of drinking smoking and

cannabis use reported fell remarkably close to population estimates for this age group in

England (Goddard amp Higgins 2001 Becher et al 2001 Currie Hurrelmann

Settertobulte Smith amp Todd 2000) On school conduct characteristics the samplewas also broadly comparable to reports from national surveys (Miller amp Plant 1999)

The cohort was also comparable to the general population on school conduct problems

Thirty-seven percent admitted that they had truanted at least once in the past year and

this compares to 33 of boys who admitted truanting in the latest Office for National

Statistics school survey (Boreham amp Shaw 2001)

Drinking was well established within the social networks of the cohort The majority

reported that most or all of their friends drank alcohol and two-thirds of the drinkers

said that they typically spent time with friendsacquaintances who were drinking atleast once a week Two-thirds did not consider that they were under any peer pressure

to drink

In the UK alcopop beverages are well established in the drinks market (Clarke

2000) and concerns have been raised about the marketing of these products to younger

drinkers (Hughes et al 1997 McKeganey 1998) In our study males reported a limited

preference for these drinks and tended to favour beer and lager whereas females had a

greater preference for spirits alcopops wine and liqueurs Males were more frequent

drinkers but there were no gender differences in the amount of alcohol consumed ontypical day Previous studies on alcohol use have found that males drink more heavily

than their female peers (Goddard amp Higgins 2001 Miller amp Plant 1996) However as

alcohol use among school-age students approximately doubled between 1990 and 2000

(from 53 units in 1990 to 104 units in 2000) the gender gap in consumption has

narrowed (Goddard amp Higgins 2001) The drinking patterns of young females are of

concern given their greater vulnerability to alcohol-related harms (Goist amp Sutker 1985

Plant amp Plant 2001)

Correlates of drinking frequencyThe regression analyses were able to account for approximately 40 of the variance in

scores on the measure of drinking frequency There was no evidence for the hypothesized

negative relationship between age of first drink and recent drinking frequency although

there was a positive association with feeling intoxicated after drinking alcohol It is

however possible that the effect of earlier initiation to drinking is not seen until drinking

patterns have further developed This was observed in a longitudinal study in the USAreported by Hawkins et al (1997) In this study of a cohort of students who were

followed-up annually from age 10ndash11 to age 17ndash18 a younger age of alcohol initiation was

strongly related to a higher level of alcohol misuse at age 17ndash18 Consequently we will

assess the influence of age of alcohol initiation in further follow-ups

John Marsden et al442

Studies examining the putative relationship between lifetime smoking cannabis use

and recent drinking frequency suggest that earlier initiation to substance use mediates

peers alcohol involvement and parental drinking risk factors (eg Hawkins et al 1997)

However findings from research using twins suggests that the association between age

of onset of alcohol use and later problematic drinking may not be directly causal but

that age of onset and problematic drinking in later life are both associated with anunderlying vulnerability to behavioural problems (Prescott amp Kendler 1999)

There was no support for the predicted relationship between the frequency of

parental drinking and adolescent drinking frequency It must be acknowledged that

influence of parental drinking parental alcohol use norms and family environment and

relations are complex (Peterson et al 1994) Foxcroft and Lowe (1997) found that

increased drinking levels among 11ndash17-year-olds were linked to regular perceived

parental drinking while Casswell and her colleagues noted a positive association

between the frequency of drinking in early- to mid-adolescents and the frequency of

their mother and fatherrsquos drinking (Casswell et al 1991) Peterson et al showed thatclear communication by parents about their expectations of their childrenrsquos drinking

together with positive reinforcement for desired behaviours can reduce the impact of

parentrsquos drinking on adolescent alcohol use

Several studies have also noted a negative relationship between parental support

a positive family environment and feelings of connectedness and adolescent substance

use (Resnick et al 1997 Hops Davis amp Lewin 1999) The role that parental approval of

drinking has in predicting intensity of alcohol use in their children has also been

explored (eg Barnes amp Welte 1986) Wilks Callan and Austin (1989) found that the

fatherrsquos approval or disapproval of drinking behaviour predicted self-perception as adrinker in young males yet found no normative influences for females A gender

interaction in the present study also suggests a differential effect for discouraging

drinking More frequent parental discouragement to drink was related to more frequent

drinking in females and less frequent drinking in males This finding could indicate that

parents are more likely to disapprove of drinking in their daughters (and therefore

discourage alcohol use more strongly) than in their sons Alternatively it could point to a

tendency for girls to rebel more strongly against their parentsrsquo attitudes towards alcohol

use The direction of this relationship cannot be judged from the baseline data but our

post hoc item analysis does suggest that this effect may be due to parental reactions todrinking and proscriptions about drinking at home Future analyses of the longitudinal

data collected during the course of this study will examine this issue more closely

In the present analyses although frequency of mother and fathersrsquo alcohol use was

significantly related to drinking frequency these variables were not retained in the

regression analysis This suggests that other variables explain the relationship between

these factors Zhang Welte and Wieczorek (1999) found that the drinking behaviour of

each parent has a differential effect on their male offspring (aged 16ndash19 years) In their

study the fatherrsquos drinking but not their motherrsquos drinking affects their sons drinking

and closeness to the mother was a protective factor against adolescent drinking On theother hand male adolescent drinking increases if closeness to the mother is low and she

drinks excessively There appears to be no comparable effect for closeness to the father

and the fatherrsquos drinking

For the analysis of psychological measures there was an association in the predicted

direction between alcohol involvement and drinking for mood alteration functions but

not drinking to fulfil social functions Poorer psychological well-being was negatively

associated with drinking frequency only and contrary to our hypothesis there were no

Adolescent drinking 443

associations between the positive and negative alcohol-related attitude scales The

present results provide further evidence for the link between reasons or motives for

alcohol use and consumption patterns A strong relationship was observed between

increased frequency of drinking to serve mood alteration functions and increased

drinking frequency Our research group has also observed this effect among young

alcohol cannabis and ecstasy users (Boys et al 1999) These findings are consistentwith previous studies which have found a positive relationship between the number of

reasons for alcohol use and drinking frequency (Cooper Frone Russell amp Mudar 1995

Beck amp Treiman 1996 Bradizza Reifman amp Barnes 1999) For the social and peer

factors buying alcohol was as predicted associated with increased alcohol

involvement but there was only weak supporting evidence for an association with

having older friends There was a strong positive and consistent relationship between

spending time with friends who drink and perceived social pressure to drink and more

frequent drinking These independent social influences are interpreted in the context ofdeveloping peer relations and peer norms in which the majority of adolescents report

spending time with friends who are drinking as a recreational activity and where there

may be expectations to drink with the group sometimes to excessive levels (Iannotti

amp Bush 1992 Bahr Marcos amp Maughan 1995) Finally school conduct problems were

independently associated with drinking frequency with the number of times truanted

and being temporarily excluded having the strongest correlations Drinking more often

than other peers has been linked to more frequent unauthorized absences from school

(Currie et al 2000) Drinking smoking and drug use is also much more prevalentamong 12- to 15-year-olds who had ever truanted compared to those who had never

done so (Becher et al 2001)

Correlates of drinking intensityOverall 285 of the cohort typically drank six or more units on a drinking day which

can be taken to be a conservative indicator of underage binge drinking The regression

analyses were able to account for approximately 30 of the variance in drinkingintensity Age of first alcohol intoxication and lifetime smoking and cannabis use was

associated with more intense recent drinking For the family factors in contrast to

drinking frequency there was evidence for a positive association between how often

the mother usually drank alcohol and how much the adolescent drank on a drinking day

but contrary to prediction there was a negative association with the fatherrsquos drinking

It is possible that more frequent drinking by the father serves to discourage binge

drinking among mid-adolescents Nonetheless this effect was weak and was not

retained in the stepwise regression As predicted drinking to alter mood was associatedwith more intensive drinking but not with drinking for social facilitation functions This

effect however was not sufficiently strong to be retained in the stepwise regression

There was also a positive association between more favourable attitudes towards

alcohol and drinking intensity Among the social and peer factors a similar set of

associations was seen with the exception of perceived social pressure to drink

suggesting that mid-adolescents do not feel that the amount they consume is influenced

by their peers Finally the school conduct factors were quite strongly associated with

more intensive drinking and being in trouble with teachers and having beingtemporarily excluded had the strongest associations

The links between binge drinking and school conduct problems are a concern and

elsewhere studies have shown that binge drinking is related to poorer actual educational

performance (Newcomb Measham amp Parker 1995) Clinical diagnostic criteria for

John Marsden et al444

alcohol abuse recognize that recurrent drinking can result in school performance

problems and expulsions (American Psychiatric Association 1994) and the trajectory of

those experiencing school problems will be a focus of subsequent analyses of further

follow-up in the study The finding that lifetime use of cannabis was independently

associated with more intensive drinking is supportive of other work that argues that

those adolescents who use substances tend to have other attributes that increase therisk of poor psychosocial adjustment and school performance For example Jessor

Chase and Donovan (1980) argued that the reason that cannabis users tend to be less

well adjusted is that cannabis use is a general characteristic of individuals who are

predisposed to behavioural problems Furthermore Fergusson Lynskey and Horwood

(1997) suggested that instead of early cannabis use having a causal link with poor

psychosocial adjustment this association could be explained by family and other factors

that related to cannabis use Other alternative explanations include those proposed by

Kandel and colleagues They argue that early substance use sets into motion a chain ofevents which result in greater subsequent drug involvement and a range of other

negative psychosocial consequences (Kandel Davies Karus amp Yamaguchi 1986)

Again the causal direction of this relationship cannot be judged from the baseline data

but will be examined in more detail in subsequent reports on the longitudinal data

Strengths and limitations of the studyThe main strength of the present study was the analysis of the multiple influences on

drinking behaviour Studies of this kind have been rare in the UK but are encouraged as

good opportunities to gain an understanding of how early use of alcohol smoking and

other substance involvement evolves across the adolescent years (Edwards et al 1994

Duncan Duncan amp Hops 1998) Several limitations of the present study are also

acknowledged Given the reliance on self-report it is difficult to judge the reliability ofthe data and the findings should be interpreted with caution Nevertheless steps were

taken to maximize the privacy of the recruitment interviews to emphasize the

confidentiality of the study and the interviews were all conducted by young adults

Overall it has been argued that it is better to collect social survey data on this age group

at school than in the home (Becher et al 2001)

Implications for school-based alcohol educationThese results underline the importance of addressing personal family peer and school

conduct factors as part of alcohol education and problem prevention initiatives Theidentified correlates of drinking involvement in the present study could be usefully

taken up and discussed with students as part of alcohol education and prevention

programmes Elsewhere it has been argued that the main goal of school prevention

programmes should be to delay alcohol initiation (DeWit et al 2000 Griffin Botvin

Epstein Doyle amp Diaz 2000) However the very early age of onset in the UK suggests

that educational approaches based on harm minimization may be more realistic Recent

work in Australia has indicated that a harm minimization approach to alcohol education

together with adult supervision of initial drinking experiences can help to reduce theharms associated with alcohol use in young people (McBride Midford Farringdon amp

Phillips 2000b) Research into the merits of adopting a harm minimization approach to

alcohol education in schools has highlighted the importance of ensuring that

programme content and materials are relevant to local patterns of behaviour and are

Adolescent drinking 445

based on experiences that are relevant to the target audience (McBride Farringdon amp

Midford 2000a Dusenbury amp Falco 1995)

The potential feasibility and benefits of including parents as part of education

programmes in school should be examined The possibility of encouraging parents to

consider how their own behaviour and attitudes towards drinking might influence the

choices regarding alcohol use that are made by their offspring should be explored

Given the high prevalence of drinking involvement in mid-adolescence understanding

the influences on the further development of drinking attitudes and behaviours is of

critical importance Further reports from the study will describe the associations

between risky and heavy drinking patterns and alcohol-related problems and

developmental transitions to heavier consumption patterns as the cohort reaches the

period of late-adolescence

Acknowledgements

We would like to thank the students and staff from each school for their kind and enthusiastic

participation in the study The study was supported by a research grant from the LloydsTSB

charitable trust and conducted in association with Alcohol Concern

References

American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders

(4th ed) Washington DC APA

Anderson K Plant M amp Plant M (1998) Associations between drinking smoking and illicit

drug use among adolescents in the Western Isles of Scotland Implications for harm

minimization Journal of Substance Misuse 3 13ndash20

Ary D V Tildesley E Hops H amp Andrews J (1993) The influence of parent sibling and peer

modelling and attitudes on adolescent use of alcohol International Journal of Addiction 28

853ndash880

Bahr S J Marcos A C amp Maughan S L (1995) Family educational and peer influences on the

alcohol use of female and male adolescents Journal of Studies on Alcohol 56 457ndash469

Barnes G (1990) Impact of the family on adolescent drinking patterns In R Collins K Leonard

amp J Searles (Eds) Alcohol and the family Research and clinical perspectives (pp 137ndash161)

New York Guilford Press

Barnes G amp Welte J (1986) Patterns and predictors of alcohol use among 7ndash12th grade students

in New York State Journal of Studies on Alcohol 47 53ndash62

Becher H Boreham R Emery P Hinds K Jamison J amp Schagen I (2001) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Beck K H amp Treiman K A (1996) The relationship of social context of drinking perceived

social norms and parental influence to various drinking patterns of adolescents Addictive

Behaviors 21 633ndash644

Blenkinsop S Boreham R McManus S Natarajan L amp Prescott A (2003) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Blum R W Beuhring T amp Rinehart P M (2000) Protecting teens Beyond race income and

family structure Minneapolis MN Center for Adolescent Health University of Minnesota

Bonomo Y Coffey C Wolfe R Lynskey M Bowes G amp Patton G (2001) Adverse outcomes

of alcohol use in adolescents Addiction 96 1485ndash1496

Boreham R amp Shaw (2001) Smoking drinking and drug use among young people in England

in 2000 London The Stationery Office

John Marsden et al446

they had had experience of being intoxicated by alcohol Males reported an earlier age

of first being intoxicated after drinking than females (136 vs 138 years t frac14 2229

p 05) All of the drinkers reported that they had drunk alcohol without the

knowledge of their parents on at least one occasion On average they were 14 years old

( SD frac14 721 range frac14 7ndash16 years) when they first drank without parental knowledge

Over half of the drinkers estimated that they had drunk alcohol without their parentsrsquoknowledge on at least 13 separate occasions in total

Alcohol involvementThe majority of the lifetime drinkers (N frac14 467 917) had consumed alcohol during

the past 90 days and a third of the sample (175 324) reported that they had

purchased alcohol themselves from a bar or club during this period Table 1 summarizes

the frequency of drinking and scores on the dependent variables by gender In terms of

drinking frequency participants estimated that they had drunk alcohol on an average of175 days ( SD frac14 147) in the past 3 months with males tending to report frequent

drinking than females (187 days vs 16 days t frac14 204 p frac14 042) On average

participants consumed 47 units (47 ml by volume) on a typical drinking day and there

were no differences in drinking intensity between males and females (49 units vs 45

units respectively t frac14 0103 p frac14 302) As can be seen 285 of the cohort recalled

drinking six or more units on a typical day

In general beerlager was the most commonly used beverage (by 434) followed

by spirits (200) liqueurs (96) alcopops (88) and wine (59) Males tended to

prefer beerlager (691 vs 146 x2 frac14 15370 p 000) while females preferred

spirits (321 vs 93 x2 frac14 4111 p 000) liqueurs (175 vs 26 x2 frac14 3236

p 000) alcopops (133 vs 33 x2 frac14 1708 p 000) and wine (104 vs

19 x2 frac14 1675 p 000) In the past 3 months a similar profile of beverage

Table 1 Frequency and intensity of alcohol use in the past 90 days by gender (N frac14 467)

Males ()(N frac14 251)

Females()(N frac14 216)

Total()

Frequency of alcohol use in past 90 daysLess than monthly 17 (68) 19 (88) 36 (77)1ndash3 days per month 79 (315) 76 (352) 155 (332)One day per week 58 (231) 52 (241) 110 (236)2ndash3 days per week 82 (327) 64 (296) 146 (313)4ndash6 days per week 14 (56) 4 (19) 18 (39)Everyday 1 (04) 1 (05) 2 (04)

Units consumed on a typical drinking dayUp to 10 unit 11 (44) 15 (69) 26 (56)1ndash19 units 31 (124) 33 (153) 64 (137)2ndash39 units 78 (311) 59 (273) 137 (293)4ndash59 units 44 (175) 35 (162) 79 (169)6ndash99 units 56 (223) 38 (176) 94 (201)10 or more 20 (80) 19 (88) 39 (84)Number of drinking days90 (meanSD) 187 (155) 160 (137) 175 (147)Amount drunk on typical day (meanSD) 49 (36) 45 (38) 47 (37)

p 05

John Marsden et al436

preferences was recorded When asked what type of alcohol they had consumed

most often during the time 60 said beerlager 143 said spirits 18 said wine

and 58 said alcopops

Family factorsHalf of the sample (271 502) estimated that their mother generally drank alcohol at

least once a week and 704 (380) estimated that their father drank at least once a

week In terms of parental encouragement to drink around one quarter of the

sample estimated that they had often drunk alcohol at home with their parents in the

past year (129 239) although only 161 said that their parents had often bought

them an alcoholic drink at a restaurant or other establishment Conversely just 138

(255) of the sample said that their parents had actively discouraged them from

drinking in the past year The two 5-item scales assessing the extent to which parentsencouraged or discouraged drinking were approximately normally distributed and

had acceptable internal reliability The average total score on the parental

encouragement scale was 1363 ( SD frac14 501 Cronbachrsquos a frac14 77) and the average

total score on the parental discouragement scale was 888 ( SD frac14 367 a frac14 77)

While a fifth (203) of the sample reported that in the past 3 months they had never

drunk alcohol without the knowledge of their parents a quarter (N frac14 139) reported

that when they had recently drunk alcohol it was often or always without their

parentsrsquo knowledge

Psychological factorsThe average total score for the mood alteration function scale was 122

(median frac14 120) and it had acceptable internal reliability (a frac14 71) The most

commonly endorsed mood alteration function was drinking to relax (51 reporting

that they drank sometimes or more frequently for this reason) followed by drinking in

order to forget about a problem (endorsed by 34) The average total score for thesocial facilitation function scale was 114 (median frac14 110 a frac14 70) and the most

commonly endorsed social item was drinking to enjoy the company of friends (by 63)

followed by drinking to lose inhibitions (endorsed by 48) Scores on the GHQ-12

ranged from 0 to 34 with a mean of 121 (median frac14 110 a frac14 85) The sample were

equally likely to report positive and negative alcohol-related attitudes The mean scores

on these scales were 228 and 238 respectively (range frac14 13ndash39 and 13ndash34 a frac14 68

and a frac14 73)

Social and peer factorsJust under one half (246 483) estimated that a few of their friends were older than

them and a minority 64 (126) of the drinkers estimated that all or most of their

friends were at least 1 year older than them Two-fifths (N frac14 202) said that all of their

friends drank alcohol and a further 391 said that they believed most did so In the past

3 months two-thirds of the drinkers (338 664) reported that they typically spent time

with friendsacquaintances who were drinking at least once a week Just 68 individuals(134) estimated that this generally occurred less than once a month and a further

17 (33) said that they never spent time with friendsacquaintances who

were drinking A small proportion of the drinkers (79) considered that they

felt pressure from their peers to drink alcohol but the majority (578) did not feel

Adolescent drinking 437

this way and a further 193 indicated that they strongly disagreed that such pressure

was present in their social network

School conduct problemsIn the past year the majority of the drinkers (356 76) had received a detention afterschool or some other minor punishment There was also a minority (95 187) who

estimated that they found themselves in trouble with teachers once or twice each

month and a further small group who said that they received some form of disciplinary

action at school once a week (57 112) A quarter (138 256) reported that they had

had a fight with another student in the past year Just over a third (187 367) admitted

that they had been absent from school without authorization (truanted) at least once in

the past year and the average number of occasions on which this had occurred was 78

days ( SD frac14 150 days range frac14 05ndash80) Sixty-six students (122) had beentemporarily excluded from school in the past year

Regression of covariates of alcohol involvementThe two dependent variables were judged to be reasonably normally distributed and

were not transformed Following negative screening for multicollinearity within the

covariate set multiple regression analysis was performed separately for each of thefive blocks of covariates to assess their individual contribution to explaining variance in

the dependent variables A further regression was then performed in which all 26

covariates were entered simultaneously to calculate the overall level of variance

accounted for Table 2 presents the standardized regression coefficients (b) and the

overall R 2 for each block for these analyses

There was no significant association between age of first drink and recent drinking

although as predicted there was a positive association between feeling intoxicated after

drinking alcohol and both recent drinking frequency and intensity As predicted therewas a positive correlation between lifetime smoking and cannabis use and alcohol

involvement and this association was stronger for cannabis Among the set of

predictions concerning parents there was evidence for an association between the

frequency of parentsrsquo drinking for drinking intensity but this was in the anticipated

direction for the motherrsquos drinking only ( p 01) The frequency of the fatherrsquos

drinking was associated with drinking of lower intensity ( p 05)

As predicted there were significant positive associations between the extent that

parents encouraged drinking and both drinking frequency ( p 001) and intensity( p 01) Contrary to prediction there was a weak but positive relationship between

the extent that parents discouraged drinking and recent alcohol involvement ( p 05)

For the psychological factors there was support for the predicted association between

alcohol involvement and drinking for mood alteration functions ( p 001) but not to

fulfil social functions Higher scores on the GHQ-12 indicative of poorer psychological

well-being were negatively associated with drinking frequency only ( p 001)

Contrary to prediction there were no associations between the positive and negative

alcohol-related attitude scales with the exception of a significant association betweenpositive attitudes and recent drinking intensity ( p 05)

In the social and peer factors block there was evidence that personally buying

alcohol was associated with higher drinking intensity ( p 01) and drinking frequency

( p 001) There was rather weak supporting evidence for the relationship between

having older friends and more frequent drinking ( p 05) There were mixed findings

John Marsden et al438

concerning having more friends who drink spending time with friends who drink and

feeling under social pressure to drink The proportion of friends who drink was related

to intensity ( p 05) but not frequency There was a strong positive and consistent

relationship between spending time with friends who drink and drinking ( p 001)

and there were significant associations between perceived social pressure to drink and

Table 2 Standard multiple regression of background family psychological social and school factors on

recent alcohol involvement (N frac14 467)

Drinking frequency Drinking intensity

1 Background R 2 frac14 0211 R 2 frac14 0192Age 0100 0079Gender 098 0025School 1 100 100School 2 20024 20073School 3 0065 0012School 4 20065 20128School 5 0077 0101Age of first drink 20076 20044Ever intoxicated from alcohol 0591 1092Age first intoxicated on alcohol 20396 20899Ever smoked cigarettes 0155 0076Ever used cannabis 0160 0140

2 Family R 2 frac14 0141 R 2 frac14 0060Frequency of motherrsquos drinking 0052 0153Frequency of fatherrsquos drinking 0041 20121Extent parents encourage drinking 0231 0156Extent parents discourage drinking 0109 0094Drinking without parents knowledge 0280 0137

3 Psychological R 2 frac14 0156 R 2 frac14 0095Mood functions for drinking 0385 0307Social functions for drinking 20002 20068Psychological well-being 20116 20062Positive drinking attitudes 20050 0102Negative drinking attitudes 20014 0001

4 Social R 2 frac14 0322 R 2 frac14 0210Personally bought alcohol 0150 0131Proportion of older friends 0074 0090Proportion of friends who drink 0083 0094Time with friends drinking 0387 0307Perceived social pressure to drink 0148 0062

5 School R 2 frac14 0121 R 2 frac14 0144Been in trouble with teachers 0213 0212Had a fight with student at school 0054 0090Times truanted in past year 0155 0120Temporarily excluded in past year 0090 0152Overall R 2 frac14 0418 R 2 frac14 0339Adjusted R 2 frac14 0381 R 2 frac14 0290

frac14 p 05 frac14 p 01 frac14 p 001

Adolescent drinking 439

drinking frequency but not recent intensity There was a positive correlation between

more positive alcohol-related attitudes and high drinking intensity only ( p 05)

There were also mixed associations relating to school conduct problems and

drinking Being temporarily excluded from school and the number of times truanted

were positively related to recent frequency ( p 05 and p 001 respectively) and

recent intensity ( p 01) Having had a fight with another student with associated withrecent drinking intensity only ( p 05) while there was a strong positive and

consistent relationship between being in trouble with teachers and the both drinking

measures ( p 001)

In total the five blocks of factors explained 42 (38 adjusted) of the variance in

frequency of drinking scores and 34 (29 adjusted) of the variance in typical intensity

Taking the covariate blocks in turn the regression analysis indicated that the social and

peer factors had the strongest correlations (accounting for 32 and 21 of the variance

in drinking frequency and intensity respectively) For drinking frequency the strengthof association for the remaining factors was as follows background variables (21)

psychological factors (16) family factors (14) and school conduct problems (12)

The regression analysis for recent typical drinking intensity revealed a somewhat

contrasting pattern of predictors background variables (19) school conduct

problems (14) psychological factors (10) and family factors (6)

The dataset was then screened for the presence of moderation effects between

gender and each covariate Those variables (gender the covariate and their interaction)

that emerged as statistically significant were then entered into two regression equationsusing each of the dependent variables If the interaction term exerted a significant effect

on the dependent variable in this equation when its constituent parts were controlled

for this was taken as evidence of a moderation effect by gender The single interaction

term that was identified in this way was added to the covariate set in a backwards

stepwise regression equation controlling for gender and age This process resulted in a

final lsquotrimmed downrsquo regression model for the two dependent variables and is shown in

Table 3 The total proportions of variance in the dependent variables explained by the

final models were as follows 40 (38 adjusted) for drinking frequency( F12 441 frac14 2690 p 001) and 27 (26 adjusted) for drinking intensity

( F7 441 frac14 2316 p 001)

Drinking frequencyEleven covariates were retained in the model as significantly associated with recent

drinking frequency As can be seen most were from the family factors and social and

peer factors blocks Males tended to be more frequent drinkers than females(b frac14 0272) However the strongest predictor of frequency of alcohol use in the model

was the amount of time spent with friends who are drinking (b frac14 0316) Other

influential variables included the extent to which parents encourage (b frac14 0155) and

discourage (b frac14 20223) alcohol use with the latter association moderated by gender

More frequent parental discouragement to drink was related to more frequent drinking

in females and less frequent drinking frequency in males In a post hoc analysis the

parental discouragement scale items were entered into a regression equation This

showed that two items exerted an effect over and above the others lsquomy parents havetold me off because of drinking or buying alcoholrsquo and lsquomy parents have said that

I cannot drink alcohol at homersquo A positive relationship was also observed between

drinking more frequently without parentsrsquo knowledge and recent frequency of use

(b frac14 0110) Other independent influences on drinking frequency were higher mood

John Marsden et al440

alteration function scores (b frac14 0113) greater perceived social pressure to drink

alcohol (b frac14 0155) a history of temporary school exclusion (b frac14 0121) and more

frequent occasions of truanting from school in the past year (b frac14 0086)

Drinking intensityIn common with the final model for drinking frequency just five covariates were

retained in the regression equation for drinking intensity The amount of time spent with

friends who are drinking alcohol was the strongest predictor (b frac14 0319) This was

followed by having a history of school exclusion (b frac14 0197) and more frequently being

in trouble with teachers in the past year (b frac14 0142) Greater parental encouragement

to drink was associated with higher actual drinking intensity (b frac14 0124) Finally a

single background factor ndash lifetime use of cannabis ndash was associated with higher

drinking intensity (b frac14 0113)

Discussion

This report has presented first results from a cohort follow-up study of alcohol use

among a sample of mid-adolescents in England Baseline data on personal backgroundand demographics family psychological social factors and school conduct problems

were correlated with reports of recent drinking frequency and intensity As expected

regular drinking was the norm among the cohort 19 in 20 of the cohort had consumed a

whole alcoholic drink at some point in their lives and approximately 17 in 20 were

current drinkers This prevalence of alcohol use is comparable to that reported for the

Table 3 Stepwise multiple regression of background family psychological social and school factors on

recent alcohol involvement (N frac14 467)

Drinking frequencyR 2 frac14 0396

Drinking intensityR 2 frac14 0273

1 BackgroundAge 0033 0046Gender 0272 0004Ever smoked cannabis ndash 0113

2 FamilyExtent parents encourage drinking 0155 0124Extent parents discourage drinking 0223 ndashGender pound extent parents discourage drinkinga 0302 ndashDrinking without parents knowledge 0113 ndash

3 PsychologicalMood functions for drinking 0113 ndash

4 SocialPersonally bought alcohol 0118 ndashTime with friends who are drinking 0316 0319Perceived social pressure to drink 0155 ndash

5 SchoolIn trouble with teachers in past year ndash 0142Times truanted in past year 0086 ndashTemporarily excluded in past year 0121 0197

a frac14 interaction term frac14 p 05 frac14 p 01 frac14 p 001

Adolescent drinking 441

general adult population in the UK (Singleton Bumpstead OrsquoBrien Lee amp Meltzer

2001) and is also comparable to drinking levels reported for 15-year-olds in other

countries (eg Casswell Stewart Conolly amp Silva 1991 for New Zealand) In terms of

typical drinking intensity study participants estimated that they drank about five

standard units of alcohol on a typical day Although the government has not issued

recommended drinking levels for the under-18 s this level exceeds the safer drinkinglevels for adults as recommended by the English Department of Health (Department of

Health 1995) and is therefore a cause for concern A substantial proportion of the

sample also reported lifetime tobacco smoking (70) and use of cannabis (40) Despite

the fact that the study cohort was not generated using probability sampling techniques

it is reasonable to believe that it is unbiased The levels of drinking smoking and

cannabis use reported fell remarkably close to population estimates for this age group in

England (Goddard amp Higgins 2001 Becher et al 2001 Currie Hurrelmann

Settertobulte Smith amp Todd 2000) On school conduct characteristics the samplewas also broadly comparable to reports from national surveys (Miller amp Plant 1999)

The cohort was also comparable to the general population on school conduct problems

Thirty-seven percent admitted that they had truanted at least once in the past year and

this compares to 33 of boys who admitted truanting in the latest Office for National

Statistics school survey (Boreham amp Shaw 2001)

Drinking was well established within the social networks of the cohort The majority

reported that most or all of their friends drank alcohol and two-thirds of the drinkers

said that they typically spent time with friendsacquaintances who were drinking atleast once a week Two-thirds did not consider that they were under any peer pressure

to drink

In the UK alcopop beverages are well established in the drinks market (Clarke

2000) and concerns have been raised about the marketing of these products to younger

drinkers (Hughes et al 1997 McKeganey 1998) In our study males reported a limited

preference for these drinks and tended to favour beer and lager whereas females had a

greater preference for spirits alcopops wine and liqueurs Males were more frequent

drinkers but there were no gender differences in the amount of alcohol consumed ontypical day Previous studies on alcohol use have found that males drink more heavily

than their female peers (Goddard amp Higgins 2001 Miller amp Plant 1996) However as

alcohol use among school-age students approximately doubled between 1990 and 2000

(from 53 units in 1990 to 104 units in 2000) the gender gap in consumption has

narrowed (Goddard amp Higgins 2001) The drinking patterns of young females are of

concern given their greater vulnerability to alcohol-related harms (Goist amp Sutker 1985

Plant amp Plant 2001)

Correlates of drinking frequencyThe regression analyses were able to account for approximately 40 of the variance in

scores on the measure of drinking frequency There was no evidence for the hypothesized

negative relationship between age of first drink and recent drinking frequency although

there was a positive association with feeling intoxicated after drinking alcohol It is

however possible that the effect of earlier initiation to drinking is not seen until drinking

patterns have further developed This was observed in a longitudinal study in the USAreported by Hawkins et al (1997) In this study of a cohort of students who were

followed-up annually from age 10ndash11 to age 17ndash18 a younger age of alcohol initiation was

strongly related to a higher level of alcohol misuse at age 17ndash18 Consequently we will

assess the influence of age of alcohol initiation in further follow-ups

John Marsden et al442

Studies examining the putative relationship between lifetime smoking cannabis use

and recent drinking frequency suggest that earlier initiation to substance use mediates

peers alcohol involvement and parental drinking risk factors (eg Hawkins et al 1997)

However findings from research using twins suggests that the association between age

of onset of alcohol use and later problematic drinking may not be directly causal but

that age of onset and problematic drinking in later life are both associated with anunderlying vulnerability to behavioural problems (Prescott amp Kendler 1999)

There was no support for the predicted relationship between the frequency of

parental drinking and adolescent drinking frequency It must be acknowledged that

influence of parental drinking parental alcohol use norms and family environment and

relations are complex (Peterson et al 1994) Foxcroft and Lowe (1997) found that

increased drinking levels among 11ndash17-year-olds were linked to regular perceived

parental drinking while Casswell and her colleagues noted a positive association

between the frequency of drinking in early- to mid-adolescents and the frequency of

their mother and fatherrsquos drinking (Casswell et al 1991) Peterson et al showed thatclear communication by parents about their expectations of their childrenrsquos drinking

together with positive reinforcement for desired behaviours can reduce the impact of

parentrsquos drinking on adolescent alcohol use

Several studies have also noted a negative relationship between parental support

a positive family environment and feelings of connectedness and adolescent substance

use (Resnick et al 1997 Hops Davis amp Lewin 1999) The role that parental approval of

drinking has in predicting intensity of alcohol use in their children has also been

explored (eg Barnes amp Welte 1986) Wilks Callan and Austin (1989) found that the

fatherrsquos approval or disapproval of drinking behaviour predicted self-perception as adrinker in young males yet found no normative influences for females A gender

interaction in the present study also suggests a differential effect for discouraging

drinking More frequent parental discouragement to drink was related to more frequent

drinking in females and less frequent drinking in males This finding could indicate that

parents are more likely to disapprove of drinking in their daughters (and therefore

discourage alcohol use more strongly) than in their sons Alternatively it could point to a

tendency for girls to rebel more strongly against their parentsrsquo attitudes towards alcohol

use The direction of this relationship cannot be judged from the baseline data but our

post hoc item analysis does suggest that this effect may be due to parental reactions todrinking and proscriptions about drinking at home Future analyses of the longitudinal

data collected during the course of this study will examine this issue more closely

In the present analyses although frequency of mother and fathersrsquo alcohol use was

significantly related to drinking frequency these variables were not retained in the

regression analysis This suggests that other variables explain the relationship between

these factors Zhang Welte and Wieczorek (1999) found that the drinking behaviour of

each parent has a differential effect on their male offspring (aged 16ndash19 years) In their

study the fatherrsquos drinking but not their motherrsquos drinking affects their sons drinking

and closeness to the mother was a protective factor against adolescent drinking On theother hand male adolescent drinking increases if closeness to the mother is low and she

drinks excessively There appears to be no comparable effect for closeness to the father

and the fatherrsquos drinking

For the analysis of psychological measures there was an association in the predicted

direction between alcohol involvement and drinking for mood alteration functions but

not drinking to fulfil social functions Poorer psychological well-being was negatively

associated with drinking frequency only and contrary to our hypothesis there were no

Adolescent drinking 443

associations between the positive and negative alcohol-related attitude scales The

present results provide further evidence for the link between reasons or motives for

alcohol use and consumption patterns A strong relationship was observed between

increased frequency of drinking to serve mood alteration functions and increased

drinking frequency Our research group has also observed this effect among young

alcohol cannabis and ecstasy users (Boys et al 1999) These findings are consistentwith previous studies which have found a positive relationship between the number of

reasons for alcohol use and drinking frequency (Cooper Frone Russell amp Mudar 1995

Beck amp Treiman 1996 Bradizza Reifman amp Barnes 1999) For the social and peer

factors buying alcohol was as predicted associated with increased alcohol

involvement but there was only weak supporting evidence for an association with

having older friends There was a strong positive and consistent relationship between

spending time with friends who drink and perceived social pressure to drink and more

frequent drinking These independent social influences are interpreted in the context ofdeveloping peer relations and peer norms in which the majority of adolescents report

spending time with friends who are drinking as a recreational activity and where there

may be expectations to drink with the group sometimes to excessive levels (Iannotti

amp Bush 1992 Bahr Marcos amp Maughan 1995) Finally school conduct problems were

independently associated with drinking frequency with the number of times truanted

and being temporarily excluded having the strongest correlations Drinking more often

than other peers has been linked to more frequent unauthorized absences from school

(Currie et al 2000) Drinking smoking and drug use is also much more prevalentamong 12- to 15-year-olds who had ever truanted compared to those who had never

done so (Becher et al 2001)

Correlates of drinking intensityOverall 285 of the cohort typically drank six or more units on a drinking day which

can be taken to be a conservative indicator of underage binge drinking The regression

analyses were able to account for approximately 30 of the variance in drinkingintensity Age of first alcohol intoxication and lifetime smoking and cannabis use was

associated with more intense recent drinking For the family factors in contrast to

drinking frequency there was evidence for a positive association between how often

the mother usually drank alcohol and how much the adolescent drank on a drinking day

but contrary to prediction there was a negative association with the fatherrsquos drinking

It is possible that more frequent drinking by the father serves to discourage binge

drinking among mid-adolescents Nonetheless this effect was weak and was not

retained in the stepwise regression As predicted drinking to alter mood was associatedwith more intensive drinking but not with drinking for social facilitation functions This

effect however was not sufficiently strong to be retained in the stepwise regression

There was also a positive association between more favourable attitudes towards

alcohol and drinking intensity Among the social and peer factors a similar set of

associations was seen with the exception of perceived social pressure to drink

suggesting that mid-adolescents do not feel that the amount they consume is influenced

by their peers Finally the school conduct factors were quite strongly associated with

more intensive drinking and being in trouble with teachers and having beingtemporarily excluded had the strongest associations

The links between binge drinking and school conduct problems are a concern and

elsewhere studies have shown that binge drinking is related to poorer actual educational

performance (Newcomb Measham amp Parker 1995) Clinical diagnostic criteria for

John Marsden et al444

alcohol abuse recognize that recurrent drinking can result in school performance

problems and expulsions (American Psychiatric Association 1994) and the trajectory of

those experiencing school problems will be a focus of subsequent analyses of further

follow-up in the study The finding that lifetime use of cannabis was independently

associated with more intensive drinking is supportive of other work that argues that

those adolescents who use substances tend to have other attributes that increase therisk of poor psychosocial adjustment and school performance For example Jessor

Chase and Donovan (1980) argued that the reason that cannabis users tend to be less

well adjusted is that cannabis use is a general characteristic of individuals who are

predisposed to behavioural problems Furthermore Fergusson Lynskey and Horwood

(1997) suggested that instead of early cannabis use having a causal link with poor

psychosocial adjustment this association could be explained by family and other factors

that related to cannabis use Other alternative explanations include those proposed by

Kandel and colleagues They argue that early substance use sets into motion a chain ofevents which result in greater subsequent drug involvement and a range of other

negative psychosocial consequences (Kandel Davies Karus amp Yamaguchi 1986)

Again the causal direction of this relationship cannot be judged from the baseline data

but will be examined in more detail in subsequent reports on the longitudinal data

Strengths and limitations of the studyThe main strength of the present study was the analysis of the multiple influences on

drinking behaviour Studies of this kind have been rare in the UK but are encouraged as

good opportunities to gain an understanding of how early use of alcohol smoking and

other substance involvement evolves across the adolescent years (Edwards et al 1994

Duncan Duncan amp Hops 1998) Several limitations of the present study are also

acknowledged Given the reliance on self-report it is difficult to judge the reliability ofthe data and the findings should be interpreted with caution Nevertheless steps were

taken to maximize the privacy of the recruitment interviews to emphasize the

confidentiality of the study and the interviews were all conducted by young adults

Overall it has been argued that it is better to collect social survey data on this age group

at school than in the home (Becher et al 2001)

Implications for school-based alcohol educationThese results underline the importance of addressing personal family peer and school

conduct factors as part of alcohol education and problem prevention initiatives Theidentified correlates of drinking involvement in the present study could be usefully

taken up and discussed with students as part of alcohol education and prevention

programmes Elsewhere it has been argued that the main goal of school prevention

programmes should be to delay alcohol initiation (DeWit et al 2000 Griffin Botvin

Epstein Doyle amp Diaz 2000) However the very early age of onset in the UK suggests

that educational approaches based on harm minimization may be more realistic Recent

work in Australia has indicated that a harm minimization approach to alcohol education

together with adult supervision of initial drinking experiences can help to reduce theharms associated with alcohol use in young people (McBride Midford Farringdon amp

Phillips 2000b) Research into the merits of adopting a harm minimization approach to

alcohol education in schools has highlighted the importance of ensuring that

programme content and materials are relevant to local patterns of behaviour and are

Adolescent drinking 445

based on experiences that are relevant to the target audience (McBride Farringdon amp

Midford 2000a Dusenbury amp Falco 1995)

The potential feasibility and benefits of including parents as part of education

programmes in school should be examined The possibility of encouraging parents to

consider how their own behaviour and attitudes towards drinking might influence the

choices regarding alcohol use that are made by their offspring should be explored

Given the high prevalence of drinking involvement in mid-adolescence understanding

the influences on the further development of drinking attitudes and behaviours is of

critical importance Further reports from the study will describe the associations

between risky and heavy drinking patterns and alcohol-related problems and

developmental transitions to heavier consumption patterns as the cohort reaches the

period of late-adolescence

Acknowledgements

We would like to thank the students and staff from each school for their kind and enthusiastic

participation in the study The study was supported by a research grant from the LloydsTSB

charitable trust and conducted in association with Alcohol Concern

References

American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders

(4th ed) Washington DC APA

Anderson K Plant M amp Plant M (1998) Associations between drinking smoking and illicit

drug use among adolescents in the Western Isles of Scotland Implications for harm

minimization Journal of Substance Misuse 3 13ndash20

Ary D V Tildesley E Hops H amp Andrews J (1993) The influence of parent sibling and peer

modelling and attitudes on adolescent use of alcohol International Journal of Addiction 28

853ndash880

Bahr S J Marcos A C amp Maughan S L (1995) Family educational and peer influences on the

alcohol use of female and male adolescents Journal of Studies on Alcohol 56 457ndash469

Barnes G (1990) Impact of the family on adolescent drinking patterns In R Collins K Leonard

amp J Searles (Eds) Alcohol and the family Research and clinical perspectives (pp 137ndash161)

New York Guilford Press

Barnes G amp Welte J (1986) Patterns and predictors of alcohol use among 7ndash12th grade students

in New York State Journal of Studies on Alcohol 47 53ndash62

Becher H Boreham R Emery P Hinds K Jamison J amp Schagen I (2001) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Beck K H amp Treiman K A (1996) The relationship of social context of drinking perceived

social norms and parental influence to various drinking patterns of adolescents Addictive

Behaviors 21 633ndash644

Blenkinsop S Boreham R McManus S Natarajan L amp Prescott A (2003) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Blum R W Beuhring T amp Rinehart P M (2000) Protecting teens Beyond race income and

family structure Minneapolis MN Center for Adolescent Health University of Minnesota

Bonomo Y Coffey C Wolfe R Lynskey M Bowes G amp Patton G (2001) Adverse outcomes

of alcohol use in adolescents Addiction 96 1485ndash1496

Boreham R amp Shaw (2001) Smoking drinking and drug use among young people in England

in 2000 London The Stationery Office

John Marsden et al446

preferences was recorded When asked what type of alcohol they had consumed

most often during the time 60 said beerlager 143 said spirits 18 said wine

and 58 said alcopops

Family factorsHalf of the sample (271 502) estimated that their mother generally drank alcohol at

least once a week and 704 (380) estimated that their father drank at least once a

week In terms of parental encouragement to drink around one quarter of the

sample estimated that they had often drunk alcohol at home with their parents in the

past year (129 239) although only 161 said that their parents had often bought

them an alcoholic drink at a restaurant or other establishment Conversely just 138

(255) of the sample said that their parents had actively discouraged them from

drinking in the past year The two 5-item scales assessing the extent to which parentsencouraged or discouraged drinking were approximately normally distributed and

had acceptable internal reliability The average total score on the parental

encouragement scale was 1363 ( SD frac14 501 Cronbachrsquos a frac14 77) and the average

total score on the parental discouragement scale was 888 ( SD frac14 367 a frac14 77)

While a fifth (203) of the sample reported that in the past 3 months they had never

drunk alcohol without the knowledge of their parents a quarter (N frac14 139) reported

that when they had recently drunk alcohol it was often or always without their

parentsrsquo knowledge

Psychological factorsThe average total score for the mood alteration function scale was 122

(median frac14 120) and it had acceptable internal reliability (a frac14 71) The most

commonly endorsed mood alteration function was drinking to relax (51 reporting

that they drank sometimes or more frequently for this reason) followed by drinking in

order to forget about a problem (endorsed by 34) The average total score for thesocial facilitation function scale was 114 (median frac14 110 a frac14 70) and the most

commonly endorsed social item was drinking to enjoy the company of friends (by 63)

followed by drinking to lose inhibitions (endorsed by 48) Scores on the GHQ-12

ranged from 0 to 34 with a mean of 121 (median frac14 110 a frac14 85) The sample were

equally likely to report positive and negative alcohol-related attitudes The mean scores

on these scales were 228 and 238 respectively (range frac14 13ndash39 and 13ndash34 a frac14 68

and a frac14 73)

Social and peer factorsJust under one half (246 483) estimated that a few of their friends were older than

them and a minority 64 (126) of the drinkers estimated that all or most of their

friends were at least 1 year older than them Two-fifths (N frac14 202) said that all of their

friends drank alcohol and a further 391 said that they believed most did so In the past

3 months two-thirds of the drinkers (338 664) reported that they typically spent time

with friendsacquaintances who were drinking at least once a week Just 68 individuals(134) estimated that this generally occurred less than once a month and a further

17 (33) said that they never spent time with friendsacquaintances who

were drinking A small proportion of the drinkers (79) considered that they

felt pressure from their peers to drink alcohol but the majority (578) did not feel

Adolescent drinking 437

this way and a further 193 indicated that they strongly disagreed that such pressure

was present in their social network

School conduct problemsIn the past year the majority of the drinkers (356 76) had received a detention afterschool or some other minor punishment There was also a minority (95 187) who

estimated that they found themselves in trouble with teachers once or twice each

month and a further small group who said that they received some form of disciplinary

action at school once a week (57 112) A quarter (138 256) reported that they had

had a fight with another student in the past year Just over a third (187 367) admitted

that they had been absent from school without authorization (truanted) at least once in

the past year and the average number of occasions on which this had occurred was 78

days ( SD frac14 150 days range frac14 05ndash80) Sixty-six students (122) had beentemporarily excluded from school in the past year

Regression of covariates of alcohol involvementThe two dependent variables were judged to be reasonably normally distributed and

were not transformed Following negative screening for multicollinearity within the

covariate set multiple regression analysis was performed separately for each of thefive blocks of covariates to assess their individual contribution to explaining variance in

the dependent variables A further regression was then performed in which all 26

covariates were entered simultaneously to calculate the overall level of variance

accounted for Table 2 presents the standardized regression coefficients (b) and the

overall R 2 for each block for these analyses

There was no significant association between age of first drink and recent drinking

although as predicted there was a positive association between feeling intoxicated after

drinking alcohol and both recent drinking frequency and intensity As predicted therewas a positive correlation between lifetime smoking and cannabis use and alcohol

involvement and this association was stronger for cannabis Among the set of

predictions concerning parents there was evidence for an association between the

frequency of parentsrsquo drinking for drinking intensity but this was in the anticipated

direction for the motherrsquos drinking only ( p 01) The frequency of the fatherrsquos

drinking was associated with drinking of lower intensity ( p 05)

As predicted there were significant positive associations between the extent that

parents encouraged drinking and both drinking frequency ( p 001) and intensity( p 01) Contrary to prediction there was a weak but positive relationship between

the extent that parents discouraged drinking and recent alcohol involvement ( p 05)

For the psychological factors there was support for the predicted association between

alcohol involvement and drinking for mood alteration functions ( p 001) but not to

fulfil social functions Higher scores on the GHQ-12 indicative of poorer psychological

well-being were negatively associated with drinking frequency only ( p 001)

Contrary to prediction there were no associations between the positive and negative

alcohol-related attitude scales with the exception of a significant association betweenpositive attitudes and recent drinking intensity ( p 05)

In the social and peer factors block there was evidence that personally buying

alcohol was associated with higher drinking intensity ( p 01) and drinking frequency

( p 001) There was rather weak supporting evidence for the relationship between

having older friends and more frequent drinking ( p 05) There were mixed findings

John Marsden et al438

concerning having more friends who drink spending time with friends who drink and

feeling under social pressure to drink The proportion of friends who drink was related

to intensity ( p 05) but not frequency There was a strong positive and consistent

relationship between spending time with friends who drink and drinking ( p 001)

and there were significant associations between perceived social pressure to drink and

Table 2 Standard multiple regression of background family psychological social and school factors on

recent alcohol involvement (N frac14 467)

Drinking frequency Drinking intensity

1 Background R 2 frac14 0211 R 2 frac14 0192Age 0100 0079Gender 098 0025School 1 100 100School 2 20024 20073School 3 0065 0012School 4 20065 20128School 5 0077 0101Age of first drink 20076 20044Ever intoxicated from alcohol 0591 1092Age first intoxicated on alcohol 20396 20899Ever smoked cigarettes 0155 0076Ever used cannabis 0160 0140

2 Family R 2 frac14 0141 R 2 frac14 0060Frequency of motherrsquos drinking 0052 0153Frequency of fatherrsquos drinking 0041 20121Extent parents encourage drinking 0231 0156Extent parents discourage drinking 0109 0094Drinking without parents knowledge 0280 0137

3 Psychological R 2 frac14 0156 R 2 frac14 0095Mood functions for drinking 0385 0307Social functions for drinking 20002 20068Psychological well-being 20116 20062Positive drinking attitudes 20050 0102Negative drinking attitudes 20014 0001

4 Social R 2 frac14 0322 R 2 frac14 0210Personally bought alcohol 0150 0131Proportion of older friends 0074 0090Proportion of friends who drink 0083 0094Time with friends drinking 0387 0307Perceived social pressure to drink 0148 0062

5 School R 2 frac14 0121 R 2 frac14 0144Been in trouble with teachers 0213 0212Had a fight with student at school 0054 0090Times truanted in past year 0155 0120Temporarily excluded in past year 0090 0152Overall R 2 frac14 0418 R 2 frac14 0339Adjusted R 2 frac14 0381 R 2 frac14 0290

frac14 p 05 frac14 p 01 frac14 p 001

Adolescent drinking 439

drinking frequency but not recent intensity There was a positive correlation between

more positive alcohol-related attitudes and high drinking intensity only ( p 05)

There were also mixed associations relating to school conduct problems and

drinking Being temporarily excluded from school and the number of times truanted

were positively related to recent frequency ( p 05 and p 001 respectively) and

recent intensity ( p 01) Having had a fight with another student with associated withrecent drinking intensity only ( p 05) while there was a strong positive and

consistent relationship between being in trouble with teachers and the both drinking

measures ( p 001)

In total the five blocks of factors explained 42 (38 adjusted) of the variance in

frequency of drinking scores and 34 (29 adjusted) of the variance in typical intensity

Taking the covariate blocks in turn the regression analysis indicated that the social and

peer factors had the strongest correlations (accounting for 32 and 21 of the variance

in drinking frequency and intensity respectively) For drinking frequency the strengthof association for the remaining factors was as follows background variables (21)

psychological factors (16) family factors (14) and school conduct problems (12)

The regression analysis for recent typical drinking intensity revealed a somewhat

contrasting pattern of predictors background variables (19) school conduct

problems (14) psychological factors (10) and family factors (6)

The dataset was then screened for the presence of moderation effects between

gender and each covariate Those variables (gender the covariate and their interaction)

that emerged as statistically significant were then entered into two regression equationsusing each of the dependent variables If the interaction term exerted a significant effect

on the dependent variable in this equation when its constituent parts were controlled

for this was taken as evidence of a moderation effect by gender The single interaction

term that was identified in this way was added to the covariate set in a backwards

stepwise regression equation controlling for gender and age This process resulted in a

final lsquotrimmed downrsquo regression model for the two dependent variables and is shown in

Table 3 The total proportions of variance in the dependent variables explained by the

final models were as follows 40 (38 adjusted) for drinking frequency( F12 441 frac14 2690 p 001) and 27 (26 adjusted) for drinking intensity

( F7 441 frac14 2316 p 001)

Drinking frequencyEleven covariates were retained in the model as significantly associated with recent

drinking frequency As can be seen most were from the family factors and social and

peer factors blocks Males tended to be more frequent drinkers than females(b frac14 0272) However the strongest predictor of frequency of alcohol use in the model

was the amount of time spent with friends who are drinking (b frac14 0316) Other

influential variables included the extent to which parents encourage (b frac14 0155) and

discourage (b frac14 20223) alcohol use with the latter association moderated by gender

More frequent parental discouragement to drink was related to more frequent drinking

in females and less frequent drinking frequency in males In a post hoc analysis the

parental discouragement scale items were entered into a regression equation This

showed that two items exerted an effect over and above the others lsquomy parents havetold me off because of drinking or buying alcoholrsquo and lsquomy parents have said that

I cannot drink alcohol at homersquo A positive relationship was also observed between

drinking more frequently without parentsrsquo knowledge and recent frequency of use

(b frac14 0110) Other independent influences on drinking frequency were higher mood

John Marsden et al440

alteration function scores (b frac14 0113) greater perceived social pressure to drink

alcohol (b frac14 0155) a history of temporary school exclusion (b frac14 0121) and more

frequent occasions of truanting from school in the past year (b frac14 0086)

Drinking intensityIn common with the final model for drinking frequency just five covariates were

retained in the regression equation for drinking intensity The amount of time spent with

friends who are drinking alcohol was the strongest predictor (b frac14 0319) This was

followed by having a history of school exclusion (b frac14 0197) and more frequently being

in trouble with teachers in the past year (b frac14 0142) Greater parental encouragement

to drink was associated with higher actual drinking intensity (b frac14 0124) Finally a

single background factor ndash lifetime use of cannabis ndash was associated with higher

drinking intensity (b frac14 0113)

Discussion

This report has presented first results from a cohort follow-up study of alcohol use

among a sample of mid-adolescents in England Baseline data on personal backgroundand demographics family psychological social factors and school conduct problems

were correlated with reports of recent drinking frequency and intensity As expected

regular drinking was the norm among the cohort 19 in 20 of the cohort had consumed a

whole alcoholic drink at some point in their lives and approximately 17 in 20 were

current drinkers This prevalence of alcohol use is comparable to that reported for the

Table 3 Stepwise multiple regression of background family psychological social and school factors on

recent alcohol involvement (N frac14 467)

Drinking frequencyR 2 frac14 0396

Drinking intensityR 2 frac14 0273

1 BackgroundAge 0033 0046Gender 0272 0004Ever smoked cannabis ndash 0113

2 FamilyExtent parents encourage drinking 0155 0124Extent parents discourage drinking 0223 ndashGender pound extent parents discourage drinkinga 0302 ndashDrinking without parents knowledge 0113 ndash

3 PsychologicalMood functions for drinking 0113 ndash

4 SocialPersonally bought alcohol 0118 ndashTime with friends who are drinking 0316 0319Perceived social pressure to drink 0155 ndash

5 SchoolIn trouble with teachers in past year ndash 0142Times truanted in past year 0086 ndashTemporarily excluded in past year 0121 0197

a frac14 interaction term frac14 p 05 frac14 p 01 frac14 p 001

Adolescent drinking 441

general adult population in the UK (Singleton Bumpstead OrsquoBrien Lee amp Meltzer

2001) and is also comparable to drinking levels reported for 15-year-olds in other

countries (eg Casswell Stewart Conolly amp Silva 1991 for New Zealand) In terms of

typical drinking intensity study participants estimated that they drank about five

standard units of alcohol on a typical day Although the government has not issued

recommended drinking levels for the under-18 s this level exceeds the safer drinkinglevels for adults as recommended by the English Department of Health (Department of

Health 1995) and is therefore a cause for concern A substantial proportion of the

sample also reported lifetime tobacco smoking (70) and use of cannabis (40) Despite

the fact that the study cohort was not generated using probability sampling techniques

it is reasonable to believe that it is unbiased The levels of drinking smoking and

cannabis use reported fell remarkably close to population estimates for this age group in

England (Goddard amp Higgins 2001 Becher et al 2001 Currie Hurrelmann

Settertobulte Smith amp Todd 2000) On school conduct characteristics the samplewas also broadly comparable to reports from national surveys (Miller amp Plant 1999)

The cohort was also comparable to the general population on school conduct problems

Thirty-seven percent admitted that they had truanted at least once in the past year and

this compares to 33 of boys who admitted truanting in the latest Office for National

Statistics school survey (Boreham amp Shaw 2001)

Drinking was well established within the social networks of the cohort The majority

reported that most or all of their friends drank alcohol and two-thirds of the drinkers

said that they typically spent time with friendsacquaintances who were drinking atleast once a week Two-thirds did not consider that they were under any peer pressure

to drink

In the UK alcopop beverages are well established in the drinks market (Clarke

2000) and concerns have been raised about the marketing of these products to younger

drinkers (Hughes et al 1997 McKeganey 1998) In our study males reported a limited

preference for these drinks and tended to favour beer and lager whereas females had a

greater preference for spirits alcopops wine and liqueurs Males were more frequent

drinkers but there were no gender differences in the amount of alcohol consumed ontypical day Previous studies on alcohol use have found that males drink more heavily

than their female peers (Goddard amp Higgins 2001 Miller amp Plant 1996) However as

alcohol use among school-age students approximately doubled between 1990 and 2000

(from 53 units in 1990 to 104 units in 2000) the gender gap in consumption has

narrowed (Goddard amp Higgins 2001) The drinking patterns of young females are of

concern given their greater vulnerability to alcohol-related harms (Goist amp Sutker 1985

Plant amp Plant 2001)

Correlates of drinking frequencyThe regression analyses were able to account for approximately 40 of the variance in

scores on the measure of drinking frequency There was no evidence for the hypothesized

negative relationship between age of first drink and recent drinking frequency although

there was a positive association with feeling intoxicated after drinking alcohol It is

however possible that the effect of earlier initiation to drinking is not seen until drinking

patterns have further developed This was observed in a longitudinal study in the USAreported by Hawkins et al (1997) In this study of a cohort of students who were

followed-up annually from age 10ndash11 to age 17ndash18 a younger age of alcohol initiation was

strongly related to a higher level of alcohol misuse at age 17ndash18 Consequently we will

assess the influence of age of alcohol initiation in further follow-ups

John Marsden et al442

Studies examining the putative relationship between lifetime smoking cannabis use

and recent drinking frequency suggest that earlier initiation to substance use mediates

peers alcohol involvement and parental drinking risk factors (eg Hawkins et al 1997)

However findings from research using twins suggests that the association between age

of onset of alcohol use and later problematic drinking may not be directly causal but

that age of onset and problematic drinking in later life are both associated with anunderlying vulnerability to behavioural problems (Prescott amp Kendler 1999)

There was no support for the predicted relationship between the frequency of

parental drinking and adolescent drinking frequency It must be acknowledged that

influence of parental drinking parental alcohol use norms and family environment and

relations are complex (Peterson et al 1994) Foxcroft and Lowe (1997) found that

increased drinking levels among 11ndash17-year-olds were linked to regular perceived

parental drinking while Casswell and her colleagues noted a positive association

between the frequency of drinking in early- to mid-adolescents and the frequency of

their mother and fatherrsquos drinking (Casswell et al 1991) Peterson et al showed thatclear communication by parents about their expectations of their childrenrsquos drinking

together with positive reinforcement for desired behaviours can reduce the impact of

parentrsquos drinking on adolescent alcohol use

Several studies have also noted a negative relationship between parental support

a positive family environment and feelings of connectedness and adolescent substance

use (Resnick et al 1997 Hops Davis amp Lewin 1999) The role that parental approval of

drinking has in predicting intensity of alcohol use in their children has also been

explored (eg Barnes amp Welte 1986) Wilks Callan and Austin (1989) found that the

fatherrsquos approval or disapproval of drinking behaviour predicted self-perception as adrinker in young males yet found no normative influences for females A gender

interaction in the present study also suggests a differential effect for discouraging

drinking More frequent parental discouragement to drink was related to more frequent

drinking in females and less frequent drinking in males This finding could indicate that

parents are more likely to disapprove of drinking in their daughters (and therefore

discourage alcohol use more strongly) than in their sons Alternatively it could point to a

tendency for girls to rebel more strongly against their parentsrsquo attitudes towards alcohol

use The direction of this relationship cannot be judged from the baseline data but our

post hoc item analysis does suggest that this effect may be due to parental reactions todrinking and proscriptions about drinking at home Future analyses of the longitudinal

data collected during the course of this study will examine this issue more closely

In the present analyses although frequency of mother and fathersrsquo alcohol use was

significantly related to drinking frequency these variables were not retained in the

regression analysis This suggests that other variables explain the relationship between

these factors Zhang Welte and Wieczorek (1999) found that the drinking behaviour of

each parent has a differential effect on their male offspring (aged 16ndash19 years) In their

study the fatherrsquos drinking but not their motherrsquos drinking affects their sons drinking

and closeness to the mother was a protective factor against adolescent drinking On theother hand male adolescent drinking increases if closeness to the mother is low and she

drinks excessively There appears to be no comparable effect for closeness to the father

and the fatherrsquos drinking

For the analysis of psychological measures there was an association in the predicted

direction between alcohol involvement and drinking for mood alteration functions but

not drinking to fulfil social functions Poorer psychological well-being was negatively

associated with drinking frequency only and contrary to our hypothesis there were no

Adolescent drinking 443

associations between the positive and negative alcohol-related attitude scales The

present results provide further evidence for the link between reasons or motives for

alcohol use and consumption patterns A strong relationship was observed between

increased frequency of drinking to serve mood alteration functions and increased

drinking frequency Our research group has also observed this effect among young

alcohol cannabis and ecstasy users (Boys et al 1999) These findings are consistentwith previous studies which have found a positive relationship between the number of

reasons for alcohol use and drinking frequency (Cooper Frone Russell amp Mudar 1995

Beck amp Treiman 1996 Bradizza Reifman amp Barnes 1999) For the social and peer

factors buying alcohol was as predicted associated with increased alcohol

involvement but there was only weak supporting evidence for an association with

having older friends There was a strong positive and consistent relationship between

spending time with friends who drink and perceived social pressure to drink and more

frequent drinking These independent social influences are interpreted in the context ofdeveloping peer relations and peer norms in which the majority of adolescents report

spending time with friends who are drinking as a recreational activity and where there

may be expectations to drink with the group sometimes to excessive levels (Iannotti

amp Bush 1992 Bahr Marcos amp Maughan 1995) Finally school conduct problems were

independently associated with drinking frequency with the number of times truanted

and being temporarily excluded having the strongest correlations Drinking more often

than other peers has been linked to more frequent unauthorized absences from school

(Currie et al 2000) Drinking smoking and drug use is also much more prevalentamong 12- to 15-year-olds who had ever truanted compared to those who had never

done so (Becher et al 2001)

Correlates of drinking intensityOverall 285 of the cohort typically drank six or more units on a drinking day which

can be taken to be a conservative indicator of underage binge drinking The regression

analyses were able to account for approximately 30 of the variance in drinkingintensity Age of first alcohol intoxication and lifetime smoking and cannabis use was

associated with more intense recent drinking For the family factors in contrast to

drinking frequency there was evidence for a positive association between how often

the mother usually drank alcohol and how much the adolescent drank on a drinking day

but contrary to prediction there was a negative association with the fatherrsquos drinking

It is possible that more frequent drinking by the father serves to discourage binge

drinking among mid-adolescents Nonetheless this effect was weak and was not

retained in the stepwise regression As predicted drinking to alter mood was associatedwith more intensive drinking but not with drinking for social facilitation functions This

effect however was not sufficiently strong to be retained in the stepwise regression

There was also a positive association between more favourable attitudes towards

alcohol and drinking intensity Among the social and peer factors a similar set of

associations was seen with the exception of perceived social pressure to drink

suggesting that mid-adolescents do not feel that the amount they consume is influenced

by their peers Finally the school conduct factors were quite strongly associated with

more intensive drinking and being in trouble with teachers and having beingtemporarily excluded had the strongest associations

The links between binge drinking and school conduct problems are a concern and

elsewhere studies have shown that binge drinking is related to poorer actual educational

performance (Newcomb Measham amp Parker 1995) Clinical diagnostic criteria for

John Marsden et al444

alcohol abuse recognize that recurrent drinking can result in school performance

problems and expulsions (American Psychiatric Association 1994) and the trajectory of

those experiencing school problems will be a focus of subsequent analyses of further

follow-up in the study The finding that lifetime use of cannabis was independently

associated with more intensive drinking is supportive of other work that argues that

those adolescents who use substances tend to have other attributes that increase therisk of poor psychosocial adjustment and school performance For example Jessor

Chase and Donovan (1980) argued that the reason that cannabis users tend to be less

well adjusted is that cannabis use is a general characteristic of individuals who are

predisposed to behavioural problems Furthermore Fergusson Lynskey and Horwood

(1997) suggested that instead of early cannabis use having a causal link with poor

psychosocial adjustment this association could be explained by family and other factors

that related to cannabis use Other alternative explanations include those proposed by

Kandel and colleagues They argue that early substance use sets into motion a chain ofevents which result in greater subsequent drug involvement and a range of other

negative psychosocial consequences (Kandel Davies Karus amp Yamaguchi 1986)

Again the causal direction of this relationship cannot be judged from the baseline data

but will be examined in more detail in subsequent reports on the longitudinal data

Strengths and limitations of the studyThe main strength of the present study was the analysis of the multiple influences on

drinking behaviour Studies of this kind have been rare in the UK but are encouraged as

good opportunities to gain an understanding of how early use of alcohol smoking and

other substance involvement evolves across the adolescent years (Edwards et al 1994

Duncan Duncan amp Hops 1998) Several limitations of the present study are also

acknowledged Given the reliance on self-report it is difficult to judge the reliability ofthe data and the findings should be interpreted with caution Nevertheless steps were

taken to maximize the privacy of the recruitment interviews to emphasize the

confidentiality of the study and the interviews were all conducted by young adults

Overall it has been argued that it is better to collect social survey data on this age group

at school than in the home (Becher et al 2001)

Implications for school-based alcohol educationThese results underline the importance of addressing personal family peer and school

conduct factors as part of alcohol education and problem prevention initiatives Theidentified correlates of drinking involvement in the present study could be usefully

taken up and discussed with students as part of alcohol education and prevention

programmes Elsewhere it has been argued that the main goal of school prevention

programmes should be to delay alcohol initiation (DeWit et al 2000 Griffin Botvin

Epstein Doyle amp Diaz 2000) However the very early age of onset in the UK suggests

that educational approaches based on harm minimization may be more realistic Recent

work in Australia has indicated that a harm minimization approach to alcohol education

together with adult supervision of initial drinking experiences can help to reduce theharms associated with alcohol use in young people (McBride Midford Farringdon amp

Phillips 2000b) Research into the merits of adopting a harm minimization approach to

alcohol education in schools has highlighted the importance of ensuring that

programme content and materials are relevant to local patterns of behaviour and are

Adolescent drinking 445

based on experiences that are relevant to the target audience (McBride Farringdon amp

Midford 2000a Dusenbury amp Falco 1995)

The potential feasibility and benefits of including parents as part of education

programmes in school should be examined The possibility of encouraging parents to

consider how their own behaviour and attitudes towards drinking might influence the

choices regarding alcohol use that are made by their offspring should be explored

Given the high prevalence of drinking involvement in mid-adolescence understanding

the influences on the further development of drinking attitudes and behaviours is of

critical importance Further reports from the study will describe the associations

between risky and heavy drinking patterns and alcohol-related problems and

developmental transitions to heavier consumption patterns as the cohort reaches the

period of late-adolescence

Acknowledgements

We would like to thank the students and staff from each school for their kind and enthusiastic

participation in the study The study was supported by a research grant from the LloydsTSB

charitable trust and conducted in association with Alcohol Concern

References

American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders

(4th ed) Washington DC APA

Anderson K Plant M amp Plant M (1998) Associations between drinking smoking and illicit

drug use among adolescents in the Western Isles of Scotland Implications for harm

minimization Journal of Substance Misuse 3 13ndash20

Ary D V Tildesley E Hops H amp Andrews J (1993) The influence of parent sibling and peer

modelling and attitudes on adolescent use of alcohol International Journal of Addiction 28

853ndash880

Bahr S J Marcos A C amp Maughan S L (1995) Family educational and peer influences on the

alcohol use of female and male adolescents Journal of Studies on Alcohol 56 457ndash469

Barnes G (1990) Impact of the family on adolescent drinking patterns In R Collins K Leonard

amp J Searles (Eds) Alcohol and the family Research and clinical perspectives (pp 137ndash161)

New York Guilford Press

Barnes G amp Welte J (1986) Patterns and predictors of alcohol use among 7ndash12th grade students

in New York State Journal of Studies on Alcohol 47 53ndash62

Becher H Boreham R Emery P Hinds K Jamison J amp Schagen I (2001) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Beck K H amp Treiman K A (1996) The relationship of social context of drinking perceived

social norms and parental influence to various drinking patterns of adolescents Addictive

Behaviors 21 633ndash644

Blenkinsop S Boreham R McManus S Natarajan L amp Prescott A (2003) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Blum R W Beuhring T amp Rinehart P M (2000) Protecting teens Beyond race income and

family structure Minneapolis MN Center for Adolescent Health University of Minnesota

Bonomo Y Coffey C Wolfe R Lynskey M Bowes G amp Patton G (2001) Adverse outcomes

of alcohol use in adolescents Addiction 96 1485ndash1496

Boreham R amp Shaw (2001) Smoking drinking and drug use among young people in England

in 2000 London The Stationery Office

John Marsden et al446

this way and a further 193 indicated that they strongly disagreed that such pressure

was present in their social network

School conduct problemsIn the past year the majority of the drinkers (356 76) had received a detention afterschool or some other minor punishment There was also a minority (95 187) who

estimated that they found themselves in trouble with teachers once or twice each

month and a further small group who said that they received some form of disciplinary

action at school once a week (57 112) A quarter (138 256) reported that they had

had a fight with another student in the past year Just over a third (187 367) admitted

that they had been absent from school without authorization (truanted) at least once in

the past year and the average number of occasions on which this had occurred was 78

days ( SD frac14 150 days range frac14 05ndash80) Sixty-six students (122) had beentemporarily excluded from school in the past year

Regression of covariates of alcohol involvementThe two dependent variables were judged to be reasonably normally distributed and

were not transformed Following negative screening for multicollinearity within the

covariate set multiple regression analysis was performed separately for each of thefive blocks of covariates to assess their individual contribution to explaining variance in

the dependent variables A further regression was then performed in which all 26

covariates were entered simultaneously to calculate the overall level of variance

accounted for Table 2 presents the standardized regression coefficients (b) and the

overall R 2 for each block for these analyses

There was no significant association between age of first drink and recent drinking

although as predicted there was a positive association between feeling intoxicated after

drinking alcohol and both recent drinking frequency and intensity As predicted therewas a positive correlation between lifetime smoking and cannabis use and alcohol

involvement and this association was stronger for cannabis Among the set of

predictions concerning parents there was evidence for an association between the

frequency of parentsrsquo drinking for drinking intensity but this was in the anticipated

direction for the motherrsquos drinking only ( p 01) The frequency of the fatherrsquos

drinking was associated with drinking of lower intensity ( p 05)

As predicted there were significant positive associations between the extent that

parents encouraged drinking and both drinking frequency ( p 001) and intensity( p 01) Contrary to prediction there was a weak but positive relationship between

the extent that parents discouraged drinking and recent alcohol involvement ( p 05)

For the psychological factors there was support for the predicted association between

alcohol involvement and drinking for mood alteration functions ( p 001) but not to

fulfil social functions Higher scores on the GHQ-12 indicative of poorer psychological

well-being were negatively associated with drinking frequency only ( p 001)

Contrary to prediction there were no associations between the positive and negative

alcohol-related attitude scales with the exception of a significant association betweenpositive attitudes and recent drinking intensity ( p 05)

In the social and peer factors block there was evidence that personally buying

alcohol was associated with higher drinking intensity ( p 01) and drinking frequency

( p 001) There was rather weak supporting evidence for the relationship between

having older friends and more frequent drinking ( p 05) There were mixed findings

John Marsden et al438

concerning having more friends who drink spending time with friends who drink and

feeling under social pressure to drink The proportion of friends who drink was related

to intensity ( p 05) but not frequency There was a strong positive and consistent

relationship between spending time with friends who drink and drinking ( p 001)

and there were significant associations between perceived social pressure to drink and

Table 2 Standard multiple regression of background family psychological social and school factors on

recent alcohol involvement (N frac14 467)

Drinking frequency Drinking intensity

1 Background R 2 frac14 0211 R 2 frac14 0192Age 0100 0079Gender 098 0025School 1 100 100School 2 20024 20073School 3 0065 0012School 4 20065 20128School 5 0077 0101Age of first drink 20076 20044Ever intoxicated from alcohol 0591 1092Age first intoxicated on alcohol 20396 20899Ever smoked cigarettes 0155 0076Ever used cannabis 0160 0140

2 Family R 2 frac14 0141 R 2 frac14 0060Frequency of motherrsquos drinking 0052 0153Frequency of fatherrsquos drinking 0041 20121Extent parents encourage drinking 0231 0156Extent parents discourage drinking 0109 0094Drinking without parents knowledge 0280 0137

3 Psychological R 2 frac14 0156 R 2 frac14 0095Mood functions for drinking 0385 0307Social functions for drinking 20002 20068Psychological well-being 20116 20062Positive drinking attitudes 20050 0102Negative drinking attitudes 20014 0001

4 Social R 2 frac14 0322 R 2 frac14 0210Personally bought alcohol 0150 0131Proportion of older friends 0074 0090Proportion of friends who drink 0083 0094Time with friends drinking 0387 0307Perceived social pressure to drink 0148 0062

5 School R 2 frac14 0121 R 2 frac14 0144Been in trouble with teachers 0213 0212Had a fight with student at school 0054 0090Times truanted in past year 0155 0120Temporarily excluded in past year 0090 0152Overall R 2 frac14 0418 R 2 frac14 0339Adjusted R 2 frac14 0381 R 2 frac14 0290

frac14 p 05 frac14 p 01 frac14 p 001

Adolescent drinking 439

drinking frequency but not recent intensity There was a positive correlation between

more positive alcohol-related attitudes and high drinking intensity only ( p 05)

There were also mixed associations relating to school conduct problems and

drinking Being temporarily excluded from school and the number of times truanted

were positively related to recent frequency ( p 05 and p 001 respectively) and

recent intensity ( p 01) Having had a fight with another student with associated withrecent drinking intensity only ( p 05) while there was a strong positive and

consistent relationship between being in trouble with teachers and the both drinking

measures ( p 001)

In total the five blocks of factors explained 42 (38 adjusted) of the variance in

frequency of drinking scores and 34 (29 adjusted) of the variance in typical intensity

Taking the covariate blocks in turn the regression analysis indicated that the social and

peer factors had the strongest correlations (accounting for 32 and 21 of the variance

in drinking frequency and intensity respectively) For drinking frequency the strengthof association for the remaining factors was as follows background variables (21)

psychological factors (16) family factors (14) and school conduct problems (12)

The regression analysis for recent typical drinking intensity revealed a somewhat

contrasting pattern of predictors background variables (19) school conduct

problems (14) psychological factors (10) and family factors (6)

The dataset was then screened for the presence of moderation effects between

gender and each covariate Those variables (gender the covariate and their interaction)

that emerged as statistically significant were then entered into two regression equationsusing each of the dependent variables If the interaction term exerted a significant effect

on the dependent variable in this equation when its constituent parts were controlled

for this was taken as evidence of a moderation effect by gender The single interaction

term that was identified in this way was added to the covariate set in a backwards

stepwise regression equation controlling for gender and age This process resulted in a

final lsquotrimmed downrsquo regression model for the two dependent variables and is shown in

Table 3 The total proportions of variance in the dependent variables explained by the

final models were as follows 40 (38 adjusted) for drinking frequency( F12 441 frac14 2690 p 001) and 27 (26 adjusted) for drinking intensity

( F7 441 frac14 2316 p 001)

Drinking frequencyEleven covariates were retained in the model as significantly associated with recent

drinking frequency As can be seen most were from the family factors and social and

peer factors blocks Males tended to be more frequent drinkers than females(b frac14 0272) However the strongest predictor of frequency of alcohol use in the model

was the amount of time spent with friends who are drinking (b frac14 0316) Other

influential variables included the extent to which parents encourage (b frac14 0155) and

discourage (b frac14 20223) alcohol use with the latter association moderated by gender

More frequent parental discouragement to drink was related to more frequent drinking

in females and less frequent drinking frequency in males In a post hoc analysis the

parental discouragement scale items were entered into a regression equation This

showed that two items exerted an effect over and above the others lsquomy parents havetold me off because of drinking or buying alcoholrsquo and lsquomy parents have said that

I cannot drink alcohol at homersquo A positive relationship was also observed between

drinking more frequently without parentsrsquo knowledge and recent frequency of use

(b frac14 0110) Other independent influences on drinking frequency were higher mood

John Marsden et al440

alteration function scores (b frac14 0113) greater perceived social pressure to drink

alcohol (b frac14 0155) a history of temporary school exclusion (b frac14 0121) and more

frequent occasions of truanting from school in the past year (b frac14 0086)

Drinking intensityIn common with the final model for drinking frequency just five covariates were

retained in the regression equation for drinking intensity The amount of time spent with

friends who are drinking alcohol was the strongest predictor (b frac14 0319) This was

followed by having a history of school exclusion (b frac14 0197) and more frequently being

in trouble with teachers in the past year (b frac14 0142) Greater parental encouragement

to drink was associated with higher actual drinking intensity (b frac14 0124) Finally a

single background factor ndash lifetime use of cannabis ndash was associated with higher

drinking intensity (b frac14 0113)

Discussion

This report has presented first results from a cohort follow-up study of alcohol use

among a sample of mid-adolescents in England Baseline data on personal backgroundand demographics family psychological social factors and school conduct problems

were correlated with reports of recent drinking frequency and intensity As expected

regular drinking was the norm among the cohort 19 in 20 of the cohort had consumed a

whole alcoholic drink at some point in their lives and approximately 17 in 20 were

current drinkers This prevalence of alcohol use is comparable to that reported for the

Table 3 Stepwise multiple regression of background family psychological social and school factors on

recent alcohol involvement (N frac14 467)

Drinking frequencyR 2 frac14 0396

Drinking intensityR 2 frac14 0273

1 BackgroundAge 0033 0046Gender 0272 0004Ever smoked cannabis ndash 0113

2 FamilyExtent parents encourage drinking 0155 0124Extent parents discourage drinking 0223 ndashGender pound extent parents discourage drinkinga 0302 ndashDrinking without parents knowledge 0113 ndash

3 PsychologicalMood functions for drinking 0113 ndash

4 SocialPersonally bought alcohol 0118 ndashTime with friends who are drinking 0316 0319Perceived social pressure to drink 0155 ndash

5 SchoolIn trouble with teachers in past year ndash 0142Times truanted in past year 0086 ndashTemporarily excluded in past year 0121 0197

a frac14 interaction term frac14 p 05 frac14 p 01 frac14 p 001

Adolescent drinking 441

general adult population in the UK (Singleton Bumpstead OrsquoBrien Lee amp Meltzer

2001) and is also comparable to drinking levels reported for 15-year-olds in other

countries (eg Casswell Stewart Conolly amp Silva 1991 for New Zealand) In terms of

typical drinking intensity study participants estimated that they drank about five

standard units of alcohol on a typical day Although the government has not issued

recommended drinking levels for the under-18 s this level exceeds the safer drinkinglevels for adults as recommended by the English Department of Health (Department of

Health 1995) and is therefore a cause for concern A substantial proportion of the

sample also reported lifetime tobacco smoking (70) and use of cannabis (40) Despite

the fact that the study cohort was not generated using probability sampling techniques

it is reasonable to believe that it is unbiased The levels of drinking smoking and

cannabis use reported fell remarkably close to population estimates for this age group in

England (Goddard amp Higgins 2001 Becher et al 2001 Currie Hurrelmann

Settertobulte Smith amp Todd 2000) On school conduct characteristics the samplewas also broadly comparable to reports from national surveys (Miller amp Plant 1999)

The cohort was also comparable to the general population on school conduct problems

Thirty-seven percent admitted that they had truanted at least once in the past year and

this compares to 33 of boys who admitted truanting in the latest Office for National

Statistics school survey (Boreham amp Shaw 2001)

Drinking was well established within the social networks of the cohort The majority

reported that most or all of their friends drank alcohol and two-thirds of the drinkers

said that they typically spent time with friendsacquaintances who were drinking atleast once a week Two-thirds did not consider that they were under any peer pressure

to drink

In the UK alcopop beverages are well established in the drinks market (Clarke

2000) and concerns have been raised about the marketing of these products to younger

drinkers (Hughes et al 1997 McKeganey 1998) In our study males reported a limited

preference for these drinks and tended to favour beer and lager whereas females had a

greater preference for spirits alcopops wine and liqueurs Males were more frequent

drinkers but there were no gender differences in the amount of alcohol consumed ontypical day Previous studies on alcohol use have found that males drink more heavily

than their female peers (Goddard amp Higgins 2001 Miller amp Plant 1996) However as

alcohol use among school-age students approximately doubled between 1990 and 2000

(from 53 units in 1990 to 104 units in 2000) the gender gap in consumption has

narrowed (Goddard amp Higgins 2001) The drinking patterns of young females are of

concern given their greater vulnerability to alcohol-related harms (Goist amp Sutker 1985

Plant amp Plant 2001)

Correlates of drinking frequencyThe regression analyses were able to account for approximately 40 of the variance in

scores on the measure of drinking frequency There was no evidence for the hypothesized

negative relationship between age of first drink and recent drinking frequency although

there was a positive association with feeling intoxicated after drinking alcohol It is

however possible that the effect of earlier initiation to drinking is not seen until drinking

patterns have further developed This was observed in a longitudinal study in the USAreported by Hawkins et al (1997) In this study of a cohort of students who were

followed-up annually from age 10ndash11 to age 17ndash18 a younger age of alcohol initiation was

strongly related to a higher level of alcohol misuse at age 17ndash18 Consequently we will

assess the influence of age of alcohol initiation in further follow-ups

John Marsden et al442

Studies examining the putative relationship between lifetime smoking cannabis use

and recent drinking frequency suggest that earlier initiation to substance use mediates

peers alcohol involvement and parental drinking risk factors (eg Hawkins et al 1997)

However findings from research using twins suggests that the association between age

of onset of alcohol use and later problematic drinking may not be directly causal but

that age of onset and problematic drinking in later life are both associated with anunderlying vulnerability to behavioural problems (Prescott amp Kendler 1999)

There was no support for the predicted relationship between the frequency of

parental drinking and adolescent drinking frequency It must be acknowledged that

influence of parental drinking parental alcohol use norms and family environment and

relations are complex (Peterson et al 1994) Foxcroft and Lowe (1997) found that

increased drinking levels among 11ndash17-year-olds were linked to regular perceived

parental drinking while Casswell and her colleagues noted a positive association

between the frequency of drinking in early- to mid-adolescents and the frequency of

their mother and fatherrsquos drinking (Casswell et al 1991) Peterson et al showed thatclear communication by parents about their expectations of their childrenrsquos drinking

together with positive reinforcement for desired behaviours can reduce the impact of

parentrsquos drinking on adolescent alcohol use

Several studies have also noted a negative relationship between parental support

a positive family environment and feelings of connectedness and adolescent substance

use (Resnick et al 1997 Hops Davis amp Lewin 1999) The role that parental approval of

drinking has in predicting intensity of alcohol use in their children has also been

explored (eg Barnes amp Welte 1986) Wilks Callan and Austin (1989) found that the

fatherrsquos approval or disapproval of drinking behaviour predicted self-perception as adrinker in young males yet found no normative influences for females A gender

interaction in the present study also suggests a differential effect for discouraging

drinking More frequent parental discouragement to drink was related to more frequent

drinking in females and less frequent drinking in males This finding could indicate that

parents are more likely to disapprove of drinking in their daughters (and therefore

discourage alcohol use more strongly) than in their sons Alternatively it could point to a

tendency for girls to rebel more strongly against their parentsrsquo attitudes towards alcohol

use The direction of this relationship cannot be judged from the baseline data but our

post hoc item analysis does suggest that this effect may be due to parental reactions todrinking and proscriptions about drinking at home Future analyses of the longitudinal

data collected during the course of this study will examine this issue more closely

In the present analyses although frequency of mother and fathersrsquo alcohol use was

significantly related to drinking frequency these variables were not retained in the

regression analysis This suggests that other variables explain the relationship between

these factors Zhang Welte and Wieczorek (1999) found that the drinking behaviour of

each parent has a differential effect on their male offspring (aged 16ndash19 years) In their

study the fatherrsquos drinking but not their motherrsquos drinking affects their sons drinking

and closeness to the mother was a protective factor against adolescent drinking On theother hand male adolescent drinking increases if closeness to the mother is low and she

drinks excessively There appears to be no comparable effect for closeness to the father

and the fatherrsquos drinking

For the analysis of psychological measures there was an association in the predicted

direction between alcohol involvement and drinking for mood alteration functions but

not drinking to fulfil social functions Poorer psychological well-being was negatively

associated with drinking frequency only and contrary to our hypothesis there were no

Adolescent drinking 443

associations between the positive and negative alcohol-related attitude scales The

present results provide further evidence for the link between reasons or motives for

alcohol use and consumption patterns A strong relationship was observed between

increased frequency of drinking to serve mood alteration functions and increased

drinking frequency Our research group has also observed this effect among young

alcohol cannabis and ecstasy users (Boys et al 1999) These findings are consistentwith previous studies which have found a positive relationship between the number of

reasons for alcohol use and drinking frequency (Cooper Frone Russell amp Mudar 1995

Beck amp Treiman 1996 Bradizza Reifman amp Barnes 1999) For the social and peer

factors buying alcohol was as predicted associated with increased alcohol

involvement but there was only weak supporting evidence for an association with

having older friends There was a strong positive and consistent relationship between

spending time with friends who drink and perceived social pressure to drink and more

frequent drinking These independent social influences are interpreted in the context ofdeveloping peer relations and peer norms in which the majority of adolescents report

spending time with friends who are drinking as a recreational activity and where there

may be expectations to drink with the group sometimes to excessive levels (Iannotti

amp Bush 1992 Bahr Marcos amp Maughan 1995) Finally school conduct problems were

independently associated with drinking frequency with the number of times truanted

and being temporarily excluded having the strongest correlations Drinking more often

than other peers has been linked to more frequent unauthorized absences from school

(Currie et al 2000) Drinking smoking and drug use is also much more prevalentamong 12- to 15-year-olds who had ever truanted compared to those who had never

done so (Becher et al 2001)

Correlates of drinking intensityOverall 285 of the cohort typically drank six or more units on a drinking day which

can be taken to be a conservative indicator of underage binge drinking The regression

analyses were able to account for approximately 30 of the variance in drinkingintensity Age of first alcohol intoxication and lifetime smoking and cannabis use was

associated with more intense recent drinking For the family factors in contrast to

drinking frequency there was evidence for a positive association between how often

the mother usually drank alcohol and how much the adolescent drank on a drinking day

but contrary to prediction there was a negative association with the fatherrsquos drinking

It is possible that more frequent drinking by the father serves to discourage binge

drinking among mid-adolescents Nonetheless this effect was weak and was not

retained in the stepwise regression As predicted drinking to alter mood was associatedwith more intensive drinking but not with drinking for social facilitation functions This

effect however was not sufficiently strong to be retained in the stepwise regression

There was also a positive association between more favourable attitudes towards

alcohol and drinking intensity Among the social and peer factors a similar set of

associations was seen with the exception of perceived social pressure to drink

suggesting that mid-adolescents do not feel that the amount they consume is influenced

by their peers Finally the school conduct factors were quite strongly associated with

more intensive drinking and being in trouble with teachers and having beingtemporarily excluded had the strongest associations

The links between binge drinking and school conduct problems are a concern and

elsewhere studies have shown that binge drinking is related to poorer actual educational

performance (Newcomb Measham amp Parker 1995) Clinical diagnostic criteria for

John Marsden et al444

alcohol abuse recognize that recurrent drinking can result in school performance

problems and expulsions (American Psychiatric Association 1994) and the trajectory of

those experiencing school problems will be a focus of subsequent analyses of further

follow-up in the study The finding that lifetime use of cannabis was independently

associated with more intensive drinking is supportive of other work that argues that

those adolescents who use substances tend to have other attributes that increase therisk of poor psychosocial adjustment and school performance For example Jessor

Chase and Donovan (1980) argued that the reason that cannabis users tend to be less

well adjusted is that cannabis use is a general characteristic of individuals who are

predisposed to behavioural problems Furthermore Fergusson Lynskey and Horwood

(1997) suggested that instead of early cannabis use having a causal link with poor

psychosocial adjustment this association could be explained by family and other factors

that related to cannabis use Other alternative explanations include those proposed by

Kandel and colleagues They argue that early substance use sets into motion a chain ofevents which result in greater subsequent drug involvement and a range of other

negative psychosocial consequences (Kandel Davies Karus amp Yamaguchi 1986)

Again the causal direction of this relationship cannot be judged from the baseline data

but will be examined in more detail in subsequent reports on the longitudinal data

Strengths and limitations of the studyThe main strength of the present study was the analysis of the multiple influences on

drinking behaviour Studies of this kind have been rare in the UK but are encouraged as

good opportunities to gain an understanding of how early use of alcohol smoking and

other substance involvement evolves across the adolescent years (Edwards et al 1994

Duncan Duncan amp Hops 1998) Several limitations of the present study are also

acknowledged Given the reliance on self-report it is difficult to judge the reliability ofthe data and the findings should be interpreted with caution Nevertheless steps were

taken to maximize the privacy of the recruitment interviews to emphasize the

confidentiality of the study and the interviews were all conducted by young adults

Overall it has been argued that it is better to collect social survey data on this age group

at school than in the home (Becher et al 2001)

Implications for school-based alcohol educationThese results underline the importance of addressing personal family peer and school

conduct factors as part of alcohol education and problem prevention initiatives Theidentified correlates of drinking involvement in the present study could be usefully

taken up and discussed with students as part of alcohol education and prevention

programmes Elsewhere it has been argued that the main goal of school prevention

programmes should be to delay alcohol initiation (DeWit et al 2000 Griffin Botvin

Epstein Doyle amp Diaz 2000) However the very early age of onset in the UK suggests

that educational approaches based on harm minimization may be more realistic Recent

work in Australia has indicated that a harm minimization approach to alcohol education

together with adult supervision of initial drinking experiences can help to reduce theharms associated with alcohol use in young people (McBride Midford Farringdon amp

Phillips 2000b) Research into the merits of adopting a harm minimization approach to

alcohol education in schools has highlighted the importance of ensuring that

programme content and materials are relevant to local patterns of behaviour and are

Adolescent drinking 445

based on experiences that are relevant to the target audience (McBride Farringdon amp

Midford 2000a Dusenbury amp Falco 1995)

The potential feasibility and benefits of including parents as part of education

programmes in school should be examined The possibility of encouraging parents to

consider how their own behaviour and attitudes towards drinking might influence the

choices regarding alcohol use that are made by their offspring should be explored

Given the high prevalence of drinking involvement in mid-adolescence understanding

the influences on the further development of drinking attitudes and behaviours is of

critical importance Further reports from the study will describe the associations

between risky and heavy drinking patterns and alcohol-related problems and

developmental transitions to heavier consumption patterns as the cohort reaches the

period of late-adolescence

Acknowledgements

We would like to thank the students and staff from each school for their kind and enthusiastic

participation in the study The study was supported by a research grant from the LloydsTSB

charitable trust and conducted in association with Alcohol Concern

References

American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders

(4th ed) Washington DC APA

Anderson K Plant M amp Plant M (1998) Associations between drinking smoking and illicit

drug use among adolescents in the Western Isles of Scotland Implications for harm

minimization Journal of Substance Misuse 3 13ndash20

Ary D V Tildesley E Hops H amp Andrews J (1993) The influence of parent sibling and peer

modelling and attitudes on adolescent use of alcohol International Journal of Addiction 28

853ndash880

Bahr S J Marcos A C amp Maughan S L (1995) Family educational and peer influences on the

alcohol use of female and male adolescents Journal of Studies on Alcohol 56 457ndash469

Barnes G (1990) Impact of the family on adolescent drinking patterns In R Collins K Leonard

amp J Searles (Eds) Alcohol and the family Research and clinical perspectives (pp 137ndash161)

New York Guilford Press

Barnes G amp Welte J (1986) Patterns and predictors of alcohol use among 7ndash12th grade students

in New York State Journal of Studies on Alcohol 47 53ndash62

Becher H Boreham R Emery P Hinds K Jamison J amp Schagen I (2001) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Beck K H amp Treiman K A (1996) The relationship of social context of drinking perceived

social norms and parental influence to various drinking patterns of adolescents Addictive

Behaviors 21 633ndash644

Blenkinsop S Boreham R McManus S Natarajan L amp Prescott A (2003) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Blum R W Beuhring T amp Rinehart P M (2000) Protecting teens Beyond race income and

family structure Minneapolis MN Center for Adolescent Health University of Minnesota

Bonomo Y Coffey C Wolfe R Lynskey M Bowes G amp Patton G (2001) Adverse outcomes

of alcohol use in adolescents Addiction 96 1485ndash1496

Boreham R amp Shaw (2001) Smoking drinking and drug use among young people in England

in 2000 London The Stationery Office

John Marsden et al446

concerning having more friends who drink spending time with friends who drink and

feeling under social pressure to drink The proportion of friends who drink was related

to intensity ( p 05) but not frequency There was a strong positive and consistent

relationship between spending time with friends who drink and drinking ( p 001)

and there were significant associations between perceived social pressure to drink and

Table 2 Standard multiple regression of background family psychological social and school factors on

recent alcohol involvement (N frac14 467)

Drinking frequency Drinking intensity

1 Background R 2 frac14 0211 R 2 frac14 0192Age 0100 0079Gender 098 0025School 1 100 100School 2 20024 20073School 3 0065 0012School 4 20065 20128School 5 0077 0101Age of first drink 20076 20044Ever intoxicated from alcohol 0591 1092Age first intoxicated on alcohol 20396 20899Ever smoked cigarettes 0155 0076Ever used cannabis 0160 0140

2 Family R 2 frac14 0141 R 2 frac14 0060Frequency of motherrsquos drinking 0052 0153Frequency of fatherrsquos drinking 0041 20121Extent parents encourage drinking 0231 0156Extent parents discourage drinking 0109 0094Drinking without parents knowledge 0280 0137

3 Psychological R 2 frac14 0156 R 2 frac14 0095Mood functions for drinking 0385 0307Social functions for drinking 20002 20068Psychological well-being 20116 20062Positive drinking attitudes 20050 0102Negative drinking attitudes 20014 0001

4 Social R 2 frac14 0322 R 2 frac14 0210Personally bought alcohol 0150 0131Proportion of older friends 0074 0090Proportion of friends who drink 0083 0094Time with friends drinking 0387 0307Perceived social pressure to drink 0148 0062

5 School R 2 frac14 0121 R 2 frac14 0144Been in trouble with teachers 0213 0212Had a fight with student at school 0054 0090Times truanted in past year 0155 0120Temporarily excluded in past year 0090 0152Overall R 2 frac14 0418 R 2 frac14 0339Adjusted R 2 frac14 0381 R 2 frac14 0290

frac14 p 05 frac14 p 01 frac14 p 001

Adolescent drinking 439

drinking frequency but not recent intensity There was a positive correlation between

more positive alcohol-related attitudes and high drinking intensity only ( p 05)

There were also mixed associations relating to school conduct problems and

drinking Being temporarily excluded from school and the number of times truanted

were positively related to recent frequency ( p 05 and p 001 respectively) and

recent intensity ( p 01) Having had a fight with another student with associated withrecent drinking intensity only ( p 05) while there was a strong positive and

consistent relationship between being in trouble with teachers and the both drinking

measures ( p 001)

In total the five blocks of factors explained 42 (38 adjusted) of the variance in

frequency of drinking scores and 34 (29 adjusted) of the variance in typical intensity

Taking the covariate blocks in turn the regression analysis indicated that the social and

peer factors had the strongest correlations (accounting for 32 and 21 of the variance

in drinking frequency and intensity respectively) For drinking frequency the strengthof association for the remaining factors was as follows background variables (21)

psychological factors (16) family factors (14) and school conduct problems (12)

The regression analysis for recent typical drinking intensity revealed a somewhat

contrasting pattern of predictors background variables (19) school conduct

problems (14) psychological factors (10) and family factors (6)

The dataset was then screened for the presence of moderation effects between

gender and each covariate Those variables (gender the covariate and their interaction)

that emerged as statistically significant were then entered into two regression equationsusing each of the dependent variables If the interaction term exerted a significant effect

on the dependent variable in this equation when its constituent parts were controlled

for this was taken as evidence of a moderation effect by gender The single interaction

term that was identified in this way was added to the covariate set in a backwards

stepwise regression equation controlling for gender and age This process resulted in a

final lsquotrimmed downrsquo regression model for the two dependent variables and is shown in

Table 3 The total proportions of variance in the dependent variables explained by the

final models were as follows 40 (38 adjusted) for drinking frequency( F12 441 frac14 2690 p 001) and 27 (26 adjusted) for drinking intensity

( F7 441 frac14 2316 p 001)

Drinking frequencyEleven covariates were retained in the model as significantly associated with recent

drinking frequency As can be seen most were from the family factors and social and

peer factors blocks Males tended to be more frequent drinkers than females(b frac14 0272) However the strongest predictor of frequency of alcohol use in the model

was the amount of time spent with friends who are drinking (b frac14 0316) Other

influential variables included the extent to which parents encourage (b frac14 0155) and

discourage (b frac14 20223) alcohol use with the latter association moderated by gender

More frequent parental discouragement to drink was related to more frequent drinking

in females and less frequent drinking frequency in males In a post hoc analysis the

parental discouragement scale items were entered into a regression equation This

showed that two items exerted an effect over and above the others lsquomy parents havetold me off because of drinking or buying alcoholrsquo and lsquomy parents have said that

I cannot drink alcohol at homersquo A positive relationship was also observed between

drinking more frequently without parentsrsquo knowledge and recent frequency of use

(b frac14 0110) Other independent influences on drinking frequency were higher mood

John Marsden et al440

alteration function scores (b frac14 0113) greater perceived social pressure to drink

alcohol (b frac14 0155) a history of temporary school exclusion (b frac14 0121) and more

frequent occasions of truanting from school in the past year (b frac14 0086)

Drinking intensityIn common with the final model for drinking frequency just five covariates were

retained in the regression equation for drinking intensity The amount of time spent with

friends who are drinking alcohol was the strongest predictor (b frac14 0319) This was

followed by having a history of school exclusion (b frac14 0197) and more frequently being

in trouble with teachers in the past year (b frac14 0142) Greater parental encouragement

to drink was associated with higher actual drinking intensity (b frac14 0124) Finally a

single background factor ndash lifetime use of cannabis ndash was associated with higher

drinking intensity (b frac14 0113)

Discussion

This report has presented first results from a cohort follow-up study of alcohol use

among a sample of mid-adolescents in England Baseline data on personal backgroundand demographics family psychological social factors and school conduct problems

were correlated with reports of recent drinking frequency and intensity As expected

regular drinking was the norm among the cohort 19 in 20 of the cohort had consumed a

whole alcoholic drink at some point in their lives and approximately 17 in 20 were

current drinkers This prevalence of alcohol use is comparable to that reported for the

Table 3 Stepwise multiple regression of background family psychological social and school factors on

recent alcohol involvement (N frac14 467)

Drinking frequencyR 2 frac14 0396

Drinking intensityR 2 frac14 0273

1 BackgroundAge 0033 0046Gender 0272 0004Ever smoked cannabis ndash 0113

2 FamilyExtent parents encourage drinking 0155 0124Extent parents discourage drinking 0223 ndashGender pound extent parents discourage drinkinga 0302 ndashDrinking without parents knowledge 0113 ndash

3 PsychologicalMood functions for drinking 0113 ndash

4 SocialPersonally bought alcohol 0118 ndashTime with friends who are drinking 0316 0319Perceived social pressure to drink 0155 ndash

5 SchoolIn trouble with teachers in past year ndash 0142Times truanted in past year 0086 ndashTemporarily excluded in past year 0121 0197

a frac14 interaction term frac14 p 05 frac14 p 01 frac14 p 001

Adolescent drinking 441

general adult population in the UK (Singleton Bumpstead OrsquoBrien Lee amp Meltzer

2001) and is also comparable to drinking levels reported for 15-year-olds in other

countries (eg Casswell Stewart Conolly amp Silva 1991 for New Zealand) In terms of

typical drinking intensity study participants estimated that they drank about five

standard units of alcohol on a typical day Although the government has not issued

recommended drinking levels for the under-18 s this level exceeds the safer drinkinglevels for adults as recommended by the English Department of Health (Department of

Health 1995) and is therefore a cause for concern A substantial proportion of the

sample also reported lifetime tobacco smoking (70) and use of cannabis (40) Despite

the fact that the study cohort was not generated using probability sampling techniques

it is reasonable to believe that it is unbiased The levels of drinking smoking and

cannabis use reported fell remarkably close to population estimates for this age group in

England (Goddard amp Higgins 2001 Becher et al 2001 Currie Hurrelmann

Settertobulte Smith amp Todd 2000) On school conduct characteristics the samplewas also broadly comparable to reports from national surveys (Miller amp Plant 1999)

The cohort was also comparable to the general population on school conduct problems

Thirty-seven percent admitted that they had truanted at least once in the past year and

this compares to 33 of boys who admitted truanting in the latest Office for National

Statistics school survey (Boreham amp Shaw 2001)

Drinking was well established within the social networks of the cohort The majority

reported that most or all of their friends drank alcohol and two-thirds of the drinkers

said that they typically spent time with friendsacquaintances who were drinking atleast once a week Two-thirds did not consider that they were under any peer pressure

to drink

In the UK alcopop beverages are well established in the drinks market (Clarke

2000) and concerns have been raised about the marketing of these products to younger

drinkers (Hughes et al 1997 McKeganey 1998) In our study males reported a limited

preference for these drinks and tended to favour beer and lager whereas females had a

greater preference for spirits alcopops wine and liqueurs Males were more frequent

drinkers but there were no gender differences in the amount of alcohol consumed ontypical day Previous studies on alcohol use have found that males drink more heavily

than their female peers (Goddard amp Higgins 2001 Miller amp Plant 1996) However as

alcohol use among school-age students approximately doubled between 1990 and 2000

(from 53 units in 1990 to 104 units in 2000) the gender gap in consumption has

narrowed (Goddard amp Higgins 2001) The drinking patterns of young females are of

concern given their greater vulnerability to alcohol-related harms (Goist amp Sutker 1985

Plant amp Plant 2001)

Correlates of drinking frequencyThe regression analyses were able to account for approximately 40 of the variance in

scores on the measure of drinking frequency There was no evidence for the hypothesized

negative relationship between age of first drink and recent drinking frequency although

there was a positive association with feeling intoxicated after drinking alcohol It is

however possible that the effect of earlier initiation to drinking is not seen until drinking

patterns have further developed This was observed in a longitudinal study in the USAreported by Hawkins et al (1997) In this study of a cohort of students who were

followed-up annually from age 10ndash11 to age 17ndash18 a younger age of alcohol initiation was

strongly related to a higher level of alcohol misuse at age 17ndash18 Consequently we will

assess the influence of age of alcohol initiation in further follow-ups

John Marsden et al442

Studies examining the putative relationship between lifetime smoking cannabis use

and recent drinking frequency suggest that earlier initiation to substance use mediates

peers alcohol involvement and parental drinking risk factors (eg Hawkins et al 1997)

However findings from research using twins suggests that the association between age

of onset of alcohol use and later problematic drinking may not be directly causal but

that age of onset and problematic drinking in later life are both associated with anunderlying vulnerability to behavioural problems (Prescott amp Kendler 1999)

There was no support for the predicted relationship between the frequency of

parental drinking and adolescent drinking frequency It must be acknowledged that

influence of parental drinking parental alcohol use norms and family environment and

relations are complex (Peterson et al 1994) Foxcroft and Lowe (1997) found that

increased drinking levels among 11ndash17-year-olds were linked to regular perceived

parental drinking while Casswell and her colleagues noted a positive association

between the frequency of drinking in early- to mid-adolescents and the frequency of

their mother and fatherrsquos drinking (Casswell et al 1991) Peterson et al showed thatclear communication by parents about their expectations of their childrenrsquos drinking

together with positive reinforcement for desired behaviours can reduce the impact of

parentrsquos drinking on adolescent alcohol use

Several studies have also noted a negative relationship between parental support

a positive family environment and feelings of connectedness and adolescent substance

use (Resnick et al 1997 Hops Davis amp Lewin 1999) The role that parental approval of

drinking has in predicting intensity of alcohol use in their children has also been

explored (eg Barnes amp Welte 1986) Wilks Callan and Austin (1989) found that the

fatherrsquos approval or disapproval of drinking behaviour predicted self-perception as adrinker in young males yet found no normative influences for females A gender

interaction in the present study also suggests a differential effect for discouraging

drinking More frequent parental discouragement to drink was related to more frequent

drinking in females and less frequent drinking in males This finding could indicate that

parents are more likely to disapprove of drinking in their daughters (and therefore

discourage alcohol use more strongly) than in their sons Alternatively it could point to a

tendency for girls to rebel more strongly against their parentsrsquo attitudes towards alcohol

use The direction of this relationship cannot be judged from the baseline data but our

post hoc item analysis does suggest that this effect may be due to parental reactions todrinking and proscriptions about drinking at home Future analyses of the longitudinal

data collected during the course of this study will examine this issue more closely

In the present analyses although frequency of mother and fathersrsquo alcohol use was

significantly related to drinking frequency these variables were not retained in the

regression analysis This suggests that other variables explain the relationship between

these factors Zhang Welte and Wieczorek (1999) found that the drinking behaviour of

each parent has a differential effect on their male offspring (aged 16ndash19 years) In their

study the fatherrsquos drinking but not their motherrsquos drinking affects their sons drinking

and closeness to the mother was a protective factor against adolescent drinking On theother hand male adolescent drinking increases if closeness to the mother is low and she

drinks excessively There appears to be no comparable effect for closeness to the father

and the fatherrsquos drinking

For the analysis of psychological measures there was an association in the predicted

direction between alcohol involvement and drinking for mood alteration functions but

not drinking to fulfil social functions Poorer psychological well-being was negatively

associated with drinking frequency only and contrary to our hypothesis there were no

Adolescent drinking 443

associations between the positive and negative alcohol-related attitude scales The

present results provide further evidence for the link between reasons or motives for

alcohol use and consumption patterns A strong relationship was observed between

increased frequency of drinking to serve mood alteration functions and increased

drinking frequency Our research group has also observed this effect among young

alcohol cannabis and ecstasy users (Boys et al 1999) These findings are consistentwith previous studies which have found a positive relationship between the number of

reasons for alcohol use and drinking frequency (Cooper Frone Russell amp Mudar 1995

Beck amp Treiman 1996 Bradizza Reifman amp Barnes 1999) For the social and peer

factors buying alcohol was as predicted associated with increased alcohol

involvement but there was only weak supporting evidence for an association with

having older friends There was a strong positive and consistent relationship between

spending time with friends who drink and perceived social pressure to drink and more

frequent drinking These independent social influences are interpreted in the context ofdeveloping peer relations and peer norms in which the majority of adolescents report

spending time with friends who are drinking as a recreational activity and where there

may be expectations to drink with the group sometimes to excessive levels (Iannotti

amp Bush 1992 Bahr Marcos amp Maughan 1995) Finally school conduct problems were

independently associated with drinking frequency with the number of times truanted

and being temporarily excluded having the strongest correlations Drinking more often

than other peers has been linked to more frequent unauthorized absences from school

(Currie et al 2000) Drinking smoking and drug use is also much more prevalentamong 12- to 15-year-olds who had ever truanted compared to those who had never

done so (Becher et al 2001)

Correlates of drinking intensityOverall 285 of the cohort typically drank six or more units on a drinking day which

can be taken to be a conservative indicator of underage binge drinking The regression

analyses were able to account for approximately 30 of the variance in drinkingintensity Age of first alcohol intoxication and lifetime smoking and cannabis use was

associated with more intense recent drinking For the family factors in contrast to

drinking frequency there was evidence for a positive association between how often

the mother usually drank alcohol and how much the adolescent drank on a drinking day

but contrary to prediction there was a negative association with the fatherrsquos drinking

It is possible that more frequent drinking by the father serves to discourage binge

drinking among mid-adolescents Nonetheless this effect was weak and was not

retained in the stepwise regression As predicted drinking to alter mood was associatedwith more intensive drinking but not with drinking for social facilitation functions This

effect however was not sufficiently strong to be retained in the stepwise regression

There was also a positive association between more favourable attitudes towards

alcohol and drinking intensity Among the social and peer factors a similar set of

associations was seen with the exception of perceived social pressure to drink

suggesting that mid-adolescents do not feel that the amount they consume is influenced

by their peers Finally the school conduct factors were quite strongly associated with

more intensive drinking and being in trouble with teachers and having beingtemporarily excluded had the strongest associations

The links between binge drinking and school conduct problems are a concern and

elsewhere studies have shown that binge drinking is related to poorer actual educational

performance (Newcomb Measham amp Parker 1995) Clinical diagnostic criteria for

John Marsden et al444

alcohol abuse recognize that recurrent drinking can result in school performance

problems and expulsions (American Psychiatric Association 1994) and the trajectory of

those experiencing school problems will be a focus of subsequent analyses of further

follow-up in the study The finding that lifetime use of cannabis was independently

associated with more intensive drinking is supportive of other work that argues that

those adolescents who use substances tend to have other attributes that increase therisk of poor psychosocial adjustment and school performance For example Jessor

Chase and Donovan (1980) argued that the reason that cannabis users tend to be less

well adjusted is that cannabis use is a general characteristic of individuals who are

predisposed to behavioural problems Furthermore Fergusson Lynskey and Horwood

(1997) suggested that instead of early cannabis use having a causal link with poor

psychosocial adjustment this association could be explained by family and other factors

that related to cannabis use Other alternative explanations include those proposed by

Kandel and colleagues They argue that early substance use sets into motion a chain ofevents which result in greater subsequent drug involvement and a range of other

negative psychosocial consequences (Kandel Davies Karus amp Yamaguchi 1986)

Again the causal direction of this relationship cannot be judged from the baseline data

but will be examined in more detail in subsequent reports on the longitudinal data

Strengths and limitations of the studyThe main strength of the present study was the analysis of the multiple influences on

drinking behaviour Studies of this kind have been rare in the UK but are encouraged as

good opportunities to gain an understanding of how early use of alcohol smoking and

other substance involvement evolves across the adolescent years (Edwards et al 1994

Duncan Duncan amp Hops 1998) Several limitations of the present study are also

acknowledged Given the reliance on self-report it is difficult to judge the reliability ofthe data and the findings should be interpreted with caution Nevertheless steps were

taken to maximize the privacy of the recruitment interviews to emphasize the

confidentiality of the study and the interviews were all conducted by young adults

Overall it has been argued that it is better to collect social survey data on this age group

at school than in the home (Becher et al 2001)

Implications for school-based alcohol educationThese results underline the importance of addressing personal family peer and school

conduct factors as part of alcohol education and problem prevention initiatives Theidentified correlates of drinking involvement in the present study could be usefully

taken up and discussed with students as part of alcohol education and prevention

programmes Elsewhere it has been argued that the main goal of school prevention

programmes should be to delay alcohol initiation (DeWit et al 2000 Griffin Botvin

Epstein Doyle amp Diaz 2000) However the very early age of onset in the UK suggests

that educational approaches based on harm minimization may be more realistic Recent

work in Australia has indicated that a harm minimization approach to alcohol education

together with adult supervision of initial drinking experiences can help to reduce theharms associated with alcohol use in young people (McBride Midford Farringdon amp

Phillips 2000b) Research into the merits of adopting a harm minimization approach to

alcohol education in schools has highlighted the importance of ensuring that

programme content and materials are relevant to local patterns of behaviour and are

Adolescent drinking 445

based on experiences that are relevant to the target audience (McBride Farringdon amp

Midford 2000a Dusenbury amp Falco 1995)

The potential feasibility and benefits of including parents as part of education

programmes in school should be examined The possibility of encouraging parents to

consider how their own behaviour and attitudes towards drinking might influence the

choices regarding alcohol use that are made by their offspring should be explored

Given the high prevalence of drinking involvement in mid-adolescence understanding

the influences on the further development of drinking attitudes and behaviours is of

critical importance Further reports from the study will describe the associations

between risky and heavy drinking patterns and alcohol-related problems and

developmental transitions to heavier consumption patterns as the cohort reaches the

period of late-adolescence

Acknowledgements

We would like to thank the students and staff from each school for their kind and enthusiastic

participation in the study The study was supported by a research grant from the LloydsTSB

charitable trust and conducted in association with Alcohol Concern

References

American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders

(4th ed) Washington DC APA

Anderson K Plant M amp Plant M (1998) Associations between drinking smoking and illicit

drug use among adolescents in the Western Isles of Scotland Implications for harm

minimization Journal of Substance Misuse 3 13ndash20

Ary D V Tildesley E Hops H amp Andrews J (1993) The influence of parent sibling and peer

modelling and attitudes on adolescent use of alcohol International Journal of Addiction 28

853ndash880

Bahr S J Marcos A C amp Maughan S L (1995) Family educational and peer influences on the

alcohol use of female and male adolescents Journal of Studies on Alcohol 56 457ndash469

Barnes G (1990) Impact of the family on adolescent drinking patterns In R Collins K Leonard

amp J Searles (Eds) Alcohol and the family Research and clinical perspectives (pp 137ndash161)

New York Guilford Press

Barnes G amp Welte J (1986) Patterns and predictors of alcohol use among 7ndash12th grade students

in New York State Journal of Studies on Alcohol 47 53ndash62

Becher H Boreham R Emery P Hinds K Jamison J amp Schagen I (2001) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Beck K H amp Treiman K A (1996) The relationship of social context of drinking perceived

social norms and parental influence to various drinking patterns of adolescents Addictive

Behaviors 21 633ndash644

Blenkinsop S Boreham R McManus S Natarajan L amp Prescott A (2003) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Blum R W Beuhring T amp Rinehart P M (2000) Protecting teens Beyond race income and

family structure Minneapolis MN Center for Adolescent Health University of Minnesota

Bonomo Y Coffey C Wolfe R Lynskey M Bowes G amp Patton G (2001) Adverse outcomes

of alcohol use in adolescents Addiction 96 1485ndash1496

Boreham R amp Shaw (2001) Smoking drinking and drug use among young people in England

in 2000 London The Stationery Office

John Marsden et al446

drinking frequency but not recent intensity There was a positive correlation between

more positive alcohol-related attitudes and high drinking intensity only ( p 05)

There were also mixed associations relating to school conduct problems and

drinking Being temporarily excluded from school and the number of times truanted

were positively related to recent frequency ( p 05 and p 001 respectively) and

recent intensity ( p 01) Having had a fight with another student with associated withrecent drinking intensity only ( p 05) while there was a strong positive and

consistent relationship between being in trouble with teachers and the both drinking

measures ( p 001)

In total the five blocks of factors explained 42 (38 adjusted) of the variance in

frequency of drinking scores and 34 (29 adjusted) of the variance in typical intensity

Taking the covariate blocks in turn the regression analysis indicated that the social and

peer factors had the strongest correlations (accounting for 32 and 21 of the variance

in drinking frequency and intensity respectively) For drinking frequency the strengthof association for the remaining factors was as follows background variables (21)

psychological factors (16) family factors (14) and school conduct problems (12)

The regression analysis for recent typical drinking intensity revealed a somewhat

contrasting pattern of predictors background variables (19) school conduct

problems (14) psychological factors (10) and family factors (6)

The dataset was then screened for the presence of moderation effects between

gender and each covariate Those variables (gender the covariate and their interaction)

that emerged as statistically significant were then entered into two regression equationsusing each of the dependent variables If the interaction term exerted a significant effect

on the dependent variable in this equation when its constituent parts were controlled

for this was taken as evidence of a moderation effect by gender The single interaction

term that was identified in this way was added to the covariate set in a backwards

stepwise regression equation controlling for gender and age This process resulted in a

final lsquotrimmed downrsquo regression model for the two dependent variables and is shown in

Table 3 The total proportions of variance in the dependent variables explained by the

final models were as follows 40 (38 adjusted) for drinking frequency( F12 441 frac14 2690 p 001) and 27 (26 adjusted) for drinking intensity

( F7 441 frac14 2316 p 001)

Drinking frequencyEleven covariates were retained in the model as significantly associated with recent

drinking frequency As can be seen most were from the family factors and social and

peer factors blocks Males tended to be more frequent drinkers than females(b frac14 0272) However the strongest predictor of frequency of alcohol use in the model

was the amount of time spent with friends who are drinking (b frac14 0316) Other

influential variables included the extent to which parents encourage (b frac14 0155) and

discourage (b frac14 20223) alcohol use with the latter association moderated by gender

More frequent parental discouragement to drink was related to more frequent drinking

in females and less frequent drinking frequency in males In a post hoc analysis the

parental discouragement scale items were entered into a regression equation This

showed that two items exerted an effect over and above the others lsquomy parents havetold me off because of drinking or buying alcoholrsquo and lsquomy parents have said that

I cannot drink alcohol at homersquo A positive relationship was also observed between

drinking more frequently without parentsrsquo knowledge and recent frequency of use

(b frac14 0110) Other independent influences on drinking frequency were higher mood

John Marsden et al440

alteration function scores (b frac14 0113) greater perceived social pressure to drink

alcohol (b frac14 0155) a history of temporary school exclusion (b frac14 0121) and more

frequent occasions of truanting from school in the past year (b frac14 0086)

Drinking intensityIn common with the final model for drinking frequency just five covariates were

retained in the regression equation for drinking intensity The amount of time spent with

friends who are drinking alcohol was the strongest predictor (b frac14 0319) This was

followed by having a history of school exclusion (b frac14 0197) and more frequently being

in trouble with teachers in the past year (b frac14 0142) Greater parental encouragement

to drink was associated with higher actual drinking intensity (b frac14 0124) Finally a

single background factor ndash lifetime use of cannabis ndash was associated with higher

drinking intensity (b frac14 0113)

Discussion

This report has presented first results from a cohort follow-up study of alcohol use

among a sample of mid-adolescents in England Baseline data on personal backgroundand demographics family psychological social factors and school conduct problems

were correlated with reports of recent drinking frequency and intensity As expected

regular drinking was the norm among the cohort 19 in 20 of the cohort had consumed a

whole alcoholic drink at some point in their lives and approximately 17 in 20 were

current drinkers This prevalence of alcohol use is comparable to that reported for the

Table 3 Stepwise multiple regression of background family psychological social and school factors on

recent alcohol involvement (N frac14 467)

Drinking frequencyR 2 frac14 0396

Drinking intensityR 2 frac14 0273

1 BackgroundAge 0033 0046Gender 0272 0004Ever smoked cannabis ndash 0113

2 FamilyExtent parents encourage drinking 0155 0124Extent parents discourage drinking 0223 ndashGender pound extent parents discourage drinkinga 0302 ndashDrinking without parents knowledge 0113 ndash

3 PsychologicalMood functions for drinking 0113 ndash

4 SocialPersonally bought alcohol 0118 ndashTime with friends who are drinking 0316 0319Perceived social pressure to drink 0155 ndash

5 SchoolIn trouble with teachers in past year ndash 0142Times truanted in past year 0086 ndashTemporarily excluded in past year 0121 0197

a frac14 interaction term frac14 p 05 frac14 p 01 frac14 p 001

Adolescent drinking 441

general adult population in the UK (Singleton Bumpstead OrsquoBrien Lee amp Meltzer

2001) and is also comparable to drinking levels reported for 15-year-olds in other

countries (eg Casswell Stewart Conolly amp Silva 1991 for New Zealand) In terms of

typical drinking intensity study participants estimated that they drank about five

standard units of alcohol on a typical day Although the government has not issued

recommended drinking levels for the under-18 s this level exceeds the safer drinkinglevels for adults as recommended by the English Department of Health (Department of

Health 1995) and is therefore a cause for concern A substantial proportion of the

sample also reported lifetime tobacco smoking (70) and use of cannabis (40) Despite

the fact that the study cohort was not generated using probability sampling techniques

it is reasonable to believe that it is unbiased The levels of drinking smoking and

cannabis use reported fell remarkably close to population estimates for this age group in

England (Goddard amp Higgins 2001 Becher et al 2001 Currie Hurrelmann

Settertobulte Smith amp Todd 2000) On school conduct characteristics the samplewas also broadly comparable to reports from national surveys (Miller amp Plant 1999)

The cohort was also comparable to the general population on school conduct problems

Thirty-seven percent admitted that they had truanted at least once in the past year and

this compares to 33 of boys who admitted truanting in the latest Office for National

Statistics school survey (Boreham amp Shaw 2001)

Drinking was well established within the social networks of the cohort The majority

reported that most or all of their friends drank alcohol and two-thirds of the drinkers

said that they typically spent time with friendsacquaintances who were drinking atleast once a week Two-thirds did not consider that they were under any peer pressure

to drink

In the UK alcopop beverages are well established in the drinks market (Clarke

2000) and concerns have been raised about the marketing of these products to younger

drinkers (Hughes et al 1997 McKeganey 1998) In our study males reported a limited

preference for these drinks and tended to favour beer and lager whereas females had a

greater preference for spirits alcopops wine and liqueurs Males were more frequent

drinkers but there were no gender differences in the amount of alcohol consumed ontypical day Previous studies on alcohol use have found that males drink more heavily

than their female peers (Goddard amp Higgins 2001 Miller amp Plant 1996) However as

alcohol use among school-age students approximately doubled between 1990 and 2000

(from 53 units in 1990 to 104 units in 2000) the gender gap in consumption has

narrowed (Goddard amp Higgins 2001) The drinking patterns of young females are of

concern given their greater vulnerability to alcohol-related harms (Goist amp Sutker 1985

Plant amp Plant 2001)

Correlates of drinking frequencyThe regression analyses were able to account for approximately 40 of the variance in

scores on the measure of drinking frequency There was no evidence for the hypothesized

negative relationship between age of first drink and recent drinking frequency although

there was a positive association with feeling intoxicated after drinking alcohol It is

however possible that the effect of earlier initiation to drinking is not seen until drinking

patterns have further developed This was observed in a longitudinal study in the USAreported by Hawkins et al (1997) In this study of a cohort of students who were

followed-up annually from age 10ndash11 to age 17ndash18 a younger age of alcohol initiation was

strongly related to a higher level of alcohol misuse at age 17ndash18 Consequently we will

assess the influence of age of alcohol initiation in further follow-ups

John Marsden et al442

Studies examining the putative relationship between lifetime smoking cannabis use

and recent drinking frequency suggest that earlier initiation to substance use mediates

peers alcohol involvement and parental drinking risk factors (eg Hawkins et al 1997)

However findings from research using twins suggests that the association between age

of onset of alcohol use and later problematic drinking may not be directly causal but

that age of onset and problematic drinking in later life are both associated with anunderlying vulnerability to behavioural problems (Prescott amp Kendler 1999)

There was no support for the predicted relationship between the frequency of

parental drinking and adolescent drinking frequency It must be acknowledged that

influence of parental drinking parental alcohol use norms and family environment and

relations are complex (Peterson et al 1994) Foxcroft and Lowe (1997) found that

increased drinking levels among 11ndash17-year-olds were linked to regular perceived

parental drinking while Casswell and her colleagues noted a positive association

between the frequency of drinking in early- to mid-adolescents and the frequency of

their mother and fatherrsquos drinking (Casswell et al 1991) Peterson et al showed thatclear communication by parents about their expectations of their childrenrsquos drinking

together with positive reinforcement for desired behaviours can reduce the impact of

parentrsquos drinking on adolescent alcohol use

Several studies have also noted a negative relationship between parental support

a positive family environment and feelings of connectedness and adolescent substance

use (Resnick et al 1997 Hops Davis amp Lewin 1999) The role that parental approval of

drinking has in predicting intensity of alcohol use in their children has also been

explored (eg Barnes amp Welte 1986) Wilks Callan and Austin (1989) found that the

fatherrsquos approval or disapproval of drinking behaviour predicted self-perception as adrinker in young males yet found no normative influences for females A gender

interaction in the present study also suggests a differential effect for discouraging

drinking More frequent parental discouragement to drink was related to more frequent

drinking in females and less frequent drinking in males This finding could indicate that

parents are more likely to disapprove of drinking in their daughters (and therefore

discourage alcohol use more strongly) than in their sons Alternatively it could point to a

tendency for girls to rebel more strongly against their parentsrsquo attitudes towards alcohol

use The direction of this relationship cannot be judged from the baseline data but our

post hoc item analysis does suggest that this effect may be due to parental reactions todrinking and proscriptions about drinking at home Future analyses of the longitudinal

data collected during the course of this study will examine this issue more closely

In the present analyses although frequency of mother and fathersrsquo alcohol use was

significantly related to drinking frequency these variables were not retained in the

regression analysis This suggests that other variables explain the relationship between

these factors Zhang Welte and Wieczorek (1999) found that the drinking behaviour of

each parent has a differential effect on their male offspring (aged 16ndash19 years) In their

study the fatherrsquos drinking but not their motherrsquos drinking affects their sons drinking

and closeness to the mother was a protective factor against adolescent drinking On theother hand male adolescent drinking increases if closeness to the mother is low and she

drinks excessively There appears to be no comparable effect for closeness to the father

and the fatherrsquos drinking

For the analysis of psychological measures there was an association in the predicted

direction between alcohol involvement and drinking for mood alteration functions but

not drinking to fulfil social functions Poorer psychological well-being was negatively

associated with drinking frequency only and contrary to our hypothesis there were no

Adolescent drinking 443

associations between the positive and negative alcohol-related attitude scales The

present results provide further evidence for the link between reasons or motives for

alcohol use and consumption patterns A strong relationship was observed between

increased frequency of drinking to serve mood alteration functions and increased

drinking frequency Our research group has also observed this effect among young

alcohol cannabis and ecstasy users (Boys et al 1999) These findings are consistentwith previous studies which have found a positive relationship between the number of

reasons for alcohol use and drinking frequency (Cooper Frone Russell amp Mudar 1995

Beck amp Treiman 1996 Bradizza Reifman amp Barnes 1999) For the social and peer

factors buying alcohol was as predicted associated with increased alcohol

involvement but there was only weak supporting evidence for an association with

having older friends There was a strong positive and consistent relationship between

spending time with friends who drink and perceived social pressure to drink and more

frequent drinking These independent social influences are interpreted in the context ofdeveloping peer relations and peer norms in which the majority of adolescents report

spending time with friends who are drinking as a recreational activity and where there

may be expectations to drink with the group sometimes to excessive levels (Iannotti

amp Bush 1992 Bahr Marcos amp Maughan 1995) Finally school conduct problems were

independently associated with drinking frequency with the number of times truanted

and being temporarily excluded having the strongest correlations Drinking more often

than other peers has been linked to more frequent unauthorized absences from school

(Currie et al 2000) Drinking smoking and drug use is also much more prevalentamong 12- to 15-year-olds who had ever truanted compared to those who had never

done so (Becher et al 2001)

Correlates of drinking intensityOverall 285 of the cohort typically drank six or more units on a drinking day which

can be taken to be a conservative indicator of underage binge drinking The regression

analyses were able to account for approximately 30 of the variance in drinkingintensity Age of first alcohol intoxication and lifetime smoking and cannabis use was

associated with more intense recent drinking For the family factors in contrast to

drinking frequency there was evidence for a positive association between how often

the mother usually drank alcohol and how much the adolescent drank on a drinking day

but contrary to prediction there was a negative association with the fatherrsquos drinking

It is possible that more frequent drinking by the father serves to discourage binge

drinking among mid-adolescents Nonetheless this effect was weak and was not

retained in the stepwise regression As predicted drinking to alter mood was associatedwith more intensive drinking but not with drinking for social facilitation functions This

effect however was not sufficiently strong to be retained in the stepwise regression

There was also a positive association between more favourable attitudes towards

alcohol and drinking intensity Among the social and peer factors a similar set of

associations was seen with the exception of perceived social pressure to drink

suggesting that mid-adolescents do not feel that the amount they consume is influenced

by their peers Finally the school conduct factors were quite strongly associated with

more intensive drinking and being in trouble with teachers and having beingtemporarily excluded had the strongest associations

The links between binge drinking and school conduct problems are a concern and

elsewhere studies have shown that binge drinking is related to poorer actual educational

performance (Newcomb Measham amp Parker 1995) Clinical diagnostic criteria for

John Marsden et al444

alcohol abuse recognize that recurrent drinking can result in school performance

problems and expulsions (American Psychiatric Association 1994) and the trajectory of

those experiencing school problems will be a focus of subsequent analyses of further

follow-up in the study The finding that lifetime use of cannabis was independently

associated with more intensive drinking is supportive of other work that argues that

those adolescents who use substances tend to have other attributes that increase therisk of poor psychosocial adjustment and school performance For example Jessor

Chase and Donovan (1980) argued that the reason that cannabis users tend to be less

well adjusted is that cannabis use is a general characteristic of individuals who are

predisposed to behavioural problems Furthermore Fergusson Lynskey and Horwood

(1997) suggested that instead of early cannabis use having a causal link with poor

psychosocial adjustment this association could be explained by family and other factors

that related to cannabis use Other alternative explanations include those proposed by

Kandel and colleagues They argue that early substance use sets into motion a chain ofevents which result in greater subsequent drug involvement and a range of other

negative psychosocial consequences (Kandel Davies Karus amp Yamaguchi 1986)

Again the causal direction of this relationship cannot be judged from the baseline data

but will be examined in more detail in subsequent reports on the longitudinal data

Strengths and limitations of the studyThe main strength of the present study was the analysis of the multiple influences on

drinking behaviour Studies of this kind have been rare in the UK but are encouraged as

good opportunities to gain an understanding of how early use of alcohol smoking and

other substance involvement evolves across the adolescent years (Edwards et al 1994

Duncan Duncan amp Hops 1998) Several limitations of the present study are also

acknowledged Given the reliance on self-report it is difficult to judge the reliability ofthe data and the findings should be interpreted with caution Nevertheless steps were

taken to maximize the privacy of the recruitment interviews to emphasize the

confidentiality of the study and the interviews were all conducted by young adults

Overall it has been argued that it is better to collect social survey data on this age group

at school than in the home (Becher et al 2001)

Implications for school-based alcohol educationThese results underline the importance of addressing personal family peer and school

conduct factors as part of alcohol education and problem prevention initiatives Theidentified correlates of drinking involvement in the present study could be usefully

taken up and discussed with students as part of alcohol education and prevention

programmes Elsewhere it has been argued that the main goal of school prevention

programmes should be to delay alcohol initiation (DeWit et al 2000 Griffin Botvin

Epstein Doyle amp Diaz 2000) However the very early age of onset in the UK suggests

that educational approaches based on harm minimization may be more realistic Recent

work in Australia has indicated that a harm minimization approach to alcohol education

together with adult supervision of initial drinking experiences can help to reduce theharms associated with alcohol use in young people (McBride Midford Farringdon amp

Phillips 2000b) Research into the merits of adopting a harm minimization approach to

alcohol education in schools has highlighted the importance of ensuring that

programme content and materials are relevant to local patterns of behaviour and are

Adolescent drinking 445

based on experiences that are relevant to the target audience (McBride Farringdon amp

Midford 2000a Dusenbury amp Falco 1995)

The potential feasibility and benefits of including parents as part of education

programmes in school should be examined The possibility of encouraging parents to

consider how their own behaviour and attitudes towards drinking might influence the

choices regarding alcohol use that are made by their offspring should be explored

Given the high prevalence of drinking involvement in mid-adolescence understanding

the influences on the further development of drinking attitudes and behaviours is of

critical importance Further reports from the study will describe the associations

between risky and heavy drinking patterns and alcohol-related problems and

developmental transitions to heavier consumption patterns as the cohort reaches the

period of late-adolescence

Acknowledgements

We would like to thank the students and staff from each school for their kind and enthusiastic

participation in the study The study was supported by a research grant from the LloydsTSB

charitable trust and conducted in association with Alcohol Concern

References

American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders

(4th ed) Washington DC APA

Anderson K Plant M amp Plant M (1998) Associations between drinking smoking and illicit

drug use among adolescents in the Western Isles of Scotland Implications for harm

minimization Journal of Substance Misuse 3 13ndash20

Ary D V Tildesley E Hops H amp Andrews J (1993) The influence of parent sibling and peer

modelling and attitudes on adolescent use of alcohol International Journal of Addiction 28

853ndash880

Bahr S J Marcos A C amp Maughan S L (1995) Family educational and peer influences on the

alcohol use of female and male adolescents Journal of Studies on Alcohol 56 457ndash469

Barnes G (1990) Impact of the family on adolescent drinking patterns In R Collins K Leonard

amp J Searles (Eds) Alcohol and the family Research and clinical perspectives (pp 137ndash161)

New York Guilford Press

Barnes G amp Welte J (1986) Patterns and predictors of alcohol use among 7ndash12th grade students

in New York State Journal of Studies on Alcohol 47 53ndash62

Becher H Boreham R Emery P Hinds K Jamison J amp Schagen I (2001) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Beck K H amp Treiman K A (1996) The relationship of social context of drinking perceived

social norms and parental influence to various drinking patterns of adolescents Addictive

Behaviors 21 633ndash644

Blenkinsop S Boreham R McManus S Natarajan L amp Prescott A (2003) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Blum R W Beuhring T amp Rinehart P M (2000) Protecting teens Beyond race income and

family structure Minneapolis MN Center for Adolescent Health University of Minnesota

Bonomo Y Coffey C Wolfe R Lynskey M Bowes G amp Patton G (2001) Adverse outcomes

of alcohol use in adolescents Addiction 96 1485ndash1496

Boreham R amp Shaw (2001) Smoking drinking and drug use among young people in England

in 2000 London The Stationery Office

John Marsden et al446

alteration function scores (b frac14 0113) greater perceived social pressure to drink

alcohol (b frac14 0155) a history of temporary school exclusion (b frac14 0121) and more

frequent occasions of truanting from school in the past year (b frac14 0086)

Drinking intensityIn common with the final model for drinking frequency just five covariates were

retained in the regression equation for drinking intensity The amount of time spent with

friends who are drinking alcohol was the strongest predictor (b frac14 0319) This was

followed by having a history of school exclusion (b frac14 0197) and more frequently being

in trouble with teachers in the past year (b frac14 0142) Greater parental encouragement

to drink was associated with higher actual drinking intensity (b frac14 0124) Finally a

single background factor ndash lifetime use of cannabis ndash was associated with higher

drinking intensity (b frac14 0113)

Discussion

This report has presented first results from a cohort follow-up study of alcohol use

among a sample of mid-adolescents in England Baseline data on personal backgroundand demographics family psychological social factors and school conduct problems

were correlated with reports of recent drinking frequency and intensity As expected

regular drinking was the norm among the cohort 19 in 20 of the cohort had consumed a

whole alcoholic drink at some point in their lives and approximately 17 in 20 were

current drinkers This prevalence of alcohol use is comparable to that reported for the

Table 3 Stepwise multiple regression of background family psychological social and school factors on

recent alcohol involvement (N frac14 467)

Drinking frequencyR 2 frac14 0396

Drinking intensityR 2 frac14 0273

1 BackgroundAge 0033 0046Gender 0272 0004Ever smoked cannabis ndash 0113

2 FamilyExtent parents encourage drinking 0155 0124Extent parents discourage drinking 0223 ndashGender pound extent parents discourage drinkinga 0302 ndashDrinking without parents knowledge 0113 ndash

3 PsychologicalMood functions for drinking 0113 ndash

4 SocialPersonally bought alcohol 0118 ndashTime with friends who are drinking 0316 0319Perceived social pressure to drink 0155 ndash

5 SchoolIn trouble with teachers in past year ndash 0142Times truanted in past year 0086 ndashTemporarily excluded in past year 0121 0197

a frac14 interaction term frac14 p 05 frac14 p 01 frac14 p 001

Adolescent drinking 441

general adult population in the UK (Singleton Bumpstead OrsquoBrien Lee amp Meltzer

2001) and is also comparable to drinking levels reported for 15-year-olds in other

countries (eg Casswell Stewart Conolly amp Silva 1991 for New Zealand) In terms of

typical drinking intensity study participants estimated that they drank about five

standard units of alcohol on a typical day Although the government has not issued

recommended drinking levels for the under-18 s this level exceeds the safer drinkinglevels for adults as recommended by the English Department of Health (Department of

Health 1995) and is therefore a cause for concern A substantial proportion of the

sample also reported lifetime tobacco smoking (70) and use of cannabis (40) Despite

the fact that the study cohort was not generated using probability sampling techniques

it is reasonable to believe that it is unbiased The levels of drinking smoking and

cannabis use reported fell remarkably close to population estimates for this age group in

England (Goddard amp Higgins 2001 Becher et al 2001 Currie Hurrelmann

Settertobulte Smith amp Todd 2000) On school conduct characteristics the samplewas also broadly comparable to reports from national surveys (Miller amp Plant 1999)

The cohort was also comparable to the general population on school conduct problems

Thirty-seven percent admitted that they had truanted at least once in the past year and

this compares to 33 of boys who admitted truanting in the latest Office for National

Statistics school survey (Boreham amp Shaw 2001)

Drinking was well established within the social networks of the cohort The majority

reported that most or all of their friends drank alcohol and two-thirds of the drinkers

said that they typically spent time with friendsacquaintances who were drinking atleast once a week Two-thirds did not consider that they were under any peer pressure

to drink

In the UK alcopop beverages are well established in the drinks market (Clarke

2000) and concerns have been raised about the marketing of these products to younger

drinkers (Hughes et al 1997 McKeganey 1998) In our study males reported a limited

preference for these drinks and tended to favour beer and lager whereas females had a

greater preference for spirits alcopops wine and liqueurs Males were more frequent

drinkers but there were no gender differences in the amount of alcohol consumed ontypical day Previous studies on alcohol use have found that males drink more heavily

than their female peers (Goddard amp Higgins 2001 Miller amp Plant 1996) However as

alcohol use among school-age students approximately doubled between 1990 and 2000

(from 53 units in 1990 to 104 units in 2000) the gender gap in consumption has

narrowed (Goddard amp Higgins 2001) The drinking patterns of young females are of

concern given their greater vulnerability to alcohol-related harms (Goist amp Sutker 1985

Plant amp Plant 2001)

Correlates of drinking frequencyThe regression analyses were able to account for approximately 40 of the variance in

scores on the measure of drinking frequency There was no evidence for the hypothesized

negative relationship between age of first drink and recent drinking frequency although

there was a positive association with feeling intoxicated after drinking alcohol It is

however possible that the effect of earlier initiation to drinking is not seen until drinking

patterns have further developed This was observed in a longitudinal study in the USAreported by Hawkins et al (1997) In this study of a cohort of students who were

followed-up annually from age 10ndash11 to age 17ndash18 a younger age of alcohol initiation was

strongly related to a higher level of alcohol misuse at age 17ndash18 Consequently we will

assess the influence of age of alcohol initiation in further follow-ups

John Marsden et al442

Studies examining the putative relationship between lifetime smoking cannabis use

and recent drinking frequency suggest that earlier initiation to substance use mediates

peers alcohol involvement and parental drinking risk factors (eg Hawkins et al 1997)

However findings from research using twins suggests that the association between age

of onset of alcohol use and later problematic drinking may not be directly causal but

that age of onset and problematic drinking in later life are both associated with anunderlying vulnerability to behavioural problems (Prescott amp Kendler 1999)

There was no support for the predicted relationship between the frequency of

parental drinking and adolescent drinking frequency It must be acknowledged that

influence of parental drinking parental alcohol use norms and family environment and

relations are complex (Peterson et al 1994) Foxcroft and Lowe (1997) found that

increased drinking levels among 11ndash17-year-olds were linked to regular perceived

parental drinking while Casswell and her colleagues noted a positive association

between the frequency of drinking in early- to mid-adolescents and the frequency of

their mother and fatherrsquos drinking (Casswell et al 1991) Peterson et al showed thatclear communication by parents about their expectations of their childrenrsquos drinking

together with positive reinforcement for desired behaviours can reduce the impact of

parentrsquos drinking on adolescent alcohol use

Several studies have also noted a negative relationship between parental support

a positive family environment and feelings of connectedness and adolescent substance

use (Resnick et al 1997 Hops Davis amp Lewin 1999) The role that parental approval of

drinking has in predicting intensity of alcohol use in their children has also been

explored (eg Barnes amp Welte 1986) Wilks Callan and Austin (1989) found that the

fatherrsquos approval or disapproval of drinking behaviour predicted self-perception as adrinker in young males yet found no normative influences for females A gender

interaction in the present study also suggests a differential effect for discouraging

drinking More frequent parental discouragement to drink was related to more frequent

drinking in females and less frequent drinking in males This finding could indicate that

parents are more likely to disapprove of drinking in their daughters (and therefore

discourage alcohol use more strongly) than in their sons Alternatively it could point to a

tendency for girls to rebel more strongly against their parentsrsquo attitudes towards alcohol

use The direction of this relationship cannot be judged from the baseline data but our

post hoc item analysis does suggest that this effect may be due to parental reactions todrinking and proscriptions about drinking at home Future analyses of the longitudinal

data collected during the course of this study will examine this issue more closely

In the present analyses although frequency of mother and fathersrsquo alcohol use was

significantly related to drinking frequency these variables were not retained in the

regression analysis This suggests that other variables explain the relationship between

these factors Zhang Welte and Wieczorek (1999) found that the drinking behaviour of

each parent has a differential effect on their male offspring (aged 16ndash19 years) In their

study the fatherrsquos drinking but not their motherrsquos drinking affects their sons drinking

and closeness to the mother was a protective factor against adolescent drinking On theother hand male adolescent drinking increases if closeness to the mother is low and she

drinks excessively There appears to be no comparable effect for closeness to the father

and the fatherrsquos drinking

For the analysis of psychological measures there was an association in the predicted

direction between alcohol involvement and drinking for mood alteration functions but

not drinking to fulfil social functions Poorer psychological well-being was negatively

associated with drinking frequency only and contrary to our hypothesis there were no

Adolescent drinking 443

associations between the positive and negative alcohol-related attitude scales The

present results provide further evidence for the link between reasons or motives for

alcohol use and consumption patterns A strong relationship was observed between

increased frequency of drinking to serve mood alteration functions and increased

drinking frequency Our research group has also observed this effect among young

alcohol cannabis and ecstasy users (Boys et al 1999) These findings are consistentwith previous studies which have found a positive relationship between the number of

reasons for alcohol use and drinking frequency (Cooper Frone Russell amp Mudar 1995

Beck amp Treiman 1996 Bradizza Reifman amp Barnes 1999) For the social and peer

factors buying alcohol was as predicted associated with increased alcohol

involvement but there was only weak supporting evidence for an association with

having older friends There was a strong positive and consistent relationship between

spending time with friends who drink and perceived social pressure to drink and more

frequent drinking These independent social influences are interpreted in the context ofdeveloping peer relations and peer norms in which the majority of adolescents report

spending time with friends who are drinking as a recreational activity and where there

may be expectations to drink with the group sometimes to excessive levels (Iannotti

amp Bush 1992 Bahr Marcos amp Maughan 1995) Finally school conduct problems were

independently associated with drinking frequency with the number of times truanted

and being temporarily excluded having the strongest correlations Drinking more often

than other peers has been linked to more frequent unauthorized absences from school

(Currie et al 2000) Drinking smoking and drug use is also much more prevalentamong 12- to 15-year-olds who had ever truanted compared to those who had never

done so (Becher et al 2001)

Correlates of drinking intensityOverall 285 of the cohort typically drank six or more units on a drinking day which

can be taken to be a conservative indicator of underage binge drinking The regression

analyses were able to account for approximately 30 of the variance in drinkingintensity Age of first alcohol intoxication and lifetime smoking and cannabis use was

associated with more intense recent drinking For the family factors in contrast to

drinking frequency there was evidence for a positive association between how often

the mother usually drank alcohol and how much the adolescent drank on a drinking day

but contrary to prediction there was a negative association with the fatherrsquos drinking

It is possible that more frequent drinking by the father serves to discourage binge

drinking among mid-adolescents Nonetheless this effect was weak and was not

retained in the stepwise regression As predicted drinking to alter mood was associatedwith more intensive drinking but not with drinking for social facilitation functions This

effect however was not sufficiently strong to be retained in the stepwise regression

There was also a positive association between more favourable attitudes towards

alcohol and drinking intensity Among the social and peer factors a similar set of

associations was seen with the exception of perceived social pressure to drink

suggesting that mid-adolescents do not feel that the amount they consume is influenced

by their peers Finally the school conduct factors were quite strongly associated with

more intensive drinking and being in trouble with teachers and having beingtemporarily excluded had the strongest associations

The links between binge drinking and school conduct problems are a concern and

elsewhere studies have shown that binge drinking is related to poorer actual educational

performance (Newcomb Measham amp Parker 1995) Clinical diagnostic criteria for

John Marsden et al444

alcohol abuse recognize that recurrent drinking can result in school performance

problems and expulsions (American Psychiatric Association 1994) and the trajectory of

those experiencing school problems will be a focus of subsequent analyses of further

follow-up in the study The finding that lifetime use of cannabis was independently

associated with more intensive drinking is supportive of other work that argues that

those adolescents who use substances tend to have other attributes that increase therisk of poor psychosocial adjustment and school performance For example Jessor

Chase and Donovan (1980) argued that the reason that cannabis users tend to be less

well adjusted is that cannabis use is a general characteristic of individuals who are

predisposed to behavioural problems Furthermore Fergusson Lynskey and Horwood

(1997) suggested that instead of early cannabis use having a causal link with poor

psychosocial adjustment this association could be explained by family and other factors

that related to cannabis use Other alternative explanations include those proposed by

Kandel and colleagues They argue that early substance use sets into motion a chain ofevents which result in greater subsequent drug involvement and a range of other

negative psychosocial consequences (Kandel Davies Karus amp Yamaguchi 1986)

Again the causal direction of this relationship cannot be judged from the baseline data

but will be examined in more detail in subsequent reports on the longitudinal data

Strengths and limitations of the studyThe main strength of the present study was the analysis of the multiple influences on

drinking behaviour Studies of this kind have been rare in the UK but are encouraged as

good opportunities to gain an understanding of how early use of alcohol smoking and

other substance involvement evolves across the adolescent years (Edwards et al 1994

Duncan Duncan amp Hops 1998) Several limitations of the present study are also

acknowledged Given the reliance on self-report it is difficult to judge the reliability ofthe data and the findings should be interpreted with caution Nevertheless steps were

taken to maximize the privacy of the recruitment interviews to emphasize the

confidentiality of the study and the interviews were all conducted by young adults

Overall it has been argued that it is better to collect social survey data on this age group

at school than in the home (Becher et al 2001)

Implications for school-based alcohol educationThese results underline the importance of addressing personal family peer and school

conduct factors as part of alcohol education and problem prevention initiatives Theidentified correlates of drinking involvement in the present study could be usefully

taken up and discussed with students as part of alcohol education and prevention

programmes Elsewhere it has been argued that the main goal of school prevention

programmes should be to delay alcohol initiation (DeWit et al 2000 Griffin Botvin

Epstein Doyle amp Diaz 2000) However the very early age of onset in the UK suggests

that educational approaches based on harm minimization may be more realistic Recent

work in Australia has indicated that a harm minimization approach to alcohol education

together with adult supervision of initial drinking experiences can help to reduce theharms associated with alcohol use in young people (McBride Midford Farringdon amp

Phillips 2000b) Research into the merits of adopting a harm minimization approach to

alcohol education in schools has highlighted the importance of ensuring that

programme content and materials are relevant to local patterns of behaviour and are

Adolescent drinking 445

based on experiences that are relevant to the target audience (McBride Farringdon amp

Midford 2000a Dusenbury amp Falco 1995)

The potential feasibility and benefits of including parents as part of education

programmes in school should be examined The possibility of encouraging parents to

consider how their own behaviour and attitudes towards drinking might influence the

choices regarding alcohol use that are made by their offspring should be explored

Given the high prevalence of drinking involvement in mid-adolescence understanding

the influences on the further development of drinking attitudes and behaviours is of

critical importance Further reports from the study will describe the associations

between risky and heavy drinking patterns and alcohol-related problems and

developmental transitions to heavier consumption patterns as the cohort reaches the

period of late-adolescence

Acknowledgements

We would like to thank the students and staff from each school for their kind and enthusiastic

participation in the study The study was supported by a research grant from the LloydsTSB

charitable trust and conducted in association with Alcohol Concern

References

American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders

(4th ed) Washington DC APA

Anderson K Plant M amp Plant M (1998) Associations between drinking smoking and illicit

drug use among adolescents in the Western Isles of Scotland Implications for harm

minimization Journal of Substance Misuse 3 13ndash20

Ary D V Tildesley E Hops H amp Andrews J (1993) The influence of parent sibling and peer

modelling and attitudes on adolescent use of alcohol International Journal of Addiction 28

853ndash880

Bahr S J Marcos A C amp Maughan S L (1995) Family educational and peer influences on the

alcohol use of female and male adolescents Journal of Studies on Alcohol 56 457ndash469

Barnes G (1990) Impact of the family on adolescent drinking patterns In R Collins K Leonard

amp J Searles (Eds) Alcohol and the family Research and clinical perspectives (pp 137ndash161)

New York Guilford Press

Barnes G amp Welte J (1986) Patterns and predictors of alcohol use among 7ndash12th grade students

in New York State Journal of Studies on Alcohol 47 53ndash62

Becher H Boreham R Emery P Hinds K Jamison J amp Schagen I (2001) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Beck K H amp Treiman K A (1996) The relationship of social context of drinking perceived

social norms and parental influence to various drinking patterns of adolescents Addictive

Behaviors 21 633ndash644

Blenkinsop S Boreham R McManus S Natarajan L amp Prescott A (2003) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Blum R W Beuhring T amp Rinehart P M (2000) Protecting teens Beyond race income and

family structure Minneapolis MN Center for Adolescent Health University of Minnesota

Bonomo Y Coffey C Wolfe R Lynskey M Bowes G amp Patton G (2001) Adverse outcomes

of alcohol use in adolescents Addiction 96 1485ndash1496

Boreham R amp Shaw (2001) Smoking drinking and drug use among young people in England

in 2000 London The Stationery Office

John Marsden et al446

general adult population in the UK (Singleton Bumpstead OrsquoBrien Lee amp Meltzer

2001) and is also comparable to drinking levels reported for 15-year-olds in other

countries (eg Casswell Stewart Conolly amp Silva 1991 for New Zealand) In terms of

typical drinking intensity study participants estimated that they drank about five

standard units of alcohol on a typical day Although the government has not issued

recommended drinking levels for the under-18 s this level exceeds the safer drinkinglevels for adults as recommended by the English Department of Health (Department of

Health 1995) and is therefore a cause for concern A substantial proportion of the

sample also reported lifetime tobacco smoking (70) and use of cannabis (40) Despite

the fact that the study cohort was not generated using probability sampling techniques

it is reasonable to believe that it is unbiased The levels of drinking smoking and

cannabis use reported fell remarkably close to population estimates for this age group in

England (Goddard amp Higgins 2001 Becher et al 2001 Currie Hurrelmann

Settertobulte Smith amp Todd 2000) On school conduct characteristics the samplewas also broadly comparable to reports from national surveys (Miller amp Plant 1999)

The cohort was also comparable to the general population on school conduct problems

Thirty-seven percent admitted that they had truanted at least once in the past year and

this compares to 33 of boys who admitted truanting in the latest Office for National

Statistics school survey (Boreham amp Shaw 2001)

Drinking was well established within the social networks of the cohort The majority

reported that most or all of their friends drank alcohol and two-thirds of the drinkers

said that they typically spent time with friendsacquaintances who were drinking atleast once a week Two-thirds did not consider that they were under any peer pressure

to drink

In the UK alcopop beverages are well established in the drinks market (Clarke

2000) and concerns have been raised about the marketing of these products to younger

drinkers (Hughes et al 1997 McKeganey 1998) In our study males reported a limited

preference for these drinks and tended to favour beer and lager whereas females had a

greater preference for spirits alcopops wine and liqueurs Males were more frequent

drinkers but there were no gender differences in the amount of alcohol consumed ontypical day Previous studies on alcohol use have found that males drink more heavily

than their female peers (Goddard amp Higgins 2001 Miller amp Plant 1996) However as

alcohol use among school-age students approximately doubled between 1990 and 2000

(from 53 units in 1990 to 104 units in 2000) the gender gap in consumption has

narrowed (Goddard amp Higgins 2001) The drinking patterns of young females are of

concern given their greater vulnerability to alcohol-related harms (Goist amp Sutker 1985

Plant amp Plant 2001)

Correlates of drinking frequencyThe regression analyses were able to account for approximately 40 of the variance in

scores on the measure of drinking frequency There was no evidence for the hypothesized

negative relationship between age of first drink and recent drinking frequency although

there was a positive association with feeling intoxicated after drinking alcohol It is

however possible that the effect of earlier initiation to drinking is not seen until drinking

patterns have further developed This was observed in a longitudinal study in the USAreported by Hawkins et al (1997) In this study of a cohort of students who were

followed-up annually from age 10ndash11 to age 17ndash18 a younger age of alcohol initiation was

strongly related to a higher level of alcohol misuse at age 17ndash18 Consequently we will

assess the influence of age of alcohol initiation in further follow-ups

John Marsden et al442

Studies examining the putative relationship between lifetime smoking cannabis use

and recent drinking frequency suggest that earlier initiation to substance use mediates

peers alcohol involvement and parental drinking risk factors (eg Hawkins et al 1997)

However findings from research using twins suggests that the association between age

of onset of alcohol use and later problematic drinking may not be directly causal but

that age of onset and problematic drinking in later life are both associated with anunderlying vulnerability to behavioural problems (Prescott amp Kendler 1999)

There was no support for the predicted relationship between the frequency of

parental drinking and adolescent drinking frequency It must be acknowledged that

influence of parental drinking parental alcohol use norms and family environment and

relations are complex (Peterson et al 1994) Foxcroft and Lowe (1997) found that

increased drinking levels among 11ndash17-year-olds were linked to regular perceived

parental drinking while Casswell and her colleagues noted a positive association

between the frequency of drinking in early- to mid-adolescents and the frequency of

their mother and fatherrsquos drinking (Casswell et al 1991) Peterson et al showed thatclear communication by parents about their expectations of their childrenrsquos drinking

together with positive reinforcement for desired behaviours can reduce the impact of

parentrsquos drinking on adolescent alcohol use

Several studies have also noted a negative relationship between parental support

a positive family environment and feelings of connectedness and adolescent substance

use (Resnick et al 1997 Hops Davis amp Lewin 1999) The role that parental approval of

drinking has in predicting intensity of alcohol use in their children has also been

explored (eg Barnes amp Welte 1986) Wilks Callan and Austin (1989) found that the

fatherrsquos approval or disapproval of drinking behaviour predicted self-perception as adrinker in young males yet found no normative influences for females A gender

interaction in the present study also suggests a differential effect for discouraging

drinking More frequent parental discouragement to drink was related to more frequent

drinking in females and less frequent drinking in males This finding could indicate that

parents are more likely to disapprove of drinking in their daughters (and therefore

discourage alcohol use more strongly) than in their sons Alternatively it could point to a

tendency for girls to rebel more strongly against their parentsrsquo attitudes towards alcohol

use The direction of this relationship cannot be judged from the baseline data but our

post hoc item analysis does suggest that this effect may be due to parental reactions todrinking and proscriptions about drinking at home Future analyses of the longitudinal

data collected during the course of this study will examine this issue more closely

In the present analyses although frequency of mother and fathersrsquo alcohol use was

significantly related to drinking frequency these variables were not retained in the

regression analysis This suggests that other variables explain the relationship between

these factors Zhang Welte and Wieczorek (1999) found that the drinking behaviour of

each parent has a differential effect on their male offspring (aged 16ndash19 years) In their

study the fatherrsquos drinking but not their motherrsquos drinking affects their sons drinking

and closeness to the mother was a protective factor against adolescent drinking On theother hand male adolescent drinking increases if closeness to the mother is low and she

drinks excessively There appears to be no comparable effect for closeness to the father

and the fatherrsquos drinking

For the analysis of psychological measures there was an association in the predicted

direction between alcohol involvement and drinking for mood alteration functions but

not drinking to fulfil social functions Poorer psychological well-being was negatively

associated with drinking frequency only and contrary to our hypothesis there were no

Adolescent drinking 443

associations between the positive and negative alcohol-related attitude scales The

present results provide further evidence for the link between reasons or motives for

alcohol use and consumption patterns A strong relationship was observed between

increased frequency of drinking to serve mood alteration functions and increased

drinking frequency Our research group has also observed this effect among young

alcohol cannabis and ecstasy users (Boys et al 1999) These findings are consistentwith previous studies which have found a positive relationship between the number of

reasons for alcohol use and drinking frequency (Cooper Frone Russell amp Mudar 1995

Beck amp Treiman 1996 Bradizza Reifman amp Barnes 1999) For the social and peer

factors buying alcohol was as predicted associated with increased alcohol

involvement but there was only weak supporting evidence for an association with

having older friends There was a strong positive and consistent relationship between

spending time with friends who drink and perceived social pressure to drink and more

frequent drinking These independent social influences are interpreted in the context ofdeveloping peer relations and peer norms in which the majority of adolescents report

spending time with friends who are drinking as a recreational activity and where there

may be expectations to drink with the group sometimes to excessive levels (Iannotti

amp Bush 1992 Bahr Marcos amp Maughan 1995) Finally school conduct problems were

independently associated with drinking frequency with the number of times truanted

and being temporarily excluded having the strongest correlations Drinking more often

than other peers has been linked to more frequent unauthorized absences from school

(Currie et al 2000) Drinking smoking and drug use is also much more prevalentamong 12- to 15-year-olds who had ever truanted compared to those who had never

done so (Becher et al 2001)

Correlates of drinking intensityOverall 285 of the cohort typically drank six or more units on a drinking day which

can be taken to be a conservative indicator of underage binge drinking The regression

analyses were able to account for approximately 30 of the variance in drinkingintensity Age of first alcohol intoxication and lifetime smoking and cannabis use was

associated with more intense recent drinking For the family factors in contrast to

drinking frequency there was evidence for a positive association between how often

the mother usually drank alcohol and how much the adolescent drank on a drinking day

but contrary to prediction there was a negative association with the fatherrsquos drinking

It is possible that more frequent drinking by the father serves to discourage binge

drinking among mid-adolescents Nonetheless this effect was weak and was not

retained in the stepwise regression As predicted drinking to alter mood was associatedwith more intensive drinking but not with drinking for social facilitation functions This

effect however was not sufficiently strong to be retained in the stepwise regression

There was also a positive association between more favourable attitudes towards

alcohol and drinking intensity Among the social and peer factors a similar set of

associations was seen with the exception of perceived social pressure to drink

suggesting that mid-adolescents do not feel that the amount they consume is influenced

by their peers Finally the school conduct factors were quite strongly associated with

more intensive drinking and being in trouble with teachers and having beingtemporarily excluded had the strongest associations

The links between binge drinking and school conduct problems are a concern and

elsewhere studies have shown that binge drinking is related to poorer actual educational

performance (Newcomb Measham amp Parker 1995) Clinical diagnostic criteria for

John Marsden et al444

alcohol abuse recognize that recurrent drinking can result in school performance

problems and expulsions (American Psychiatric Association 1994) and the trajectory of

those experiencing school problems will be a focus of subsequent analyses of further

follow-up in the study The finding that lifetime use of cannabis was independently

associated with more intensive drinking is supportive of other work that argues that

those adolescents who use substances tend to have other attributes that increase therisk of poor psychosocial adjustment and school performance For example Jessor

Chase and Donovan (1980) argued that the reason that cannabis users tend to be less

well adjusted is that cannabis use is a general characteristic of individuals who are

predisposed to behavioural problems Furthermore Fergusson Lynskey and Horwood

(1997) suggested that instead of early cannabis use having a causal link with poor

psychosocial adjustment this association could be explained by family and other factors

that related to cannabis use Other alternative explanations include those proposed by

Kandel and colleagues They argue that early substance use sets into motion a chain ofevents which result in greater subsequent drug involvement and a range of other

negative psychosocial consequences (Kandel Davies Karus amp Yamaguchi 1986)

Again the causal direction of this relationship cannot be judged from the baseline data

but will be examined in more detail in subsequent reports on the longitudinal data

Strengths and limitations of the studyThe main strength of the present study was the analysis of the multiple influences on

drinking behaviour Studies of this kind have been rare in the UK but are encouraged as

good opportunities to gain an understanding of how early use of alcohol smoking and

other substance involvement evolves across the adolescent years (Edwards et al 1994

Duncan Duncan amp Hops 1998) Several limitations of the present study are also

acknowledged Given the reliance on self-report it is difficult to judge the reliability ofthe data and the findings should be interpreted with caution Nevertheless steps were

taken to maximize the privacy of the recruitment interviews to emphasize the

confidentiality of the study and the interviews were all conducted by young adults

Overall it has been argued that it is better to collect social survey data on this age group

at school than in the home (Becher et al 2001)

Implications for school-based alcohol educationThese results underline the importance of addressing personal family peer and school

conduct factors as part of alcohol education and problem prevention initiatives Theidentified correlates of drinking involvement in the present study could be usefully

taken up and discussed with students as part of alcohol education and prevention

programmes Elsewhere it has been argued that the main goal of school prevention

programmes should be to delay alcohol initiation (DeWit et al 2000 Griffin Botvin

Epstein Doyle amp Diaz 2000) However the very early age of onset in the UK suggests

that educational approaches based on harm minimization may be more realistic Recent

work in Australia has indicated that a harm minimization approach to alcohol education

together with adult supervision of initial drinking experiences can help to reduce theharms associated with alcohol use in young people (McBride Midford Farringdon amp

Phillips 2000b) Research into the merits of adopting a harm minimization approach to

alcohol education in schools has highlighted the importance of ensuring that

programme content and materials are relevant to local patterns of behaviour and are

Adolescent drinking 445

based on experiences that are relevant to the target audience (McBride Farringdon amp

Midford 2000a Dusenbury amp Falco 1995)

The potential feasibility and benefits of including parents as part of education

programmes in school should be examined The possibility of encouraging parents to

consider how their own behaviour and attitudes towards drinking might influence the

choices regarding alcohol use that are made by their offspring should be explored

Given the high prevalence of drinking involvement in mid-adolescence understanding

the influences on the further development of drinking attitudes and behaviours is of

critical importance Further reports from the study will describe the associations

between risky and heavy drinking patterns and alcohol-related problems and

developmental transitions to heavier consumption patterns as the cohort reaches the

period of late-adolescence

Acknowledgements

We would like to thank the students and staff from each school for their kind and enthusiastic

participation in the study The study was supported by a research grant from the LloydsTSB

charitable trust and conducted in association with Alcohol Concern

References

American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders

(4th ed) Washington DC APA

Anderson K Plant M amp Plant M (1998) Associations between drinking smoking and illicit

drug use among adolescents in the Western Isles of Scotland Implications for harm

minimization Journal of Substance Misuse 3 13ndash20

Ary D V Tildesley E Hops H amp Andrews J (1993) The influence of parent sibling and peer

modelling and attitudes on adolescent use of alcohol International Journal of Addiction 28

853ndash880

Bahr S J Marcos A C amp Maughan S L (1995) Family educational and peer influences on the

alcohol use of female and male adolescents Journal of Studies on Alcohol 56 457ndash469

Barnes G (1990) Impact of the family on adolescent drinking patterns In R Collins K Leonard

amp J Searles (Eds) Alcohol and the family Research and clinical perspectives (pp 137ndash161)

New York Guilford Press

Barnes G amp Welte J (1986) Patterns and predictors of alcohol use among 7ndash12th grade students

in New York State Journal of Studies on Alcohol 47 53ndash62

Becher H Boreham R Emery P Hinds K Jamison J amp Schagen I (2001) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Beck K H amp Treiman K A (1996) The relationship of social context of drinking perceived

social norms and parental influence to various drinking patterns of adolescents Addictive

Behaviors 21 633ndash644

Blenkinsop S Boreham R McManus S Natarajan L amp Prescott A (2003) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Blum R W Beuhring T amp Rinehart P M (2000) Protecting teens Beyond race income and

family structure Minneapolis MN Center for Adolescent Health University of Minnesota

Bonomo Y Coffey C Wolfe R Lynskey M Bowes G amp Patton G (2001) Adverse outcomes

of alcohol use in adolescents Addiction 96 1485ndash1496

Boreham R amp Shaw (2001) Smoking drinking and drug use among young people in England

in 2000 London The Stationery Office

John Marsden et al446

Studies examining the putative relationship between lifetime smoking cannabis use

and recent drinking frequency suggest that earlier initiation to substance use mediates

peers alcohol involvement and parental drinking risk factors (eg Hawkins et al 1997)

However findings from research using twins suggests that the association between age

of onset of alcohol use and later problematic drinking may not be directly causal but

that age of onset and problematic drinking in later life are both associated with anunderlying vulnerability to behavioural problems (Prescott amp Kendler 1999)

There was no support for the predicted relationship between the frequency of

parental drinking and adolescent drinking frequency It must be acknowledged that

influence of parental drinking parental alcohol use norms and family environment and

relations are complex (Peterson et al 1994) Foxcroft and Lowe (1997) found that

increased drinking levels among 11ndash17-year-olds were linked to regular perceived

parental drinking while Casswell and her colleagues noted a positive association

between the frequency of drinking in early- to mid-adolescents and the frequency of

their mother and fatherrsquos drinking (Casswell et al 1991) Peterson et al showed thatclear communication by parents about their expectations of their childrenrsquos drinking

together with positive reinforcement for desired behaviours can reduce the impact of

parentrsquos drinking on adolescent alcohol use

Several studies have also noted a negative relationship between parental support

a positive family environment and feelings of connectedness and adolescent substance

use (Resnick et al 1997 Hops Davis amp Lewin 1999) The role that parental approval of

drinking has in predicting intensity of alcohol use in their children has also been

explored (eg Barnes amp Welte 1986) Wilks Callan and Austin (1989) found that the

fatherrsquos approval or disapproval of drinking behaviour predicted self-perception as adrinker in young males yet found no normative influences for females A gender

interaction in the present study also suggests a differential effect for discouraging

drinking More frequent parental discouragement to drink was related to more frequent

drinking in females and less frequent drinking in males This finding could indicate that

parents are more likely to disapprove of drinking in their daughters (and therefore

discourage alcohol use more strongly) than in their sons Alternatively it could point to a

tendency for girls to rebel more strongly against their parentsrsquo attitudes towards alcohol

use The direction of this relationship cannot be judged from the baseline data but our

post hoc item analysis does suggest that this effect may be due to parental reactions todrinking and proscriptions about drinking at home Future analyses of the longitudinal

data collected during the course of this study will examine this issue more closely

In the present analyses although frequency of mother and fathersrsquo alcohol use was

significantly related to drinking frequency these variables were not retained in the

regression analysis This suggests that other variables explain the relationship between

these factors Zhang Welte and Wieczorek (1999) found that the drinking behaviour of

each parent has a differential effect on their male offspring (aged 16ndash19 years) In their

study the fatherrsquos drinking but not their motherrsquos drinking affects their sons drinking

and closeness to the mother was a protective factor against adolescent drinking On theother hand male adolescent drinking increases if closeness to the mother is low and she

drinks excessively There appears to be no comparable effect for closeness to the father

and the fatherrsquos drinking

For the analysis of psychological measures there was an association in the predicted

direction between alcohol involvement and drinking for mood alteration functions but

not drinking to fulfil social functions Poorer psychological well-being was negatively

associated with drinking frequency only and contrary to our hypothesis there were no

Adolescent drinking 443

associations between the positive and negative alcohol-related attitude scales The

present results provide further evidence for the link between reasons or motives for

alcohol use and consumption patterns A strong relationship was observed between

increased frequency of drinking to serve mood alteration functions and increased

drinking frequency Our research group has also observed this effect among young

alcohol cannabis and ecstasy users (Boys et al 1999) These findings are consistentwith previous studies which have found a positive relationship between the number of

reasons for alcohol use and drinking frequency (Cooper Frone Russell amp Mudar 1995

Beck amp Treiman 1996 Bradizza Reifman amp Barnes 1999) For the social and peer

factors buying alcohol was as predicted associated with increased alcohol

involvement but there was only weak supporting evidence for an association with

having older friends There was a strong positive and consistent relationship between

spending time with friends who drink and perceived social pressure to drink and more

frequent drinking These independent social influences are interpreted in the context ofdeveloping peer relations and peer norms in which the majority of adolescents report

spending time with friends who are drinking as a recreational activity and where there

may be expectations to drink with the group sometimes to excessive levels (Iannotti

amp Bush 1992 Bahr Marcos amp Maughan 1995) Finally school conduct problems were

independently associated with drinking frequency with the number of times truanted

and being temporarily excluded having the strongest correlations Drinking more often

than other peers has been linked to more frequent unauthorized absences from school

(Currie et al 2000) Drinking smoking and drug use is also much more prevalentamong 12- to 15-year-olds who had ever truanted compared to those who had never

done so (Becher et al 2001)

Correlates of drinking intensityOverall 285 of the cohort typically drank six or more units on a drinking day which

can be taken to be a conservative indicator of underage binge drinking The regression

analyses were able to account for approximately 30 of the variance in drinkingintensity Age of first alcohol intoxication and lifetime smoking and cannabis use was

associated with more intense recent drinking For the family factors in contrast to

drinking frequency there was evidence for a positive association between how often

the mother usually drank alcohol and how much the adolescent drank on a drinking day

but contrary to prediction there was a negative association with the fatherrsquos drinking

It is possible that more frequent drinking by the father serves to discourage binge

drinking among mid-adolescents Nonetheless this effect was weak and was not

retained in the stepwise regression As predicted drinking to alter mood was associatedwith more intensive drinking but not with drinking for social facilitation functions This

effect however was not sufficiently strong to be retained in the stepwise regression

There was also a positive association between more favourable attitudes towards

alcohol and drinking intensity Among the social and peer factors a similar set of

associations was seen with the exception of perceived social pressure to drink

suggesting that mid-adolescents do not feel that the amount they consume is influenced

by their peers Finally the school conduct factors were quite strongly associated with

more intensive drinking and being in trouble with teachers and having beingtemporarily excluded had the strongest associations

The links between binge drinking and school conduct problems are a concern and

elsewhere studies have shown that binge drinking is related to poorer actual educational

performance (Newcomb Measham amp Parker 1995) Clinical diagnostic criteria for

John Marsden et al444

alcohol abuse recognize that recurrent drinking can result in school performance

problems and expulsions (American Psychiatric Association 1994) and the trajectory of

those experiencing school problems will be a focus of subsequent analyses of further

follow-up in the study The finding that lifetime use of cannabis was independently

associated with more intensive drinking is supportive of other work that argues that

those adolescents who use substances tend to have other attributes that increase therisk of poor psychosocial adjustment and school performance For example Jessor

Chase and Donovan (1980) argued that the reason that cannabis users tend to be less

well adjusted is that cannabis use is a general characteristic of individuals who are

predisposed to behavioural problems Furthermore Fergusson Lynskey and Horwood

(1997) suggested that instead of early cannabis use having a causal link with poor

psychosocial adjustment this association could be explained by family and other factors

that related to cannabis use Other alternative explanations include those proposed by

Kandel and colleagues They argue that early substance use sets into motion a chain ofevents which result in greater subsequent drug involvement and a range of other

negative psychosocial consequences (Kandel Davies Karus amp Yamaguchi 1986)

Again the causal direction of this relationship cannot be judged from the baseline data

but will be examined in more detail in subsequent reports on the longitudinal data

Strengths and limitations of the studyThe main strength of the present study was the analysis of the multiple influences on

drinking behaviour Studies of this kind have been rare in the UK but are encouraged as

good opportunities to gain an understanding of how early use of alcohol smoking and

other substance involvement evolves across the adolescent years (Edwards et al 1994

Duncan Duncan amp Hops 1998) Several limitations of the present study are also

acknowledged Given the reliance on self-report it is difficult to judge the reliability ofthe data and the findings should be interpreted with caution Nevertheless steps were

taken to maximize the privacy of the recruitment interviews to emphasize the

confidentiality of the study and the interviews were all conducted by young adults

Overall it has been argued that it is better to collect social survey data on this age group

at school than in the home (Becher et al 2001)

Implications for school-based alcohol educationThese results underline the importance of addressing personal family peer and school

conduct factors as part of alcohol education and problem prevention initiatives Theidentified correlates of drinking involvement in the present study could be usefully

taken up and discussed with students as part of alcohol education and prevention

programmes Elsewhere it has been argued that the main goal of school prevention

programmes should be to delay alcohol initiation (DeWit et al 2000 Griffin Botvin

Epstein Doyle amp Diaz 2000) However the very early age of onset in the UK suggests

that educational approaches based on harm minimization may be more realistic Recent

work in Australia has indicated that a harm minimization approach to alcohol education

together with adult supervision of initial drinking experiences can help to reduce theharms associated with alcohol use in young people (McBride Midford Farringdon amp

Phillips 2000b) Research into the merits of adopting a harm minimization approach to

alcohol education in schools has highlighted the importance of ensuring that

programme content and materials are relevant to local patterns of behaviour and are

Adolescent drinking 445

based on experiences that are relevant to the target audience (McBride Farringdon amp

Midford 2000a Dusenbury amp Falco 1995)

The potential feasibility and benefits of including parents as part of education

programmes in school should be examined The possibility of encouraging parents to

consider how their own behaviour and attitudes towards drinking might influence the

choices regarding alcohol use that are made by their offspring should be explored

Given the high prevalence of drinking involvement in mid-adolescence understanding

the influences on the further development of drinking attitudes and behaviours is of

critical importance Further reports from the study will describe the associations

between risky and heavy drinking patterns and alcohol-related problems and

developmental transitions to heavier consumption patterns as the cohort reaches the

period of late-adolescence

Acknowledgements

We would like to thank the students and staff from each school for their kind and enthusiastic

participation in the study The study was supported by a research grant from the LloydsTSB

charitable trust and conducted in association with Alcohol Concern

References

American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders

(4th ed) Washington DC APA

Anderson K Plant M amp Plant M (1998) Associations between drinking smoking and illicit

drug use among adolescents in the Western Isles of Scotland Implications for harm

minimization Journal of Substance Misuse 3 13ndash20

Ary D V Tildesley E Hops H amp Andrews J (1993) The influence of parent sibling and peer

modelling and attitudes on adolescent use of alcohol International Journal of Addiction 28

853ndash880

Bahr S J Marcos A C amp Maughan S L (1995) Family educational and peer influences on the

alcohol use of female and male adolescents Journal of Studies on Alcohol 56 457ndash469

Barnes G (1990) Impact of the family on adolescent drinking patterns In R Collins K Leonard

amp J Searles (Eds) Alcohol and the family Research and clinical perspectives (pp 137ndash161)

New York Guilford Press

Barnes G amp Welte J (1986) Patterns and predictors of alcohol use among 7ndash12th grade students

in New York State Journal of Studies on Alcohol 47 53ndash62

Becher H Boreham R Emery P Hinds K Jamison J amp Schagen I (2001) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Beck K H amp Treiman K A (1996) The relationship of social context of drinking perceived

social norms and parental influence to various drinking patterns of adolescents Addictive

Behaviors 21 633ndash644

Blenkinsop S Boreham R McManus S Natarajan L amp Prescott A (2003) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Blum R W Beuhring T amp Rinehart P M (2000) Protecting teens Beyond race income and

family structure Minneapolis MN Center for Adolescent Health University of Minnesota

Bonomo Y Coffey C Wolfe R Lynskey M Bowes G amp Patton G (2001) Adverse outcomes

of alcohol use in adolescents Addiction 96 1485ndash1496

Boreham R amp Shaw (2001) Smoking drinking and drug use among young people in England

in 2000 London The Stationery Office

John Marsden et al446

associations between the positive and negative alcohol-related attitude scales The

present results provide further evidence for the link between reasons or motives for

alcohol use and consumption patterns A strong relationship was observed between

increased frequency of drinking to serve mood alteration functions and increased

drinking frequency Our research group has also observed this effect among young

alcohol cannabis and ecstasy users (Boys et al 1999) These findings are consistentwith previous studies which have found a positive relationship between the number of

reasons for alcohol use and drinking frequency (Cooper Frone Russell amp Mudar 1995

Beck amp Treiman 1996 Bradizza Reifman amp Barnes 1999) For the social and peer

factors buying alcohol was as predicted associated with increased alcohol

involvement but there was only weak supporting evidence for an association with

having older friends There was a strong positive and consistent relationship between

spending time with friends who drink and perceived social pressure to drink and more

frequent drinking These independent social influences are interpreted in the context ofdeveloping peer relations and peer norms in which the majority of adolescents report

spending time with friends who are drinking as a recreational activity and where there

may be expectations to drink with the group sometimes to excessive levels (Iannotti

amp Bush 1992 Bahr Marcos amp Maughan 1995) Finally school conduct problems were

independently associated with drinking frequency with the number of times truanted

and being temporarily excluded having the strongest correlations Drinking more often

than other peers has been linked to more frequent unauthorized absences from school

(Currie et al 2000) Drinking smoking and drug use is also much more prevalentamong 12- to 15-year-olds who had ever truanted compared to those who had never

done so (Becher et al 2001)

Correlates of drinking intensityOverall 285 of the cohort typically drank six or more units on a drinking day which

can be taken to be a conservative indicator of underage binge drinking The regression

analyses were able to account for approximately 30 of the variance in drinkingintensity Age of first alcohol intoxication and lifetime smoking and cannabis use was

associated with more intense recent drinking For the family factors in contrast to

drinking frequency there was evidence for a positive association between how often

the mother usually drank alcohol and how much the adolescent drank on a drinking day

but contrary to prediction there was a negative association with the fatherrsquos drinking

It is possible that more frequent drinking by the father serves to discourage binge

drinking among mid-adolescents Nonetheless this effect was weak and was not

retained in the stepwise regression As predicted drinking to alter mood was associatedwith more intensive drinking but not with drinking for social facilitation functions This

effect however was not sufficiently strong to be retained in the stepwise regression

There was also a positive association between more favourable attitudes towards

alcohol and drinking intensity Among the social and peer factors a similar set of

associations was seen with the exception of perceived social pressure to drink

suggesting that mid-adolescents do not feel that the amount they consume is influenced

by their peers Finally the school conduct factors were quite strongly associated with

more intensive drinking and being in trouble with teachers and having beingtemporarily excluded had the strongest associations

The links between binge drinking and school conduct problems are a concern and

elsewhere studies have shown that binge drinking is related to poorer actual educational

performance (Newcomb Measham amp Parker 1995) Clinical diagnostic criteria for

John Marsden et al444

alcohol abuse recognize that recurrent drinking can result in school performance

problems and expulsions (American Psychiatric Association 1994) and the trajectory of

those experiencing school problems will be a focus of subsequent analyses of further

follow-up in the study The finding that lifetime use of cannabis was independently

associated with more intensive drinking is supportive of other work that argues that

those adolescents who use substances tend to have other attributes that increase therisk of poor psychosocial adjustment and school performance For example Jessor

Chase and Donovan (1980) argued that the reason that cannabis users tend to be less

well adjusted is that cannabis use is a general characteristic of individuals who are

predisposed to behavioural problems Furthermore Fergusson Lynskey and Horwood

(1997) suggested that instead of early cannabis use having a causal link with poor

psychosocial adjustment this association could be explained by family and other factors

that related to cannabis use Other alternative explanations include those proposed by

Kandel and colleagues They argue that early substance use sets into motion a chain ofevents which result in greater subsequent drug involvement and a range of other

negative psychosocial consequences (Kandel Davies Karus amp Yamaguchi 1986)

Again the causal direction of this relationship cannot be judged from the baseline data

but will be examined in more detail in subsequent reports on the longitudinal data

Strengths and limitations of the studyThe main strength of the present study was the analysis of the multiple influences on

drinking behaviour Studies of this kind have been rare in the UK but are encouraged as

good opportunities to gain an understanding of how early use of alcohol smoking and

other substance involvement evolves across the adolescent years (Edwards et al 1994

Duncan Duncan amp Hops 1998) Several limitations of the present study are also

acknowledged Given the reliance on self-report it is difficult to judge the reliability ofthe data and the findings should be interpreted with caution Nevertheless steps were

taken to maximize the privacy of the recruitment interviews to emphasize the

confidentiality of the study and the interviews were all conducted by young adults

Overall it has been argued that it is better to collect social survey data on this age group

at school than in the home (Becher et al 2001)

Implications for school-based alcohol educationThese results underline the importance of addressing personal family peer and school

conduct factors as part of alcohol education and problem prevention initiatives Theidentified correlates of drinking involvement in the present study could be usefully

taken up and discussed with students as part of alcohol education and prevention

programmes Elsewhere it has been argued that the main goal of school prevention

programmes should be to delay alcohol initiation (DeWit et al 2000 Griffin Botvin

Epstein Doyle amp Diaz 2000) However the very early age of onset in the UK suggests

that educational approaches based on harm minimization may be more realistic Recent

work in Australia has indicated that a harm minimization approach to alcohol education

together with adult supervision of initial drinking experiences can help to reduce theharms associated with alcohol use in young people (McBride Midford Farringdon amp

Phillips 2000b) Research into the merits of adopting a harm minimization approach to

alcohol education in schools has highlighted the importance of ensuring that

programme content and materials are relevant to local patterns of behaviour and are

Adolescent drinking 445

based on experiences that are relevant to the target audience (McBride Farringdon amp

Midford 2000a Dusenbury amp Falco 1995)

The potential feasibility and benefits of including parents as part of education

programmes in school should be examined The possibility of encouraging parents to

consider how their own behaviour and attitudes towards drinking might influence the

choices regarding alcohol use that are made by their offspring should be explored

Given the high prevalence of drinking involvement in mid-adolescence understanding

the influences on the further development of drinking attitudes and behaviours is of

critical importance Further reports from the study will describe the associations

between risky and heavy drinking patterns and alcohol-related problems and

developmental transitions to heavier consumption patterns as the cohort reaches the

period of late-adolescence

Acknowledgements

We would like to thank the students and staff from each school for their kind and enthusiastic

participation in the study The study was supported by a research grant from the LloydsTSB

charitable trust and conducted in association with Alcohol Concern

References

American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders

(4th ed) Washington DC APA

Anderson K Plant M amp Plant M (1998) Associations between drinking smoking and illicit

drug use among adolescents in the Western Isles of Scotland Implications for harm

minimization Journal of Substance Misuse 3 13ndash20

Ary D V Tildesley E Hops H amp Andrews J (1993) The influence of parent sibling and peer

modelling and attitudes on adolescent use of alcohol International Journal of Addiction 28

853ndash880

Bahr S J Marcos A C amp Maughan S L (1995) Family educational and peer influences on the

alcohol use of female and male adolescents Journal of Studies on Alcohol 56 457ndash469

Barnes G (1990) Impact of the family on adolescent drinking patterns In R Collins K Leonard

amp J Searles (Eds) Alcohol and the family Research and clinical perspectives (pp 137ndash161)

New York Guilford Press

Barnes G amp Welte J (1986) Patterns and predictors of alcohol use among 7ndash12th grade students

in New York State Journal of Studies on Alcohol 47 53ndash62

Becher H Boreham R Emery P Hinds K Jamison J amp Schagen I (2001) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Beck K H amp Treiman K A (1996) The relationship of social context of drinking perceived

social norms and parental influence to various drinking patterns of adolescents Addictive

Behaviors 21 633ndash644

Blenkinsop S Boreham R McManus S Natarajan L amp Prescott A (2003) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Blum R W Beuhring T amp Rinehart P M (2000) Protecting teens Beyond race income and

family structure Minneapolis MN Center for Adolescent Health University of Minnesota

Bonomo Y Coffey C Wolfe R Lynskey M Bowes G amp Patton G (2001) Adverse outcomes

of alcohol use in adolescents Addiction 96 1485ndash1496

Boreham R amp Shaw (2001) Smoking drinking and drug use among young people in England

in 2000 London The Stationery Office

John Marsden et al446

alcohol abuse recognize that recurrent drinking can result in school performance

problems and expulsions (American Psychiatric Association 1994) and the trajectory of

those experiencing school problems will be a focus of subsequent analyses of further

follow-up in the study The finding that lifetime use of cannabis was independently

associated with more intensive drinking is supportive of other work that argues that

those adolescents who use substances tend to have other attributes that increase therisk of poor psychosocial adjustment and school performance For example Jessor

Chase and Donovan (1980) argued that the reason that cannabis users tend to be less

well adjusted is that cannabis use is a general characteristic of individuals who are

predisposed to behavioural problems Furthermore Fergusson Lynskey and Horwood

(1997) suggested that instead of early cannabis use having a causal link with poor

psychosocial adjustment this association could be explained by family and other factors

that related to cannabis use Other alternative explanations include those proposed by

Kandel and colleagues They argue that early substance use sets into motion a chain ofevents which result in greater subsequent drug involvement and a range of other

negative psychosocial consequences (Kandel Davies Karus amp Yamaguchi 1986)

Again the causal direction of this relationship cannot be judged from the baseline data

but will be examined in more detail in subsequent reports on the longitudinal data

Strengths and limitations of the studyThe main strength of the present study was the analysis of the multiple influences on

drinking behaviour Studies of this kind have been rare in the UK but are encouraged as

good opportunities to gain an understanding of how early use of alcohol smoking and

other substance involvement evolves across the adolescent years (Edwards et al 1994

Duncan Duncan amp Hops 1998) Several limitations of the present study are also

acknowledged Given the reliance on self-report it is difficult to judge the reliability ofthe data and the findings should be interpreted with caution Nevertheless steps were

taken to maximize the privacy of the recruitment interviews to emphasize the

confidentiality of the study and the interviews were all conducted by young adults

Overall it has been argued that it is better to collect social survey data on this age group

at school than in the home (Becher et al 2001)

Implications for school-based alcohol educationThese results underline the importance of addressing personal family peer and school

conduct factors as part of alcohol education and problem prevention initiatives Theidentified correlates of drinking involvement in the present study could be usefully

taken up and discussed with students as part of alcohol education and prevention

programmes Elsewhere it has been argued that the main goal of school prevention

programmes should be to delay alcohol initiation (DeWit et al 2000 Griffin Botvin

Epstein Doyle amp Diaz 2000) However the very early age of onset in the UK suggests

that educational approaches based on harm minimization may be more realistic Recent

work in Australia has indicated that a harm minimization approach to alcohol education

together with adult supervision of initial drinking experiences can help to reduce theharms associated with alcohol use in young people (McBride Midford Farringdon amp

Phillips 2000b) Research into the merits of adopting a harm minimization approach to

alcohol education in schools has highlighted the importance of ensuring that

programme content and materials are relevant to local patterns of behaviour and are

Adolescent drinking 445

based on experiences that are relevant to the target audience (McBride Farringdon amp

Midford 2000a Dusenbury amp Falco 1995)

The potential feasibility and benefits of including parents as part of education

programmes in school should be examined The possibility of encouraging parents to

consider how their own behaviour and attitudes towards drinking might influence the

choices regarding alcohol use that are made by their offspring should be explored

Given the high prevalence of drinking involvement in mid-adolescence understanding

the influences on the further development of drinking attitudes and behaviours is of

critical importance Further reports from the study will describe the associations

between risky and heavy drinking patterns and alcohol-related problems and

developmental transitions to heavier consumption patterns as the cohort reaches the

period of late-adolescence

Acknowledgements

We would like to thank the students and staff from each school for their kind and enthusiastic

participation in the study The study was supported by a research grant from the LloydsTSB

charitable trust and conducted in association with Alcohol Concern

References

American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders

(4th ed) Washington DC APA

Anderson K Plant M amp Plant M (1998) Associations between drinking smoking and illicit

drug use among adolescents in the Western Isles of Scotland Implications for harm

minimization Journal of Substance Misuse 3 13ndash20

Ary D V Tildesley E Hops H amp Andrews J (1993) The influence of parent sibling and peer

modelling and attitudes on adolescent use of alcohol International Journal of Addiction 28

853ndash880

Bahr S J Marcos A C amp Maughan S L (1995) Family educational and peer influences on the

alcohol use of female and male adolescents Journal of Studies on Alcohol 56 457ndash469

Barnes G (1990) Impact of the family on adolescent drinking patterns In R Collins K Leonard

amp J Searles (Eds) Alcohol and the family Research and clinical perspectives (pp 137ndash161)

New York Guilford Press

Barnes G amp Welte J (1986) Patterns and predictors of alcohol use among 7ndash12th grade students

in New York State Journal of Studies on Alcohol 47 53ndash62

Becher H Boreham R Emery P Hinds K Jamison J amp Schagen I (2001) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Beck K H amp Treiman K A (1996) The relationship of social context of drinking perceived

social norms and parental influence to various drinking patterns of adolescents Addictive

Behaviors 21 633ndash644

Blenkinsop S Boreham R McManus S Natarajan L amp Prescott A (2003) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Blum R W Beuhring T amp Rinehart P M (2000) Protecting teens Beyond race income and

family structure Minneapolis MN Center for Adolescent Health University of Minnesota

Bonomo Y Coffey C Wolfe R Lynskey M Bowes G amp Patton G (2001) Adverse outcomes

of alcohol use in adolescents Addiction 96 1485ndash1496

Boreham R amp Shaw (2001) Smoking drinking and drug use among young people in England

in 2000 London The Stationery Office

John Marsden et al446

based on experiences that are relevant to the target audience (McBride Farringdon amp

Midford 2000a Dusenbury amp Falco 1995)

The potential feasibility and benefits of including parents as part of education

programmes in school should be examined The possibility of encouraging parents to

consider how their own behaviour and attitudes towards drinking might influence the

choices regarding alcohol use that are made by their offspring should be explored

Given the high prevalence of drinking involvement in mid-adolescence understanding

the influences on the further development of drinking attitudes and behaviours is of

critical importance Further reports from the study will describe the associations

between risky and heavy drinking patterns and alcohol-related problems and

developmental transitions to heavier consumption patterns as the cohort reaches the

period of late-adolescence

Acknowledgements

We would like to thank the students and staff from each school for their kind and enthusiastic

participation in the study The study was supported by a research grant from the LloydsTSB

charitable trust and conducted in association with Alcohol Concern

References

American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders

(4th ed) Washington DC APA

Anderson K Plant M amp Plant M (1998) Associations between drinking smoking and illicit

drug use among adolescents in the Western Isles of Scotland Implications for harm

minimization Journal of Substance Misuse 3 13ndash20

Ary D V Tildesley E Hops H amp Andrews J (1993) The influence of parent sibling and peer

modelling and attitudes on adolescent use of alcohol International Journal of Addiction 28

853ndash880

Bahr S J Marcos A C amp Maughan S L (1995) Family educational and peer influences on the

alcohol use of female and male adolescents Journal of Studies on Alcohol 56 457ndash469

Barnes G (1990) Impact of the family on adolescent drinking patterns In R Collins K Leonard

amp J Searles (Eds) Alcohol and the family Research and clinical perspectives (pp 137ndash161)

New York Guilford Press

Barnes G amp Welte J (1986) Patterns and predictors of alcohol use among 7ndash12th grade students

in New York State Journal of Studies on Alcohol 47 53ndash62

Becher H Boreham R Emery P Hinds K Jamison J amp Schagen I (2001) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Beck K H amp Treiman K A (1996) The relationship of social context of drinking perceived

social norms and parental influence to various drinking patterns of adolescents Addictive

Behaviors 21 633ndash644

Blenkinsop S Boreham R McManus S Natarajan L amp Prescott A (2003) Smoking drinking

and drug use among young people in England in 2000 London The Stationery Office

Blum R W Beuhring T amp Rinehart P M (2000) Protecting teens Beyond race income and

family structure Minneapolis MN Center for Adolescent Health University of Minnesota

Bonomo Y Coffey C Wolfe R Lynskey M Bowes G amp Patton G (2001) Adverse outcomes

of alcohol use in adolescents Addiction 96 1485ndash1496

Boreham R amp Shaw (2001) Smoking drinking and drug use among young people in England

in 2000 London The Stationery Office

John Marsden et al446

Boreham R amp Shaw A (2002) Drug use smoking and drinking among young people in

England 2001 London The Stationery Office

Boys A Marsden J Griffiths P Fountain J Stillwell G amp Strang J (1999) Substance use

among young people The relationship between functions and intentions Addiction 94

1043ndash1050

Boys A Marsden J Stillwell G Hutchings K Griffiths P amp Farrell M (2003) Minimizing

respondent attrition in longitudinal research Practical implications from a cohort study of

adolescent drinking Journal of Adolescence 26 363ndash373

Bradizza C M Reifman A amp Barnes G M (1999) Social and coping reasons for drinking

Predicting alcohol misuse in adolescents Journal of Studies on Alcohol 60 491ndash499

Bronfenbrenner U (1986) Recent advances in research on the ecology of human development In

R K Silbereisen K Eyferth amp G Rudinger (Eds) Development as action in context Problem

behavior and normal youth development (pp 287ndash309) New York Springer

Casswell S Stewart J Conolly G amp Silva P (1991) A longitudinal study of New Zealand

childrensrsquo experience with alcohol British Journal of Addiction 87 277ndash285

Chassin L Pillow F Curran P Molina B S amp Barrera M (1993) Relation of parental

alcoholism to early adolescent substance use A test of three mediating mechanisms Journal

of Abnormal Psychology 102 3ndash19

Chou S amp Pickering R (1992) Early onset of drinking as a risk factor for lifetime alcohol-related

problems British Journal of Addiction 87 1199ndash1204

Clarke E (2000) The UK drinks market Hampton Middlesex Key Note

Cohen J (1988) Statistical Power Analysis for the Behavioral Sciences (2nd Edition) Hillsdale

NJ Erlbaum

Cooper M L Frone M R Russell M amp Mudar P (1995) Drinking to regulate positive and

negative emotions A motivational model of alcohol use Journal of Personality and Social

Psychology 69 990ndash1005

Currie C Fairgrave J Akhtar P amp Currie D (2003) Scottish School Adolescent Lifestyles and

Substance Use Survey (SALSUS) National report Scottish Executive Child and Adolescent

Health Research Unit

Currie C Hurrelmann K Settertobulte W Smith R amp Todd J (2000) Health and health

behaviour among young people Health behaviour in school-aged children A WHO cross-

national study Copenhagen WHO Regional Office for Europe

Denton R E amp Kampfe C M (1994) The relationship between family variables and adolescent

substance abuse A literature review Adolescence 29 475ndash495

Department for Education and Employment (1998a) Protecting young people Circular 495

London Department for Education and Employment

Department for Education and Employment (1998b) Performance tables 1998 London

Department for Education and Employment

Department of Health (1995) Sensible drinking The report of an inter-departmental working

group London Her Majestyrsquos Stationery Office

Department of Health (2001) The State of Public Health Report from the Chief Medical Officer

of the Department of Health London The Stationery Office

DeWit D J Adlaf E M Offord D R amp Ogborne A C (2000) Age at first alcohol use A risk

factor for the development of alcohol disorders American Journal of Psychiatry 157

745ndash750

Duncan S C Duncan T E amp Hops H (1998) Progressions of alcohol cigarette and marijuana

use in adolescence Journal of Behavioral Medicine 21 375ndash388

Duncan T E Tildesley E Duncan S C amp Hops H (1995) The consistency of family and peer

influences on the development of substance use in adolescence Addiction 90 1647ndash1660

Dusenbury L amp Falco M (1995) Eleven components of effective drug abuse prevention

curricula Journal of School Health 65 420ndash424

Edwards G Anderson P Babor T F Casswell S Ferrance R Giesbrecht N Godfrey C

Holder H Lemmens P Makela K Midanik L Norstrom T Osterberg E Romelsjo A

Adolescent drinking 447

Room R Simpura J amp Skog O (1994) Alcohol policy and the public good Oxford Oxford

University Press

Ellickson P L amp Hays R D (1991) Antecedents of drinking among young adolescents with

different alcohol use histories Journal of Studies on Alcohol 52 398ndash408

Ellickson P L Tucker J S Klein D amp McGuigan K A (2001) Prospective risk factors for

alcohol misuse in late adolescence Journal of Studies on Alcohol 62 773ndash782

Fergusson D M Horwood L J amp Lynskey M T (1995) The prevalence and risk factors

associated with abusive or hazardous alcohol consumption in 16-year olds Addiction 90

935ndash946

Fergusson D M Lynskey M T amp Horwood J L (1997) The short-term consequences of early

onset cannabis use Journal of Abnormal Child Psychology 24 499ndash512

Foxcroft D R amp Lowe G (1997) Adolescentsrsquo alcohol use and misuse The socializing influence

of perceived family life Drugs Education prevention and policy 4 215ndash229

Foxcroft D R Lowe G amp May G (1994) Adolescent alcohol use and family influences

Attributive statements by teenage drinkers Drug Education Prevention and Policy 1 63ndash69

Glanz K Lewis F M amp Rimer B K (2002) Health Behaviour and Health Education Theory

Research and Practice (4th ed) San Francisco CA Jossey-Bass

Goddard E amp Higgins V (2001) Smoking drinking and drug use among young teenagers in

2000 London The Stationery Office

Goist K C amp Sutker P B (1985) Acute alcohol intoxication and body composition in women

and men Biochemistry and Behaviour 22 811ndash814

Goldberg D amp Williams P (1988) A Userrsquos Guide to the General Health Questionnaire

Windsor NFER-NELSON

Goulden C amp Sondhi A (2001) At the margins Drug use by vulnerable young people in the

199899 Youth Lifestyles Survey Home Office Research Study No 228 London Home

Office

Graham J amp Bowling B (1995) Young People and Crime Home Office Research Study 145

London Home Office

Graham J W Hansen W B Sobel J L Shelton J L Flay B R amp Johnson C A (1987) The

consistency of peer and parent influences on tobacco alcohol and marijuana use among

young adolescents Journal of Behavioral Medicine 10 559ndash579

Grant B F (1998) Age at smoking onset and its association with alcohol consumption and DSM-IV

alcohol abuse and dependence Results from the National Longitudinal Alcohol Epidemiologic

Survey Journal of Substance Abuse 10 59ndash73

Griffin K W Botvin G J Epstein J A Doyle M M amp Diaz T (2000) Psychosocial and

behavioral factors in early adolescence as predictors of heavy drinking among high school

seniors Journal of Studies on Alcohol 61 603ndash606

Harnett R Thom B Herring R amp Kelly M (2000) Alcohol in transition Towards a model of

young menrsquos drinking styles Journal of Youth Studies 3 61ndash67

Hawkings J D Graham J W Maguin E Abbott R Hill K G amp Catalono R F (1997)

Exploring the effects of age of alcohol use initiation and psychoscocial risk factors on

subsequent alcohol misuse Journal of Studies on Alcohol 58 280ndash290

Hibbell B Andersson B Ahlstrom S Balakireva O Bjarnson T Kokkevi A amp Morgan M

(1997) The 1995 ESPAD Report Alcohol and other drug use amongst students in 26

European countries Stockholm Swedish Council for Information on Alcohol and Other

Drugs

Hibbell B Andersson B Ahlstrom S Balakireva O Bjarnson T Kokkevi A amp Morgan M

(2000) The 1999 European School Survey Project on Alcohol and Other Drugs report

(ESPAD) Stockholm Swedish Council for Information on Alcohol and Other Drugs

Hill S Y amp Yuan H (1999) Familial density of alcoholism and onset of adolescent drinking

Journal of Studies on Alcohol 60 7ndash17

Honess T Seymour L amp Webster R (2000) The social contexts of underage drinking London

Home Office

John Marsden et al448

Hops H Davis B amp Lewin L M (1999) The development of alcohol and other substance use

A gender study of family and peer context Journal of Studies on Alcohol 13 22ndash31

Hughes K MacKintosh A M Hastings G Wheeler C Watson J amp Inglis J (1997) Young

people alcohol and designer drinks Quantitative and qualitative study British Medical

Journal 314 414ndash418

Hundleby J D amp Mercer G W (1987) Family and friends as social environments and their

relationship to young adolescentsrsquo use of alcohol tobacco and marijuana Journal of

Marriage and the Family 49 151ndash164

Iannotti R J amp Bush P J (1992) Perceived versus actual friends use of alcohol cigarettes

marijuana and cocaine Which has the most influence Journal of Youth and Adolescence 21

375ndash389

Jackson C (1997) Initial and experimental stages of tobacco and alcohol use during late

childhood Relation to peer parent and personal risk factors Addictive Behaviors 22

685ndash698

Jessor R Chase J A amp Donovan J E (1980) Psychosocial correlates of marijuana use and

problem drinking in a national sample of adolescents American Journal of Public Health 70

604ndash610

Kandel D amp Andrews K (1987) Processes of adolescent socialization by parents and peers

International Journal of the Addictions 22 319ndash342

Kandel D B Davies M Karus D amp Yamaguchi K (1986) The consequences in young

adulthood of adolescent drug involvement An overview Archives of General Psychiatry 43

746ndash754

Keefe K (1994) Perceptions of normative social pressure and attitudes toward alcohol use

Changes during adolescence Journal of Studies on Alcohol 55 46ndash54

Lowe G Foxcroft D R amp Sibley D (1993) Adolescent Drinking and Family Life Chur

Switzerland Harwood Academic Publishers

Marcoux B C amp Shope J T (1997) Application of the theory of planned behavior to adolescent

use and misuse of alcohol Health Education Research 12 323ndash331

Marsden J Gossop M Stewart D Best D Farrell F Lehman P Edwards C amp Strang J

(1998) The Maudsley Addiction Profile (MAP) A brief instrument for assessing treatment

outcome Addiction 93 1857ndash1868

Marsh A Dobbs J amp White A (1986) Adolescent drinking London Her Majestyrsquos Stationery

Office

McBride N Farringdon F amp Midford R (2000a) What harms do young Australians experience in

alcohol-use situations Australian and New Zealand Journal of Public Health 24 54ndash59

McBride N Midford R Farringdon F amp Phillips M (2000b) Early results from a school alcohol

harm minimisation study The school health and alcohol harm reduction project Addiction

95 1021ndash1042

McKeganey N (1998) Alcopops and young people A suitable case for concern Editorial

Addiction 93 471ndash473

Midanik L (1999) Drunkenness feeling the effects and 5 thorn measures Addiction 94 887ndash897

Miller P amp Plant M (1996) Drinking smoking and illicit drug use among 15 and 16 year olds in

the United Kingdom British Medical Journal 313 394ndash397

Miller P amp Plant M (1999) Truancy and perceived school performance An alcohol and drug

study of UK teenagers Alcohol and Alcoholism 34 886ndash893

Miller P amp Plant M (2003) The family peer influences and substance use Findings from a study

of teenagers Journal of Substance Use 8 18ndash26

Moos R H amp Moos B S (1994) LISRES-Y Life Stressors and Social Resources Inventory ndash

Youth Form Professional Manual Odessa FL Psychological Assessment Resources

Monshouwer K Smit F De Zwart W M Spruit I amp Van Ameijden E J C (2003) Progress

from a first drink to first intoxication Age of onset time-windows and risk factors in a Dutch

national sample of secondary school students Journal of Substance Use 8 155ndash163

Adolescent drinking 449

Murgraft V Parrott A amp Bennett P (1999) Risky single-occasional drinking amongst young

people ndash definition correlates policy and intervention A broad overview of research findings

Alcohol and Alcoholism 34 3ndash14

Newcomb R Measham F amp Parker H (1995) A survey of drinking and deviant behaviour

among 1415 year olds in North West England Addiction Research 2 19ndash41

Plant M Peck D F amp Samuel E (1985) Alcohol drugs amp school-leavers London Tavistock

Publications

Plant M amp Plant M (2001) Heavy drinking by young British women gives cause for concern

British Medical Journal 323 1183

Peterson P Hawkins J Abbott R amp Catalano R (1994) Disentangling the effects of parental

drinking family management and parental alcohol norms on current drinking by black and

white adolescents Journal of Research on Adolescents 4 203ndash227

Poikolainen K (2002) Antecedents of substance use in adolescence Current Opinion in

Psychiatry 15 241ndash245

Prescott C A amp Kendler K S (1999) Age at first drink and risk for alcoholism A non-causal

association Alcoholism Clinical and Experimental Research 23 101ndash107

Reed E S (1996) Encountering the world Toward an Ecological Psychology Oxford Oxford

University Press

Reifman A Barnes G M Dintcheff B A Farrell M P amp Uhteg L (1998) Parental and peer

influences on the onset of heavier drinking among adolescents Journal of Studies on Alcohol

59 311ndash317

Resnick M D Bearman P S Blum R W Bauman K E Harris K M Jones J Tabor J

Beuhring T Sieving R E Shew M Ireland M Bearinger L H amp Udry J R (1997)

Protecting adolescents from harm Findings from the national longitudinal study on adolescent

health Journal of the American Medical Association 278 823ndash828

Substance Abuse and Mental health Services Administration (1999) National Household Survey

on Drug Abuse Population Estimates 1998 Rockville MD US Department of Health and

Human Services

Shen S A Lock-Wellman J amp Hill S Y (2001) Adolescent alcohol expectancies in offspring

from families at high risk for developing alcoholism Journal of Studies on Alcohol 62

763ndash772

Singleton N Bumpstead R OrsquoBrien M Lee A amp Meltzer H (2001) Psychiatric Morbidity

among adults living in private households 2000 London The Stationary Office

Strategy Unit (2004) Alcohol Harm Reduction Strategy For England The Prime Minsterrsquos

Strategy Unit The Cabinet Office

Sutherland I amp Willner P (1998) Patterns of alcohol cigarette and illicit drug use in English

adolescents Addiction 93 1199ndash1208

Swadi H amp Zeitlin H (1988) Peer influence and adolescent substance abuse A promising side

British Journal of Addiction 83 123ndash127

Tabachnik B G amp Fidell L S (2001) Using multivariate statistics (4th ed) Needham Heights

MA Alleyn amp Bacon

Webb E Ashton C Kelly P amp Kamali F (1996) Alcohol and drug use in UK university students

Lancet 348 922ndash925

Wilks J Callan V J amp Austin D A (1989) Parent peer and personal determinants of adolescent

drinking British Journal of Addiction 84 619ndash630

Windle M amp Barnes G M (1988) Similarities and differences in correlates of alcohol

consumption and problem behaviours among male and female adolescents International

Journal of Addictions 23 707ndash728

Zhang L Welte J amp Wieczorek W (1999) The Influence of parental drinking and closeness on

adolescent drinking Journal of Studies on Alcohol 60 245ndash251

Received 20 February 2003 revised version received 7 July 2004

John Marsden et al450