RESEARCH

The Role of Drinking Contexts in Alcohol-Related Problems among Youth

Component Directors: Sharon Lipperman-Kreda, Ph.D. and Melina Bersamin, Ph.D.

Introduction

Underage drinking and the problems that arise among young people who drink are big concerns in the United States.  Kids who begin drinking at an early age are at greater risk for alcohol problems later in life and are more likely to become alcohol dependent.  Just consider the facts related to drinking and emergency room visits cited by the Substance Abuse and Mental Health Administration (SAMSHA).  In 2010 there were about 189,000 emergency rooms visits by young people under age 21 for injuries and other conditions linked to alcohol including injuries of violence and of car crashes or alcohol poisoning.  Other consequences of underage drinking include unwanted, unintended or unprotected sex, other substance use, and physical consequences like black outs and hangovers.

Though most parents and adults think they know where and how adolescents get and drink alcohol, adolescents obtain alcohol in many different situations and contexts.  Contexts in which young people drink are often outside of adult supervision and may contribute to the alcohol-related problems they experience.  Young people who have problems related to drinking are very different from those who do not.  They drink in different places, drink with others who are similar to themselves, share access to alcohol with others, and may engage in problem behaviors beyond alcohol use.

If we can understand the situations in which young people drink and are likely to experience problems with alcohol, then we can develop preventive interventions specific to those contexts. In order to do that we are conducting a study about:

  1. Where, when, with whom adolescents drink alcohol, and
  2. The number and kinds of problems they experience in contexts where they drink.

The results of this study will help us to:

  1. Reduce opportunities for young people to drink in high-risk contexts,
  2. Increase parental or other adult control over those contexts, and
  3. Develop effective prevention messages tailored to youths drinking in those contexts.

Research Goals and Activities

Our overall goal is to understand drinking in specific situations or contexts in greater detail so we can develop ways to protect young people in these specific circumstances.

To achieve this goal, we use a mixed-method approach with telephone surveys, day-to-day surveys during weekends (Ecological Momentary Assessments, EMA) and qualitative interviews with adolescents:

  • We use telephone surveys to obtain information from adolescents about their drinking behaviors and alcohol-related problems in the past year and past month, how many times they drink alcohol in different places, and specific details about characteristics and problems of the most recent drinking events.  This survey allows us to investigate statistical associations between drinking situations, consumption, and problems, and identify a sample of drinking and non-drinking young people for day-to-day surveys. 
  • Smartphone surveys enable us to collect day-to-day information over weekends from a smaller group of adolescents.  In these brief surveys we ask whether, how much, where, when, with whom, and under what circumstances they have been drinking over the past 3 hours, and whether they have experienced any problems as a result of this drinking.  This provides us with fine-grained information about drinking situations and problems and helps us see the causal impacts of drinking in specific contexts.

Here is an outline of typical Smartphone data gathered from one individual:

  • We interview adolescents to find out about their experiences and descriptions of places and situations where they drink alcohol and use other substances. We also ask about problems related to these situations.
  • We use follow-up surveys with our adolescent participants to investigate how drinking locations and situations and alcohol problems change as young people get older.

Discoveries

Using these different methods we have already found out some surprising things about adolescent drinking.  We have found that:

  • Different adolescents (e.g., heavier drinkers or males) drink in many different contexts. Heavier drinkers, for example, tend to drink in specific places like parking lots or street corners.
  • As youths get older, they select different contexts for drinking; they will drink more frequently at parties and someone else’s home and much less in parking lots or street corners.
  • Drinking in some contexts causes many more specific problems than other contexts, not necessarily because of heavy drinking in those contexts. Fights, for example, result from heavier drinking at unsupervised house parties and in restaurants/bars/nightclubs but conflicts with parents or police are associated with drinking (but not heavier drinking) in outdoor places.
  • The presence of a parent or responsible adult and other contextual characteristics have different effects on different adolescents such as boys and girls.
  • Putting it all together, young people have many different opportunities to drink in different contexts, they may spend more time in contexts where risks are greater, and drinking in those places may increase their risks, and characteristics of those places may moderate risks for heavy drinking and problems.  This is a long causal chain, but is surprisingly stable and as the accompanying figure shows, we can simplify it to show where most risks arise.  Very few underage drinkers ever use alcohol in bars/nightclubs leading to some risks for heavier drinking and violence. On the other hand, private residences are the most frequent context for underage drinking and heavier drinking in this context is associated with greater risk of violence. Heavier drinking in these contexts increases when the number of people and availability of alcohol increase.  

The critical questions we all want to answer is, “How can we reduce drinking and alcohol-related problems among adolescents and underage youth?”

Our research is beginning to build the case that interventions that target specific places and situations (e.g., unsupervised parties in private residences) would be most effective in reducing underage drinking, heavy drinking and problems.  For example, parents can be informed about what social situations at private residences are likely to lead to underage drinking, heavy drinking and risks.