Abstainers and Drinkers - Two Sides of the Same Coin?

This commentary discusses a recently published literature review focussing on the growing trend of young people abstaining from drinking alcohol. Despite the recent increase in research on the decline in youth drinking, the review only identified 10 papers that explicitly examined abstainers. The inclusion criteria used thus excluded and overlooked the vast literature available on the decline in youth drinking. This commentary discusses the implications of this and raises the issue of how the adolescent abstainer should be viewed in research; is it a distinct social phenomenon with unique determinants or are abstainers merely the flip side of drinkers?

The great decline in adolescent risk behaviours: Unitary trend, separate trends, or cascade?

In many high-income countries, the proportion of adolescents who smoke, drink, or engage in other risk behaviours has declined markedly over the past 25 years. We illustrate this behavioural shift by collating and presenting previously published data (1990-2019) on smoking, alcohol use, cannabis use, early sexual initiation and juvenile crime in Australia, England, the Netherlands, New Zealand, and the USA, also providing European averages where comparable data are available. Then we explore empirical evidence for and against hypothesised causes of these declines. Specifically, we explore whether the declines across risk behaviours can be considered 1) a 'unitary trend' caused by common underlying drivers; 2) separate trends with behaviour-specific causes; or 3) the result of a 'cascade' effect, with declines in one risk behaviour causing declines in others. We find the unitary trend hypothesis has theoretical and empirical support, and there is international evidence that decreasing unstructured face-to-face time with friends is a common underlying driver. Additionally, evidence suggests that behaviour-specific factors have played a role in the decline of tobacco smoking (e.g. decreasing adolescent approval of smoking, increasing strength of tobacco control policies) and drinking (e.g. more restrictive parental rules and attitudes toward adolescent drinking, decreasing ease of access to alcohol). Finally, declining tobacco and alcohol use may have suppressed adolescent cannabis use (and perhaps other risk behaviours), but evidence for such a cascade is equivocal. We conclude that the causal factors behind the great decline in adolescent risk behaviours are multiple. While broad contextual changes appear to have reduced the opportunities for risk behaviours in general, behaviour-specific factors have also played an important role in smoking and drinking declines, and 'knock-on' effect from these behavioural domains to others are possible. Many hypothesised explanations remain to be tested empirically.

The association between MPOWER tobacco control policies and adolescent smoking across 36 countries: An ecological study over time (2006-2014).

OBJECTIVE: To examine associations over time between national tobacco control policies and adolescent smoking prevalence in Europe and Canada. DESIGN: In this ecological study, national tobacco control policies (MPOWER measures, as derived from WHO data) in 36 countries and their changes over time were related to national-level adolescent smoking rates (as derived from the Health Behaviour in School-aged Children study, 2006-2014). MPOWER measures included were: Protecting people from tobacco smoke (P), offering help to quit tobacco use (O), warning about the dangers of tobacco (W), enforcing bans on advertising, promotion and sponsorship (E) and raising taxes on tobacco (R). RESULTS: Across countries, adolescent weekly smoking decreased from 17.7% in 2006 to 11.6% in 2014. It decreased most strongly between 2010 and 2014. Although baseline MPOWER policies were not directly associated with differences in average rates of adolescent smoking between countries, countries with higher baseline smoke-free policies (P) showed faster rates of change in smoking over the time period. Moreover, countries that adopted increasingly strict policies regarding warning labels (W) over time, faced stronger declines over time in adolescent weekly smoking. CONCLUSION: A decade after the introduction of the WHO MPOWER package, we observed that, in our sample of European countries and Canada, measures targeting social norms around smoking (i.e., smoke-free policies in public places and policies related to warning people about the dangers of tobacco) are most strongly related to declines in adolescent smoking.

U.S. Trends in Adolescent Substance Use and Conduct Problems and Their Relation to Trends in Unstructured In-Person Socializing With Peers.

PURPOSE: This study examined whether national trends in unstructured in-person socializing with peers (i.e., socializing without goals or supervision) among adolescents could help explain recent declines in adolescent risk behaviors (e.g., substance use, fighting, theft). METHODS: The sample contained of 44,842 U.S. 12th-grade students (aged 17-18 years) from the Monitoring the Future survey (years 1999-2017). Analyses examined (1) prevalence trends, (2) latent factor structure of risk behaviors and unstructured in-person socializing, and (3) whether trends in the unstructured in-person socializing factor accounted for the relationship between time (i.e., survey year) and the risk behavior factor. RESULTS: Adolescent risk behaviors and unstructured in-person socializing declined by approximately 30% in the U.S., and both formed coherent latent factors. After adjusting for sociodemographics, declines in unstructured in-person socializing accounted for approximately 86% of declines in risk behaviors. CONCLUSIONS: The prevalence of risk behaviors and unstructured in-person socializing behaviors declined among U.S. 12th graders from 1999 to 2017. It is unknown whether such effects are directly causal and/or influenced by unmeasured variables. However, the results provide evidence that national declines in unstructured in-person socializing are a likely component of the explanation for national declines in adolescent risk behaviors.

Parental alcohol-specific rules effectively reduce adolescents' tobacco and cannabis use: A longitudinal study.

AIMS: The current study aimed to longitudinally examine the direct and indirect effects (via alcohol use) of parental alcohol-specific rule-setting on adolescent tobacco and cannabis use. Based on the gateway hypothesis, we expected parental alcohol-specific rules to affect adolescent tobacco and cannabis use through adolescent alcohol use. DESIGN AND PARTICIPANTS: A longitudinal design including three waves and 906 Dutch adolescents (Mage = 13.51 years, SD = 0.60) was used to apply zero-inflated Poisson models (ZIP). MEASUREMENTS: Self-report questionnaires measured adolescents' perceived rules about alcohol at T1, cigarette use at T1 and T3 (frequency of life-time and current smoking), cannabis use at T1/T3 (frequency of yearly and monthly use) and frequency of monthly alcohol use at T1/T2. FINDINGS: Stricter alcohol-specific rules at T1 predicted lower incidence and prevalence rates of cigarette (life-time: ß = -0.20, p < .00; current: ß = -0.21, p = .04) and cannabis use (monthly: ß = -0.43, p = .02; yearly: ß = -0.28, p = .19) two years later (T3). This direct effect was no longer significant when alcohol use at T1 was controlled for. Moreover, a significant indirect effect of alcohol-specific rules at T1 on tobacco and cannabis use T3 via monthly alcohol use T2 was found. CONCLUSIONS: The current study demonstrated that strict rules regarding alcohol may not only reduce alcohol but subsequently also other substance use such as tobacco and cannabis. Thus, interventions targeting the prevention of alcohol use, which appears to serve as a gateway, also affects the involvement in other substances.

Getting the Baby on a Schedule: Dutch and American Mothers' Ethnotheories and the Establishment of Diurnal Rhythms in Early Infancy.

One of the earliest challenges for infants and their parents is developing a diurnal sleep-wake cycle. Although the human biological rhythm is circadian by nature, its development varies across cultures, based in part on "zeitgebers" (German: literally "time-givers") or environmental cues. This study uses the developmental niche framework by Super and Harkness to address two different approaches to getting the baby on a schedule. 33 Dutch and 41 U.S. mothers were interviewed when their babies were 2 and 6 months old. A mixed-methods analysis including counts of themes and practices as well as the examination of actual quotes shows that Dutch mothers emphasized the importance of regularity in the baby's daily life and mentioned practices to establish regular schedules for the baby's sleeping, eating, and time outside more than American mothers did. The U.S. mothers, in contrast, discussed regularity less often and when they did, they emphasized that their baby should develop his or her own schedule. Furthermore, actual daily schedules, based on time allocation diaries kept by the mothers, revealed greater regularity among the Dutch babies. Discussion focuses on how culture shapes the development of diurnal rhythms, with implications for "best practices" for infant care.

Clusters of Contemporary Risk and Their Relationship to Mental Well-Being Among 15-Year-Old Adolescents Across 37 Countries.

PURPOSE: Adolescents' mental well-being has become a growing public health concern. Adolescents' daily lives and their engagement in risks have changed dramatically in the course of the 21st century, leading to a need to update traditional models of risk to include new exposures and behaviors. To date, studies have examined the relationship between (mainly traditional) risk behaviors and adolescent mental well-being or looked at risk factors that jeopardize mental well-being such as lack of social support but have not combined them together to highlight the most significant risks for adolescent mental well-being today. The present study included new and traditional risk behaviors and risk factors, robustly derived an empirically based model of clusters of risk, and examined the relative association of these clusters to adolescent mental well-being. METHODS: Data from the 2017-2018 Health Behaviours in School-aged Children study were used. The sample included 32,884 adolescents (51.7% girls) aged 15 years from 37 countries and regions. The principal component analysis was used to determine the existence of clusters of risk, using 21 items related to adolescent mental well-being that included both risk behaviors (e.g., substance use) and risk factors (e.g., peer support). Analysis was conducted in both a randomly split training and test set and in gender separate models. Mixed-effects logistic regressions examined the association between clusters of risk and mental well-being indices (low life satisfaction and psychosomatic complaints). RESULTS: Seven clusters of risk were identified: substance use and early sex, low social support, insufficient nutrition, bullying, sugary foods and drinks, physical health risk, and problematic social media use (SMU). Low social support and SMU were the strongest predictors of low life satisfaction (odds ratios = 2.167 and 1.330, respectively) and psychosomatic complaints (odds ratio = 1.687 and 1.386, respectively). Few gender differences in predictors were found. Exposure to bullying was somewhat more associated with psychosomatic complaints for girls, whereas physical health risk was associated with reduced relative odds of low life satisfaction among boys. Split-sample validation and out-of-sample prediction confirmed the robustness of the results. CONCLUSIONS: The results highlight the importance of contemporary clusters of risk, such as low social support and SMU in the mental well-being of young people and the need to focus on these as targets for prevention. We propose that future studies should use composite risk measures that take into account both risk behaviors and risk factors to explain adolescents' mental well-being.

Cross-National Time Trends in Adolescent Mental Well-Being From 2002 to 2018 and the Explanatory Role of Schoolwork Pressure.

PURPOSE: Previous research has shown inconsistent time trends in adolescent mental well-being, but potential underlying mechanisms for such trends are yet to be examined. This study investigates cross-national time trends in adolescent mental well-being (psychosomatic health complaints and life satisfaction) in mainly European countries and the extent to which time trends in schoolwork pressure explain these trends. METHODS: Data from 915,054 adolescents from 36 countries (50.8% girls; meanage = 13.54; standard deviationage = 1.63) across five Health Behaviour in School-aged Children surveys (2002, 2006, 2010, 2014, and 2018) were included in the analyses. Hierarchical multilevel models estimated cross-national trends in adolescent mental well-being and schoolwork pressure. We also tested whether schoolwork pressure could explain these trends in mental well-being. RESULTS: A small linear increase over time in psychosomatic complaints and schoolwork pressure was found. No change in life satisfaction emerged. Furthermore, there was large cross-country variation in the prevalence of, and trends over time in, adolescent mental well-being and schoolwork pressure. Overall, declines in well-being and increases in schoolwork pressure were apparent in the higher income countries. Across countries, the small increase in schoolwork pressure over time partly explained the decline in psychosomatic health complaints. CONCLUSIONS: Our findings do not provide evidence for substantial declines in mental well-being among adolescents. Yet, the small declines in mental well-being and increases in schoolwork pressure appear to be quite consistent across high-income countries. This calls for the attention of public health professionals and policy-makers. Country differences in trends in both adolescent mental well-being outcomes and schoolwork pressure were considerable, which requires caution regarding the cross-national generalization of national trends.

Do country-level environmental factors explain cross-national variation in adolescent physical activity? A multilevel study in 29 European countries.

BACKGROUND: Worldwide, roughly 80% of adolescents fail to meet World Health Organization (WHO) recommendations regarding physical activity, though there is substantial variation in adolescent physical activity prevalence across countries. This study explored whether country-level environmental differences explained cross-national variation in adolescent moderate- to vigorous-intensity physical activity (MVPA) and vigorous-intensity activity (VPA). METHOD: Using the data of 138,014 11- to 15-year-olds from 29 European countries in the 2013/2014 Health Behaviour in School-aged Children (HBSC) study, multilevel regression models examined the influence of four types of country-level environmental factors (physical, socio-cultural, economic, and political) on self-reported individual-level physical activity (MVPA and VPA). RESULTS: The environmental variables explained 38% of country-level variance in MVPA and 81% of country-level variance in VPA. Lower annual average national temperature, higher community safety, lower average national household income and a weaker physical education policy were significantly associated with more MVPA. Greater urbanisation, lower annual average national temperature, higher adult physical activity and higher average national household income were significantly associated with more VPA. CONCLUSIONS: The findings showed that national differences in the physical, socio-cultural and economic environment were related to adolescent physical activity. They point to potential avenues for future research looking at interactions between individual and environmental factors.

Country-Level Gender Equality and Adolescents' Contraceptive Use in Europe, Canada and Israel: Findings from 33 Countries.

CONTEXT: Although an association between gender equality and contraceptive use has been confirmed among adult samples, few studies have explored this relationship among adolescents. An examination of whether adolescents' contraceptive use is more prevalent in countries with higher levels of gender equality is needed to fill this gap. METHODS: Nationally representative data from 33 countries that participated in the 2013-2014 Health Behaviour in School-Aged Children study and country-level measures of gender equality-using the 2014 Global Gender Gap Index-were analyzed. Multilevel multinomial logistic regression analyses were employed to assess associations between gender equality and contraceptive use (condom only, pill only and dual methods) at last intercourse as reported by 4,071 females and 4,110 males aged 14-16. RESULTS: Increasing gender equality was positively associated with contraceptive use among both males and females. For every 0.1-point increase on the equality scale, the likelihood of condom use at last intercourse rose (odds ratio, 2.1 for females), as did the likelihood of pill use (6.5 and 9.6, respectively, for males and females) and dual method use (2.1 and 5.6, respectively). Associations with pill use and dual use remained significant after national wealth and income inequality were controlled for. Overall, associations were stronger for females than for males. CONCLUSIONS: More research is needed to identify potential causal pathways and mechanisms through which gender equality and adolescents' contraceptive use may influence one another.

Gender Inequality and Sex Differences in Physical Fighting, Physical Activity, and Injury Among Adolescents Across 36 Countries.

PURPOSE: Sex differences in adolescent health are widely documented, but social explanations for these sex differences are scarce. This study examines whether societal gender inequality (i.e., men's and women's unequal share in political participation, decision-making power, economic participation, and command over resources) relates to sex differences in adolescent physical fighting, physical activity, and injuries. METHODS: National-level data on gender inequality (i.e., the United Nations Development Program's Gender Inequality Index) were linked to health data from 71,255 15-year-olds from 36 countries in the 2009-2010 Health Behaviour in School-Aged Children study. Using multilevel logistic regression analyses, we tested the association between gender inequality and sex differences in health while controlling for country wealth (gross domestic product per capita). RESULTS: In all countries, boys reported more physical fighting, physical activity, and injuries than girls, but the magnitude of these sex differences varied greatly between countries. Societal gender inequality positively related to sex differences in all three outcomes. In more gender unequal countries, boys reported higher levels of fighting and physical activity compared with boys in more gender equal countries. In girls, scores were consistently low for these outcomes; however, injury was more common in countries with less gender inequality. CONCLUSIONS: Societal gender inequality appears to relate to sex differences in some adolescent health behaviors and may contribute to the establishment of sex differences in morbidity and mortality. To reduce inequalities in the health of future generations, public health policy should target social and cultural factors that shape perceived gender norms in young people.

The decline in adolescent substance use across Europe and North America in the early twenty-first century: A result of the digital revolution?

OBJECTIVES: Increases in electronic media communication (EMC) and decreases in face-to-face peer contact in the evening (FTF) have been thought to explain the recent decline in adolescent substance use (alcohol, tobacco, cannabis). This study addresses this hypothesis, by examining associations between (time trends in) EMC, FTF, and substance use in more than 25 mainly European countries. METHODS: Using 2002-2014 data from the international Health Behaviour in School-aged Children (HBSC) study, we ran multilevel logistic regression analyses to investigate the above associations. RESULTS: National declines in substance use were associated with declines in FTF, but not with increases in EMC. At the individual level, both EMC and FTF related positively to substance use. For alcohol and cannabis use, the positive association with EMC was stronger in more recent years. Associations between EMC and substance use varied across countries, but this variation could not be explained by the proportion of young people using EMC within countries. CONCLUSIONS: Our research suggests that the decrease in FTF, but not the increase in EMC, plays a role in the recent decrease in adolescent substance use.

Trends in adolescent alcohol use in the Netherlands, 1992-2015: Differences across sociodemographic groups and links with strict parental rule-setting.

BACKGROUND: From an international perspective, studying trends in adolescent alcohol use in the Netherlands is an important case study. Whereas Dutch adolescents topped the international rankings of alcohol consumption in the beginning of this century, they are nowadays found more toward the bottom of these rankings. This study examines time trends in adolescent alcohol use between 1992 and 2015, and tests whether these trends differ according to gender, age group, and educational track. Moreover, it examines to what extent the strictness of parental rule-setting can explain the identified trends. METHODS: Using data from ten waves of two nationally representative studies with a repeated cross-sectional design, trends were examined for eight different alcohol measures. Interaction analyses were conducted to test for subgroup differences. All analyses were controlled for educational track, family structure, and ethnicity. For the period 2007-2015, trends in parental alcohol-specific rule-setting were included as a predictor of the trends in adolescent alcohol use. RESULTS: Adolescent alcohol use increased substantially between 1992 and 2003, and decreased sharply thereafter. Trends were stronger for 12- to 15-year olds, compared to the 16-year olds, and for adolescents attending higher educational tracks, compared to adolescents attending lower educational tracks. Overall, gender differences remained constant over time. Between 2007 and 2015, strict parental alcohol-specific rule-setting increased substantially, and this (partly) explained the strong decline in adolescent alcohol use during this period. CONCLUSION: This study shows clear time trend changes in alcohol use among Dutch adolescents. The phenomenal decrease in adolescent alcohol use since 2003 appears to be closely related to a radical change in parenting behaviours surrounding the alcohol use of their children. While national prevention programs may have encouraged stricter parenting behaviours, the decline in alcohol use should be interpreted in a broader context of internationally changing sociocultural norms regarding adolescent alcohol use.

Socioeconomic inequalities in the impact of tobacco control policies on adolescent smoking. A multilevel study in 29 European countries.

INTRODUCTION: There are concerns that tobacco control policies may be less effective in reducing smoking among disadvantaged socioeconomic groups and thus may contribute to inequalities in adolescent smoking. This study examines how the association between tobacco control policies and smoking of 15-year-old boys and girls among 29 European countries varies according to socioeconomic group. METHODS: Data were used from the Health Behaviour in School-aged Children (HBSC) study conducted in 2005/2006 comprising 50,338 adolescents aged 15 years from 29 European countries. Multilevel logistic regression analyses were conducted to assess the association of weekly smoking with components of the Tobacco Control Scale (TCS), and to assess whether this association varied according to family affluence (FAS). Analyses were carried out per gender and adjusted for national wealth and general smoking rate. RESULTS: For boys, tobacco price was negatively associated with weekly smoking rates. This association did not significantly differ between low and high FAS. Levels of tobacco-dependence treatment were significantly associated with weekly smoking. This association varied between low and high FAS, with higher treatment levels associated with higher probability of smoking only for low FAS boys. For girls, no tobacco policy was significantly associated with weekly smoking, irrespective of the FAS. CONCLUSIONS: Results indicated that most tobacco control policies are not clearly related to adolescent weekly smoking across European countries. Only tobacco price seemed to be adequate decreasing smoking prevalence among boys, irrespective of their socioeconomic status.

Cross-national evidence for the clustering and psychosocial correlates of adolescent risk behaviours in 27 countries.

BACKGROUND: According to Jessor's Problem Behaviour Theory (PBT) and Moffitt's theory of adolescence-limited antisocial behaviour, adolescent risk behaviours cluster and can be predicted by various psychosocial factors including parent, peer and school attachment. This study tested the potential influence of the sociocultural, or macro-level, environment on the clustering and correlates of adolescent risk behaviour across 27 European and North American countries. METHODS: Analyses were based on data from the 2009-10 Health Behaviour in School-aged Children (HBSC) study. Participants compromised 56,090 adolescents (M(age) = 15.5 years) who self-reported on substance use (tobacco, alcohol, cannabis) and early sexual activity as well as on psychosocial factors (parent, peer and school attachment). RESULTS: Multiple group confirmatory factor analyses (with country as grouping variable) showed that substance use and early sexual activity loaded on a single underlying factor across countries. In addition, multiple group path analyses (with country as grouping variable) showed that associations between this factor and parent, peer and school attachment were identical across countries. CONCLUSION: Cross-national consistencies exist in the clustering and psychosocial correlates of substance use and early sexual activity across western countries. While Jessor's PBT stresses the problematic aspects of adolescent risk behaviours, Moffitt emphasizes their normative character. Although the problematic nature of risk behaviours overall receives more attention in the literature, it is important to consider both perspectives to fully understand why they cluster and correlate with psychosocial factors. This is essential for the development and implementation of prevention programmes aimed at reducing adolescent risk behaviours across Europe and North America.

Neighbourhood crime and adolescent cannabis use in Canadian adolescents.

BACKGROUND: Although neighbourhood factors have been proposed as determinants of adolescent behaviour, few studies document their relative etiological importance. We investigated the relationship between neighbourhood crime and cannabis use in a nationally representative sample of Canadian adolescents. METHODS: Data from the 2009/10 Canadian Health Behaviour in School-aged Children (HBSC) survey (n=9134 14- and 15-year-olds) were combined with area-level data on crime and socioeconomic status of the neighbourhood surrounding the schools (n=218). RESULTS: Multilevel logistic regression analyses showed that after individual and contextual differences were held constant, neighbourhood crime related to cannabis use (OR 1.29, CI 1.12-1.47 per 1.0 SD increase in crime). This association was not moderated by parental support nor having cannabis-using friends. The amount of explained variance at the neighbourhood level was 19%. CONCLUSIONS: Neighbourhood crime is an important factor to consider when designing interventions aimed at reducing adolescent cannabis use. Interventional research should examine the effectiveness of community-based interventions that target adolescents through parents and peers.

Parent-adolescent sexual communication and its association with adolescent sexual behaviors: a nationally representative analysis in the Netherlands.

Sexual communication is a principal means of transmitting sexual values, beliefs, expectations, and knowledge from parents to children. Although this area has received considerable research attention, more studies with representative samples are needed to assure that findings are reflective of populations of interest. A nationally representative sample of parent-adolescent dyads (N = 2,965; mean adolescent age = 13.8 years) in the Netherlands was employed to examine the frequency of parent-adolescent sexual communication and its association with adolescent sexual behaviors (defined as sexual initiation, condom use, and contraceptive pill use). Nine communication topics in the areas of anatomy, relationships and rights, and protection and contraception were examined. In all, 75%of parents reported having discussed at least one topic multiple times with their adolescents. Romantic relationships were discussed most frequently. Hierarchical logistic regression analyses indicated that parent-adolescent sexual communication on protection and contraception was positively associated with adolescent sexual initiation and contraceptive pill use but not condom use. This may reflect that adolescents, when they become sexually active, are more likely to discuss sexuality with their parents. Findings are interpreted within the context of Dutch culture, which is generally accepting of adolescent sexuality and characterized by open sexual communication.

Adolescents' psychological health complaints and the economic recession in late 2007: a multilevel study in 31 countries.

BACKGROUND: The recent economic recession, which began in 2007, has had a detrimental effect on the health of the adult population, but no study yet has investigated the impact of this downturn on adolescent health. This article uniquely examines the effect of the crisis on adolescents' psychological health complaints in a cross-national comparison. METHODS: Data came from the World Health Organization collaborative 'Health Behaviour in School-aged Children' study in 2005-06 and 2009-10. We measured change in psychological health complaints from before to during the recession in the context of changing adult and adolescent unemployment rates. Furthermore, we used logistic multilevel regression to model the impact of absolute unemployment in 2010 and its change rate between 2005-06 and 2009-10 on adolescents' psychological health complaints in 2010. RESULTS: Descriptive results showed that although youth and adult unemployment has increased during the economic crisis, rates of psychological health complaints among adolescents were unaffected in some countries and even decreased in others. Multilevel regression models support this finding and reveal that only youth unemployment in 2010 increased the likelihood of psychological health complaints, whereas its change rate in light of the recession as well as adult unemployment did not relate to levels of psychological health complaints. CONCLUSION: In contrast to recent findings, our study indicates that the negative shift of the recent recession on the employment market in several countries has not affected adolescents' psychological health complaints. Adolescents' well-being instead seems to be influenced by the current situation on the labour market that shapes their occupational outlook.

Macro-level age norms for the timing of sexual initiation and adolescents' early sexual initiation in 17 European countries.

PURPOSE: To examine the relationship between country-level age norms for sexual initiation timing and early sexual initiation (ESI) among adolescent boys and girls. METHODS: Nationally representative data from 17 countries that participated in the 2006/2007 European Social Survey (ESS-3, n = 33,092) and the 2005/2006 Health Behaviour in School-Aged Children Study (HBSC, n = 27,702) were analyzed. Age norms were measured as the average country-level response to an item asking the age at which ESS respondents believed someone is too young to have sexual intercourse. HBSC respondents (aged 14-16 years) self-reported age at sexual initiation, which we defined as early (<15 years) or not early (≥15 years or no initiation). Control variables included age, family affluence, perceived socioeconomic status, family living arrangement, substance use, school attachment, and country-level legal age of consent. Multivariable three-level logistic models with random intercepts were run separately by sex. RESULTS: In multivariable analyses, higher overall age norms were associated with reduced likelihood of ESI among girls (AOR .60, 95% CI .45-.79); associations with ESI were stronger for parent cohort (ages 31-65 years) norms (AOR .37, 95% CI .23-.58) than for peer cohort (ages 15-20 years) norms (AOR .60, 95% CI .49-.74). For boys, overall norms were also significantly negatively associated with ESI (AOR .68, 95% CI .46-.99), as were parent cohort norms (AOR .66, 95% CI .45-.96). Peer cohort norms were not significantly related to boys' ESI. CONCLUSION: Macrolevel cultural norms may impact adolescents' sexual initiation timing. Research exploring the sexual health outcomes of early initiators in countries with contrasting age norms is warranted.

Trends in alcohol-specific parenting practices and adolescent alcohol use between 2007 and 2011 in the Netherlands.

BACKGROUND: Following increased research and policy attention on the harmful effects of alcohol use among adolescents and the implementation of prevention programs aimed at reducing adolescent alcohol use, this study examined whether alcohol-specific parenting practices have become stricter and whether adolescent alcohol use has declined between 2007 and 2011 in the Netherlands. METHODS: Data were derived from three nationally representative cross-sectional studies of 12 to 16-year old adolescents - the Dutch National School Survey on Substance Use (2007 and 2011) and the Health Behaviour in School-aged Children (2009). These data were obtained using self-report questionnaires in the classroom (adolescents, Mage=13.8 years, SD=.04) and at home (parents). RESULTS: Between 2007 and 2011, Dutch parents increasingly adopted strict alcohol-specific practices, except for parents of 16-year old adolescents. Furthermore, adolescent reports of lifetime and last month alcohol use decreased, except for 16-year olds. The quantity of alcohol consumed by adolescents did not change between 2007 and 2011. Alcohol-specific parenting practices were associated with lower adolescent alcohol use. These associations were generally stable over time. CONCLUSION: Our findings are consistent with the recent increased awareness in research, policy and the media about the harmful effects of alcohol on young people. Specifically, they are consistent with the focus of recent prevention efforts aimed at parents to postpone the alcohol use of their child at least until the age of 16. Future prevention programs should also target older age groups (i.e., age 16 years and older) and address the quantity of alcohol consumed by adolescents when they drink.