The Role of Parental Control and Support in Declining Adolescent Drinking: A Multi-Level Study Across 30 European Countries.

BACKGROUND: Adolescent drinking has declined in many high-income countries since the early 2000s. It has been suggested that changing parenting practices may have contributed to the decline. However, previous studies investigating parenting have focused on single countries and have provided conflicting evidence. This study tested the association between changes in individual- and population-level parental control and parental support and changes in past month adolescent drinking. METHODS: A total of 271,823 adolescents aged 15-16 years, from 30 European countries between 2003 and 2015 were included in this study. Our key independent variables were adolescent reports of parental control and parental support. Our outcome measure was a dichotomous measure of any alcohol use in the 30 days before the survey, referred as past month drinking. Aggregated measures of parenting variables were used to estimate between-country and within-country effects of parenting on adolescent drinking. Data were analysed using three-level hierarchical linear probability methods. RESULTS: At the individual-level, we found a negative association between the two parental measures, i.e. parental control (ß = -0.003 and 95% CI = -0.021 to 0.017) and parental support (ß = -0.008 and 95% CI = -0.010 to 0.006) and past month drinking. This suggests adolescents whose parents exert higher control and provide more support tend to drink less. At a population level, we did not find any evidence of association on between-country and within-country parenting changes and past month drinking. CONCLUSIONS: It is unlikely that changes in parental control or support at the population-level have contributed to the decline in drinking among adolescents in 30 European countries.

Are changes in attitudes towards school associated with declining youth drinking? A multi-level analysis of 37 countries.

BACKGROUND: Changes in adolescents' attitudes towards school are a potential explanation for recent declines in young people's alcohol consumption. However, this has not been tested using multi-national survey data, which would permit stronger causal inferences by ruling out other country-specific explanations. This study, therefore, uses an international survey of schoolchildren to examine the associations between changing attitudes towards school and adolescent alcohol consumption. METHODS: We used data from 247 325 15-year-olds across 37 countries participating in four waves of the Health Behaviour in School-aged Children study (2001/02-2013/14). Attitudes towards school were assessed using two measures-self-reported pressure from schoolwork and whether respondents like school. Outcome measures were weekly alcohol consumption and having been drunk twice in one's lifetime. We used whole population and gender-specific hierarchical linear probability models to assess the relationship between attitudes and alcohol outcomes within countries over time. RESULTS: Country-level changes over time in liking school were not associated with changes in alcohol consumption. However, a 10% increase in feeling pressured by schoolwork was associated with a 1.8% decline in drunkenness [95% confidence interval (CI): -3.2% to -0.3%] and weakly associated with a 1.7% decline in weekly drinking (95% CI: -3.6% to 0.2%). Among girls only, increases in feeling pressured by schoolwork were associated with a 2.1% decline in weekly drinking (95% CI: -3.7% to -0.6%) and a 2.4% decline in drunkenness (95% CI: -3.8% to -1.1%). CONCLUSION: Changes in attitudes towards school may have played a minor role in the decline in alcohol consumption among adolescent girls only.

Trends in adolescent drinking across 39 high-income countries: exploring the timing and magnitude of decline.

BACKGROUND: Evidence suggests adolescent alcohol consumption has declined since the turn of the millennium in almost all high-income countries. However, differences in the timing and magnitude of the decline have not been explored across countries. METHODS: We examined trends in adolescent past month or monthly alcohol consumption prevalence from cross-national or national survey reports for 39 countries and four US territories. For each country, we calculated the magnitude of the decline in youth drinking as the relative change in prevalence from the peak year to the most recent year available. Heat maps were utilized to present the timing and magnitudes of these declines. RESULTS: The timing and extent of youth drinking declines have varied markedly across countries. The decline began in the USA before 1999, followed by Northern European countries in the early 2000s; Western Europe and Australasia in the mid-2000s. The steepest declines were found for Northern Europe and the UK, and the shallowest declines were observed in Eastern and Southern European countries. CONCLUSIONS: Previous analyses of the decline in adolescent drinking have emphasized the wide reach of the changes and their near-coincidence in time. Our analysis points to the other side of the picture that there were limits to the wide reach, and that there was considerable variation in timing. These findings suggest that as well as broader explanations that stretch across countries, efforts to explain recent trends in adolescent drinking should also consider factors specific to countries and regions.

Trends in the prevalence and distribution of teacher-identified special health-care needs across three successive population cohorts.

AIM: Some children's special health-care needs (SHCN) are formalised at the start of schooling (established SHCN), but a larger proportion start with difficulties that are milder or not yet diagnosed (emerging SHCN). This study explores whether: (i) the prevalence of teacher-identified SHCN (both overall and according to type of needs) and (ii) distribution across disadvantaged communities have changed over three successive population cohorts of Australian children. METHODS: We draw on repeated cross-sectional data from the Australian Early Development Census, a teacher-reported checklist completed on full populations of Australian school entrants in 2009, 2012 and 2015. It includes a measure of SHCN, as well as demographic information. RESULTS: The proportion of children with emerging and established needs was mostly stable from 2009 to 2015 (emerging needs: 17.1-18.9%; established needs: 4.4-4.9%). Change over time was observed in the prevalence of some specific types of impairment. Speech impairment rose by 14.7% for children with emerging needs, and emotional problems rose by 13.7% for children with established needs. Children living in the most disadvantaged neighbourhoods had higher odds of SHCN in all years (e.g. emerging needs relative risk ratio 1.65 (99% confidence interval 1.55-1.75) in 2015; established needs relative risk ratio 1.88 (99% confidence interval 1.71-2.06) in 2015). CONCLUSIONS: A large proportion of children starting school each year have SHCN. The types of SHCN that children present with increasingly reflect complex difficulties that require input from both the health and education sectors. Effective responses also need to consider the added impact of disadvantage.

An examination of the role of changes in country-level leisure time internet use and computer gaming on adolescent drinking in 33 European countries.

INTRODUCTION: Adolescent alcohol consumption has been declining in many high-income countries since the turn of this century. Research investigating the plausible explanations for these declines has been mostly based on individual-level studies, which are largely inconclusive. Changes in leisure time internet use and computer gaming (referred to in this article as 'computer activities') have been hypothesised to play a role in declining adolescent alcohol consumption at a country-level. The aim of this study was to examine the association between country-level changes over time in computer activities and adolescent drinking in 33 European countries. METHODS: This is a multi-level repeated cross-national study examining the role of changes over time in country-level and individual-level computer activities on regular drinking. We utilised four waves of the European School Survey Project on Alcohol and Drugs (ESPAD) from 2003, 2007, 2011 and 2015. At an individual-level the primary exposure of interest was daily engagement in computer activities and aggregated means were used to measure country-level daily computer activities in each included country. Data were analysed using three-level hierarchical linear probability methods. RESULTS: In the fully adjusted model, for between individual effects, we found significant positive association between daily computer activities and regular drinking (ß = 0.043, p-value <0.001 and 95% CI = 0.033-0.054). However, at a country-level, we did not find any association between within-country changes in daily computer activities and regular drinking (ß = 0.031, p-value = 0.652 and 95% CI = -0.103-0.164. CONCLUSION: Findings from this study suggest that broad cultural shifts towards increased computer-based activities among adolescents has played a little or no role in declining adolescent drinking. Future research should be directed towards examining other high-level cultural changes which may have influenced cross-national reductions in adolescent drinking.

Tracking the decline in Australian adolescent drinking into adulthood.

BACKGROUND AND AIMS: Adolescent drinking in Australia (and many other countries) has declined substantially since the early 2000s. This study aimed to test whether these declines have been maintained into adulthood and whether they are consistent across sub-groups defined by sex and socio-economic status. DESIGN: Quasi-cohorts were constructed from seven repeated waves of cross-sectional household survey data (2001-2019). SETTING: Australia. PARTICIPANTS: A total of 20 733 respondents age between 14 and 24 (male: 9492; female: 11 241). MEASUREMENTS: Participants were grouped into five cohorts based on their birth year (from 1979-1983 to 1999-2003). Three measures of drinking were assessed: any past-year consumption (yes/no), past-year regular risky drinking (12 or more drinking episodes of >40 g of pure alcohol, yes/no) and total volume of alcohol consumed in the past year (in Australian standard drinks, 10 g of alcohol). Socio-economic status was measured based on neighbourhood of residence. FINDINGS: Drinking declines were consistent across socio-economic groups on all measures and trends were broadly similar for women and men. More recent birth cohorts had significantly lower levels of drinking across all three measures (odds ratios between 0.31 and 0.70 for drinking and risky drinking, coefficients between -0.28 and -0.80 for drinking volume). There were significant interactions between birth cohort and age for past-year drinking and past-year regular risky drinking, with cohort differences diminishing as age increased. CONCLUSIONS: Lighter drinking adolescent cohorts appear to partly 'catch up' to previous cohorts by early adulthood, but maintain lower levels of drinking and risky drinking up to the age of 24. These ongoing reductions in drinking are spread evenly across socio-economic groups.

Declining drinking among adolescents: Are we seeing a denormalisation of drinking and a normalisation of non-drinking?

BACKGROUND: In the early 2000s, alcohol use among young people began to decline in many western countries, especially among adolescents (ages between 12-17 years old). These declines have continued steadily over the past two decades, against the backdrop of much smaller declines among the general population. ARGUMENT: Hypotheses examining individual factors fail adequately to provide the necessary 'big picture' thinking needed to understand declines in adolescent drinking. We use the normalisation thesis to argue that there is strong international evidence for both processes of denormalisation of drinking and normalisation of non-drinking occurring for adolescents in many western countries. CONCLUSIONS: Research on declining adolescent drinking provides evidence of both denormalisation of alcohol consumption and normalisation of non-drinking. This has implications for enabling policy environments more amenable to regulation and increasing the acceptability of non-drinking in social contexts. Normalisation theory (and its various interpretations) provides a useful multi-dimensional tool for understanding declines in adolescent drinking.

Examining trends in the representation of young people and alcohol in Australian newspapers over twenty years (2000-2019).

BACKGROUND: The news media can reflect and influence public opinion, as well as affect individual practice. In the context of significant changes in alcohol consumption among young people over the past twenty years, we examined Australian newspaper reporting of young people (under 18 years) and alcohol to assess whether there have been changes over time in the content and slant of articles that reflect or elucidate these trends. METHODS: Factiva was used to search newspaper articles from major Australian newspapers over a twenty year period (2000-2019). After screening, two researchers coded 2415 newspaper articles across four key domains: article type, article theme, sources cited and topic slant (e.g. approving, disapproving tone). Change over time across the study period was assessed using joinpoint Poisson regression analyses. RESULTS: There was a significant increase in articles on young people and alcohol between 2000 and 2008, before a corresponding decrease to 2019. Policy or prevention strategies were the most common theme of articles (35.8%), followed by articles reporting on risks or harms associated with alcohol use for young people (18.1%). Researchers were the most common source reported (25.1%), followed by politicians (19.0%). Three quarters of articles (75.9%) had a socially disapproving topic slant, which increased significantly up until 2011, with a corresponding decrease thereafter. CONCLUSION: Attention to, and problematisation of, young people and alcohol increased in the first decade of this millennium which may have acted to sustain or accelerate declining drinking trends. However, this dissipated back to baseline levels in the second decade, which may indicate a lag time in recognition of young people's drinking becoming less of a public health 'problem'.

Exploring the Impact of Secondary Supply Laws on Adolescent Drinking Trends in Australia.

OBJECTIVE: Adolescent alcohol consumption has declined in Australia over the past 20 years. Secondary supply laws (SSLs) typically prohibit the supply of alcohol to adolescents by persons other than parents or guardians, or without parental consent. SSLs were introduced in Australia at different times in different states and territories over the period of declining alcohol consumption. In this study we examined the impact of variations in SSLs across Australia on young people's drinking. METHOD: We used six waves of the National Drug Strategy Household Survey, a cross-sectional survey of the Australian population, from 2001 to 2016. The study population was adolescents ages 14-17 years. Our primary measure of interest was exposure to SSLs. Data were analyzed using two-way linear and logistic regression models with fixed effects of Australian state/territory and time to identify the effect of SSLs on the frequency of drinking, past-year drinking, and the secondary supply source, respectively. RESULTS: We found no evidence of an association between SSLs and any of the three outcomes of interest. CONCLUSIONS: SSLs are challenging to enforce, and, although they may empower parents to have more control over their children's drinking, they were not associated with reductions in adolescent drinking in Australia. Researchers looking to explain the decline in adolescent drinking in Australia should investigate factors beyond SSLs.

Trends in adolescent alcohol and other risky health- and school-related behaviours and outcomes in Australia.

INTRODUCTION: Adolescent drinking has been declining in Australia over the past two decades, but this trend may be part of a broader shift towards healthier lifestyles for adolescents. We examined trends in the prevalence of multiple risky health- and school-related behaviours and outcomes to test whether this was the case. METHODS: Data on multiple behaviours and outcomes were collated from Australian government agencies and other relevant sources for 10-19-year-olds from the year 2000 onward. Trends were examined descriptively. RESULTS: Rates of substance use, youth offending and injuries due to underage driving declined over the study period. Some health-related behaviours (physical activity and diet) worsened between 2001 and 2017; however, obesity rates remained stable. Risky sexual behaviours increased in terms of early initiation of lifetime sexual intercourse and decreased condom use. However, sexual health outcomes improved with a reduction in teenage pregnancies and there was a recent decline in sexually transmitted infection rates from 2011 onward. Suicide rates and rates of major depressive disorders increased. School attendance and engagement in full-time work or study remained stable. DISCUSSION AND CONCLUSIONS: The decline in adolescent drinking does not appear to correspond with increased engagement in healthier behaviours; however, it may be related to a more risk-averse way of living. Future work could be directed towards identifying which social, economic, policy and environmental factors have impacted positive changes in risky behaviours. Public health efforts can then be directed towards behaviours or outcomes, which have not yet improved.

Effect of Stem Cell Injections on Osteoarthritis-related Structural Outcomes: A Systematic Review.

OBJECTIVE: To systematically review the evidence for the efficacy of mesenchymal stem cell (MSC) injections in improving osteoarthritis (OA)-related structural outcomes. METHODS: Ovid Medline and EMBASE were searched from their inceptions to April 2020 using MeSH terms and key words. Independent reviewers extracted data and assessed methodological quality. Qualitative evidence synthesis was performed due to the heterogeneity of interventions and outcome measures. RESULTS: Thirteen randomized controlled trials (phase I or II) were identified: 10 in OA populations and 3 in populations at risk of OA, with low (n = 9), moderate (n = 3), or high (n = 1) risk of bias. Seven studies used allogeneic MSCs (4 bone marrow, 1 umbilical cord, 1 placenta, 1 adipose tissue), 6 studies used autologous MSCs (3 adipose tissue, 2 bone marrow, 1 peripheral blood). Among the 11 studies examining cartilage outcomes, 10 found a benefit of MSCs on cartilage volume, morphology, quality, regeneration, and repair, assessed by magnetic resonance imaging, arthroscopy, or histology. The evidence for subchondral bone was consistent in all 3 studies in populations at risk of OA, showing beneficial effects. Sixteen unpublished, eligible trials were identified by searching trial registries, including 8 with actual or estimated completion dates before 2016. CONCLUSION: Our systematic review of early-phase clinical trials demonstrated consistent evidence of a beneficial effect of intraarticular MSC injections on articular cartilage and subchondral bone. Due to the heterogeneity of MSCs, modest sample sizes, methodological limitations, and potential for publication bias, further work is needed before this therapy is recommended in the management of OA.

Trends in the sequence of first alcohol, cannabis and cigarette use in Australia, 2001-2016.

BACKGROUND: Recent analyses of data from the US found that young people were increasingly engaging in cannabis use before alcohol and cigarettes. These shifts are important for public health, but it is not clear whether such trends extend beyond the US. The aim of this study is to examine whether and how the age and sequencing of initiation into alcohol, cannabis and cigarette use has changed in Australia since the early 2000s. METHODS: Data came from six waves of the Australian National Drug Strategy Household Survey, spanning 2001-2016. We used data from 18 to 21 year-olds (n = 6849) and examined trends in the age at first use for each of the three substances plus any changes in the order of initiation. RESULTS: The mean age of initiation increased steadily for all three substances (e.g. from 14.9 in 2001 to 16.4 in 2016 for alcohol), while the prevalence of any use declined. There were some changes in ordering of use. For example, in 2001, 62 % of respondents who used both cigarettes and cannabis had first used cigarettes at an earlier age than cannabis, compared with 41 % in 2016. Young people who used both alcohol and cannabis remained more likely to try alcohol before cannabis across the study period. CONCLUSIONS: Our results partly replicated US findings, with differences potentially reflecting the substantially different environment around these substances in the US compared to Australia. The age of initiation for alcohol, cigarette and cannabis use in Australia has increased sharply over the past 15 years.