gms | German Medical Science

Introduction: Predictors of harmful alcohol consumption in adulthood can be tracked back into adolescence. Low psychosocial well-being and high emotion-driven impulsiveness are associated with alcohol consumption. Yet, it is unclear whether a hypothetical intervention targeting one or the other in adolescence might be more effective in reducing alcohol consumption in young adulthood. Therefore, we aimed to compare the separate causal effects of psychosocial well-being and emotion-driven impulsiveness in European adolescents aged 12 to 17 years on the amount of weekly consumed alcoholic beverages in young adulthood.

Methods: We included 505 participants (mean age at baseline: 13.3 years, range: 11.9-15.6 years; mean age at follow-up: 20.2 years, range: 18.2-23.5 years), providing data from three waves of the pan-European IDEFICS/I.Family cohort (2009-2022). Participants who have reported drinking alcohol at baseline were excluded from the analysis. Alcohol consumption was operationalized as the amount of weekly consumed alcoholic beverages during young adulthood (mean: 4.5 drinks per week; range: 0.25-70) by multiplying the drinking quantity with the drinking frequency based on self-reports. Emotion-driven impulsiveness was assessed using the negative urgency subscale from the UPPS-P Impulsive Behaviour Scale [1]. Psychosocial well-being was assessed using the KINDLR Health-Related Quality of Life Questionnaire [2]. Confounding variables were identified via a directed acyclic graph. Applying the principles of target trial emulation, we estimated, separately, the average causal effects of psychosocial well-being and emotion-driven impulsiveness in adolescence on alcohol consumption applying a semi-parametric doubly robust method [3] (targeted maximum likelihood estimation [4]). We further estimated additional effects stratified by sex and parental education.

Results: If all adolescents, hypothetically, had high levels of psychosocial well-being, compared to low levels, we estimated a difference in the average amount of weekly consumed alcoholic beverages in young adulthood of -0.10 drinks per week [95%-confidence interval (95%-CI): -2.30; 2.10]. Furthermore, if all adolescents had low levels of emotion-driven impulsiveness, compared to high levels, we estimated an average difference in alcoholic beverages by 1.48 [95%-CI: 0.06; 2.91] in young adulthood. Different effects for sex and parental education groups were found.

Conclusion: Our analysis provides no clear evidence that hypothetical interventions targeting either emotion-driven impulsiveness or psychosocial well-being in adolescents aged 12 to 17 years would have an effect of reducing alcohol consumption in young adulthood. At face value, the analysis suggests that psychosocial well-being has no effect and that reducing emotion-driven impulsiveness even increases alcohol consumption. The inconclusive results suggest a more informative target trial with, for instance, smaller time gaps and more specific outcome and exposure measurements. This study extends previous work within the IDEFICS/I.Family cohort regarding the hypothetical interventions on psychosocial well-being and emotion-driven impulsiveness to reduce the consumption of sugar-rich or high-fat foods in adolescence [5].

The authors declare that they have no competing interests.

The authors declare that an ethics committee vote is not required.