ALCOHOL USE AND AGGRESSION IN ADOLESCENTS - A META-ANALYSIS

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ALCOHOL USE AND AGGRESSION IN ADOLESCENTS - A
META-ANALYSIS

• Jouko Miettunen, Adjunct Professor
• Department of Psychiatry
• University of Oulu, Finland
• e-mail jouko.miettunen_at_oulu.fi

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Background

• Alcohol use and aggressive (violent) behaviour
  have been found to associate with each other in
  adolescent samples.
• The strength of this association is largely
  unknown
• Epidemiological association or intoxication
  effect?
• Alcohol use risk factor also for vulnerability
  for physical violence

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Background

• Adolescence important period
• Onset of substance use
• Onset of criminal behaviour
• Early alcohol use ? early alcoholism?
• Early behavioural problems ? later criminality?

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Data collection

• The literature search for studies was done in a
  systematic way. The studies were searched one
  database at a time, in abstract and title
• Originally time limit (1995-), but now also older
  studies included (ongoing study!)
• Databases searched included PsycINFO, Science
  Direct, PubMed and Google Scholar. The search was
  done in October and November 2008
• Also manual search was done and authors were
  contacted to get more information

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Data collection

• The search was limited to studies on the relation
  of aggression and alcohol use in the age group of
  normal adolescents between age 13 and 18
• Studies were included if they measured aggression
  and alcohol use in a standardized and most
  similar way, at the same point in time, and in an
  adolescent cross-sectional sample.
• Results are presented with meta-analytic methods
  using pooled odds ratios (OR).

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Preliminary results

• Eight studies compared proportion of aggressive
  or violent persons between alcohol using and
  non-using adolescents
• Included to the current meta-analysis!
• Many other studies compared alcohol using and
  non-using adolescents using various other summary
  statistics (correlations, means, )
• These studies are not presented here!

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Included studies

• Choquet et al. Alcohol Alcohol 199126381-90.
• Orpinas et al. J Adolesc Health 199516216-25.
• Fergusson et al. Addiction 199691483-94.
• Ellickson et al. Am J Public Health
  199787985-91.
• Gudlaugsdottir et al. Int J Epidemiol
  2004331046-51.
• Eklund af Klinteberg. J Indiv Dif
  20052663-73.
• Wade Pevalin. Can J Criminol Crim Justice
  200547619-49.
• Shepherd et al. J Adolesc 200629539-53.

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Choquet et al. Interpersonal aggressive behaviour
and alcohol consumption among young urban
adolescents in France. Alcohol Alcoholism
199126381-90

• An epidemiological survey was carried out among
  1601 adolescents (aged 13-16) from a suburban
  area of Paris.
• A majority of the adolescents had already
  demonstrated violent behaviour, 41 showed
  repetitive delinquent behaviour, and 12
  cumulated several types of such behaviour.
• The aggressive teenagers differed from the
  non-aggressive subjects firstly in their alcohol,
  tobacco and illicit drug consumption, and
  secondly with respect to other deviant behaviour,
  such as stealing, running away from home or
  violent victimization.

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Orpinas et al. The co-morbidity of
violence-related behaviors with health-risk
behaviors in a population of high school
students. J Adolesc Health 199516216-25.

• All ninth and eleventh graders (n 2075) of a
  school district in Texas.
• Overall, 20 of the students were involved in a
  physical fight but had not carried a weapon, 10
  carried a weapon but had not been involved in a
  physical fight, and 17 had been involved in a
  physical fight and had carried a weapon.
• Students who both fought and carried a weapon
  were 19 times more likely to drink alcohol six or
  more days than students who did not fight nor
  carried a weapon.

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Fergusson et al. Alcohol misuse and juvenile
offending in adolescence. Addiction
199691483-94.

• The associations between alcohol misuse and
  juvenile offending during the period from 15 to
  16 years of age were studied in a birth cohort of
  New Zealand adolescents.
• This analysis showed that young people who
  misused alcohol had significantly (p lt0.001)
  higher rates of both violent and property
  offences.
• A substantial component of the association
  between alcohol misuse and juvenile offending
  arose from shared risk factors that were common
  to both outcomes.
• However, young people who abused alcohol had odds
  of violent offending that were 3.2 times (plt
  0.001) the odds of those offences for young
  people who did not misuse alcohol.

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Ellickson et al. Profiles of violent youth
substance use and other concurrent problems. Am J
Public Health 199787985-91.

• Longitudinal data for more than 4500 high school
  seniors and dropouts from California and Oregon
• More than half the sample had engaged in violence
  during the last year, and one in four had
  committed predatory violence.
• Violent youth were more likely than their peers
  to have poor mental health, use drugs, drop out
  of school, and be delinquent.

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Gudlaugsdottir et al.Violent behaviour among
adolescents in Iceland a national survey. Int J
Epidemiol 2004331046-51.

• In 1997, a cross-sectional survey was conducted
  among a random half of all Icelandic
  schoolchildren aged 15-16 years (N 3872).
• The majority of the respondents reported having
  committed violence within the last year.
• Smokers were more likely than non-smokers to use
  violence (OR 1.7 95 CI 1.2, 2.2)
• Adolescents who had used alcohol gt20x in their
  lifetime were more than twice as likely to commit
  violence compared with those who had never used
  alcohol (OR 2.5 95 CI 1.8, 3.4).

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Eklund af Klinteberg. Personality
Characteristics as Risk Indications of Alcohol
Use and Violent Behavior in Male and Female
Adolescents. J Indiv Dif 2005266373.

• The present study focused on personality
  characteristics in adolescent boys (n 414) and
  girls (n 552) in 8th grade with self-reported
  violent behavior and risky alcohol use.
• Adolescents with indications of violent behavior
  and/or risky alcohol use, compared to others,
  were generally more impulsive, had a stronger
  need for change and action, were less adjusted
  and socially conforming, as well as more
  aggressive.
• The findings pointed toward a clustering of
  problem behaviors.
• Similar personality profiles between alcohol
  using and violent adolescents.

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Wade Pevalin. Adolescent delinquency and
health. Can J Criminol Crim Justice
200547619-49.

• Data from the first two waves of the publicly
  available US National Longitudinal Study of
  Adolescent Health (n4,834).
• Results indicate that delinquent behaviours such
  as violence, aggression and property damage are
  similarly predicted by the same risk factors as
  are depression and perceived health, and tobacco,
  alcohol, marijuana and hard drug use.
• Most outcomes were associated with one another,
  suggesting they may be comorbid manifestations of
  risk exposure.

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Shepherd et al. Relations between alcohol,
violence and victimization in adolescence. J
Adolesc 200629539-53.

• Cross-sectional study of 4187 adolescents aged
  11-16 in a stratified sample of 13 English
  schools.
• Relationships between fighting, hitting others
  and vulnerability to being hit and frequency of
  drinking and drunkenness were all highly
  significant (plt0.0001), and were evident at all
  ages.
• The outcome most strongly related to frequency of
  drunkenness was hitting others (odds ratio (OR)
  6.62), followed by being hit (OR 4.01) and
  fighting (OR 2.10).

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Shepherd et al. Relations between alcohol,
violence and victimization in adolescence. J
Adolesc 200629539-53.
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Forest plot with odds ratios
Study
Odds ratio (95 CI)
2.1 (1.7 - 2.6)
USA Ellickson et al. 1997
2.3 (2.0 - 2.6)
USA Wade and Pevalin 2005
2.8 (2.5 - 3.3)
Iceland Gudlaugsdottir et al. 2004
4.2 (3.3 - 5.3)
USA Orpinas et al. 1995
5.9 (3.4 - 10.2)
France Choquet et al. 1991
7.1 (5.2 - 9.7)
UK Shepherd et al. 2006
7.4 (4.9 - 11.3)
Sweden Eklund and af Klinteberg 2005
4.07 (2.97 - 5.58)
Overall (95 CI)
1
1.5
2
3
4
5
6
7
8
Odds ratio
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Summary of results

• Alcohol using adolescents had four times more
  commonly aggressive behaviour
• Results were consistent
• Odds ratios between 2 and 7

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Methodological issues

• Self-reported data
• Differences in assessment methods
• Alcohol and behaviour/violence
• Attrition in original studies
• Differences by age and sex
• Similar risk factors (covariates?)
• Other substances?
• Dose response? Causality?

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Conclusions

• This study was the first one to pool studies on
  association between alcohol use and aggression in
  adolescence.
• The results indicate a strong association between
  alcohol use and aggressive behaviour.
• Odds ratios (cross-sectional associations) were
  quite similar between studies

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Conclusions

• Although these results are not a proof for causal
  relationship between alcohol use and aggression,
  the association is strong and should be paid
  attention to both in research and clinical
  settings (health and violence-prevention
  programs)
• Temporal associations between alcohol (and other
  substance) use and aggressive behaviour needs to
  be further studied

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Research Group
Bettina von der Pahlen, Professor
National Institute for Health and Welfare,
Helsinki, Finland
Marina Lindholm, Student
Department of Psychology, Abo Akademi University,
Turku, Finland
Mauri Marttunen, Professor
National Institute for Health and Welfare,
Helsinki, Finland
Jouko Miettunen, Academy Research Fellow
Department of Psychiatry, University of Oulu,
Oulu, Finland