title: Adolescent alcohol use reflects community-level alcohol consumption irrespective of parental drinking.
abstract: OBJECTIVE
  Risk factors for adolescent alcohol use are typically conceptualized at the individual level, and school- and community-level risk factors have received little attention. Based on the theoretical understanding of youth alcohol consumption as a reflection of community social practice, we analyzed whether adolescent drunkenness was related to community-level adult alcohol use (AAC), when taking individual and school-level risk factors for drunkenness into account. Furthermore, we investigated whether the association between community-level AAC and adolescent drunkenness was attenuated after inclusion of parental drinking.
  
  
  METHODS
  We used data from three sources: data about adolescent drunkenness from the Health Behavior in School-Aged Children 2010 survey (N = 2,911; 13- to 15-year-olds nested in 175 school classes and 51 schools); data about community-level AAC derived from the Danish National Health Survey 2010 (177,639 participants); and data on school-level variables from Health Behavior in School-Aged Children School Leader Survey 2010. We performed multilevel logistic regression analysis with data from students nested within school classes and schools.
  
  
  RESULTS
  Overall, 33.5% of students had been drunk twice or more. High community-level AAC was significantly associated with adolescent drunkenness (odds ratio [95% confidence interval], 1.94 [1.21-3.11]). Parental drinking was strongly related to adolescent drunkenness but did not attenuate the relationship between community-level AAC and adolescent drunkenness. We found no association between adolescent drunkenness and school-level variables (youth friendly environment, alcohol education, and exposure to alcohol outlets).
  
  
  CONCLUSIONS
  Adolescent drunkenness was associated with community-level AAC and was not explained by parental drinking.
authors.affiliation: National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark. pebn@niph.dk
authors.forename: Pernille
authors.initials: P
authors.lastname: Bendtsen
authors.forename: Mogens Trab
authors.initials: MT
authors.lastname: Damsgaard
authors.forename: Janne Schurmann
authors.initials: JS
authors.lastname: Tolstrup
authors.forename: Annette Kjær
authors.initials: AK
authors.lastname: Ersbøll
authors.forename: Bjørn E
authors.initials: BE
authors.lastname: Holstein
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000435:Alcoholic Intoxication / Q000453:epidemiology*; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D010290:Parents; D012307:Risk Factors; D011795:Surveys and Questionnaires
keywords: Adolescents; Alcohol use; Community; Multilevel analysis; Social context