Adolescent heavy episodic drinking trajectories and health in young adulthood.

Drinking at least five alcoholic drinks on one occasion (called heavy episodic or binge drinking by some; Kandel, 1980; White, 1987; Zucker and Gomberg, 1986) is a relatively common behavior among adolescents in the United States. According to the most recent Monitoring the Future study (Johnston et al., 2002), 25% of 10th-grade and 30% of 12th-grade students had at least five drinks in a row during the 2 weeks before the survey. Certain patterns of drinking—particularly heavy, frequent and prolonged use of alcohol during adolescence—are especially detrimental to the health of adolescents and young adults (Aarons et al., 1999; Johnson and Richter, 2002), Some health effects of adolescent heavy episodic drinking are immediate and already observable in adolescence, including reduced nervous and cognitive functioning and reduced general physical well-being (e.g., fatigue, headaches and sleeping problems; Arria et al., 1995; Brook et al., 2002; Brook et al., 2000; Hansell et al., 1991; Hansell and White, 1999; Johnson and Richter, 2002; National Institute on Alcohol Abuse and Alcoholism, 2000). It is less clear, however, whether adolescent heavy drinking has long-term health consequences. Some patterns of adolescent alcohol use may have long-term health consequences beyond the immediate effects in adolescence. For example, early-onset, heavy adolescent alcohol use has been linked with continued alcohol abuse and dependence in adulthood (Guo et al., 2000), which in turn have been associated with negative physical and mental health consequences (e.g., coronary heart disease, hypertension, mood and personality disorders and aggression; Brook et al., 2000; National Institute on Alcohol Abuse and Alcoholism, 2000). Life-span developmental research suggests that adolescence (approximately ages 12–18) and emerging adulthood (approximately ages 12–25) are theoretically and empirically distinct developmental periods (see Arnett 1998, 2000; Furstenberg, 2000; Shanahan, 2000). Compared with alcohol use in young adulthood, drinking in adolescence is deemed age-inappropriate and precocious behavior and is illegal in the United Stales. The context and meaning of adolescent drinking, and probably its consequences, are, therefore, different from alcohol consumption in young adulthood, which is legal at age 21. Furthermore, trajectories of early heavy drinking are associated with later alcohol abuse and dependence in young adulthood as well as with numerous negative social and personal outcomes (Guo et al., 2002; Hill et al., 2000; Kandel et al., 1986; Newcomb and Bentler, 1987, 1988). Focusing an alcohol use during adolescence is important because it sets the stage for later alcohol misuse and health problems and, therefore, has unique implications for prevention. Thus, in the present study we chose to examine the impact of heavy episodic drinking trajectories during the junior high and high school years (ages 13–18) on health behaviors and statuses in emerging adulthood (age 24). Our understanding of substance use consequences is enhanced by a person-centered approach, because different trajectories of substance use in adolescence may have different consequences in young adulthood (Guo et al., 2002; Hill et al., 2000; Labouvie et al., 1991), Prior analyses of our panel data have identified distinct trajectories of alcohol use in adolescence (Guo et al., 2000, 2002; Hill et al., 2000). As have others (Muthen and Shedden, 1999; Schulenberg et al., 1996), Hill et al., (2000) identified four types of adolescent heavy episodic drinkers: those who never or rarely drank heavily (nonheavy drinkers); those who increased their involvement in heavy episodic drinking in mid adolescence (escalators); those who began heavy drinking only in late adolescence (late onsetters); and those who engaged in high levels of heavy episodic drinking throughout the adolescent years (chronic heavy drinkers). Hill et al., (2000) showed that these four heavy episodic drinking trajectories had distinctly different patterns of prosocial (e.g., academic attainment and social involvement) and antisocial (e.g., depression and crime) functioning at age 21. Different adolescent heavy episodic drinking trajectories also may have different consequences for health outcomes in young adulthood. Different patterns of alcohol use may influence health directly and indirectly (Aarons et al., 1999; Brook et al., 2002). On the one hand, alcohol has a direct physiological effect due to its toxicity to the body, Based on their long-term heavy use of alcohol, we would expect to see physical health problems in young adulthood, especially among chronic heavy drinkers. Negative health effects also could be expected for escalators, who delayed their frequent involvement in heavy drinking until mid adolescence but rapidly increased the frequency of heavy drinking subsequently. By age 18, escalators had the highest frequency of heavy episodic drinking of all groups. Despite this rapid increase, however, physical health problems may not yet be observable in the escalator group at age 24, because they lack chronic or long-term exposure to alcohol and their heavy drinking occurs during a time when the body’s ability to recover from the physical effects of alcohol consumption may be high (Schulenberg et al., 2002). Alcohol use also may affect health indirectly as a result of its association with such behaviors as risk taking, delinquency and violence, as well as other substance use, including smoking. We observed such behavioral patterns in late onsetters and escalators, who were more likely to participate in risky sex at age 21 and to continue using alcohol and drugs during young adulthood (Guo et al., 2002; Hill et al., 2000). These findings suggest that their risk-taking behavior also may extend to health-related practices. In comparison, nonheavy drinkers should have the lowest occurrence of health problems and should be most likely to engage in safe health practices. Because clinical or chronic diseases still tend to be rare in young adulthood, health consequences of adolescent alcohol misuse in the early 20s are most likely to be observable in general health-related practices and in health conditions that may foreshadow later, more serious adult health problems and diseases (Arria et al., 1995; Johnson and Richter, 2002; Newcomb and Bentler, 1987), In the present study, we focused on common health behaviors (seat belt use, safe driving and physical activity) and general health conditions (overweight and obesity, hypertension and illness), which increase the risk for illness, injury or disease, including cardiovascular disease, diabetes and coronary heart disease (National Heart, Lung, and Blood Institute [NHLBI], 1997, 1998a, 2000). Using the previously identified developmental trajectories of adolescent heavy episodic drinking in our panel data (Hill et al., 2000), we examined the association of heavy drinking during adolescence with health status and practices at age 24.