Table 3

Summary of determinants of early alcohol use

Family and parents
  • Parent and child drinking are associated, but mechanisms and pathways are complex.

  • Genetic factors are less important in childhood than in later life.

  • Social learning contributes to childhood drinking, where parental intake models acceptable behaviour for their children.

  • Access to alcohol in the home and parental permissiveness of alcohol use are factors associated with higher intake and frequency of drinking by children.

  • Parental alcohol use is also associated with increased exposure to mental stressors for children, which in turn is associated with alcohol intake.

Mental health and stressors
  • Alcohol use is positively associated with mental illness, including depression, conduct disorders and suicidality, as well as mental stressors, such as neglect and post-traumatic stress.

  • The pattern is inconsistent among subgroups of vulnerable children that experience mental stress.

    • Youth in foster care initiated earlier and had a higher lifetime use, but past year use was comparable with that of their peers outside foster care.

    • Migrant adolescents in Europe reported lower use, despite hardships related to socioeconomic status and exposure to discrimination.

Wider environmental aspects
  • Context matters, and wider environmental factors related to cultural norms influence alcohol use in societies, including the use by children.

  • Within-country differences, such as urban and rural residence, are observed in certain contexts. This pattern is not necessarily consistent between countries but demonstrates an example of how local norms influence family practices and child exposure to alcohol.

  • Peer norms and positive social markers of alcohol use further prompt initiation to ‘fit in’. Social media and other media platforms contribute to these positive social associations with alcohol use and accentuate norm generation.