Exploring the relationships between adolescent alcohol misuse and

later-life health outcomes

Angela Pascale, M.S.1, Mallory Stephenson, M.S.1, Peter Barr, Ph.D.2, FinnTwin Collaborators3, Richard Rose, Ph.D.4, Jaakko
Kaprio, M.D., Ph.D.3, Danielle Dick, Ph.D.5, Jessica Salvatore, Ph.D.5
1
Virginia Commonwealth University, USA 2 SUNY Downstate Health Sciences University, USA 3 University of Helsinki, Finland 4 Indiana
University, USA 5 Rutgers Robert Wood Johnson Medical School, USA

Background and Goal Results

• There is little understanding of the long-reaching
consequences of adolescent alcohol misuse on physical
health and life satisfaction in early midlife.
• To understand the nature of associations between
adolescent alcohol misuse and early midlife health
outcomes, we examined whether the associations were
direct, or indirect and mediated through adult alcohol
problems.
• To examine whether these associations were robust to
latent genetic and environmental confounders, we
utilized a co-twin comparison design.
Methods
Does adolescent alcohol use
directly or indirectly relate to
early midlife health outcomes?
Direct Associations
Although adolescent alcohol misuse was associated at
The serial indirect effect of interest consists of multiple indirect effects highlighted a statistically significant level with early midlife somatic
in red: adolescent alcohol misuse to young adult alcohol problems (a1), young symptoms (r = 0.07, 95% CI [0.04, 0.10]) and self-rated
adult alcohol problems to early midlife alcohol problems (d21), and early midlife health (r = -0.05, 95% CI [-0.08, -0.02]), the
alcohol problems to early midlife physical health and life satisfaction (b2). associations were of very modest effect. Adolescent
Notes. YA = Young Adulthood, EM = Early Midlife alcohol misuse was not significantly associated with
early midlife life satisfaction (r = -0.01, 95% CI [-0.04,
Alcohol misuse in 0.02]).

Sample
• Participants were from FinnTwin16, a population-based adolescence impacts early Epidemiological Serial Mediation Models
Adult alcohol problems fully serially mediated the effect
of adolescent alcohol misuse on early midlife somatic
longitudinal twin study of Finnish twins.
Analysis midlife physical health and symptoms (β = 0.03, 95% CI [0.03, 0.04]) and self-
rated health (β = -0.02, 95% CI [-0.03, -0.01]), and
• Zero-order correlations were calculated to examine direct
associations between adolescent alcohol misuse (AUI; a
life satisfaction indirectly partially serially mediated the effect of adolescent
alcohol misuse on early midlife life satisfaction (β = -
composite of frequency of intoxication, alcohol use, and alcohol
problems) and early midlife health outcomes (somatic
through elevations in young 0.03, 95% CI [-0.04, -0.02).

symptoms, self-rated health, and life satisfaction).

• Serial mediation models in the epidemiological sample
adult and early midlife
(inclusive of all twins) were used to examine adult alcohol alcohol problems. Co-twin Comparison Serial
problems (Rutgers Alcohol Problem Index) as mediators of the Mediation Models
association between adolescent alcohol misuse and early
DZ and MZ Serial Mediation Models
midlife health outcomes.
• Two stages of serial mediation models within a co-twin These effects were robust in Results remained consistent with epidemiological
models, where within families, adult alcohol problems
comparison framework were used to examine whether serial
mediation effects observed in the epidemiological sample co-twin comparison models, fully serially mediated the effect of adolescent alcohol
misuse on early midlife somatic symptoms (β = 0.02,
remained significant after controlling for genetic and shared 95% CI [0.01, 0.02]), self-rated health (β = -0.01, 95%
environmental confounders. suggesting that these CI [-0.02, -0.01]), and life satisfaction (β = -0.02, 95% CI
• We included both MZ and dizygotic DZ twin pairs. Then, [-0.03, -0.02]).
we included only MZ twin pairs as they share all of their associations are not simply
MZ Only Serial Mediation Models
genetic variation and thus provided the most stringent
control of potential genetic confounds. attributable to genetic and Serially mediated effects remained significant: early
midlife somatic symptoms (β = 0.006, 95% CI [0.003,
environmental differences 0.010]), self-rated health (β = -0.002, 95% CI [-0.005,
0.000]), and life satisfaction (β = -0.006, 95% CI [-0.010,
Pre-Registered between families. -0.003]).
Analytic Plan