abstract ARTICLE BACKGROUND: Parents are a major supplier of alcohol to adolescents, often initiating use with

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1 Parents Who Supply Sips of Alcohol in Early Adolescence: A Prospective Study of Risk Factors Monika Wadolowski, PhD, a Delyse Hutchinson, PhD, a,b Raimondo Bruno, PhD, a,c Alexandra Aiken, BS, a Jackob M. Najman, PhD, d Kypros Kypri, PhD, e Tim Slade, PhD, a Nyanda McBride, PhD, f Richard P. Mattick, PhD a BACKGROUND: Parents are a major supplier of alcohol to adolescents, often initiating use with sips. Despite harms of adolescent alcohol use, research has not addressed the antecedents of such parental supply. This study investigated the prospective associations between familial, parental, peer, and adolescent characteristics on parental supply of sips. METHODS: Participants were 1729 parent child dyads recruited from Grade 7 classes, as part of the Australian Parental Supply of Alcohol Longitudinal Study. Data are from baseline surveys (Time 1) and 1-year follow-up (Time 2). Unadjusted and adjusted logistic regressions tested prospective associations between Time 1 familial, parental, peer, and adolescent characteristics and Time 2 parental supply. RESULTS: In the fully adjusted model, parental supply was associated with increased parentreport of peer substance use (odds ratio [OR] = 1.20, 95% confidence ratio [CI], ), increased home alcohol access (OR = 1.07, 95% CI, ), and lenient alcohol-specific rules (OR=0.88, 95% CI, ). CONCLUSIONS: Parents who perceived that their child engaged with substance-using peers were more likely to subsequently supply sips of alcohol. Parents may believe supply of a small quantity of alcohol will protect their child from unsupervised alcohol use with peers. It is also possible that parental perception of peer substance use may result in parents believing that this is a normative behavior for their child s age group, and in turn that supply is also normative. Further research is required to understand the impacts of such supply, even in small quantities, on adolescent alcohol use trajectories. abstract a National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, New South Wales 2052, Australia; d Queensland Alcohol and Drug Research and Education Centre, University of Queensland, Brisbane, Queensland 4072, Australia; e Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales 2308, Australia; and f National Drug Research Institute, Curtin University, Perth, Western Australia 6845, Australia b School of Psychology, Faculty of Health, Deakin University, Burwood, Victoria, Australia c School of Psychology, Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia Dr Wadolowski contributed to the conceptualization and design of the study, contributed to the design of the data collection instruments, coordinated and supervised data collection, wrote the statistical analysis plan, conducted and interpreted the statistical analyses, drafted and revised the manuscript, and approved the final draft of the manuscript; Dr Hutchinson contributed to the conceptualization and design of the study, contributed to the design of the data collection instruments, critically reviewed the manuscript, and approved the final draft of the manuscript; Asst Prof Bruno contributed to the conceptualization and design of the study, coordinated and supervised data collection, assisted with analysis planning, contributed to the interpretation of the statistical analyses, critically reviewed the manuscript, and approved the final draft of the manuscript; Ms Aiken coordinated and supervised data collection, critically reviewed the manuscript, and approved the final draft of the manuscript; Prof Najman contributed to the WHAT S KNOWN ON THIS SUBJECT: Adolescent alcohol use is associated with major long-term harms. Parents are a major supplier of alcohol to adolescent children, often initiating their child s alcohol use with sips. However, no research has addressed the antecedents of such supply. WHAT THIS STUDY ADDS: Parental factors (parental perception of substance-using peers, home alcohol access, lenient alcohol-specific rules, and initial parental supply of alcohol sips) and previous child sipping predicted subsequent parental supply of alcohol sips. To cite: Wadolowski M, Hutchinson D, Bruno R, et al. Parents Who Supply Sips of Alcohol in Early Adolescence: A Prospective Study of Risk Factors. Pediatrics. 2016; 137(3):e PEDIATRICS Volume 137, number 3, March 2016 :e ARTICLE

2 Early adolescent alcohol initiation is associated with increased risk of: delinquent behavior 1 ; physical injury 2 ; poor adolescent health and well-being 3,4 ; and alcoholuse disorders. 1 Alcohol use often commences with a sip(s)/taste(s) of alcohol, rather than consuming whole drinks. 5 7 By age 13, up to 60% of adolescents have had a sip/taste of alcohol 5,8 14 ; sipping is more prevalent than drinking in this age group. 5,6,10,15 Sipping is associated with increased risk of early adolescent drinking and binge drinking, 12,16 but the area of sipping is under-researched. Despite recommendations that parents avoid providing alcohol to children, 15 parents remain a major supplier of alcohol to adolescent children, including sips. 17,18 Reasons for this early supply are particularly poorly studied, with a recent exception, 9 where 60% to 70% of mothers disagreed that supplying access to sips was beneficial. Those authors note 9 that what remains unstudied are the antecedents associated with parental supply of sips. Understanding these reasons may inform on ways to advise parents about reducing alcohol access. Although the characteristics predicting parental supply of alcohol are poorly documented, some observers suggest parents supply sips to inoculate their children against heavy drinking, 19 while also acknowledging that little is known about the antecedents of children sipping. 6,8,20 Recent research on why parents provide alcohol suggests it is to decrease consumption and teach children to resist peer pressure. 9 However, the limited research on factors associated with parental supply has focused on parental attitudes, used only cross-sectional designs, or focused on supply of whole drinks. 9,21 23 There are no prospective studies investigating what parent and adolescent characteristics predict parental supply of sips. The lack of such prospective research runs the risk that the reasons for supply provided by parents are post hoc explanations and may obscure some antecedents of supply. Our aim was to comprehensively investigate how parental supply of sips of alcohol to adolescent children at age 14 years was prospectively associated with a range of: (1) familial, parental, and adolescent demographic characteristics; (2) parent behaviors including alcohol consumption, alcohol availability, alcohol-specific rules, and parenting practices; (3) peer substance use and alcohol attitudes; and (4) individual adolescent psychological behaviors. These factors were selected based on several theoretical perspectives identifying their importance in understanding adolescent alcohol use, including problem behavior theory, socialization theory, the social development model, and social learning theory. 24,25 METHODS Sample Grade 7 adolescents and 1 parent were recruited for the Australian Parental Supply of Alcohol Longitudinal Study, and methods are described elsewhere. 15 Families came from 49 Independent (49.0%), Government (38.8%), and Catholic (12.2%) secondary schools across 3 states: New South Wales, Tasmania, and Western Australia. A total of 2017 families expressed interest in the study, but 90 families were ineligible, as 16 adolescents were not in Grade 7 and 74 parents did not sign informed consent, yielding 1927 eligible parent adolescent dyads. Of the surveys sent, 1910 adolescents (99.1%; mean age = 12.9-yearsold, SD = 0.5), and 1913 parents (99.3%) returned baseline surveys (Time 1 [T1]), which included written consent. Of the returned T1 surveys, 1896 (98.4%) were from parent child dyads. Of these 1896 dyads, complete data were available for 1840 adolescent and 1870 parent T1 surveys, resulting in a total of 1808 parent child dyads with complete data. Data were imputed for T1 surveys in 15 cases, using the PRELIS application in the LISREL program. 26 When a case was missing a single item on a scale, the dataset was searched for the same pattern of responses on that specific scale within other cases. When multiple response patterns matched in the dataset, a reliability estimate was generated. Only imputations with high reliability (0.999, ie, a LISREL variance ratio = 0.001) were accepted. This in turn assured confidence in the accuracy of the imputed data. 27 This provided a total of 1823 parent child dyads at T1. Of these 1823 dyads, 1752 adolescents and 1746 parents (87.0% were mothers) returned follow-up surveys 1 year later (Time 2 [T2]), resulting in 1729 (94.8% of dyads with complete data at T1) T2 dyads, the sample used in the present analyses. The sample was similar to the Australian population on important demographic factors. Males comprised 55% of the adolescent sample (51% of 12- to 13-yearolds in the Australian adolescent population), 28 and 81% of children lived in 2-parent households (80.0% of 2-parent households in the Australian population), 29 and socioeconomic status (SES) 30 showed our sample was very similar to the Australian population. 31 Rates of alcohol use in our sample (parents and adolescents) were also similar to those in Australian population surveys. In a school-based population survey, any lifetime alcohol use was reported by 67.3% of 12- to 13-year-olds, 32 compared with 67.8% of adolescents in our sample at T1 (mean age = 12.9 years). Parents reported the following frequencies of T1 alcohol use: 2.7% daily, 48.5% weekly, 39.2% less than weekly, 2 WADOLOWSKI et al

3 and 9.6% not in the past 12 months. This was similar to the Australian population aged >18-years-old: 7.7% daily, 41.7% weekly, 33.0% less than weekly, and 7.7% not in the past 12-months. 33 Families completed surveys either via paper hardcopy or online. To maintain privacy, all paper surveys were sent individually to parents and adolescents, and each survey included its own reply-paid envelope for returning surveys. Where available, links to online surveys were ed directly to parents and adolescents. Participants were reimbursed 10 AUD for their time completing each survey. Paper and online surveys each had 3 reminders, including resending surveys and telephone calls. Approval to conduct this research was received by the University of New South Wales Human Research Ethics Committee (approval number 10144), and this study is registered at www. clinicaltrials. gov (identification number NCT ). Variables Outcome Variable: Parental Supply of a Sip at T2 At both T1 and T2, parents were asked: In the last 12-months, did you/your partner give your child a sip or taste of alcohol? The response option was a dichotomous yes or no. Familial Demographics Household composition: Adolescents were asked whether they lived in 1- or 2-parent households (including step-parents). SES: Family geographical locations were categorized into deciles from a standardized Australian population measure, the Index of Relative Socioeconomic Advantage and Disadvantage. The deciles were distributed between 10 equal groups, with the first decile representing the lowest scoring 10% of Australian geographical areas, and the tenth decile representing the highest scoring 10% of areas. 30 For the analyses, deciles were collapsed into 3 categories: low SES (deciles 1 3), medium SES (deciles 4 7), and high SES (deciles 8 10). Parent religiosity: One item asked how important religion was to them (very important, pretty important, and not/only a little important). Parental Alcohol Use Consumption was based on the Alcohol Use Disorders Identification Test short-form scale, AUDIT-C: quantity, frequency, and heavy episodic use. 34 Seven responses measured quantity, ranging from 1 2 drinks to 13 or more drinks. These options were then collapsed into 5 categories: 1 2 drinks to 10 or more drinks. Frequency of alcohol use was measured with 8 categories, which were collapsed into: never, less often (than monthly), monthly or less, 2 4 times a month, 2 3 times a week, and 4 or more times a week. Frequency of heavy episodic use (more than four standard drinks on a single occasion) was measured with 8 categories, collapsed into: never, less than monthly, monthly, weekly, daily or almost daily. These 3 items were then summed, with higher scores indicating increased parental alcohol use. Cronbachs α for this measure, and the other scales and variables included in the analyses, are available elsewhere. 6 Parenting Practices Context of parental suppy: If parents had supplied a sip, they were also asked In the last 12 months, when you/your partner have given your child alcohol, how many times have you provided it in these situations with response options being: with family on a holiday or special occasion; with family at dinner; and at parent-supervised parties. Home alcohol access: Parents completed 5 items about access and availability of alcohol in the family home, such as whether they kept track of, or locked up, alcohol. 35 Alcohol-specific rules: Adolescents responded to 10 items on their parents rules about drinking and binge drinking frequency and quantity, and whether drinking was permitted in supervised and unsupervised contexts. 36 Family conflict: Parents responded to 3 items about the frequency of family disagreements. 37 Positive family relations: Parents responded to another 3 items regarding family relationship quality. 37 Parental monitoring: 6 items assessed adolescent report of monitoring, such as whether parents knew about their peers, plans with peers, and unsupervised activities. 38 Parenting consistency: Parents responded to 10 items assessing the consistency of using discipline and enforcing rules. 39 Peers Substance-using peers: Parents were asked whether they thought their child s friends: had tried alcohol; drank alcohol regularly; and drank to get drunk. Adolescents also reported peer alcohol and tobacco use, responding to 6 items, including whether their friends smoked cigarettes, drank alcohol, and the frequency of drunkenness. 40 Peer disapproval of substance use: Four items asked adolescents about whether their friends disapproved of tobacco use and alcohol use. 40 Individual Adolescent Behaviors Alcohol use: Adapted from the Australian National Drug Strategy Household Survey, adolescents were asked: In the last six months, on a day that you have an alcoholic drink, how many standard drinks do you usually have? There were 7 response options, including a sip/taste of alcohol. At T1, 14.1% of adolescents reported sipping and 5.5% reported consuming a whole drink. At T2, sipping increased to 25.2%, whereas 7.8% of adolescents reported drinking. The 7 response options were collapsed into 3 categories: abstainer, sipper (only sip[s]), and drinker (at least 1 whole drink). Externalizing PEDIATRICS Volume 137, number 3, March

4 behaviors: Adolescents completed the rule-breaking and aggressive behavior subscales from the Achenbach youth self-report. 41 Internalizing behaviors: Adolescents also completed the withdrawn-depressed and anxiousdepressed subscales from the youth self-report. 41 Data Analyses Planned logistic regression analyses first tested for unadjusted associations between T1 variables and T2 parental supply of a sip. A multivariate, logistic regression analysis, adjusting for all T1 covariates (regardless of the significance of their associations with T2 supply), was then conducted to test for associations with T2 supply. The adjusted model also controlled for clustering at the school level and tested for multicollinearity. Analyses were conducted in Stata/SE 11.2, 42 using logistic and cluster commands. RESULTS Descriptive Analyses Supply was reported by 24.4% of parents (95% CI, ) at T2. Supply typically occurred in familial contexts, such as holidays and special occasions (68.0%, 95% CI, ), family dinners (50.0%, 95% CI, ), and parties (10.4%, 95% CI, ). Table 1 presents the means and proportions of T2 supply in relation to T1 familial, parental, peer, and individual adolescent characteristics. TABLE 1 Descriptive Statistics for Time 2 Parental Supply by Time 1 Familial, Parental, Adolescent and Peer Characteristics (N = 1729) Time 1 Characteristics (Score Range) Time 2 Parental Supply Mean (SD) or % No Supply a (n = 1279) Supply b (n = 450) Familial demographics Age (years) 12.4 (0.5) 12.5 (0.6) Adolescent sex, % Male Female Household composition, % Two-parent household One-parent household Importance of religion, % Very important Pretty important Not, or only a little, important Socioeconomic status, % High Medium Low Parental supply of sips of alcohol, % No a Yes b Parent alcohol use Total consumption (Score: 0 12) 3.8 (2.2) 4.3 (1.9) Parenting practices Home alcohol access (P) (Score: 6 30) 16.8 (3.7) 17.7 (3.3) Alcohol-specific rules (A) (Score: 10 50) 49.6 (1.3) 48.9 (2.2) Family conflict (P) (Score: 3 6) 3.7 (0.9) 3.8 (0.9) Positive family relations (P) (Score: 3 6) 5.9 (0.5) 5.9 (0.4) Parental monitoring (A) (Score: 6 30) 27.8 (3.0) 27.5 (3.4) Parenting consistency (P) (Score 5 25) 21.4 (2.7) 21.3 (2.7) Adolescent peers Peer substance use (P) (Score: 3 15) 4.3 (1.3) 5.0 (1.4) Peer substance use (A) (Score: 6 30) 7.9 (2.6) 8.9 (3.0) Peer disapproval of substance use (A) (Score: 4 12) 10.9 (1.9) 10.5 (2.1) Adolescent behaviors Adolescent alcohol use (A), % Abstainer c Sipper d Drinker e Externalizing behaviors (A) (Score: 0 60) 5.3 (5.9) 6.2 (6.3) Internalizing behaviors (A) (Score: 0 40) 4.3 (5.1) 4.6 (5.5) (A), Adolescent report; (P), parent report. a Parent, and/or their partner, did not supply sips of alcohol in the past six months. b Parent, and/or their partner, supplied sips of alcohol on at least one occasion in the past 6 months. c Did not consume any alcohol in the past 6 months. d Consumed only a sip(s) of alcohol. e Consumed at least a whole drink in the past 6 months. Unadjusted Analyses Compared with no supply, T2 supply was associated with increased T1 reports of: parental alcohol use (OR = 1.12, P <.001), home access to alcohol (OR = 1.08, P <.001), perceived peer substance use among both parents and adolescents (parent-report OR = 1.37, P <.001; and adolescent-report OR = 1.13, P <.001), and externalizing problems (OR = 1.02, P =.009) (Table 2). Conversely, T2 supply was also associated with decreased T1 reports of: parental alcohol-specific rules (OR = 0.73, P <.001); and perceived peer disapproval of substance use (OR = 0.91, P <.001). Notably, T2 supply had no unadjusted associations with parenting factors such as monitoring, parenting consistency, relationship quality, family conflict, or household composition. While some of these ORs appear small, ORs for scales represent differences based on single unit increases, and in turn become more pronounced when examining larger increases in the respective scales. Adjusted Analyses The multivariate logistic model was significant (χ 2 (22) = , P <.001) (Table 2). Notably, in adjusting for all familial demographic, parental, peer, and individual adolescent factors, only a few T1 variables retained significant associations with T2 4 WADOLOWSKI et al

5 supply. Compared with no supply, these factors were: increased home alcohol access (OR = 1.07, P <.001), the effect of which did not change from unadjusted analyses; increased parent perception that their child engaged with substance-using peers (OR = 1.20, P <.001); and decreased parental alcohol-specific rules (OR = 0.88, P =.033). Adjusting for the type 1 error rate (Bonferroni adjusted α = 0.05/28 = ), the association of alcoholspecific rules was no longer significant, but the other associations remained significant at < Multicollinearity was low, with the variance inflation factors ranging between 1.05 and 2.06, with a mean variance inflation factor of 1.42, indicating that the adjusted regression model was stable. Compared with no T2 supply, supply was no longer associated with T1 externalizing problems (OR = 0.99, P =.431). In the fully adjusted model, sipping at T1 retained a significant association with T2 parental supply compared with no supply (OR = 2.45, P <.001), but drinking at T1 was no longer significant (OR = 1.00, P =.991). DISCUSSION This research addresses an important public health research gap: what factors are associated with parents choosing to supply sips/tastes of alcohol to their early adolescent children. Using a large cohort of early adolescents and parents, we provide the first analysis to our knowledge of the prospective associations between familial, parental, adolescent, and peer factors, and subsequent parental supply of sips 1 year later. Our results show that over 10 variables were associated with later supply in unadjusted analyses. However, after adjustment, parent perception of substance-using peers remained a significant predictor of subsequent parental supply. Few other parenting factors were associated with subsequent supply, only increased home alcohol access and lenient TABLE 2 Unadjusted and Adjusted Associations Between Time 2 Parental Supply and Time 1 Familial, Parental, Adolescent, and Peer Characteristics (N = 1729) Time 1 Characteristics Time 2 Parental Supply of Sips of Alcohol Unadjusted Adjusted OR 95% CI OR 95% CI Familial demographics Adolescent age 1.26 * Adolescent sex Male 1.00 a 1.00 a Female Household composition Two-parent household 1.00 a 1.00 a One-parent household Importance of religion Very important 1.00 a 1.00 a Pretty important Not, or only a little, important Household socioeconomic status High 1.00 a 1.00 a Medium Low 1.50** Parental supply of sips of alcohol (P) No b 1.00 a 1.00 a Yes c 8.10*** *** Parent alcohol use Total consumption 1.12*** Parenting practices Home alcohol access (P) 1.08*** *** Alcohol-specific rules (A) 0.73*** * Family conflict (P) Positive family relations (P) Parental monitoring (A) Parenting consistency (P) Adolescent peers Peer substance use (P) 1.37*** *** Peer substance use (A) 1.13*** Peer disapproval of substance use (A) 0.91*** Adolescent behaviors Adolescent alcohol use: (A) Abstainer d 1.00 a 1.00 a Sipper e 5.86*** *** Drinker f 3.19*** Externalizing (A) 1.02** Internalizing (A) a Referent category b Parent and/or their partner did not supply sips of alcohol in the past six months. c Parent and/or their partner did supply sips of alcohol on at least one occasion in the past 6 months. d Did not consume any alcohol in the past 6 months. e Consumed only a sip(s) of alcohol. f Consumed at least a whole drink in the past 6 months. * P <.05; **P <.01; ***P <.001. (A), Adolescent report; (P), parent report alcohol-specific rules (although this last association was nonsignificant after adjustment for the type 1 error rate). Notably, even in unadjusted analyses, other parenting practices, such as monitoring, parenting consistency, relationship quality, and family conflict, were not associated with whether parents did or did not supply alcohol a year later. T1 adolescent drinking was not associated with parental supply at T2, possibly because parents were supplying or allowing whole drinks to be consumed at T2, so provision of sips did not occur. In cross-sectional studies, childhood/ early adolescent sipping has been associated especially with PEDIATRICS Volume 137, number 3, March

6 externalizing problems, peer alcohol use, and alcohol use approval by peers. 8,11,14 In our unadjusted analyses, externalizing problems, adolescent perception of substanceusing peers, and parent perception of substance-using peers, each predicted subsequent parental supply. However, after adjusting for a wide range of familial, parental, peer, and adolescent factors, only parent factors (parental perception of substanceusing peers, home alcohol access, and lenient alcohol-specific rules) retained significant predictive associations. Compared with parents who did not supply alcohol, parents were more likely to supply it if they perceived that their child was mixing with substanceusing peers and were more lenient about alcohol access. This result is consistent with recent longitudinal findings, where the strongest antecedents of sipping were parenting factors, whereas child psychosocial proneness (such as externalizing) had no association. 10 It seems parents may supply a sip of alcohol in response to perceiving that their child has substance-using peers and are motivated to inoculate their children from the potential risk of unsupervised alcohol use and binge drinking with peers. 9 In that regard, parents may be reacting to a perceived risk of their adolescent child s peers likelihood of drinking, which may not be manifest; they may be trying to inoculate against a nonexistent threat. Parental supply of sips may be motivated by the belief that smaller quantities will protect their child from unsupervised alcohol use with peers and associated harms, such as binging. 9 Sipping has been associated with parental alcohol socialization and lenient alcohol rules, 8,10,11,14 and described as an opportunistic behavior for parents to introduce alcohol in supervised contexts. 8 Consistent with these notions, the only parenting practices associated with supply in the present unadjusted and adjusted analyses were increased home alcohol access and lenient parental alcohol rules (which was nonsignificant after adjusting for capitalization on chance). Although parental alcohol use predicted parental supply in unadjusted analyses, this association disappeared in the adjusted model. It is possible that home alcohol access and lenient alcohol rules accounted for parental alcohol use. In previous studies 8,9,12 and our present sample, parental supply occurred mostly in familial social contexts. To this end, parental alcohol use may provide access and opportunity for parents to introduce alcohol to their child in supervised, familial contexts. Likewise, the associations between lenient alcohol rules and home alcohol access on parental supply may increase adolescent perception of parental alcohol permissiveness, which increases the risk of early drinking initiation. 16 This study has a number of strengths. The sample comprised a large-scale cohort of young adolescents and 1 of their parents, recruited across a range of sites, and Australia is a multicultural country increasing generalizability of the results. The prospective design accounted for a wide range of different parent and child characteristics, using both adolescent- and parentreport. Some limitations should be considered. First, participants were not randomly selected from the population, increasing the risk of self-selection and nonresponse biases. However, as outlined earlier and elsewhere, 15,28,29,33 the sample reported many similarities on a range of demographic and alcohol use variables with the Australian population, suggesting selective nonresponse biases were minimized. Second, self-report of parental supply may have resulted in social desirability bias, where parents may have underreported supply, fearing negative social consequences, but this should reduce associations, so the results found are likely to be robust. Third, other unmeasured covariates may be relevant, but we have conducted a comprehensive adjustment using variables known to predict drinking, so the effect of unmeasured unobserved covariates is likely to be small. Fourth, we have not been able to assess the long-term associations of early exposure to sips, which is a matter for our ongoing work on this cohort and not the focus of this paper. CONCLUSIONS The findings of this study are important because we identify prospective predictors of parental supply of sips of alcohol, one of the first stages of drinking. The results show that parental perceptions of whether their child engages with substance-using peers are a significant predictor of parental supply of sips, along with home access and lenient alcohol rules. Parents may be supplying sips of alcohol in response to believing their child will be exposed to unsupervised alcohol use with their peers. However, they may be wrong in their belief, and may be prematurely introducing their children to a behavior that may have marked risks. Replication is needed, and research is required on whether supply of sips quickly transitions to supply of whole drinks, and whether predictors of supply differ with increasing adolescent age and alcohol experience. Turning from the transitions of parental behaviors to the transitions in actual adolescent drinking, it is also necessary to better understand how parental supply, even sips, relates to the trajectories of adolescent from sipping to drinking and to binging. ABBREVIATIONS CI: confidence interval OR: odds ratio SES: socioeconomic status T1: time 1 T2: time 2 6 WADOLOWSKI et al

7 conceptualization and design of the study, contributed to the design of the data collection instruments, critically reviewed the manuscript, and approved the final draft of the manuscript; Prof Kypri contributed to the conceptualization and design of the study, contributed to the design of the data collection instruments, critically reviewed the manuscript, and approved the final draft of the manuscript; Asst Prof Slade contributed to the conceptualization and design of the study, contributed to the design of the data collection instruments, critically reviewed the manuscript, and approved the final draft of the manuscript; Dr McBride coordinated and supervised data collection, critically reviewed the manuscript, and approved the final draft of the manuscript; and Prof Mattick contributed to the conceptualization and design of the study, contributed to the design of the data collection instruments, coordinated and supervised data collection, contributed to revising the manuscript, and approved the final draft of the manuscript. This trial has been registered at www. clinicaltrials. gov (identifier NCT ). Dr Bruno s current affiliation is School of Psychology, Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia. DOI: /peds Accepted for publication Dec 2, 2015 Address correspondence to Dr Monika Wadolowski, National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, New South Wales 2052, Australia. m.wadolowski@unsw.edu.au. PEDIATRICS (ISSN Numbers: Print, ; Online, ). Copyright 2016 by the American Academy of Pediatrics FINANCIAL DISCLOSURE: The authors have no financial relationships relevant to this article to disclose. POTENTIAL CONFLICT OF INTEREST: The authors have no potential conflicts of interest to disclose. FUNDING: Supporteded by: a Australian Research Council Discovery Project grant (DP: ) to Prof Mattick, Prof Najman, Prof Kypri, Asst Prof Slade, and Dr Hutchinson; an Australian Rotary Health Mental Health Research grant to Prof Mattick, Dr Wadolowski, Prof Najman, Prof Kypri, Asst Prof Slade, Dr Hutchinson, and Asst Prof Bruno; an Australian Rotary Health Whitcroft Family PhD Scholarship Mental Health Research Companion grant to Dr Wadolowski; a University of New South Wales Australian Postgraduate Award to Dr Wadolowski; a National Health and Medical Research Council Principal Research Fellowship grant to Prof Mattick (APP ) and Prof Kypri (GNT , APP ); National Health and Medical Research Council project grants to Prof Mattick for the Longitudinal Cohorts Research Consortium (GNT and GNT ); and a Research Innovation grant from the Australian Foundation for Alcohol Research and Education to Prof Mattick, Prof Najman, Prof Kypri, Asst Prof Slade, Dr Hutchinson, Asst Prof Bruno, and Dr Wadolowski. The National Drug and Alcohol Research Centre at the University of New South Wales Australia (Dr Wadolowski, Dr Hutchinson, Asst Prof Bruno, Ms Aiken, Asst Prof Slade, and Prof Mattick) is supported by funding from the Australian Government under a Substance Misuse Prevention and Service Improvements grant. REFERENCES 1. Ellickson PL, Tucker JS, Klein DJ. Ten-year prospective study of public health problems associated with early drinking. Pediatrics. 2003;111(5): Hingson RW, Zha W. Age of drinking onset, alcohol use disorders, frequent heavy drinking, and unintentionally injuring oneself and others after drinking. Pediatrics. 2009;123(6): Gore FM, Bloem PJN, Patton GC, et al. Global burden of disease in young people aged years: a systematic analysis. Lancet. 2011;377(9783): Patton GC, Coffey C, Cappa C, et al. Health of the world s adolescents: a synthesis of internationally comparable data. Lancet. 2012;379(9826): Wadolowski M, Bruno R, Aiken A, et al. 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9 Parents Who Supply Sips of Alcohol in Early Adolescence: A Prospective Study of Risk Factors Monika Wadolowski, Delyse Hutchinson, Raimondo Bruno, Alexandra Aiken, Jackob M. Najman, Kypros Kypri, Tim Slade, Nyanda McBride and Richard P. Mattick Pediatrics originally published online February 26, 2016; Updated Information & Services References Subspecialty Collections Permissions & Licensing Reprints including high resolution figures, can be found at: This article cites 29 articles, 3 of which you can access for free at: #BIBL This article, along with others on similar topics, appears in the following collection(s): Adolescent Health/Medicine icine_sub Substance Use Information about reproducing this article in parts (figures, tables) or in its entirety can be found online at: Information about ordering reprints can be found online:

10 Parents Who Supply Sips of Alcohol in Early Adolescence: A Prospective Study of Risk Factors Monika Wadolowski, Delyse Hutchinson, Raimondo Bruno, Alexandra Aiken, Jackob M. Najman, Kypros Kypri, Tim Slade, Nyanda McBride and Richard P. Mattick Pediatrics originally published online February 26, 2016; The online version of this article, along with updated information and services, is located on the World Wide Web at: Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since Pediatrics is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, Copyright 2016 by the American Academy of Pediatrics. All rights reserved. Print ISSN: