Using a Mixed-Methods Approach to Elicit Explanations for Shifts in Adolescents' Self-Reported Alcohol Use

Introduction:We developed a mixed methodology, utilizing questionnaire data from seven waves of the Developmental Pathways Project (DPP) as the basis for characterizing individual alcohol use trajectories and conducting semi-structured interviews with young adults to reveal factors related to changes in their alcohol use between the ages of 11 and 20 years. Our primary aim is to construct a more multidimensional and contextualized understanding of the social and environmental factors that influence adolescent drinking behaviors and trajectories.

Methods: 12 participants were purposefully sampled based on their past reported alcohol use trajectories and gender. Crosstabs were conducted in SPSS on two measures of alcohol use frequency from 11-18 years to determine alcohol use trajectories. A graphic representation of each participant’s trajectory was created in PowerPoint to serve as a visual aide in the interview. Three investigators used a consensus coding process (DeSantis & Ugarriza, 2000) to conduct a traditional thematic content analysis of interview data (Hsieh and Shannon, 2005).  Atlas.ti 6.0 was used to manage and organize the data.

Results: Three primary themes and five sub-themes were identified as youth’s explanations for increases in alcohol consumption: 1) the presence of adult drinkers as role models (subthemes: mentors, permissive parental attitudes and family history of use), 2) coping with stress/loss, and 3) social inclusion (subthemes: social status and self-protection/fear of social exclusion. Five themes emerged explaining decreases in alcohol use: 1) internal motivation, 2) involvement in meaningful and purposeful activities, 3) pro-social relationships with non-parental adults, 4) initiation of use of another substance and; 5) fear of harm to self or fetus.

Conclusion: Five important findings emerged. First, the role that adult neighbors and community members play as facilitators to drinking, especially for young men. Second, youth are struggling with tremendous personal and familial stressors. Thirdly, the ability to imagine a positive future and develop goals was the prominent factor youth identified to decrease their drinking. Fourthly, whereas the influence of peers is a well documented contributor to adolescent drinking, our findings expand the idea that youth drink to “fit in” or “be cool.” Rather, there is a more complex social process at play; youth drink to avoid or self-protect against physical and emotional harm from peers. Finally, not all decreases are signs that youth are on “the right track” – for example ‘substituting’ alcohol for another drug of choice such as marijuana. A positive youth development framework contextualizes these findings and is proposed to inform strategies to prevent underage alcohol use.