Monika Wadolowski,[1] Chiara Bucello,[1] Alexandra Aiken,[1] Richard Mattick,[1] Tim Slade,[1] Jackob Najman,[2] Kypros Kypri,[3] Delyse Hutchinson,[1] Raimondo Bruno,[4] Nyanda McBride.[5] [1]National Drug & Alcohol Research Centre, University of New South Wales, Australia. [2]Queensland Alcohol & Drug Research & Education Centre, University of Queensland, Australia. [3]School of Medicine & Public Health, University of Newcastle, Australia. [4] School of Psychology, University of Tasmania, Australia. [5]National Drug Research Institute, Curtin University, Australia. A total of 1,842 seventh-grade students (M=12.4 years, SD=0.5; 55.3% male), and a parent, were recruited for a 4-year longitudinal parental alcohol supply study. Current data are from baseline self-complete questionnaires. Families were recruited across three Australian states via independent, government, and catholic schools. Complete data were obtained for 1,823 parent-child dyads, the sample for current multivariate analyses. Measures Parent & Adolescent Measures Alcohol use: Four items were adapted from the Australian 2007 National Drug Strategy Household Survey.[5] / Adolescent Measures: Peers: Substance-using peers, and peer alcohol disapproval. Behaviour: Rule-breaking and anxious depressed. Parenting: Alcohol-specific rules, parental monitoring. / Parent Measures: Family relationships: Conflict, and positive relations. Parenting: Parenting consistency Statistical Analyses Descriptive, logistic regression, and multinomial logistic regression analyses were conducted in Stata SE Version 12. Table 1 outlines key differences. Compared to sippers, drinkers and their parents are more likely to report lower levels of parent alcohol-specific rules and parenting consistency; more peer alcohol use, and lower levels of peer alcohol disapproval; and lower levels of rule-breaking behaviour. Adolescent alcohol use is a major cause of preventable disease burden,[1, 2] and injuries and death.[3] International data reports significant rates of early initiation, and alcohol use and misuse, across adolescence (See Figure 1 for comparison).[4-9] This has fuelled concerns over adolescent binge-drinking. The current research provides the first prevalence data of sipping in an early adolescent Australian cohort. The results highlight the need for future adolescent alcohol research to clearly articulate how alcohol use is measured and reported, as the current results show, sipping is a common adolescent behaviour. The failure to account for sipping may inflate adolescent alcohol use rates. The current results also show important differences in sippers and drinkers. Such differences may have important implications for understanding the trajectory of adolescent alcohol use, and future directions for public health policies and interventions. Figure 1. Comparison of international population lifetime alcohol use, by age and region. Table 1. Selected bivariate and multinomial analyses of past-6-month adolescent alcohol drinkers (n=111) versus sippers (n=268), N=1,823. BIVARIATE MULTIVARIATE χ234 = 404.06 (<0.001) Drinkers v. Sippers %(n) / M (SD) Sippers % (n) / M (SD) Drinkers OR 95% CI p -value Demographics Female 41.8 (112) 36.0 (40) 0.8 0.5-1.2 0.065 0.7 0.4-1.3 0.064 Age* 12.5 (0.6) 12.8 (0.6) 2.0 1.4-2.8 <0.001 1.5 1.0-2.2 One-parent home 20.9 (56) 31.5 (35) 1.7 1.1-2.9 0.028 1.4 0.8-2.5 0.309 Parent and family factors Parent alcohol use* 4.3 (2.1) 4.1 (2.5) 1.0 0.9-1.1 0.505 0.9 0.8-1.0 0.201 Alcohol rules* 48.9 (1.9) 47.1 (4.0) 0.8-0.9 0.013 Family conflict* 3.7 (0.8) 4.0 (1.0) 1.1-1.7 0.009 1.2 0.9-1.5 0.318 Positive relations* 5.9 (0.4) 5.8 (0.6) 0.6 0.4-0.9 0.016 0.5-1.6 0.747 Monitoring* 27.3 (3.6) 25.3 (4.4) 0.9-0.9 0.9-1.0 0.156 Parent consistency* 21.4 (2.7) 20.2 (2.7) 0.044 Adolescent peers and alcohol Total use* 8.9 (2.5) 12.2 (4.4) 1.1-1.3 < 0.001 Disapproval* 10.5 (2.0) 8.7 (2.5) 0.7-0.8 0.011 Adolescent behaviour Rule-breaking* 2.7 (3.0) 3.0 (3.6) 1.0-1.1 0.487 0.7-1.0 0.034 Anxious depressed* 2.4 (2.9) 2.3 (3.4) 0.578 0.145 * Continuous measure: Higher score indicates higher levels of that item. Sipping alcohol is a common early adolescent,[10-13] often representing the first alcohol experiences. Despite this, adolescent public health policy, research and interventions have focused on consumption of whole beverages, overlooking the potentially important and distinct roles of sipping and drinking alcohol in the development of different alcohol trajectories.   Europe’s largest adolescent health survey does not distinguish between sipping and drinking in measuring alcohol use.[9] Other surveys ask about “more than a few sips”, but do not specify whole beverages.[6,7] Some research reports sippers and drinkers as one “ever used alcohol” category.[4] In contrast, other surveys explicitly exclude adolescents who have only sipped.[5,8] Such lack of uniformity has several implications: Both sipping and drinking are categorised as the same levels of alcohol exposure, and thus the same risks and trajectories; Data comparisons are problematic due to inconsistent measurement across different sources; A sip of alcohol is not currently measured or reported; and Not accounting for sipping as a separate level of alcohol exposure can inflate estimates of adolescent alcohol use. Combining sippers and drinkers into a single alcohol use category, as per data reported in another Australian population survey[4] used as a comparison in Figure 2, rates of alcohol use in both samples appear similar. Figure 2. Comparison of lifetime alcohol use between the current sample and Australian population data[4], by age. …Aims to unpack early adolescent alcohol use…   Provide the first prevalence estimates of sipping, compared to drinking, among Australian early adolescents; Compare current findings with other Australian data; and Explore the differences between sipping and drinking. 1. Gore, et al., (2011) The Lancet. 2. Rehm, et al., (2009) The Lancet. 3. Chikritzhs, et al., (2004) Under-aged drinking among 14-17 year olds and related harms in Australia. 4. White & Smith (2009) Australian secondary school students' use of tobacco, alcohol, and over-the-counter and illicit substances in 2008. 5. Australian Institute of Health & Welfare (2008) 2007 National Drug Strategy Household Survey. 6. Substance Abuse & Mental Health Services Administration (2011) Results from the 2010 National Survey on Drug Use and Health. 7. Johnston, et al., (2012) Monitoring the Future national results on adolescent drug use: Overview of key findings, 2011. 8. Gill, et al., (2012) Smoking, drinking and drug use among young people in England in 2011. 9. Hibell, et al., (2012) The 2011 ESPAD report. 10. Casswell, et al., (1991) British Journal of Addiction. 11. Donovan & Molina (2008) Alcoholism. 12. Hipwell, et al., (2005) Journal of Studies on Alcohol. 13. Johnson, et al., (1997) Journal of Child & Family Studies. Distinguishing for the level of alcohol use by sipping and drinking , the current sample suggests that a substantial proportion of alcohol exposure in early adolescence is limited to having a sip of alcohol, rather than a whole beverage or more. The National Drug & Alcohol Research Centre at the University of New South Wales, Australia, is supported by funding from the Australian Government under the Substance Misuse Prevention and Service Improvements Grants Fund. This research is also funded by an Australian Research Council Discovery Project, Australian Rotary Health Mental Health Research Grant, Australian Postgraduate Award, & Australian Rotary Health Whitcroft Family PhD Scholarship in Mental Health. Contact: Monika Wadolowski m.wadolowski@unsw.edu.au Figure 3. Proportion of lifetime alcohol use (never, sippers, drinkers) in the current sample, by age.