What counts as early alcohol initiation? A methodological survey

Aims: It is generally believed that the younger the age of first alcohol consumption, the higher the risk of developing physical/psychosocial alcohol related problems, but not all studies support this association. Differences among findings may stem from heterogeneity in the definitions of alcohol initiation and its operationalization. This problem has already been recognized in the literature, but it is unclear whether recent studies have taken steps to improve this issue. In this context, we investigate current practices in inquiring about alcohol initiation. Methods: Our goal was to obtain a representative sample of recent publications and to review the questions used to assess alcohol initiation in studies with children/adolescents. To that aim, we searched PubMed for empirical studies published between 2018 and 2024 on early alcohol use and which claimed to have assessed alcohol initiation. Findings: Our search returned a total of 523 documents, of which 59 met our eligibility criteria. Overall, the questions used to assess what constituted alcohol initiation varied widely in terms of the quantity of alcohol consumed, from just one or a few sips to at least a full drink, with some studies having no definition of alcohol initiation and many failing to define alcohol and/or doses. Only 17 studies enquired about context of use, focusing on excluding drinking in religious ceremonies and parental consent. Conclusion: Definitions of alcohol initiation remain highly heterogeneous and sub-optimal in terms of clarity in respect of the quantity/context of alcohol consumption. We suggest a comprehensive and standardized set of questions to change this state of affairs.