External Publications Using GUI Data

Background:
Regulatory problems in infancy are associated with internalizing and externalizing symptom trajectories across childhood. It is unknown whether early screen media exposure exacerbates the association between infant regulatory problems and childhood internalizing and externalizing symptom trajectories.

Methods:
We studied 10,170 individuals from the Growing Up in Ireland ’08 cohort. Parents reported on their children’s regulatory problems at 9 months, screen media exposure at 3 years, and internalizing and externalizing symptoms at 3, 5, 7, and 9 years. Children were categorized based on their patterns of co-developing internalizing and externalizing symptoms using parallel process latent class growth analysis. Subsequently, multinominal logistic regression analyses were conducted to estimate whether screen media exposure (>1 hour or >2 hours) moderated the association between regulatory problems in infancy and co-developing internalizing and externalizing symptom classes across childhood.

Results:
There were four groups of children with distinct patterns of co-developing internalizing and externalizing symptoms: 1) low stable internalizing and low decreasing externalizing symptoms (N= 6236; 61.3%); 2) low stable internalizing and moderate stable externalizing symptoms (N= 2029; 20%); 3) moderate increasing internalizing and moderate decreasing externalizing symptoms (N= 1263; 12.4%); 4) moderate increasing internalizing and high increasing externalizing symptoms (N= 642; 6.3%). Presence of regulatory problems at 9 months and excessive screen media exposure at 3 years (particularly >2 hours) were independently associated with increased likelihood of all classes. Excessive screen media exposure at 3 years did not significantly moderate the association between regulatory problems at 9 months and internalizing and externalizing symptom trajectories.

Conclusions:
Both regulatory problems in infancy and screen media exposure >2 hours in early childhood are early risk factors for the development of internalizing and externalizing symptoms. However, the association between infant regulatory problems and childhood internalizing and externalizing symptoms appears to operate independently of excessive screen media exposure. Clinicians should be aware of, and treat, regulatory problems in infancy to prevent chronic patterns of self-regulatory problems across childhood. Further, they should discuss and advocate for family media plans with parents to help decrease the long-term negative effects on internalizing and externalizing symptoms.

The Irish education system is undergoing significant change as it navigates the challenges of the 2020s. Schools are at the frontline of Ireland’s efforts to integrate migrant families, build an inclusive society and tackle generational socioeconomic inequality. They are also, increasingly, key sites of contestation over deep social questions like the place of faith and secularism in public institutions and the best path to ensuring young people thrive, regardless of their gender or sexual orientation. While many of these challenges resonate across the second-level sector as all schools grapple with the difficulties and opportunities of educating young adults in today’s Ireland, the focus of this report is on the voluntary secondary school sector. The report presents rich evidence from a mixed-method research study across 21 voluntary secondary schools. The research was commissioned by the Joint Managerial Body for Voluntary Secondary Schools (JMB), with the research questions designed to examine the features and experiences of students, teachers and school leaders across the voluntary sector. However, the study allows for comparisons between experiences in voluntary secondary schools and other sectors. In particular, the survey of students undertaken in this study is compared to the nationally representative longitudinal study Growing Up in Ireland (GUI) and the International Student Assessment (PISA study) on 15 year olds in Ireland and across the European Union (EU). This approach allows for a deep exploration of the voluntary secondary sector, while also placing experiences in a national and international context.

Although children’s relationships with their parents and teachers contribute to their school adjustment and achievement, few studies have examined interactions between these relationships, particularly for father-child relationships. Using the Growing Up in Ireland birth cohort (N = 7507, 50.3% male), we examined child-adult relationship quality – rated by parents at age 3 and by teachers at age 5 – as predictors of teacher-rated behavioural adjustment and academic achievement at age 9 (indexed by self-reported academic self-concepts and performance on formal reading assessments). Controlling for prior levels of problem behaviours, verbal ability, and family SES, our results indicated that children’s relationships with parents and teachers showed small and comparable independent effects on school adjustment and achievement. For mothers and teachers, moderation analyses showed a cumulative risk pattern for conflictual relationships and a compensatory pattern for close relationships. Children are likely to benefit from improving closeness and reducing conflict in adult-child relationships as well as interventions that involve mothers, fathers, and teachers.

Specific pregnancy complications, socioeconomic position and sex have all been independently associated with child mental health outcomes, but their combined effects remain unclear. We examined whether total number of complications experienced in the pregnancy associated with mental health at 5 and 9-years, and whether this varied by sex or adverse social circumstances. Pregnancy complications were self-reported at 9-months post-natally from a list of 16 complications. Parents completed the Strengths and Difficulties Questionnaire (SDQ) when their child was 5 and 9-years. The primary outcome was the SDQ-total and scoring in the clinical range (> 16) was a secondary outcome. We applied generalized linear mixed models to a large nationally representative Irish cohort (GUI; n = 11,134). Analyses were adjusted for sex, adverse social circumstances (at 9-months), and gestational smoking. We included an interaction term between pregnancy complications and each variable respectively in separate models to examine if associations varied by sex or adverse circumstances.

After controlling for covariates, total complications associated with mental health at 5 and 9-years. Each additional pregnancy complication conferred a 10% higher total-SDQ score (exponentiated co-efficient 1.10 [95%CI 1.06–1.14], 1.20 [1.15–1.26], 1.20 [1.12–1.29] and 1.34 [1.21–1.48] for 1, 2, 3 and 4 + complications respectively). For the dichotomised outcome, generally increasing odds for clinical levels of mental health difficulties were observed (OR 1complication = 1.89, 95%CI [1.37–2.59]; OR 2complications = 2.31, 95%CI [1.53–3.50]; OR 3complications = 1.77, 95%CI [0.89–3.52]; OR 4 + complications = 6.88, 95%CI [3.29–14.40]). Females had significantly lower odds of exhibiting clinically significant mental health difficulties than males (OR = 0.43, 95%CI[0.32–0.57]).

There was no evidence that the association between pregnancy complications and child’s mental health varied by sex or social circumstances at 5 or 9-years. Males exposed to numerous pregnancy complications in the context of adverse social circumstances had the highest predicted probability of having mental health difficulties in middle childhood.

Background
Poverty is associated with poor outcomes, yet exposure to distinct poverty trajectories in early childhood is not well understood.

Objective
To understand the prevalence of different trajectories of household poverty and their association with mid-childhood and mother indicators of physical health and psychopathology in Ireland.

Methods
We used a nationally representative, prospective cohort (Growing Up in Ireland–Infant Cohort). Household poverty included lowest third income decile, subjective poverty and material deprivation when children were aged 9 months, and 3, 5, 9 years. We used group-based multitrajectory cluster modelling to classify trajectories of poverty. Using multivariable logistic regression, adjusted with separate child and mother confounders, we assessed the association of poverty trajectories from 9 months to 9 years with child outcomes (overweight, any longstanding illness and psychopathology) at age 9 years and the same poverty trajectories over the same 9-year period with mother outcomes (overweight, any longstanding illness and depression).

Results
Of 11 134 participants, 4 trajectories were identified: never in poverty (43.1%), material/subjective>monetary poverty (16.1%), monetary>material poverty (25.6%) and persistent poverty (15.2%). Children in persistent poverty compared with those in never in poverty experienced higher odds of being overweight at 9 years (adjusted OR (aOR) 1.70, 95% CI 1.34, 2.16), having a longstanding illness (aOR 1.51, 95% CI 1.20, 1.91), and psychopathology (aOR 2.06, 95% CI 1.42, 2.99). The outcomes for primary parents (99.7% were mothers) were as follows: having higher odds of being overweight (aOR 1.49, 95% CI 1.16, 1.92), having a longstanding illness (aOR 2.13, 95% CI 1.63, 2.79), and depression (aOR 3.54, 95% CI 2.54, 4.94).

Conclusions
Any poverty trajectory was associated with poorer psychopathology and physical well-being in late childhood for children and their mothers in Ireland.

This study investigates the long-term effects of victimization from middle adolescence to late adolescence and early adulthood, examining emotional and behavioral problems, peer relationships, and smoking habits and sleeping difficulties. The study also explores how these outcomes can persist into early adulthood, taking into consideration early victimization experiences, gender, cognitive ability, and family social class. The total sample included 7525 participants, spanning the ages of 13, 17, and 20, from the Child Cohort of the Growing Up in Ireland study (48.9% male). The path analysis model suggests that victimization is associated with behavioral problems at age 17, and it is also linked to emotional problems and sleeping difficulties at both ages 17 and 20. Additionally, sleeping difficulties, smoking habits, and indices of emotional and behavioral adjustment exhibit some stability between ages 13 and 17, as well as 17 and 20. Theoretical and practical implications are discussed.

Background
Past empirical evidence on the longitudinal relations between emotional mental health symptoms and parent-child close relationships has produced mixed and inconclusive results. Some studies suggest a unidirectional relation, whereas other studies point toward a bidirectional association. Additionally, most of the past research has been carried out with adolescent samples, rather than children. Hence, this study aimed to estimate the longitudinal relations between children’s trait emotional difficulties and trait parent-child closeness, accounting for the time-invariant and time-varying state components of each factor.

Methods
Participants were 7,507 children (ages 3 years, 5 years, 7 years, and 9 years) from the Growing Up in Ireland cohort. Α bivariate stable trait, autoregressive trait, and state (STARTS) model was estimated using Bayesian structural equation modelling.

Results
The STARTS model revealed that children’s emotional difficulties and parent-child closeness were relatively stable across time, and these overarching traits were strongly negatively correlated. Children’s earlier trait emotional difficulties predicted later trait parent-child closeness and vice versa between 3 years and 5 years, and between 5 years and 7 years, but these effects disappeared between 7 years and 9 years. At all pairs of time points, state emotional difficulties and state parent-child closeness were weakly negatively correlated.

Conclusions
Overall, the results suggest that early and middle childhood are critical stages for improving parent-child relationships and reducing children’s emotional difficulties. Developing close parent-child relationships in childhood appears to be a key factor in reducing children’s subsequent emotional difficulties. Children who face greater than usual emotional difficulties tend to be more withdrawn and less receptive to close parent-child relationships and this could serve as an important screening indicator.

This study draws on data on Growing Up in Ireland (GUI) Cohorts ’98 and ’08 to document changes in the lives of adolescents over the period 2011/12 to 2021/22, building on an earlier study (Smyth, 2022) which compared their experiences at nine years of age. This decade was a period of considerable social and policy change, including reform of the junior cycle, growing digitalisation and the disruption of the pandemic to all aspects of young people’s lives. Changes were also evident in the profile of young people and their families, with increasing cultural diversity, higher education levels among parents, lower levels of financial strain and increasing numbers with a disability among members of Cohort ’08 than among their older cohort counterparts. The study looks at changes in 13-year-olds’ relationships with their parents and peers, in their day-to-day activities and in their experiences of school. The main research questions addressed by the study are: How have the quality of relationships, experience of learning and activities engaged in by adolescents changed over the course of a decade? To what extent do any such changes reflect differences in the family characteristics of the young people? Are any such changes more evident for boys or girls or for young people from different social backgrounds? Is differentiation by gender and social background in adolescents’ social worlds less evident for the younger cohort than previously?

There has been a good deal of attention in Irish policy discourse to housing supply and affordability. However, there has been less focus on the extent to which the quality of housing impacts the wellbeing of children and their parents. This study addresses this gap in knowledge by using data from Growing Up in Ireland (GUI) Cohort ’08 to explore the influence of housing and neighbourhood quality on parental and child wellbeing. In particular, it looks at how the length of time households have spent experiencing inadequate housing can shape families’ wellbeing. The study adopts a multidimensional approach to measuring inadequate housing, capturing whether the home is unsuitable (in terms of size or problems like damp), whether the household struggles to adequately heat the home, lack of access to a garden or play space, the number of residential moves and the type of tenure. In addition, neighbourhood quality is assessed in terms of local disorder, having low social capital (with few family and friends in the area) and having access to fewer local services. Child wellbeing is measured using the Strengths and Difficulties Questionnaire (SDQ), which captures the extent of children’s socio-emotional difficulties.

Background
The association between multidimensional household poverty (MHP) and child and mother psychopathology trajectories is not well understood. The aim of this paper is to explore this association.

Methods
We analysed 9241 infants and mothers recruited at 9-months (m) and 32-years (y) respectively from the Growing-up-in-Ireland study and followed up when the child was aged 3, 5, 7, 9 and 13y. MHP was derived from monetary, subjective and material poverty questionnaires completed by mothers before infant age 3y using latent-class-analysis. Confounder-adjusted linear spline multilevel models were used to examine the association between MHP before 3y and trajectories of child (3-to-13y) and mother (34-to-46y) psychopathology wellbeing measures (Strengths-and-difficulties-questionnaire and Centre-for-epidemiological-studies-depression-scale, respectively).

Results
In adjusted models, MHP before 3y was associated with a higher mean difference(MD) (MD:0.67, 95%CI 0.41,0.92) in child psychopathology at 3y and this was broadly similar at age 13y (MD:0.87, 95% CI 0.57,1.17). MHP prior to 3y was associated with a higher mother psychopathology when her child was age 3y (MD:1.07, 95% CI 0.90,1.23) and this persisted albeit with a slight reduction in magnitude at age 13y of the child (MD:0.72, 95% CI 0.53,0.90).

Conclusions
Though replication in other cohorts is required, findings suggest that MHP exposure in child infancy may have early negative life course impacts on mother and child wellbeing that persist for up to a decade. If causal, these findings underscore the importance of early life course policy interventions to prevent and ameliorate poverty to reduce long term psychopathology of mothers and their children.

This article uses two longitudinal cohort studies (Growing Up in Ireland and the National Educational Panel Study) to examine how shadow education relates to academic performance in Ireland and Germany. Patterns of take-up of, and outcomes from, shadow education are found to reflect the particular country context—aimed at maintaining performance to avoid grade retention in Germany and preparing for a high-stakes upper secondary exam in Ireland. Participation enhances academic performance but only for students with lower levels of prior achievement. However, the relationship is not much stronger than with engagement in structured out-of-school activities. Thus, shadow education appears to be one of a number of strategies used by more privileged families to secure educational advantage.

Background
Research has demonstrated positive associations between adverse childhood experiences (ACEs) and substance use behaviours in young adults. However, many of these are based on cross-sectional data. The pathway between ACEs and substance misuse among emerging adults is also not fully understood and few studies have investigated potential mediating factors.

Methods
We analysed data from the Child Cohort of the Growing Up in Ireland study, a nationally representative longitudinal sample of children recruited at 9 years of age (n = 4,729). Logistic regression was used to examine individual and cumulative ACE exposure relationships with substance use at age 20 years. Mediation analyses were used to assess whether parental and peer relationships and school engagement mediate ACE history associations with substance use behaviours.

Results
ACE exposure relationships with current cannabis use, other illicit drug use and problematic drug use were observed. In particular, young adults who had experienced 2 ACEs or 3 + ACEs had an approximate two-fold (OR=1.80, 95 % CI: 1.29, 2.51) and approximate three-fold (OR=2.94, 95 % CI: 2.06, 4.19) increased odds of problematic drug use, respectively, when compared to participants who had experienced no ACEs during the study period. Mediation analyses suggested that parent and peer attachment and liking school partially mediate relationships between ACEs and substance use behaviours.

Conclusions
Children who have experienced ACEs are at higher risk of future substance use and problematic drug use. In supporting these children, identified mediators such as interpersonal relationships and school engagement may help guide selection of prevention interventions.

The world-wide COVID-19 pandemic significantly disrupted education, with school closures leading to a shift to remote learning. Existing and emerging research has shown that even a relatively short period of missed school has negative consequences for academic and social outcomes among children and young people, especially for those from more vulnerable families. While emerging research drawing on cross-sectional data has focussed on how the pandemic has affected immigrant youth, there is a paucity of longitudinal studies in this field. In this paper, we used the longitudinal Growing Up in Ireland study to investigate and analyse the wellbeing of migrant-origin 12-year-olds in Ireland during the COVID-19 pandemic. Our research shows that compared to their Irish peers, immigrant adolescents had poorer wellbeing, partly related to differences in family support for remote learning, in experiences of poor-quality interaction with peers and in levels of family strain.

The world-wide COVID-19 pandemic significantly disrupted education, with school closures leading to a shift to remote learning. Existing and emerging research has shown that even a relatively short period of missed school has negative consequences for academic and social outcomes among children and young people, especially for those from more vulnerable families. While emerging research drawing on cross-sectional data has focussed on how the pandemic has affected immigrant youth, there is a paucity of longitudinal studies in this field. In this paper, we used the longitudinal Growing Up in Ireland study to investigate and analyse the wellbeing of migrant-origin 12-year-olds in Ireland during the COVID-19 pandemic. Our research shows that compared to their Irish peers, immigrant adolescents had poorer wellbeing, partly related to differences in family support for remote learning, in experiences of poor-quality interaction with peers and in levels of family strain.

Adolescence and young adulthood are critical periods in the development of healthy sexual health and relationships, as patterns of behaviour that develop during these life stages shape outcomes throughout the life course. Recent rises in notifications of certain sexually transmitted infections (STIs) among young people in Ireland have raised concerns over the extent to which young people have the skills and information to make healthy choices in relation to their sexual health and wellbeing. In this context, sexual health literacy – i.e., the degree to which individuals have the ability to find, understand and use information and services to inform decisions and actions – is a key protective factor for the prevention of negative sexual health outcomes and for allowing young people to be more in control of their own sexual and reproductive health. In this report, we used data from Cohort ’98 of Growing Up in Ireland, the national longitudinal study of children and young people in Ireland, to examine the factors associated with sexual health literacy among young adults, and how sexual health literacy is associated with sexual health behaviours (i.e., condom and contraception use). The Growing Up in Ireland data on sexual health literacy were collected in 2018 when the young people were 20 years of age, and the measure of sexual health literacy was based on answers to two questions that gauged knowledge of female fertility and STI prevention methods.

Lone mothers have been found to report lower average mental health than partnered mothers. Following the ‘stress process model’, disparities in women’s mental health by family structure could be explained by lone mothers’ higher exposure to multiple forms of stressors, compared to partnered mothers. Yet, this hypothesis has not been tested in previous studies. This study analysed four waves of longitudinal data from the Growing Up in Ireland study, spanning between the year when women gave birth (2008) to 9 years later (2017) (N = 5,654 women), to examine how family stressors (i.e., financial strain, caregiving strain, work-related strain, and parental conflict) influence mothers’ depressive symptoms by family structure. Analyses applied random-effects models and Karlson-Holm-Breen (KHB) decomposition techniques, combined with different model specifications as robustness checks (i.e., fixed-effects). Results indicate that: (1) net of sociodemographic factors, lone mothers experience higher levels of depressive symptoms than partnered mothers, with additional analyses confirming that transitioning from partnered to lone mother is associated with higher depressive symptoms, and from lone to partnered mother with reduced depressive symptoms; (2) although 41% of the observed statistical association between family structure and mothers’ depressive symptoms is direct, a larger 59% of this mental health gap is mediated by inequalities between lone and partnered mothers in their exposure to family stressors; and (3) the largest share of the observed mediation by family stressors is explained by lone mothers’ higher risks of current and past caregiving strain and parental conflict, but also by their current higher financial strain. Overall, this study suggests that lone mothers’ lower mental health, compared to partnered mothers, is largely explained by disparities in exposure to family stressors, pointing to how accumulated caregiving and parental stressors, as well as poverty risks, are key explanatory factors behind the mental well-being disadvantage that lone mothers face.

Purpose
Despite growing concerns about trends in cocaine use, there is a shortage of longitudinal research that prospectively examines risk and protective factors associated with cocaine initiation and use in general youth populations. This study addresses this gap.

Methods
Growing Up in Ireland is a nationally representative cohort. Individual, family, and socio-environmental exposures associated with incident past-year cocaine use at ages 17 (N = 5965) and 20 (n = 4549) were assessed with survey-weighted logistic regression using generalised estimating equations. Prevalent past-year cocaine use at 20 (N = 4679) was analysed using generalised estimating equations complemented by gradient-boosted decision trees and Shapley explanations.

Results
221 (3.7%) self-reported cocaine use at 17 and 1072 (22.9%) at 20. Alcohol use at 14 or younger was associated with eight times the odds of cocaine use at 17 (aOR 8.0, 95% CI 1.7–37.3) and 19 times at 20 (aOR 19.2, 95% CI 8.6–43.2). Peer cannabis use was associated with 7 times the odds of cocaine use at 17 (aOR 7.3, 95% CI 2.9–18.3) and double at 20 (aOR 2.4, 95% CI 1.8–3.2). Growing up in a neighbourhood where substance use was common doubled the odds of cocaine use at 17 (aOR 2.4, 95% CI 1.3–4.4). Shapley explanations revealed individual-specific positive or negative impacts of exposures.

Discussion
Cocaine use among 20-year-olds in Ireland is higher than reported internationally, and increases sharply between the ages of 17 and 20, suggesting a need for interventions targeting this age group. However, associations with early adolescent factors suggest that early interventions may also be important.

This study uses high-quality longitudinal data from the Growing Up in Ireland study to examine the interplay between home learning environment (HLE) and early childhood education (ECE) in explaining children’s skills development from 9 months to 5 years old across parental socioeconomic status (SES). Random-effects linear regression models show that: (1) supportive HLE improves children’s cognitive and socioemotional skills and ECE quality critically fosters early socioemotional skills; (2) SES is associated with higher early cognitive and socioemotional outcomes, while responsive and consistent parenting behaviours among low-SES parents is particularly critical to improve their children’s socioemotional well-being; (3) high-quality ECE attendance compensates for children’s behavioural problems in less responsive parenting environments, especially among low-SES families, whereas home literacy stimulation is necessary condition for high-quality ECE attendance to benefit children’s early cognitive skills. Overall, HLE and ECE mutually interact in explaining differences in children’s early skills development across SES groups.

Background
Whether, and how, infant characteristics and parenting quality interact is one of developmental psychology’s key questions. However, whether specific interaction patterns replicate across cohorts or developmental outcomes is largely unknown. This study investigates whether infant characteristics and parenting quality are independent predictors (additive effects) of child outcomes or interact such that certain infants particularly suffer from poor parenting (diathesis stress), particularly benefit from good parenting (vantage sensitivity) or both (differential susceptibility).

Methods
Individual participant data from over 30,000 children from four prospective cohorts were pooled. Using a competitive-confirmatory approach of model evaluation, 16 possible permutations of infant characteristics (temperament and birthweight), parenting (maternal-reported stimulating and sensitive parenting) and later developmental outcomes (fluid and crystalised intelligence, internalising and externalising behaviour) were tested. The robustness of results was evaluated by subsequently varying analytic methods, using alternative parenting measures including observer reports and excluding covariates.

Results
AIC values in 10/16 analyses indicated infant characteristics acted independently of maternal-reported parenting for predicting developmental outcomes. Interaction patterns indicating diathesis stress (4/16), vantage sensitivity (2/16) or differential susceptibility (0/16) were rare or absent. However, diathesis-stress patterns were frequently found regarding birthweight and internalising behaviours, which were largely robust to methodological changes.

Conclusions
Developmental outcomes are more consistently explained by additive effects rather than by interaction effects.

Background
Early and risky adolescent alcohol use have each been associated with adult alcohol consumption. However, it remains unclear whether these behaviours independently predict later-life substance use when considered jointly, and research examining links with substances other than alcohol is limited. This study addresses these gaps by examining longitudinal associations between age at first alcohol and risky adolescent alcohol use, with alcohol, tobacco, cannabis and other drug use in early adulthood, and aims to identify critical periods for public health interventions.

Methods
Growing Up in Ireland is a nationally representative cohort (recruited aged 9 [Wave 1], born 1997–1998). Survey-weighted logistic regression examined whether age at first alcoholic drink and risky alcohol use at age 17 (Alcohol Use Disorders Identification Test scores) independently predict high-risk alcohol (AUDIT > 15), tobacco, cannabis and other drug use at age 20. Models were adjusted for age, sex, academic ability, personality, psychological factors, socioeconomic status, familial, peer and neighbourhood substance use.

Results
The study included 4554 participants (49.8% female). Early alcohol use was common, with 27% reporting use aged 14 or younger. By age 20, 14% reported high-risk alcohol, 38% tobacco, 24% cannabis and 28% other drug use. Older age at first alcohol was associated with dose-response reductions in the odds of high-risk alcohol, tobacco, cannabis and other drug use at age 20, relative to those initiating alcohol at 14 or younger. Adolescents with high-risk alcohol use had double the odds of tobacco (adjusted odds ratio (aOR) 2.1, 95% confidence intervals (CI) 1.3–3.30) and other drug use (aOR 2.5, 95% CI 1.6–4.1) and an 11-fold increase in the odds of continued high-risk alcohol use (aOR 11.5, 95% CI 7.0–18.6) at age 20, relative to adolescents with low-risk alcohol use.

Conclusions
Age at first alcohol and risky adolescent alcohol use independently predict substance use in early adulthood when considered jointly in extensively adjusted models. These findings highlight the continued urgent need for public health interventions that address factors associated with early alcohol use and support adolescents who use alcohol in a high-risk manner given their elevated risk of progression to more serious substance use as adults.