Background Children whose parents misuse alcohol have increased risks of own alcohol misuse in adulthood. Though most attain lower school marks, some still perform well in school, which could be an indicator of resilience with protective potential against negative health outcomes. Accordingly, the aim of this study was to examine the processes of mediation and interaction by school performance regarding the intergenerational transmission of alcohol misuse.
Methods Data were drawn from a prospective Swedish cohort study of children born in 1953 (n=14 608). Associations between parental alcohol misuse (ages 0–19) and participants’ own alcohol misuse in adulthood (ages 20–63) were examined by means of Cox regression analysis. Four-way decomposition was used to explore mediation and interaction by school performance in grade 6 (age 13), grade 9 (age 16) and grade 12 (age 19).
Results Mediation and/or interaction by school performance accounted for a substantial proportion of the association between parental alcohol misuse and own alcohol misuse in adulthood (58% for performance in grade 6, 27% for grade 9 and 30% for grade 12). Moreover, interaction effects appeared to be more important for the outcome than mediation.
Conclusion Above-average school performance among children whose parents misused alcohol seems to reflect processes of resilience with the potential to break the intergenerational transmission of alcohol misuse. Four-way decomposition offers a viable approach to disentangle processes of interaction from mediation, representing a promising avenue for future longitudinal research.
- Alcohol misuse
- School performance
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Contributors YBA designed the study, drafted the manuscript and conducted the analysis. LB contributed to the study design and revised the manuscript. NKG and LB participated in the interpretation of the results and revised the manuscript for important intellectual content. All authors approved the final version of the manuscript.
Funding This study was financially supported by the Swedish Research Council for Health, Working Life and Welfare (Grant No. 2016-07148 and Grant No. 2019-00058), and Systembolaget’s Alcohol Research Council (Grant No. FO 2019-0011).
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Ethical permission for the current study was obtained from the Swedish Ethical Review Authority (no. 2019-04376).
Data availability statement Owing to ethical regulations regarding the Stockholm Birth Cohort Multigenerational Study (SBC Multigen), access to the data is restricted. If there is interest in the unpublished data from this research article, a request can be made to the main author, who will forward it to the steering committee of the SBC Multigen.
Provenance and peer review Not commissioned; externally peer reviewed.
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