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Int J Adolesc Med Health. 2016 Apr 11;30(1). pii: /j/ijamh.2018.30.issue-1/ijamh-2016-0004/ijamh-2016-0004.xml. doi: 10.1515/ijamh-2016-0004.

Alcohol misuse and gateway theory: a longitudinal study among adolescents in Switzerland.

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Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, 1010 Lausanne, Switzerland.
Institute of Social Sciences and LIVES, University of Lausanne, Lausanne, Switzerland.
Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital (CHUV), Route de la Corniche 10, 1010 Lausanne, Switzerland, Phone: +4121 3147375, Fax: +4121 3147373.



Adolescence is a transitory and exploratory stage during which risky behaviors such as substance use take place. This study aims to assess the characteristics and predictive risk factors of alcohol misuse among adolescents.


A sample of 621 youths was followed from ages 14 to 16 years in Switzerland between spring 2012 (T0) and spring 2014 (T1). Participants were divided into two groups according to their alcohol misuse evolution: those who increased it (Misusers) and those who decreased or never experimented it (Non-misusers). The final sample consisted of 574 adolescents. At T0, participants reported demographic data, substance use data and emotional well-being. A multivariate regression was performed to assess the explanatory variables of alcohol misuse at T1 using Non-misusers as the reference category.


Alcohol misuse in the previous month increased dramatically from 2.4% (T0) to 29.2% (T1). At the bivariate level, alcohol misuse was associated with residence, use of alcohol, tobacco and cannabis. Compared to Non-misusers, Misusers were significantly more likely to live in a rural area (aOR: 1.75 [1.1:2.8]), use cannabis (aOR: 3.2 [1.0:9.8]) and have consumed alcohol (aOR: 2.65 [1.6:4.3]) at T0.


Alcohol misuse increases dramatically with age. However, the only demographic difference between groups was that young adolescents living in rural areas were more likely to misuse alcohol. Moreover, having consumed alcohol without drunkenness and using cannabis at age 14 years predicted alcohol misuse at age 16 years. This finding is in line with the reverse gateway theory, where cannabis use precedes the use of legal substances.


adolescents; alcohol; cannabis; gateway theory; substance use


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