Transition from alcohol to other drugs among adolescents in Taiwan: the first drinking context matters.

Objective: This study examined the extent to which youthful alcohol consumption and the initiation of tobacco, betel nut, and other illegal drugs may differ by their first drinking context in Taiwan-a society with social norms that are more tolerant of underage drinking. Method: In 2004, in a nationally representative sample of 11,943 school-attending youth ages 15-18, information pertaining to sociodemographic characteristics, problem behaviors, lifetime experiences of alcohol, tobacco, betel nut, and illegal drugs, as well as psychoactive, drug-specific age of initiation, context at first use, average frequency, and recency of use, was assessed by anonymous questionnaires. Results: Youth who had their first alcoholic beverages in entertainment settings or at friends' houses were more likely to become frequent drinkers. After adjustment for socioeconomic background and problem behaviors, having had the first drink in entertainment settings was associated with a faster progression into the initiation of illegal drugs (hazard ratio [HR] = 2.5, 95% confidence interval [CI]: 1.5-4.0) and betel nut (HR = 1.5, 95% CI: 1.1-2.1). Conclusions: Youthful drinking pattern and transition from alcohol to betel nut and illegal drugs may vary modestly by the first drinking context. This context may be recognized as a proxy variable to identify youth at a higher risk for alcohol and other drug problems and to devise context-based educational or prevention programs.