Predictors of Early Alcohol Use Initiation and Recent Adolescent Alcohol Use Among Orphaned and Separated Children in 5 Low- and Middle-Income Countries

Background: Alcohol use accounts for over 3 million deaths each year and causes negative mental and physical health outcomes. Both adolescent use and early use initiation are associated with future dependence and alcohol-related harm. Orphaned and separated children (OSC) in low- and middle-income countries (LMICs) are particularly vulnerable to alcohol use. Methods: A cross-sectional analysis was used to explore predictors of adolescent alcohol use and early alcohol initiation among a sample of OSC in 5 LMICs. Bivariable logistic regression models were used to evaluate associations between age, gender, education, care setting, OSC status (single orphan, double orphan, neither), behavior and emotional health, the experience of potentially traumatic events (PTEs), social support, and participation in chores or work and the outcomes of early initiation and recent alcohol use. Variables with p-value <0.15 were included in a multivariable model for that respective outcome and evaluated through multivariable logistic regressions. Results: In multivariable regressions, age [OR 1.28 (1.11-1.48)], community-based setting [OR 2.74 (1.57-5.02)], non-abuse trauma [OR 5.23 (2.51-12.10)], and physical or sexual abuse [OR 1.27 (0.75-2.11)] were associated with recent use. Non-abuse trauma [OR 12.86 (3.83-80.12)] and work [OR 1.72 (0.91-3.12)] were associated with early use. Conclusions: Interventions targeting alcohol use among OSC may be more effective if they target predictors identified in this study, such as a community care setting.