Jump to ContentJump to Main Navigation
Show Summary Details
More options …

International Journal of Adolescent Medicine and Health

Editor-in-Chief: Merrick, Joav

Editorial Board: Birch, Diana ML / Blum, Robert W. / Greydanus, MD, Dr. HC (Athens), Donald E. / Hardoff, Daniel / Kerr, Mike / Levy, Howard B / Morad, Mohammed / Omar, Hatim A. / de Paul, Joaquin / Rydelius, Per-Anders / Shek, Daniel T.L. / Sher, Leo / Silber, Tomas J. / Towns, Susan / Urkin, Jacob / Verhofstadt-Deneve, Leni / Zeltzer, Lonnie / Tenenbaum, Ariel

CiteScore 2018: 0.79

SCImago Journal Rank (SJR) 2018: 0.350
Source Normalized Impact per Paper (SNIP) 2018: 0.476

See all formats and pricing
More options …
Volume 30, Issue 1


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

Yara Barrense-Dias
  • Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, 1010 Lausanne, Switzerland
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ André Berchtold / Christina Akre
  • Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, 1010 Lausanne, Switzerland
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Joan-Carles Surís
  • Corresponding author
  • 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
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2016-04-11 | DOI: https://doi.org/10.1515/ijamh-2016-0004



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.

Keywords: adolescents; alcohol; cannabis; gateway theory; substance use


  • 1.

    Zimmermann G, Rossier V, Bernard M, Cerchia F, Quartier V. Sévérité de la consommation d’alcool et de cannabis chez des adolescents tout-venant et délinquants. Neuropsychiatr Enfance Adolesc 2005;53:447–52.Google Scholar

  • 2.

    Swift W, Coffey C, Degenhardt L, Carlin JB, Romaniuk H, et al. Cannabis and progression to other substance use in young adults: findings from a 13-year prospective population-based study. J Epidemiol Community Health 2012;66:e26.CrossrefWeb of SciencePubMedGoogle Scholar

  • 3.

    Marcoux BC, Shope JT. Application of the Theory of Planned Behavior to adolescent use and misuse of alcohol. Health Educ Res 1997;12:323–31.CrossrefGoogle Scholar

  • 4.

    Torabi MR, Bailey WJ, Majd-Jabbari M. Cigarette smoking as a predictor of alcohol and other drug use by children and adolescents: evidence of the “gateway drug effect”. J Sch Health 1993;63:302–6.CrossrefPubMedGoogle Scholar

  • 5.

    Marmet S, Archimi A, Windlin B, Delgrande Jordan M. Substanzkonsum bei Schülerinnen und Schülern in der Schweiz im Jahr 2014 und Trend seit 1986 – Resultate der Studie “Health Behaviour in School-aged Children” (HBSC) (Forschungsbericht Nr. 75). Lausanne: Sucht Schweiz, 2015.Google Scholar

  • 6.

    Killias MAM, Lucia S, Herrmann L, Dilitz C. Self-Reported Juvenile Delinquenty in Switzerland in 2006: Overview and Explanations. Second International Self-reported Delinquency Survey: Swiss national survey (Swiss ISRD-2), FNS n°100012-109265/1. 2007.Google Scholar

  • 7.

    Poelen EAP, Scholte RHJ, Engels RCME, Boomsma DI, Willemsen G. Prevalence and trends of alcohol use and misuse among adolescents and young adults in the Netherlands from 1993 to 2000. Drug Alcohol Depend 2005;79:413–21.CrossrefGoogle Scholar

  • 8.

    Kandel D, Faust R. Sequence and stages in patterns of adolescent drug use. Arch Gen Psychiatry 1975;32:923–32.CrossrefPubMedGoogle Scholar

  • 9.

    Hall WD, Lynskey M. Is cannabis a gateway drug? Testing hypotheses about the relationship between cannabis use and the use of other illicit drugs. Drug Alcohol Rev 2005;24:39–48.CrossrefPubMedGoogle Scholar

  • 10.

    Patton GC, Coffey C, Carlin JB, Sawyer SM, Lynskey M. Reverse gateways? Frequent cannabis use as a predictor of tobacco initiation and nicotine dependence. Addiction 2005;100:1518–25.CrossrefPubMedGoogle Scholar

  • 11.

    Getz JG, Bray JH. Predicting heavy alcohol use among adolescents. Am J Orthopsychiat 2005;75:102–16.CrossrefGoogle Scholar

  • 12.

    Ralph E. Tarter PD, Michael Vanyukov PD, Levent Kirisci PD, Maureen Reynolds PD, et al. Predictors of marijuana use in adolescents before and after licit drug use: examination of the gateway hypothesis. Am J Psychiatry 2006;163:2134–40.PubMedGoogle Scholar

  • 13.

    Hibell B, Andersson B, Bjarnason T, Ahlström S, Balakireva O, et al. The ESPAD Report 2003: Alcohol and Other Drug Use Among Students in 35 European Countries. Sweden: The Swedish Council for Information on Alcohol and Other Drugs, 2003.Google Scholar

  • 14.

    Narring F, Tschumper A, Inderwildi Bonivento L, Jeannin A, Addor V, et al. Santé et styles de vie des adolescents âgés de 16 à 20 ans en Suisse (2002). SMASH 2002: Swiss multicenter adolescent survey on health 2002. Lausanne Institut universitaire de médecine sociale et préventive, 2004.Google Scholar

  • 15.

    Michel G, Purper-Ouakil D, Mouren-Siméoni MC. Facteurs de risques des conduites de consommation de substances psycho-actives à l’adolescence. Annales Médico-psychologiques, revue psychiatrique 2001;159:622–31.CrossrefGoogle Scholar

  • 16.

    Michaud PA, Suris JC, Deppen A. Gender-related psychological and behavioural correlates of pubertal timing in a national sample of Swiss adolescents. Mol Cell Endocrinol 2006;254–255:172–8.Google Scholar

  • 17.

    Steinhausen H, Winkler Metzke C. Frequency and correlates of substance use among preadolescents and adolescents in a Swiss epidemiological study. J Child Psychol Psychiatry 1998;39:387–97.CrossrefGoogle Scholar

  • 18.

    Rohde P, Lewinsohn PM, Seeley JR. Psychiatric comorbidity with problematic alcohol use in high school students. J Am Acad Child Adolesc Psychiatry 1996;35:101–9.CrossrefPubMedGoogle Scholar

  • 19.

    World Health Organization. Wellbeing measures in primary health care: the depcare project. Copenhagen: World Health Organization, Regional Office for Europe, 1998.Google Scholar

  • 20.

    Mayet A, Legleye S, Falissard B, Chau N. Cannabis use stages as predictors of subsequent initiation with other illicit drugs among French adolescents: use of a multi-state model. Addict Behav 2012;37:160–6.CrossrefWeb of SciencePubMedGoogle Scholar

  • 21.

    Kandel D. Stages in adolescent involvement in drug use. Science 1975;190:912–4.CrossrefPubMedGoogle Scholar

  • 22.

    Studer J, Baggio S, Deline S, N’Goran AA, Henchoz Y, et al. Peer pressure and alcohol use in young men: A mediation analysis of drinking motives. Int J Drug Policy 2014;25:700–8.CrossrefWeb of ScienceGoogle Scholar

  • 23.

    Cronk CE, Sarvela PD. Alcohol, tobacco, and other drug use among rural/small town and urban youth: a secondary analysis of the monitoring the future data set. Am J Public Health 1997;87:760–4.CrossrefGoogle Scholar

  • 24.

    Swaim RC, Stanley LR. Rurality, region, ethnic community make-up and alcohol use among rural youth. J Rural Health 2011;27:91–102.PubMedWeb of ScienceCrossrefGoogle Scholar

  • 25.

    Atav S, Spencer GA. Health risk behaviors among adolescents attending rural, suburban, and urban schools: a comparative study. Fam Community Health 2002;25:53–64.CrossrefGoogle Scholar

About the article

Received: 2016-01-13

Accepted: 2016-02-28

Published Online: 2016-04-11

Author contributions: Yara Barrense-Dias ( ) analyzed and interpreted the data, drafted and revised the manuscript, and approved the final version of the manuscript as submitted. André Berchtold ( ) conceptualized and designed the study, obtained funding, analyzed and interpreted the data, critically revised the manuscript, and approved the final version of the manuscript as submitted. Christina Akre ( ) conceptualized and designed the study, coordinated data collection, critically revised the manuscript, and approved the final version of the manuscript as submitted. Joan-Carles Surís ( ) conceptualized and designed the study, obtained funding, acquired, analyzed and interpreted the data, critically revised the manuscript, and approved the final version of the manuscript as submitted.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Ethics approval: This study was approved by the Ethics Committee of the canton of Vaud.

Financial support: The ado@internet.ch study has been financed by the Service of Public Health of the canton of Vaud and by the Swiss National Science Foundation (FNS 105319_140354). The funding bodies had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript.

Citation Information: International Journal of Adolescent Medicine and Health, Volume 30, Issue 1, 20160004, ISSN (Online) 2191-0278, DOI: https://doi.org/10.1515/ijamh-2016-0004.

Export Citation

©2018 Walter de Gruyter GmbH, Berlin/Boston.Get Permission

Citing Articles

Here you can find all Crossref-listed publications in which this article is cited. If you would like to receive automatic email messages as soon as this article is cited in other publications, simply activate the “Citation Alert” on the top of this page.

Wei-Wen Wu, Chieh-Yu Liu, Shiann-Tarng Jou, Giun-Yi Hung, and Shu-Yuan Liang
Nursing & Health Sciences, 2018

Comments (0)

Please log in or register to comment.
Log in