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The usefulness of ‘age at first drink’ as a concept in alcohol research and prevention
Abstract
Kuntsche et al. raise concerns about age of first drinking research. Although numerous studies have linked age of first drinking with alcohol dependence and other problems, first drinking age measurement warrants improvement. None the less, given the rapid transition from first drink to drunkenness episodes, delaying drinking onset remains a reasonable prevention goal.
... Age at first alcohol use has been highlighted as a critical factor contributing to a number of health risk behaviors (Baiden, Mengo, Boateng, & Small, 2019;Caetano et al., 2014;Ciairano et al., 2009;Hingson et al., 2016;Hingson & Zha, 2009;Peleg-Oren et al., 2009). Liang and Chikritzhs (2015) examined data from the National Longitudinal Study of Adolescent Health (Add Health) and found that age at first alcohol use before age 18 was significantly associated with a higher risk of heavy episodic drinking at follow-up. ...
... This was after adjusting for demographic factors, household income, parental alcohol use, and self-perceived physical and mental health. Other observational studies have also found age at first alcohol use to be associated with social, behavioral, and mental health outcomes (Agrawal et al., 2009;Blomeyer et al., 2011;Darke & Torok, 2014;Doran & Waldron, 2017;Hingson et al., 2016;Liang & Chikritzhs, 2012;Temcheff et al., 2016). However, few studies have investigated the extent to which early initiation of alcohol might be associated with violent behaviors such as weapon carrying among adolescents. ...
... Although various studies have investigated and found age at first alcohol use to be associated with adverse social, behavioral, and mental health outcome (Agrawal et al., 2009;Blomeyer et al., 2011;Ciairano et al., 2009;Darke & Torok, 2014;Doran & Waldron, 2017;DuRant et al., 1999;Hingson et al., 2016;Chikritzhs, 2012, 2015;Temcheff et al., 2016), to our knowledge, few studies have investigated the association between age at first alcohol use and weapon carrying among adolescents. Most of the existing studies tend to focus on the association between current alcohol use and weapon carrying among adolescents (Bailey et al., 1997;DuRant et al., 1997;Goebert et al., 2004;Price, 2018a, 2018b;Muula et al., 2008), without taking into account the age at which adolescents had their first alcoholic drink. ...
Background
Although studies have investigated the association between alcohol use and violent behaviors such as weapon carrying, few studies have examined the association between age at first alcohol use and weapon-carrying among adolescents. The objective of this study was to investigate the association between age at first alcohol use and weapon carrying among adolescents.
Methods
Data for this study came from the 2019 Youth Risk Behavior Survey. An analytic sample of 13,442 adolescents aged 14–18 years old (51% female) was analyzed using binary logistic regression. The outcome variable investigated in this study was weapon carrying during the past 30 days, and the main explanatory variable investigated was age at first alcohol use.
Results
Of the 13,442 adolescents, 13.5% carried a weapon during the past 30 days, and 15.4% reported having their first alcoholic drink before age 13. In the multivariable logistic regression, adolescents who reported having alcohol before age 13 had more than double the odds of carrying a weapon when compared to those who never had alcohol before age 13 weapon (AOR = 2.32, p < .001, 95% CI = 1.87-2.89). Other significant factors associated with weapon carrying include male gender, victim of bullying, teen dating violence, sexual violence, suicidal ideation, and history of substance use. Adolescents who self-identified as Black/African American or Hispanic were significantly less likely to carry a weapon when compared to adolescents who self-identified as non-Hispanic White.
Conclusion
The findings of this study underscore the importance of developing ageappropriate intervention strategies to curb early initiation of alcohol use and weapon carrying among adolescents.
... An early onset of alcohol drinking (ED) is, in turn, one of the most reliable predictors of problematic alcohol use (Jackson, Barnett, Colby, & Rogers, 2015;Moss, Chen, & Yi, 2014;Pilatti, Read, & Pautassi, 2017). The mechanisms underlying the effect of ED are still under debate (Hingson, Zha, & White, 2016;Kuntsche, Rossow, Engels, & Kuntsche, 2016;Ystrom, Kendler, & Reichborn-Kjennerud, 2014), with some suggesting that ED has a direct, causal link upon the development of AUD (Hingson, Heeren, & Winter, 2006a;2006b) or alcohol-related negative consequences, for instance by altering the trajectories of brain transmitter systems or the brain pruning that takes place at adolescence. Yet others indicate that ED could be a consequence of preexisting psychopathology [e.g., depression (McGue & Iacono, 2008)]. ...
Psychological distress can promote alcohol consumption during emerging adulthood. Still unknown is, however, how predisposition to emotional contagion alters psychological distress, and how these phenomena are affected by level of education. The present study analyzed the effect of psychological distress, age of first contact with alcohol (early, late), and predisposition to emotional contagion on alcohol-induced negative consequences and on the volume of alcohol consumed during the last year. We also described alcohol-use behaviors as a function of sex, maximum level of education and age of first contact with alcohol, in 1505 youth from Uruguay (18-30 years). A survey measured alcohol use (Alcohol Use Disorders Identification Test and ad-hoc questionnaire), negative consequences of alcohol use [young adult alcohol consequences questionnaire (YAACQ)], psychological distress (Kessler scale) and proclivity to emotional contagion (Doherty Emotional contagion scale). The patterns of alcohol use were greater in men vs. women and in those featuring an early age of first alcohol use, yet similar in college and non-college graduates. Early drinkers had greater levels of psychological distress than late-onset drinkers. There was a significant bivariate and multiple correlation between psychological distress and the number of negative consequences of alcohol experienced during the last year, which remained significant even after controlling for total volume of alcohol consumed. Significant associations emerged between YAACQ scores and frequency of heavy episodic or binge drinking, and between psychological distress and emotional contagion, but not between emotional contagion and any of the remaining variables. Psychological distress was not significantly correlated with heavy episodic or binge drinking. The study indicates that, during adolescence and youth, psychological distress is associated with experiencing negative consequences of alcohol consumption. The study also suggested that greater levels of psychological distress may underlie the facilitating effect of an early age of drinking onset upon alcohol drinking patterns.
... Specifically, empirical definitions are often varied and/or imprecise; various confounding variables-such as family history of AUD or substance use disorders (SUD), depression, and anxiety-are not always adequately controlled for; and there is some suspicion age of onset interacts with other predictors (Kuntsche et al., 2016;Maimaris and McCambridge, 2014;Warner and White, 2003). Nonetheless, there is still some agreement that age of onset is a useful means of identifying risk of alcohol-related problems, especially when the period of observation is restricted to adolescence and/or young adulthood (Hingson et al., 2016;Labouvie and White, 2002;Warner and White, 2003). Moreover, both the WHO and US Department of Health and Human Services have advocated that early age of drinking onset should be considered a marker for future problems (US Department of Health and Human Services, 2007;WHO, 2014). ...
Background
The alcohol consumption patterns of young adults are of concern. Critically, tertiary students consume greater quantities of alcohol, are at increased risk of injury/harm, and have higher rates of alcohol use disorders as compared to their nonuniversity enrolled peers. The Brief Young Adult Alcohol Consequences Questionnaire (BYAACQ) is one of several tools utilized to explore adverse alcohol‐related outcomes among tertiary students. Alcohol intake behavior, assessed via retrospective summary measures, has been linked to BYAACQ score. It is unclear, however, how drinking assessed in real time, in conjunction with variables such as age of drinking onset, might predict severity of adverse alcohol consequences as captured by the BYAACQ.
Methods
The psychometric properties of the BYAACQ were explored using a large Australian sample of tertiary students (N = 893). A subsample (n = 504) provided alcohol intake information in real time (21 days; event and notification contingent) via a smartphone app (CNLab‐A) plus details related to age of drinking onset, drug use, parental alcohol/drug use, and anxiety/depression symptomology.
Results
Average BYAACQ score was 7.53 (SD = 5.37). Classical and item response theory analyses revealed inconsistencies related to dimensionality, progressive item severity, and male/female differential item functioning. Current drinking—namely, frequency of intake and quantity per drinking occasion—plus age of drinking onset predicted BYAACQ score after controlling for age, other drug use, and depression symptomology.
Conclusions
The BYAACQ is a sound tool for use with Australian samples. Information related to current drinking, age of drinking onset, and drug use is useful for predicting severity of alcohol use consequences. These markers might enable tertiary institutions to better target students who could benefit from prevention/intervention programs.
... While there is a difference between the first time someone has consumed a drink of alcohol and the age that someone has begun drinking excessively or regularly, the transition from first drink to first episode of drunkenness is rapid for many young people. Between one half and two thirds of prior research participants have reported that they first became drunk within a year of their first drink (Hingson, Zha, & White, 2016). If individuals who drank alcohol only once or only as part of religious practices had been excluded in the present study's definition of early onset drinkers, it is expected that even stronger associations would be found between early onset of alcohol use and adult risk behaviors. ...
The correlation between current alcohol use and sexual risk behaviors among men who have sex with men (MSM) is well documented, but little is known about age of drinking onset and current risks among this population. Data from a 2008 Internet survey of 8,452 MSM in the United States were used to assess factors associated with age of onset of alcohol use. In a multivariable model, drinking onset before age 15 was significantly associated with a higher number of lifetime male anal sex partners and being behaviorally bisexual in the past 12 months. Men who reported depressive symptoms in the past two weeks or who screened positive for alcohol abuse in the past 60 days were more likely to have early age of drinking onset. Findings suggest the need for targeting younger adolescents for alcohol screening, particularly sexual minority youth, to prevent risk behaviors in adulthood.
... 7 It is important to note the different methods used to measure adolescent alcohol consumption, in particular, consuming a few sips of alcohol versus consuming a whole alcoholic drink. Although there are some concerns with the test-retest reliability of self-reported age of first drink 8 , some argue that this should not preclude it from being a useful measure to understand the association between early onset drinking and later alcoholrelated outcomes. ...
The New South Wales School Students Health Behaviours Survey (2014) reported a substantial reduction in students aged 12-17 years reporting that they had ever consumed alcohol, from 82.7% in 2005 to 65.1% in 2014. Similar downward trends are reported nationally and internationally. Although overall consumption is declining, national recommendations maintain that it is safest for young people to not drink at all; however, 17% of all young people in Australia consumed alcohol in the past 7 days, with 6% consuming at a significant risk of harm. The factors that influence young people's uptake of alcohol are complex, including biological and broader social factors. This paper identifies some of the diverse influences on young people's alcohol consumption, and policies and programs that support healthy behaviours.
Background and aims
Early alcohol use may predict later alcohol problems, but the magnitude of this effect and impact of delayed onset remain uncertain. This study measured age‐based differences in progression from first full alcoholic drink to hazardous drinking in one of the largest and most recent prospective cohorts of Australian adolescents.
Design, settings, participants and measurement
A 7‐year (2012–19) prospective longitudinal cohort of 2082 Australian adolescents was established from the Climate and Preventure (cohort 1) and Climate Schools Combined (cohort 2) studies. Participants completed surveys annually from ages 13 to 20 years. Interval censored survival analyses were conducted with first episode of hazardous drinking [three or more on proxy Alcohol Use Disorders Identification Test (AUDIT‐C)] as the survival end‐point, controlling for age, sex and mental health symptomatology. Onset of hazardous drinking was expressed as hazard ratios (HRs), and median survival time (years) was used to model first onset of hazardous alcohol use in survival curves.
Findings
Compared with those aged 15 or older, those who had their first full drink at 12 or younger had significantly elevated risk of hazardous drinking onset during the study period [log (HR): 9.3; 95% confidence interval (CI) = 7.0–12.0, P < 0.001]. Compared with those who had their first full drink at ages 13–14, those who delayed until 15 or older had significantly later onset of hazardous drinking; 1.63 years for males (95% CI = 1.31–1.92, P < 0.001) and 1.50 for females (95% CI = 1.15–1.81, P < 0.001), resulting in a median age of onset of hazardous drinking of > 19 for both sexes (male: 19.05 years, 95% CI = 18.74–19.38; female: 19.47 years, 95% CI = 19.19–19.75). First drink at ages 13–14 was associated with the earliest onset of hazardous drinking (males: 17.43 years; females: 17.98 years).
Conclusions
In Australia, alcohol initiation prior to age 15 appears to be associated with an earlier onset of hazardous drinking than initiation after age 15.
Objective: Relative age refers to a difference in age between peers in the same academic year. Although younger age of alcohol use is associated with a higher risk of lifetime problematic alcohol use, the potential effects of relative age are poorly understood. We hypothesized that a younger relative age would be associated with a younger chronological age of testing positive for alcohol in a medical setting. Methods: Problematic alcohol use was operationalized and identified as a positive alcohol test (PAT) in a medical setting. This was a retrospective population study of all 12 to 18-year-old residents (n = 4610) of Olmsted County, Minnesota (USA), who were tested for alcohol in a medical care setting from 1998 through 2016. Cox regression models examined the relationship between relative age and the age at testing positive for alcohol. Results: Relative age was not associated with age at first PAT. Results remained nonsignificant after stratifying by gender, and after adjusting for race, number of nonalcohol-related psychiatric comorbidities, and type of alcohol testing. Conclusions: The results did not support a relative age effect as a risk factor for alcohol use in adolescents in Olmsted County, Minnesota. These results contrast with findings from previous studies on this topic, which suggested older relative age increases risk of alcohol use in adolescence.
Objective:
Although a reasonable volume of research has been conducted around health impacts of age at first drink of alcohol on adverse health outcomes, the effects of age at first drink of alcohol on knowledge of low-risk drinking and drinks counting habits were rarely researched. The objective of this study is to examine the associations between age at first full serve of alcohol, knowledge of low-risk drinking and frequency of drinks counting.
Study design:
This is a cross-sectional study.
Methods:
Data of six rounds of the National Drug Strategy Household Survey, conducted during the period 2001-2016, were analysed. Multivariable log-binomial regression models were used to explore the associations.
Results:
Most people drank the first full serve of alcohol during adolescence, and the age at first full serve of alcohol was consumed increased over time. The levels of knowledge of low-risk drinking and frequency of drinks counting increased with age at first drink of alcohol more steeply during adolescence than in the later period. Participants' age at drinking the first full serve of alcohol was significantly associated with knowledge of low-risk drinking and drinks counting. There was an increasing trend of significant risk ratio between knowledge score and the frequency of drinks counting.
Conclusion:
It seems conceivable that those who reported drinking the first full serve of alcohol before 16 years of age were indifferent to drinks counting, and they lacked necessary knowledge of standard drink of alcohol or low-risk drinking. Tailored prevention programs are recommended among adolescents to delay age at first drink of alcohol and to enhance their knowledge base on low-risk drinking.
Background:
College freshman are at-risk for hazardous alcohol drinking and for experiencing alcohol-related negative consequences. This is exacerbated in those featuring an early age of first alcohol use or of first drunkenness. It remains unclear which of these milestones is more strongly associated with alcohol outcomes.
Objective:
We examined, in Argentinean college drinkers (n = 4088; 43% men; racially and ethnically homogeneous), the association of age at drinking onset and progression to drunkenness (drunkenness naïve [Drunk-Naïve]; No-Delay [same age of first alcohol use and first alcohol intoxication]; one year of delay between age of first alcohol use and first alcohol intoxication; ≥2years of delay) on several alcohol outcomes.
Methods:
A survey measured substance use, age at drinking and drunkenness onset and alcohol-related consequences.
Results:
Alcohol consumption per drinking occasion was significantly greater in men than in women. An early drinking onset (alcohol use before age 13) and lifetime drunkenness independently exacerbated alcohol consumption per drinking occasion and during the last year. In men, Early-Onset was associated with a greater number of alcohol-related consequences when the delay between Early-Onset and the first drunkenness episode was 1 or ≥2 years yet did not significantly alter the number of negative consequences in Drunk-naïve or No-delay drinkers. In women, Early-Onset significantly enhanced the number of negative consequences when the delay was two years, but not when the delay was one-year or in Drunk-naïve or No-delay drinkers.
Conclusions:
The window between the first contact with alcohol and the first episode of drunkenness is a critical period to reduce alcohol-related problems.
Although various studies have investigated and found a significant link between age at first alcohol use and health risk behaviors, few studies have investigated the effect of age at first alcohol use on suicidal ideation among adolescents. The objective of this study was to investigate the effect of age at first alcohol use on suicidal ideation.
Methods
Data for this study were obtained from the 2015 Youth Risk Behavior Survey. A sample of 10,745 adolescents aged 14-18 years (50.9% males) was analyzed using logistic regression with suicidal ideation as the outcome variable and age at first alcohol use as the main explanatory variable.
Results
About 17% of adolescents experienced suicidal ideation during the past 12 months and 15.6% started having alcohol before age 13. Adolescents who started having alcohol before age 13 had 1.60 times higher odds of experiencing suicidal ideation and adolescents who started having alcohol by age 13 or over had 1.47 times higher odds of experiencing suicidal ideation. Other significant factors associated with suicidal ideation include experiences of forced sex, teen dating violence, bullying, and feeling sad or hopeless. Having sufficient sleep lowered the odds of suicidal ideation.
Limitations
The use of cross-sectional data limits the extent to which we can make causal claims regarding age at first alcohol use and suicidal ideation.
Conclusions
Younger age at first alcohol use was associated with increased likelihood of suicidal ideation. Public health initiatives that seek to address the co-occurring problems of alcohol use and mental health illness, sexual violence, and victimization among sexual minority youth could help in reducing suicidal ideation.
Children who initiate cigarette or alcohol use early-during childhood or early adolescence-experience a heightened risk of nicotine and alcohol dependence in later life as well as school failure, crime, injury, and mortality. Using prospective intergenerational data from the Millennium Cohort Study (MCS), we investigate the association between early substance use initiation (cigarettes or alcohol) and age 11 school engagement, academic achievement, and wellbeing. The ongoing MCS tracks the development of a nationally representative sample of children in the United Kingdom (born 2000-2002) from infancy through adolescence. At age 11, MCS children (n=13,221) indicated whether they had ever used cigarettes or alcohol; at age 7 and 11 they reported on school engagement and wellbeing and completed investigator-assessed tests of academic achievement. Using propensity score methods, children who had initiated cigarette or alcohol use by age 11 were matched to abstaining children with similar risks (or propensities) of early substance use, based on numerous early life risk and protective factors assessed from infancy to age 7. We then examined whether early initiators differed from non-initiators in age 11 adjustment and achievement. Results show that substance use by age 11 was uncommon (3% cigarettes; 13% alcohol). After matching for propensity for early initiation, school engagement and wellbeing were significantly lower among initiators compared to non-initiators. Academic achievement was not consistently related to early initiation. We conclude that initiation of smoking and drinking in childhood is associated with poorer adjustment.
Different definitions of age at first drink (AFD) tend to result in different conclusions about its harmfulness. Agreeing on one definition appears difficult due to the variety of dimensions involved. This impairs the value of AFD for alcohol research and prevention.
Background
Sipping alcohol is common during early adolescence, but research has ignored the distinction between sipping and drinking whole alcohol beverages, conflating the 2, or else simply classifying “sippers” as abstainers. Research has not addressed whether sippers are different to drinkers, in relation to variables known to be associated with adolescent alcohol consumption, or considered whether sipping and drinking behaviors may have quite different associations.
Methods
Parent–child dyads (N = 1,823) were recruited in 3 states from Australian grade 7 classes. Multinomial logistic analyses compared adolescents who had only had a sip/taste of alcohol (sippers) with adolescents who had consumed at least a whole drink (drinkers) in the past 6 months. The multivariate model assessed a broad range of demographics, parenting practices, peer influences, and adolescent externalizing and internalizing behaviors, and controlled for school clustering.
Results
Compared to drinkers, sippers were less likely to come from 1‐parent households (odds ratio [OR] = 0.59, 95% confidence interval [CI]: 0.35 to 0.98); less likely to come from low‐socioeconomic status (SES) households (OR = 0.54, 95% CI: 0.31 to 0.94); more likely to come from families where parents provide stricter alcohol‐specific rules (OR = 1.21, 95% CI: 1.11 to 1.32), stricter monitoring of the child's activities (OR = 1.10, 95% CI: 1.04 to 1.16), more consistent parenting practices (OR = 1.13, 95% CI: 1.05 to 1.23), and more positive family relationships (OR = 1.56, 95% CI: 1.02 to 2.43); and report having fewer substance‐using peers (OR = 0.80, 95% CI: 0.70 to 0.91) and greater peer disapproval of any substance use (OR = 1.30, 95% CI: 1.19 to 1.42). After adjustment for confounders, the associations with household composition and SES were no longer significant, but the familial and peer associations remained significant in the multivariate analysis, χ²(40) = 1,493.06, p < 0.001.
Conclusions
Sipping alcohol has different associations with known predictors of adolescent alcohol use than drinking whole beverages, and sipping may be a distinct or separable behavior. Future research should better define quantities of early consumption and assess the relationship between early sipping and drinking on long‐term outcomes separately.
Alcohol, tobacco and marijuana are the most commonly used drugs by adolescents in the U.S. However, little is known about the patterning of early adolescent substance use, and its implications for problematic involvement with substances in young adulthood. We examined patterns of substance use prior to age 16, and their associations with young adult substance use behaviors and substance use disorders in a nationally representative sample of U.S. adolescents.
Using data from Wave 4 of the Add Health Survey (n=4245), we estimated the prevalence of various patterns of early adolescent use of alcohol, cigarettes, and marijuana use individually and in combination. Then we examined the effects of patterns of early use of these substances on subsequent young adult substance use behaviors and DSM-IV substance use disorders.
While 34.4% of individuals reported no substance use prior to age 16, 34.1% reported either early use of both alcohol and marijuana or alcohol, marijuana and cigarettes, indicating the relatively high prevalence of this type of polysubstance use behavior among U.S. adolescents. Early adolescent use of all three substances was most strongly associated with a spectrum of young adult substance use problems, as well as DSM-IV substance use disorder diagnoses.
This research confirms the elevated prevalence and importance of polysubstance use behavior among adolescents prior to age 16, and puts early onset of alcohol, marijuana and cigarette use into the context of use patterns rather than single drug exposures.
Alcohol policies around the world seek to delay the initiation of drinking. This is partly based on the influential idea that earlier initiation is likely to cause adult alcohol problems. This study synthesises robust evidence for this proposition.
Systematic review of prospective cohort studies in which adolescent measurement of age of first drink in general population studies was separated by at least 3 years from adult alcohol outcomes. EMBASE, Medline, PsychINFO and Social Policy and Practice were searched for eligible studies, alongside standard non-database data collection activities. Data were extracted on included study methods and findings. Risk of bias and confounding was assessed for individual studies and a narrative synthesis of findings was performed.
The main finding was the meagre evidence base available. Only five studies were eligible for inclusion in this review. The existence of effects of age of first drink on adult drinking and related problems were supported, but not at all strongly, in some included studies, and not in others. Rigorous control for confounding markedly attenuates or eliminates any observed effects.
There is no strong evidence that starting drinking earlier leads to adult alcohol problems and more research is needed to address this important question. Policy makers should, therefore, reconsider the justification for delaying initiation as a strategy to address levels of adult alcohol problems in the general population, while also addressing the serious acute harms produced by early drinking.
Purpose:
The current study examines the prevalence and demographic correlates of self-reported substance use and identifies subgroups of polysubstance users among a cohort of United States 10th-grade students.
Methods:
A nationally representative school-based cohort of United States 10th-grade students completed the NEXT Generation Health Study baseline survey in spring 2010 (N = 2,524).
Results:
Past-year use of marijuana was most common among illicit drugs (26%), followed by misuse of medication (9%) and use of other illicit drugs (8%). During the past month, alcohol use was reported by more than one third (35%), binge drinking by 27%, and cigarette smoking by 19%. Results further show that substance use varied somewhat by demographic characteristics. Results from the latent class analysis of polysubstance use indicated a four-class solution as the best-fitting model; class 1 (59%) included the nonuser group; class 2 (23%) comprised the predominant alcohol user group; class 3 (11%) formed the predominant marijuana user group; and class 4 (8%) was characterized as the predominant polysubstance user group. Somatic and depressive symptoms varied significantly by class membership, with predominant polysubstance users reporting elevated levels of somatic and depressive symptoms.
Conclusions:
The findings from this national study of 10th-grade students indicate high rates of substance and polysubstance use. The high level of depressive and somatic symptoms among polysubstance users indicates the need for mental health screening and referral.
This study examined the association between age at alcohol use onset and adult alcohol misuse and dependence by testing the sensitive-period hypothesis that early adolescence (11-14) is a vulnerable period of development during which initiating alcohol use is particularly harmful.
Data came from a longitudinal panel of 808 participants recruited in 1981. Participants were followed through age 33 in 2008 with 92% retention.
Onset of alcohol use before age 11 (late childhood), when compared with initiation during early adolescence, was related to an increased chronicity of adult alcohol dependence, even after accounting for sociodemographic controls and other substance use in adolescence. The present study finds no evidence that early adolescence is a particularly sensitive period for the onset of alcohol use. Findings related to the onset of regular alcohol use and the chronicity of alcohol dependence suggest that the onset of regular drinking before age 21 is problematic, but no one adolescent period is more sensitive than others. Specifically, although all age groups that started drinking regularly before age 21 had a greater rate of alcohol dependence in adulthood, initiation of regular use of alcohol at or before age 14 was not related to greater chronicity of alcohol dependence than the initiation of regular use of alcohol in middle or late adolescence.
The findings suggest the importance of delaying the onset of alcohol use through prevention efforts as early as the elementary grades. In addition, prevention efforts should focus on preventing the onset of regular drinking before age 21.
The purpose of this study was to describe aspects of the first alcohol-use experience, and examine the predictive relations among age of first use, context of alcohol use initiation, and problem drinking with and without controls for psychosocial risk factors. Data were from the Rutgers Health and Human Development Project, a five-wave, prospective study of substance-use behaviors in a community sample. Respondents, who were first interviewed at age 12 (1979-81) and most recently at age 30 or 31 (1999-2000) (N=371), reported on their first drinking experience, and on a range of known risk factors for alcohol abuse. Most alcohol initiation occurred during a family gathering. Regardless of initiation context, youth who drank at an early age were more likely than youth who initiated later to become problem drinkers, although the risk was relatively greater for the youth who first drank outside a family gathering. Based on multivariate logistic regressions, feeling drunk at initiation was the only onset-related variable significantly associated with problem drinking; other significant risks factors included male gender, delinquency, and family history of alcoholism. Because most initiation occurs at a family gathering, alcoholism prevention research may benefit from examining the role that drinking in family contexts could play with regard to socializing young drinkers to less risky drinking behaviors in adulthood. In particular, further research focusing on the subjective effects experienced by youth when they first drink may be merited.
To examine whether starting to drink at an early age is associated with developing alcohol dependence at a younger age and chronic relapsing dependence, controlling for respondent demographics, smoking and illicit drug use, childhood antisocial behavior and depression, and family alcoholism history.
Cross-sectional survey.
Nationwide face-to-face survey with a multistage probability sample.
A total of 43,093 adults were surveyed in 2001-2002.
Based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria, lifetime alcohol dependence, dependence within 10 years of starting drinking, multiple episodes, an alcohol dependence episode in the past year, episodes exceeding 1 year, and meeting 6 or 7 dependence criteria.
Relative to respondents who began drinking at 21 years or older, those who began drinking before age 14 years were more likely to experience alcohol dependence ever and within 10 years of first drinking (adjusted hazard ratios and 95% confidence intervals [CIs], 1.78 [1.51-2.11] and 1.69 [1.38-2.07], respectively). They also more often experienced past-year dependence and multiple dependence episodes (adjusted odds ratios, 1.93 [95% CI, 1.40-2.64] and 3.09 [95% CI, 2.19-4.35], respectively). Among alcohol-dependent persons, the odds were 2.62 (95% CI, 1.79-3.84) for having at least 1 episode exceeding 1 year and 2.89 (95% CI, 1.97-4.23) for meeting 6 or 7 dependence diagnostic criteria.
There is a need to screen and counsel adolescents about alcohol use and to implement policies and programs that delay alcohol consumption.
To address and discuss the weaknesses of age at first drink (AFD) as a concept in alcohol research and prevention.
Narrative literature review.
Varying from one sip to the consumption of several full drinks, and sometimes including the specification of particular conditions (e.g. without parental consent), no exact definition and operationalization of AFD was found. Evidence reveals poor test-retest reliability when the same individuals report their AFD two or more times. Theoretical arguments and empirical evidence fail to explain why having one sip or one drink earlier than peers should cause heavier drinking and related problems later in life. Alternative explanations such as self-selection, third variable effects and systematic report bias are not considered in most studies. These shortcomings also make AFD unsuitable as an indicator or marker of underlying problems such as conduct problems and academic failure. Together with unjustified causal inferences, this has led to an over-emphasis on the relevance of postponing AFD as a way to prevent problems later in life.
We argue in favour of shifting the focus of alcohol research and prevention away from AFD towards a better understanding of the progression from infrequent, low-quantity drinking to more detrimental drinking patterns and the prevention of associated acute and short-term harm.
© 2015 Society for the Study of Addiction.
gray matter reduction in the cortical lateral frontal and temporal lobes and attenuated white matter growth of the corpus callosum and pons relative to nondrinking control subjects. In a study by Ruggeri et al. (2), alcohol use disorders were associated with hypermethylation in the 3:-protein-phosphatase-1G (PPM1G )g ene locus; more specifically, PPM1G hypermethylation was associated with the escalation of alcohol use, increased impulsiveness, and increased activity in the right subthalamic nucleus. How are thesetwoobservations—oneonneurocircuitryimagingchanges in adolescents and one on protein phosphatase methylation in adolescents—related? Theadolescentbrainundergoeswidespreadchangesinform and function, both within individual regions and in the connections betweenthem. Studies have shown that a reduction of cortical gray matter begins in preadolescence and continues into the mid-20s, possibly reflecting a normal pruning process(3,4).Equallycompellingaredatashowingthatwhite matter volume increases over the course of adolescence, presumably reflecting connectivity changes, including axonal extension and myelination (4). Mounting evidence suggests that the complex changes underlying neurodevelopment render the adolescent brain particularly vulnerable to the deleterious effects of alcohol. Heavy alcohol use during adolescence is associated with a range of neurobehavioral sequelae, including impairments in visuospatial processing, attention, and memory (5,6)andanincreased riskfor future alcoholuse disorders.
Context In 1997, unintentional injury was the leading cause of death for persons
aged 1 to 34 years. Approximately one third of deaths due to unintentional
injury in the United States are estimated to be alcohol related. Onset of
drinking at an early age has been found to be associated with alcohol dependence,
but whether early-onset drinking increases risk for unintentional injury while
drinking is unknown.Objective To explore whether persons who started drinking at an early age are
more likely to have experienced unintentional injuries while under the influence
of alcohol.Design and Setting The National Longitudinal Alcohol Epidemiology Survey, a cross-sectional
survey conducted in 1992 of a representative sample of the US population.Participants A total of 42,862 randomly selected adults (response rate, 90%; mean
age, 44 years).Main Outcome Measures Unintentional injury involvement while under the influence of alcohol
by age of drinking onset (categorized as <14 years, each age from 14-20
years, or ≥21 years).Results Relative to respondents who began drinking at age 21 years or older,
those who started before age 14 years as well as those who started at each
intervening age up to 21 years were significantly more likely to have been
injured while under the influence of alcohol, even after controlling for history
of alcohol dependence, heavy drinking frequency during the period that they
drank most, family history of alcoholism, and other characteristics associated
with earlier onset of drinking. After adjusting for these variables, odds
ratios for having been injured while under the influence of alcohol were as
follows: for younger than 14 years, 2.98 (95% confidence interval [CI], 2.29-3.89);
age 14 years, 2.96 (95% CI, 2.26-3.88); age 15 years, 3.14 (95% CI, 2.48-3.97);
age 16 years, 2.38 (95% CI, 1.90-2.98); age 17 years, 2.12 (95% CI, 1.66-2.71);
age 18 years, 1.33 (95% CI, 1.08-1.64); age 19 years, 1.42 (95% CI, 1.07-1.89);
and age 20 years, 1.39 (95% CI, 1.01-1.91).Conclusion Drinking onset at ages younger than 21 years is associated with having
experienced alcohol-related injuries.
Documenting changes in alcohol consumption is critical for assessing future health service and alcohol treatment needs, evaluating efforts to modify drinking behavior and understanding the impact of shifting demographics and social norms. For the period since 2000, published data on drinking trends have been scarce and inconsistent.
Using data from two large, nationally representative surveys of U.S. adults (2001-2002 and 2012-2013) that contained virtually identical questions on consumption, we assessed differences by period in the prevalence of drinking, volume of intake, frequency of drinking and prevalence of ≥monthly heavy episodic drinking (HED) and determined whether changes in consumption were consistent across beverage types and in population subgroups.
Between 2001-2002 and 2012-2013, the prevalence of drinking increased, as did volume and frequency of drinking and prevalence of ≥monthly HED among drinkers. Increases were greater for women than men for all measures and smaller among the formerly married for consumption among drinkers. The increase in overall drinking prevalence was magnified among all race-ethnic minorities, whereas the increase in ≥monthly HED was magnified only among Blacks (all relative to Whites).
Our findings are suggestive of a "wetter" drinking climate in 2012-2013 than in 2001-2002, indicating the need for continued and expanded efforts to prevent chronic and episodic heavy alcohol consumption. Given the across-the-board increases in alcohol consumption in recent years, policy efforts that address drinking at the population level are supported, even if specific drinking behaviors and subgroups of drinkers are additionally targeted for individualized approaches.
Published by Elsevier Ireland Ltd.
This article reviews the neurocognitive and neuroimaging literature regarding the effect of alcohol use on human adolescent brain structure and function. Adolescents who engage in heavy alcohol use, even at subdiagnostic levels, show differences in brain structure, function, and behavior when compared with non-drinking controls. Preliminary longitudinal studies have helped disentangle premorbid factors from consequences associated with drinking. Neural abnormalities and cognitive disadvantages both appear to predate drinking, particularly in youth who have a family history of alcoholism, and are directly related to the neurotoxic effect of alcohol use. Binge drinking and withdrawal and hangover symptoms have been associated with the greatest neural abnormalities during adolescence, particularly in frontal, parietal, and temporal regions.
The Substance Abuse and Mental Health Services Administration (SAMHSA) has twice used a nationwide network of community-focused town hall meetings (THMs) as part of a health communications strategy to promote behavior change in individuals, organizations, communities, and society at large around the issue of underage drinking (UAD). SAMHSA sponsors the initiative on behalf of the federal Interagency Coordinating Committee on the Prevention of Underage Drinking. In spring 2008, SAMHSA engaged members of the National Prevention Network to identify community-based organizations (CBOs) to host THMs. The result was a coordinated national effort to further the goals set forth in The Surgeon General's Call to Action To Prevent and Reduce Underage Drinking (2007). More than 1,600 CBOs conducted over 1,800 THMs, resulting in a 30% increase in participation over the 2006 initiative. CBOs reported high levels of satisfaction with their efforts to mobilize communities. The majority planned to conduct additional UAD prevention efforts, including more THMs.
Research suggests that individuals who start drinking at an early age are more likely to subsequently develop alcohol dependence. Twin studies have demonstrated that the liability to age at first drink and to alcohol dependence are influenced by common genetic and environmental factors, however, age at first drink may also environmentally mediate increased risk for alcohol dependence. In this study, we examine whether age at first drink moderates genetic and environmental influences, via gene x environment interactions, on DSM-IV alcohol dependence symptoms.
Using data on 6,257 adult monozygotic and dizygotic male and female twins from Australia, we examined the extent to which age at first drink (i) increased mean alcohol dependence symptoms and (ii) whether the magnitude of additive genetic, shared, and nonshared environmental influences on alcohol dependence symptoms varied as a function of decreasing age. Twin models were fitted in Mx.
Risk for alcohol dependence symptoms increased with decreasing age at first drink. Heritable influences on alcohol dependence symptoms were considerably larger in those who reported an age at first drink prior to 13 years of age. In those with later onset of alcohol use, variance in alcohol dependence was largely attributable to nonshared environmental variance (and measurement error). This evidence for unmeasured gene x measured environment interaction persisted even when controlling for the genetic influences that overlapped between age at first drink and alcohol dependence symptoms.
Early age at first drink may facilitate the expression of genes associated with vulnerability to alcohol dependence symptoms. This is important to consider, not only from a public health standpoint, but also in future genomic studies of alcohol dependence.
To explore whether early age of drinking onset is prospectively associated with respondents unintentionally injuring themselves and others when respondents were under the influence of alcohol, controlling for current alcohol dependence/abuse, frequency of consuming 5 drinks per occasion, and other demographic characteristics.
From 2001 to 2002, in-person interviews were conducted with a national multistage probability sample of 43,093 adults aged 18 years older. From 2004 to 2005, of 39,959 eligible respondents, 34,653 were reinterviewed. The cumulative 2-survey response rate was 70.2%. Respondents were asked the age at which they first started drinking (not counting tastes or sips), diagnostic questions for alcohol dependence and abuse, questions about behaviors that increase risk of injury, and whether respondents, when under the influence of alcohol, injured themselves or someone else as a driver in a motor vehicle crash or in some other way.
Logistic regression analyses revealed that the younger respondents were when they started drinking, the greater the likelihood that, between the 2 surveys, they experienced alcohol dependence/abuse, drank 5 drinks per occasion at least weekly drove under the influence of alcohol, and placed themselves in situation after drinking where they could be hurt. After controlling for those injury risk and sociodemographic characteristics, respondents who began drinking at earlier ages remained more likely between the 2 surveys to have, under the influence of alcohol, unintentionally injured themselves and someone else. More than one third of those injuries occurred when respondents 25 years of age were under the influence, although only 7% of respondents were 25 years of age. Persons other than respondents experienced 20% of those unintentional injuries, more than one third of them in traffic.
Delaying drinking onset may help reduce unintentional alcohol-related injuries that drinkers may inflict on themselves and others.
Data from 27,616 current and former drinkers interviewed in the 1992 National Longitudinal Alcohol Epidemiologic Survey were used to examine the relationship between age at first use of alcohol and the prevalence of lifetime alcohol abuse and alcohol dependence, among all U.S. adults 18 years of age and over and within subgroups defined by sex and race. The rates of lifetime dependence declined from more than 40% among individuals who started drinking at ages 14 or younger to roughly 10% among those who started drinking at ages 20 and older. The rates of lifetime abuse declined from just over 11% among those who initiated use of alcohol at ages 16 or younger to approximately 4% among those whose onset of use was at ages 20 or older. After using multivariate logistic regression models to adjust for potential confounders, the odds of dependence decreased by 14% with each increasing year of age at onset of use, and the odds of abuse decreased by 8%. These findings are discussed with respect to their implications for prevention policies and the need to integrate epidemiological and intervention research.
In 1997, unintentional injury was the leading cause of death for persons aged 1 to 34 years. Approximately one third of deaths due to unintentional injury in the United States are estimated to be alcohol related. Onset of drinking at an early age has been found to be associated with alcohol dependence, but whether early-onset drinking increases risk for unintentional injury while drinking is unknown.
To explore whether persons who started drinking at an early age are more likely to have experienced unintentional injuries while under the influence of alcohol.
The National Longitudinal Alcohol Epidemiology Survey, a cross-sectional survey conducted in 1992 of a representative sample of the US population.
A total of 42,862 randomly selected adults (response rate, 90%; mean age, 44 years).
Unintentional injury involvement while under the influence of alcohol by age of drinking onset (categorized as <14 years, each age from 14-20 years, or >/=21 years).
Relative to respondents who began drinking at age 21 years or older, those who started before age 14 years as well as those who started at each intervening age up to 21 years were significantly more likely to have been injured while under the influence of alcohol, even after controlling for history of alcohol dependence, heavy drinking frequency during the period that they drank most, family history of alcoholism, and other characteristics associated with earlier onset of drinking. After adjusting for these variables, odds ratios for having been injured while under the influence of alcohol were as follows: for younger than 14 years, 2.98 (95% confidence interval [CI], 2.29-3.89); age 14 years, 2.96 (95% CI, 2.26-3.88); age 15 years, 3.14 (95% CI, 2.48-3.97); age 16 years, 2.38 (95% CI, 1.90-2.98); age 17 years, 2.12 (95% CI, 1.66-2.71); age 18 years, 1. 33 (95% CI, 1.08-1.64); age 19 years, 1.42 (95% CI, 1.07-1.89); and age 20 years, 1.39 (95% CI, 1.01-1.91).
Drinking onset at ages younger than 21 years is associated with having experienced alcohol-related injuries. JAMA. 2000;284:1527-1533
The purpose of this study was to examine the relationship between age at drinking onset and the development of DSM-IV alcohol abuse and dependence in a 12-year prospective study of youth in the United States.
Logistic regression analyses were used to quantify the relationship between age at drinking onset and the development of alcohol abuse and dependence controlling for sociodemographic factors and problem indicators.
The odds of alcohol dependence decreased by 5% in 1989 and 9.0% in 1994 for each year drinking onset was delayed. In 1994, the odds of alcohol abuse increased by 7.0% with each decreasing year of age at drinking onset, while age at drinking onset was not related to alcohol abuse in 1989. Several other risk factors were found to be strong and consistent predictors of abuse and dependence in 1989 and 1994, including being male, divorced, separated or never married, younger, and having an early history antisocial behaviors and marijuana use.
Implications of the results of this study are discussed in terms of other factors that may impact on the onset-abuse and onset-dependence relationship and the need to focus future prevention efforts.
Early alcohol use is associated with abuse and dependence of licit and illicit substances later in life. The role of genetic and environmental factors in this association is not conclusive.
In 1992, data on substance use, abuse/dependence and psychiatric disorders were collected from 8169 male twin members of the Vietnam Era Twin Registry. The interview obtained age of onset of regular drinking (one drink/month for 6 or more months). Regression analyses of twin pairs discordant for early alcohol use tested whether the association between early drinking (before age 17) and adult substance use and abuse/dependence remained after controlling for genetic factors, family environment and covariates. Twin models tested for common genetic and/or environmental influences on early drinking and adult alcohol dependence and ever use and abuse/dependence on marijuana and other drugs.
Co-twin analyses suggested the association between early regular alcohol use and adult alcohol dependence, marijuana and other drug use, and marijuana and other drug abuse/dependence could not be entirely explained by common genetic and shared family environmental factors. Genetic contributions to early regular drinking were significantly correlated with those on use of marijuana (rA=0.59), use of other drugs (rA=0.64), alcohol dependence (rA=0.54) and abuse/dependence of marijuana and other drugs (rA=0.63 and 0.66). Small but significant unique environmental correlations (rE range 0.11-0.22) indicated that familial factors could not entirely explain the association between early alcohol use and later substance use, abuse and dependence.
Early regular drinking is associated with later alcohol dependence and use, abuse/dependence on drugs. The association is not entirely explained by genetic or shared family environmental factors. This suggests unique environmental factors contribute to transitions from early regular alcohol drinking to use, abuse and dependence on alcohol and other substances.
Age at onset of alcohol use and DSM-IV alcohol abuse and dependence: a 12-year follow-up
- Grant