Long-term effects of minimum drinking age laws on past-year alcohol and drug use disorders.

paper Primary Public

Authors: Norberg, Karen E; Bierut, Laura J; Grucza, Richard A
Year: 2009
Journal: Alcoholism, clinical and experimental research
PMID: 19775322
DOI: 10.1111/j.1530-0277.2009.01056.x
PMCID: PMC3018854

BACKGROUND: Many studies have found that earlier drinking initiation predicts higher risk of later alcohol and substance use problems, but the causal relationship between age of initiation and later risk of substance use disorder remains unknown. METHOD: We use a "natural experiment" study design to compare the 12-month prevalence of Diagnostic and Statistical Manual, Fourth Edition, alcohol and substance use disorders among adult subjects exposed to different minimum legal drinking age laws minimum legal drinking age in the 1970s and 1980s. The sample pools 33,869 respondents born in the United States 1948 to 1970, drawn from 2 nationally representative cross-sectional surveys: the 1991 National Longitudinal Alcohol Epidemiological Survey (NLAES) and the 2001 National Epidemiological Study of Alcohol and Related Conditions. Analyses control for state and birth year fixed effects, age at assessment, alcohol taxes, and other demographic and social background factors. RESULTS: Adults who had been legally allowed to purchase alcohol before age 21 were more likely to meet criteria for an alcohol use disorder [odds ratio (OR) 1.31, 95% confidence intervals (95% CI) 1.15 to 1.46, p < 0.0001] or another drug use disorder (OR 1.70, 95% CI 1.19 to 2.44, p = 0.003) within the past-year, even among subjects in their 40s and 50s. There were no significant differences in effect estimates by respondent gender, black or Hispanic ethnicity, age, birth cohort, or self-reported age of initiation of regular drinking; furthermore, the effect estimates were little changed by inclusion of age of initiation as a potential mediating variable in the multiple regression models. CONCLUSION: Exposure to a lower minimum legal purchase age was associated with a significantly higher risk of a past-year alcohol or other substance use disorder, even among respondents in their 40s or 50s. However, this association does not seem to be explained by age of initiation of drinking, per se. Instead, it seems plausible that frequency or intensity of drinking in late adolescence may have long-term effects on adult substance use patterns.

#	Section	Preview
20	MATERIALS AND METHODS — Law coding	could be estimated in both samples, and exposures based on state of birth could be estimated in…
21	MATERIALS AND METHODS — MLDA Statistical methods	Because our dependent variables were categorical indicators, we used both logistic and probit…
22	MATERIALS AND METHODS — MLDA Statistical methods	are large enough that nearly identical estimates and standard errors were generated by ordinary…
23	MATERIALS AND METHODS — MLDA Statistical methods	The basic structure of our regression model is given by:…
24	MATERIALS AND METHODS — MLDA Statistical methods	birth year, to further control for state-specific time trends. Some “long” models included other…
25	MATERIALS AND METHODS — MLDA Statistical methods	We investigated the effects of MLDA exposure on self-reported age of onset of drinking in two types…
26	RESULTS — Sample description	Table 1 describes the combined NLAES/NESARC samples. Subjects ranged from 20 to 44 years old at the…
27	RESULTS — Prediction from MLDAs to age of onset	As in other studies, we found that exposure to a lower legal purchase age did predict earlier…
28	RESULTS — Prediction from MLDAs to age of onset	.81, p <.0001), However, an earlier legal purchase age had no significant effect on the likelihood…
29	RESULTS — Prediction from MLDA exposure to mid-life alcohol and substance use disorders	Figures 1 and 2 illustrate our core results. Figure 1 shows that an association between MLDA…
30	RESULTS — Prediction from MLDA exposure to mid-life alcohol and substance use disorders	Tables 2 and 3 further quantify these associations. In Table 2, respondents exposed to a lower MLDA…
31	RESULTS — Prediction from MLDA exposure to mid-life alcohol and substance use disorders	status and sample indicator supports the statistical appropriateness of the pooling of samples. In…
32	RESULTS — Prediction from MLDA exposure to mid-life alcohol and substance use disorders	It has been suggested that decreased availability of alcohol might lead young adults to increase…
33	RESULTS — MLDA effects in the age-restricted sample	In our strictest test for the effects of other unobserved social trends, Table 4 presents a similar…
34	RESULTS — Similarity of MLDA effects among early- and later-onset drinkers and other subgroups	If MLDA laws were working primarily through age at initiation, then we might also expect that the…
35	RESULTS — MLDA’s and cross-state migration	Finally, we tested whether cross-state migration could be a confounder of the apparent MLDA effect,…
36	RESULTS — MLDA’s and cross-state migration	and age five, and the second between 18 and 21. Even in the large Census sample, respondents who…
37	DISCUSSION	MLDA laws in the US are still controversial, and though the vast majority of previous studies have…
38	DISCUSSION	earlier MLDA exposure also predicts elevated risk for a past-year drug use disorder in middle…
39	DISCUSSION	This surprisingly strong association suggests that alcohol-related experiences in adolescence may…

Name	Type
1970s cohort local	cohort
1980s cohort local	cohort
1991–1992 Survey local	cohort
2001–2002 Survey local	cohort
adolescent drinking	phenotype
adolescents	cohort
adult alcohol dependence	phenotype
adults	cohort
adults born in the US between 1948 and 1970 local	cohort
Adults in their 40’s and 50’s local	cohort
Adults with early legal purchase eligibility local	cohort
Adults with standard legal purchase age local	cohort
age	phenotype
Age at drinking initiation local	phenotype
age at initiation	phenotype
age group	cohort
Age of drinking initiation local	phenotype
age of onset of drinking local	phenotype
Age of onset of drinking local	phenotype
Age‑restricted cohort (18‑20 within two years of MLDA law change) local	cohort
age-restricted sample local	cohort
Age-restricted sample local	cohort
alcohol	phenotype
alcohol abuse	phenotype
alcohol dependence	phenotype
Alcohol Problems	phenotype
alcohol-related problems	phenotype
Alcohol-related traffic crashes local	phenotype
Alcohol Use Disorder	phenotype
alcohol use disorders	phenotype
animal models	cohort
any past-year alcohol or other substance use disorder local	phenotype
beer	drug
benzodiazepines	drug
birth cohort	cohort
black ethnicity local	phenotype
Brain areas involved in judgment and self-control local	anatomy
Census respondents born in the US between 1948 and 1970 local	cohort
Census sample local	cohort
Clandestine binge drinking local	phenotype
cocaine	phenotype
Cohort 1948-1955 local	cohort
Cohort 1956-1970 local	cohort
combined sample	cohort
crime	phenotype
cross-state migration local	phenotype
cross-state move local	phenotype
current illegal drug use disorder local	phenotype
current substance use disorder local	phenotype
drinking	phenotype
Drinking-age laws local	drug
drinks per week	phenotype
drug	drug
drug dependence	phenotype
DSM-IV	phenotype
DSM-IV alcohol use disorder	phenotype
DSM-IV Substance Use Disorder local	phenotype
Earlier cohort local	cohort
earlier legal purchase age local	phenotype
early alcohol use	phenotype
Early birth cohort local	cohort
early cohort	cohort
educational attainment	phenotype
employment	phenotype
Episodic heavy drinking local	phenotype
exposed subjects local	cohort
family history of alcoholism	phenotype
frequency of alcohol use	phenotype
full sample	cohort
genetic risk	cohort
hallucinogens	drug
hazardous drinking	phenotype
heavy drinking	phenotype
High school seniors	cohort
Hispanic	phenotype
inhalants/solvents	drug
intensity of alcohol use local	phenotype
Intensity of drinking local	phenotype
Later birth cohort local	cohort
later cohort	cohort
Later substance dependence local	phenotype
law change local	phenotype
Law Change Cohort local	cohort
lifetime abstention status local	phenotype
Lifetime alcohol use pattern local	phenotype
Lifetime other substance use pattern local	phenotype
likelihood of lifetime abstention local	phenotype
likelihood of onset of drinking after age 21 local	phenotype
likelihood of onset of drinking at 16 or 17 local	phenotype
likelihood of onset of drinking at 19 or 20 local	phenotype
liquor	drug
Louisiana local	cohort
lower drinking age local	phenotype
lower minimum legal drinking age (MLDA) local	drug
lower MLDA local	phenotype
lower MLDA exposure local	phenotype
marijuana	phenotype
marital status	phenotype
Maternal alcohol problems	phenotype
Minimum legal drinking age local	cohort
Minimum legal drinking age (MLDA) local	drug
Minimum legal drinking age (MLDA) law local	drug
minimum legal purchase age local	cohort
minor local	phenotype
MLDA local	drug
MLDA local	phenotype
MLDA exposure local	drug
MLDA exposure local	phenotype
MLDA exposure (birth state) local	drug
MLDA exposure (current residence) local	drug
MLDA exposure (state of birth) local	drug
MLDA laws local	drug
Monitoring the Future Study (MTF) local	cohort
motor vehicle crashes local	phenotype
NESARC	cohort
NESARC sample local	cohort
nicotine	drug
nicotine dependence	phenotype
NLAES	cohort
NLAES/NESARC combined sample local	cohort
NLAES sample	cohort
NLAES survey local	cohort
Non-Hispanic black	cohort
onset of regular drinking at age 16 or 17 local	phenotype
onset of regular drinking at age 18 local	phenotype
onset of regular drinking at age 19 or 20 local	phenotype
onset of regular drinking at age 21 local	phenotype
onset of regular drinking before age 16 local	phenotype
opiates	drug
other illegal drugs local	drug
Other illegal drugs local	drug
other illegal drug use disorders local	phenotype
other substances	phenotype
parental alcoholism	phenotype
past-year alcohol or other substance use disorder local	phenotype
past-year alcohol or substance abuse disorders local	phenotype
past-year alcohol or substance use disorder local	phenotype
past-year drug use disorder local	phenotype
Past-year drug use disorder local	phenotype
past-year marijuana use disorder local	phenotype
paternal alcohol use disorder	phenotype
Persons aged 15 to 17 local	cohort
Persons aged 18 to 20 local	cohort
Persons aged 21-24 local	cohort
presence of children under 13 in the home local	phenotype
psychotropic medication	drug
Public Use Micro samples (PUMS) local	cohort
race/ethnicity	phenotype
regular alcohol use	phenotype
respondents	cohort
sedatives	drug
sex	phenotype
State beer taxes local	phenotype
State Beer Taxes local	phenotype
stimulants	drug
Subjects in their 30’s or beyond local	cohort
substance abuse	phenotype
substance use	phenotype
suicide	phenotype
Survey local	cohort
target cohort	cohort
underage drinking	phenotype
unexposed subjects local	cohort
United States	cohort
US Census local	cohort
U.S. Census 1970 local	cohort
U.S. Census 1980 local	cohort
U.S. Census 1990 local	cohort
U.S. Census 2000 local	cohort
Voluntary consumption of alcohol local	phenotype
wine	drug
young adults	cohort
young drivers local	cohort

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