Objective To evaluate trends in the past 30-day prevalence of binge drinking by age, gender, and student-status, among youth and young adults in the United States between 1979 and 2006, a period that encompasses the federally mandated transition to a uniform legal drinking age of 21, and other policy changes aimed at curbing underage drinking. Methods Data were analyzed from twenty administrations of the National Survey on Drug Use and Health, yielding a pooled sample of over 500,000 subjects. Trends in relative risk for four different age groups, stratified by gender, relative to the 24–34 year old reference group were calculated. We also examined trends in risk for binge drinking associated with student status (among college-age students), and race/ethnicity. Results Significant reductions in relative risk for binge drinking over time were observed for 12–20 year old males but no changes were observed for females in this age range, and binge drinking among minority females increased. Risk for binge drinking increased among 21–23 year old women, with college women outpacing non-students in this age range. Trends also indicate that no reduction in binge drinking occurred for college men. Conclusion While the overall trend is toward lower rates of binge drinking among youth, likely a result of a higher legal drinking age and other changes in alcohol policy, little improvement has occurred for college students, and increases in binge drinking among women has offset improvements among youth. Understanding these specific demographic trends will help inform prevention efforts.

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Background-Several lines of evidence suggest that the lifetime prevalence of alcohol dependence among women has increased in recent decades, but has not risen significantly for men. Early age at onset of drinking (AOD) is strongly correlated with risk for alcohol dependence and there is evidence that mean AOD has also decreased, particularly for women. The present report sought to confirm the trends in AOD and to determine the extent to which they might account for secular trends in alcohol dependence.

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 DSM-IV alcohol and substance use disorders among adult subjects exposed to different minimum legal drinking age laws MLDA in the 1970’s and 1980’s. The sample pools 33,869 respondents born in the US 1948–1970, drawn from two nationally representative cross-sectional surveys: the 1991 National Longitudinal Alcohol Epidemiological Survey (NLAES) and the 2001 National Epidemiological Study of Alcohol and Related Conditions (NESARC). 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 (OR 1.31, 95% c.i. 1.15, 1.46, p < .0001) or another drug use disorder (OR 1.70, 95% c.i. 1.19 to 2.44, p = .003) within the past year, even among subjects in their 40’s and 50’s. 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 40’s or 50’s. 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.

Context The prevalence of obesity has risen sharply in the United States in the past few decades. Etiologic links between obesity and substance use disorders have been hypothesized. Objective To determine whether familial risk for alcohol dependence predicts obesity, and whether any such association became stronger between the early 1990s and early 2000s. Design Repeated cross-sectional surveys; analyses of the National Longitudinal Alcohol Epidemiologic Survey (1991–92) and the National Epidemiologic Survey on Alcohol and Related Conditions (2001–02) were conducted. Setting The non-institutionalized, adult population of the U.S. in 1991–92 and 2001–02. Participants Individuals drawn from population-based, multi-stage, random samples (N=39,312 and 39,625). Main Outcome Measures Obesity, defined as a body mass index >= 30 based on self-reported height and weight, and predicted from family history of alcoholism and/or problem drinking. Results In 2001–02, women with a family-history of alcoholism, operationalized as having biological parent or sibling with a history of alcoholism or alcohol problems, had 49% higher odds for obesity than those without a family history (OR=1.48, 95 % CI: 1.36, 1.61; p<0.0001), a highly significant increase (p<0.0001) from the odds ratio of 1.06 (95% CI: 0.97, 1.16) estimated for 1991–92. For men in 2001–02, the association was significant (OR=1.26; 95% CI: 1.14–1.38, p<0.0001), but not as strong as for women. Both the association and the secular trend for women were robust to adjustment for covariates, including sociodemographic variables smoking, alcohol use, alcohol/drug dependence, and major depression. Similar trends were observed for men, but did not meet statistical significance criteria after adjustment for covariates. Conclusion The results provide epidemiologic support for a link between familial alcoholism risk and obesity for women, and possibly for men. This link has emerged in recent years, and may result from an interaction between a changing food environment and predisposition to alcoholism and related disorders.

Emile Durkheim's Suicide documented a monotonically increasing relation between age and suicide. Such a relation has been observed repeatedly since the beginning of the nineteenth century, making it one of the most robust facts about suicide. The differences in suicide rates by age are very large. In the United States in 1950, for example, suicide rates were four times higher for adults (ages twenty-five to sixty-four) than for youths (ages fifteen to twenty-four) and eight times higher for the elderly (sixty-five and older) than for youths.1 Economic theory explained this relation naturally, with the young having the most life to lose and also having the least information about what their life will be like (Hamermesh and Soss 1974).In recent decades, however, the monotonic relation between age and suicide has disappeared. Figure 5.1 shows suicide rates by age in 1950 and 1990 . Between 1950 and 1990, youth-suicide rates tripled (particularly among young men), while suicide rates for adults fell by 7 percent, and suicide rates for the elderly fell by 30 percent. In 1990, suicide rates for young adults (ages twenty to twenty-four) were equal to those for primeage adults and were only 25 percent below suicide rates for the elderly.David M. Cutler is professor of economics at Harvard University and a research associate of the National Bureau of Economic Research. Edward L. Glaeser is professor of economics at Harvard University and a faculty research fellow of the National Bureau of Economic Research. Karen E. Norberg is assistant professor of psychiatry at Boston University Medical School and a clinical associate of the National Bureau of Economic Research.The authors are grateful to Srikanth Kadiyala for expert research assistance, to Jonathan Gruber and Senhil Mullainathan for comments, and to the National Institute on Aging for research support.1. Throughout the paper, we refer to the fifteen-to twenty-four-year-old age group as youths. We sometimes divide this into teens (ages fifteen to nineteen) and young adults (ages twenty to twenty-four). 219Suicide is now the second or third leading cause of death for youths in the United States, Canada, Australia, New Zealand, and many countries of Western Europe.If youth suicide is an epidemic, attempted suicide is even more so. For every teen who commits suicide (0.01 percent each year), four hundred teens report attempting suicide (4 percent per year), one hundred report requiring medical attention for a suicide attempt (1 percent per year), and thirty are hospitalized for a suicide attempt (0.3 percent per year).Why have youth-suicide rates increased so much even as suicide among adults and the elderly has fallen? Why are there so many suicide attempts? It is easier to say what suicide is not than what it is. The U.S. rise in youth suicide has not been centered in America's troubled inner cities. The states with the largest increase in youth suicides between 1950 and 1990 are predominantly rural: Wyoming, South Dakota, Montana, New Mexico, and Idaho. The states w...

Does drug treatment for depression with selective serotonin reuptake inhibitors (SSRIs) increase or decrease the risk of completed suicide? The question is important in part because of recent government warnings that question the safety of SSRIs, one of the most widely prescribed medications in the world. While there are plausible clinical and behavioral arguments that SSRIs could have either positive or negative effects on suicide, randomized clinical trials have not been very informative because of small samples and other problems. In this paper we use data from 26 countries for up to 25 years to estimate the effect of SSRI sales on suicide mortality using just the variation in SSRI sales that can be explained by cross-country variation in the growth of drug sales more generally. We find that an increase in SSRI sales of 1 pill per capita (about a 12 percent increase over 2000 sales levels) is associated with a decline in suicide mortality of around 5 percent. These estimates imply a cost per statistical life far below most other government interventions to improve health outcomes.

Background Prior to the establishment of the uniform drinking age of 21 in the United States, many states permitted legal purchase of alcohol at younger ages. Lower drinking ages were associated with several adverse outcomes, including elevated rates of suicide and homicide among youth. The objective of this study is to examine whether individuals who were legally permitted to drink prior to age 21 remained at elevated risk in adulthood. Methods Analysis of data from the U.S. Multiple Cause of Death files, 1990–2004, combined with data on the living population from the U.S. Census and American Community Survey. The assembled data contained records on over 200,000 suicides and 130,000 homicides for individuals born between 1949 and 1972, the years during which the drinking age was in flux. Logistic regression models were used to evaluate whether adults who were legally permitted to drink prior to age 21 were at elevated risk for death by these causes. A quasi-experimental analytical approach was employed which incorporated state and birth year fixed effects to account for unobserved covariates associated with policy exposure. Results In the population as a whole, we found no association between minimum drinking age and homicide or suicide. However, significant policy-by-sex interactions were observed for both outcomes, such that women exposed to permissive drinking age laws were at higher risk for both suicide (OR=1.12; 95% CI 1.05, 1.18, p=0.0003) and homicide (OR=1.15; 95% CI 1.04, 1.25; p=0.0028). Effect sizes were stronger for the portion of the cohort born after 1960, whereas no significant effects were observed for women born prior to 1960. Conclusions Lower drinking ages may result in persistent elevated risk for suicide and homicide among women born after 1960. The national drinking age of 21 may be preventing about 600 suicides and 600 homicides annually.