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.