Age of onset or age at assessment—that is the question: Estimating newly incident alcohol drinking and rapid transition to heavy drinking in the United States, 2002–2014

Abstract

Age-specific incidence estimates are important and useful facts in psychiatric epidemiology, but incidence estimation can be challenging. Methods artifacts are possible. In the United States, where the minimum legal drinking age is 21 years, recent cross-sectional field research on 12- to 25-year-olds applied conventional "age-at-assessment" approaches (AAA) for incidence estimation based on 12-month recall. Estimates disclosed unexpected nonlinear patterns in age-specific incidence estimates for both drinking onset and for transitioning from first drink to heavy drinking. Here, our aim is to draw attention to an "age of onset" (AOO) alternative to AAA approaches and to verify whether the AOO approach also discloses nonlinearity. Yearly data are from U.S. nationally representative samples drawn and assessed for National Surveys on Drug Use and Health, 2002-2014, with standardized audio computer-assisted self-interview assessments for drinking outcomes. Both AAA and AOO approaches show nonlinearities, with an unexpected dip in drinking incidence rates after age 18 and before the age 21 minimum legal drinking age. The AOO and the AAA approaches disclosed similar age-specific patterns. We discuss advantages of the AOO approach when nonlinear incidence patterns can be anticipated, but we conclude that the AAA approach has not created an artifactual nonlinear pattern.

Nation-scale primary prevention to reduce newly incident adolescent drug use: the issue of lag time

“…With a focus on variations in the population-level incidence rates for alcohol drinking (i.e., the probability of becoming a user) over multiple years, in our own work, we have added new evidence about the peak risk of drinking onset at 21 years of age in the contemporary US. This published evidence is quite consistent with the notion that the minimum legal drinking age plays a role in shaping drinking onset as young people transition from late adolescence to age 21 years (Cheng, Cantave & Anthony, 2016a, 2016b; Cheng, Lopez-Quintero & Anthony, 2017).…”

“…In this study, incidence was conceptualized as the number of newly incident users who started drinking or smoking at a specific age rising from the “at risk” population comprised of never users assessed at a specific age and newly incident users. A previous study provides more details about this approach for the estimation of age-specific incidence (Cheng, Lopez-Quintero & Anthony, 2017). From 1999 and onward, the participants’ age is only available in aggregated groups for those older than 21 years in the public downloadable datasets.…”

"An Epidemiological Hypothesis of Policy-Shaped Drug Use Onset Curves"

“…In this short communication, we build from the recent alcohol LMA hypothesis offered by Cheng, et al [7] and we present evidence Limitations of the research include reliance upon self-reports about age and timing of cannabis onsets as well as uncontrolled confounding between states. In time, the public use dataset sample sizes also will be addressed when the enclave datasets become available, and re-opening of the data enclaves will make it possible to investigate sub-state variations, given that some within-CSWS jurisdictions do not permit retail cannabis sales.…”

“…US estimates generally show that consuming the 'first full drink' of an alcoholic beverage is an exception to this pattern of a single mid-adolescent peak. Age-specific incidence of drinking alcohol follows a distinctive bimodal pattern with the mid-adolescent peak followed by a sharp decline, a second peak at the US legal minimum drinking age of 21 years, and then a continuous decline as age increases [5][6][7]. In this paper, we use the acronym PDPD to denote this specific peak-decline-peak-decline bi-modal pattern.…”

“…In this paper, we use the acronym PDPD to denote this specific peak-decline-peak-decline bi-modal pattern. Cheng, et al [7] focused on the legal minimum drinking age (LMA) in their explanation of the PDPD pattern in the age-specific estimates.…”