Ralph Hingson

▪ Abstract Integrating data from the National Highway Traffic Safety Administration, the Centers for Disease Control and Prevention, national coroner studies, census and college enrollment data for 18–24-year-olds, the National Household Survey on Drug Abuse, and the Harvard College Alcohol Survey, we calculated the alcohol-related unintentional injury deaths and other health problems among college students ages 18–24 in 1998 and 2001. Among college students ages 18–24 from 1998 to 2001, alcohol-related unintentional injury deaths increased from nearly 1600 to more than 1700, an increase of 6% per college population. The proportion of 18–24-year-old college students who reported driving under the influence of alcohol increased from 26.5% to 31.4%, an increase from 2.3 million students to 2.8 million. During both years more than 500,000 students were unintentionally injured because of drinking and more than 600,000 were hit/assaulted by another drinking student. Greater enforcement of the legal drinking age of 21 and zero tolerance laws, increases in alcohol taxes, and wider implementation of screening and counseling programs and comprehensive community interventions can reduce college drinking and associated harm to students and others.

Objectives: To examine the frequency of underage drinking, driving after drinking and alcohol-related crashes, trends in these behaviors, and promising interventions. Methods: We examined drinking and drinking- and-driving behaviors reported in the United States in the 2001 U.S. National Household Survey of Drug Abuse, the Centers for Disease Control and Prevention 2001 Youth Risk Behavior Survey, the 1992 National Longitudinal Alcohol Epidemiologic Study, and the 1999 National Survey of Drinking and Driving conducted for the National Highway Traffic Administration. We also examined the 1999 European School Survey Project on Alcohol and Other Drugs. Alcohol-related fatal crashes were examined from the U.S. Fatality Analysis Reporting System. Evaluation of interventions to reduce teenage drinking and driving after drinking were reviewed. Results: In the United States, 19% of youth ages 12–20 consumed five or more drinks on an occasion in the past 30 days. Although European nations have lower legal drinking ages (16–18) than in the United States (21), similar proportions engage in underage drinking. In two-thirds of European countries, a greater percentage of 15–16 year-olds drank five or more drinks on an occasion in the past month than in the United States. In both the United States and Europe, the earlier people begin to drink, the greater the likelihood of developing alcohol dependence and other alcohol-related problems, including alcohol-related crash involvement, during adolescence and adult years. During the past 20 years alcohol-related traffic deaths among people younger than 21 have been cut in half in the United States, but progress has halted since 1995 and the problem is still large. Interventions shown by research to reduce alcohol-related crashes among youth include raising the legal drinking age to 21, zero tolerance laws, and some interventions that are family, school, or community based. Conclusions: Despite research showing that a variety of interventions can reduce underage drinking and alcohol-related crash fatalities, the frequency of these behaviors remains high and the average age of drinking initiation is declining in the United States. Efforts are needed to enhance publicized enforcement of underage drinking laws. Comprehensive community interventions that include enforcement of these laws also are needed.

Objective. Early age of drinking onset has been associated with a greater likelihood among adults of experiencing alcohol dependence, frequent heavy drinking even among nondependent drinkers, and an increased risk of motor vehicle crashes, unintentional injuries, and physical fights after drinking. This study explores whether first getting drunk at a younger age is associated with a greater likelihood of college students reporting that they had unplanned or unprotected sexual intercourse because of their drinking. Methodology. In 1999 11 739 full-time 4-year college students from 128 randomly selected US colleges and universities completed a self-administered survey that asked them about their drinking practices and whether their drinking had caused them, since the beginning of the school year, to: 1) engage in unplanned sexual intercourse or 2) not use protection when having sex. Results. Among college students who drink, those first drunk before age 13 compared with those never drank until age 19 or older had a 2.0 times greater odds of having unplanned sex and a 2.2 times greater odds of having unprotected sex reportedly because of drinking, even after controlling for age, race/ethnicity, marital status, parental drinking history, age of first smoking, and marijuana use. After further controlling for history of alcohol dependence and frequency of heavy drinking those first drunk before age 13 had a 1.5 times greater odds of unplanned sex and a 1.7 times greater odds of unprotected sex reportedly because of drinking. Conclusions. Clinical, educational, legal, and community interventions to delay age of first getting drunk need to be coupled with efforts to prevent unplanned and unprotected sexual intercourse among US college students.

Objective: This study explored whether college students who were first intoxicated by alcohol at ages younger than 19 are more likely to become alcohol dependent and frequent heavy drinkers, drive after drinking, ride with intoxicated drivers and be injured after drinking. It also investigated whether these results occur because these students believe they can drink more and still drive legally and safely. Method: In 1999, 14,138 of 23,751 full-time 4-year students from a random sample of 119 college and universities nationwide completed self-administered questionnaires (response rate: 60%). This analysis focused on 12,550 who were aged 19 or older. Respondents were asked the age at which they first got drunk, as well as questions about recent alcohol-related behaviors and consequences. Results: Compared with respondents first drunk at age 19 or older, those first drunk prior to age 19 were significantly more likely to be alcohol dependent and frequent heavy drinkers, to report driving after any drinking,...

This article reviews comprehensive community interventions that sought to reduce (1) cardiovascular disease risks; (2) smoking; (3) alcohol use disorders, alcohol-related injury and illicit drug use; or (4) sexual risk taking that could lead to HIV infection, sexually transmitted disease and pregnancy. Comprehensive community programs typically involve multiple city government agencies as well as private citizens and organizations and use multiple intervention strategies such as school-based and public education programs, media advocacy, community organizing, environmental policy changes and heightened enforcement of existing policies. This review focused on English-language papers published over the past several decades. Some programs in each of the four problem areas achieved their behavioral and health goals. The most consistent benefits were found in programs targeting behaviors with immediate health consequences such as alcohol misuse or sexual risk taking. Results were less consistent when consequences of targeted behaviors were more distant in time such as cardiovascular risks and smoking. Also, programs that targeted youth to prevent them from starting new health-compromising behaviors tended to be more successful than programs aimed at modifying preexisting habits among adults. Programs that combined environmental and institutional policy change with theory-based education programs were the most likely to be successful. Finally, programs tailored to local conditions by the communities themselves tended to achieve more behavior change than programs imported from the outside. Comprehensive community intervention approaches may have considerable potential to reduce college-age drinking problems, especially given the success of these programs in reducing alcohol-related problems and in preventing health-compromising behaviors among youth.

This report estimates the numbers of 18-24 year old United States college students who annually experience alcohol-related deaths, injuries and other health problems. We examined traffic and unintentional injury deaths in 1998 reported by the National Highway Traffic Safety Administration and the Centers for Disease Control (CDC). We also examined results of national coroner studies, Department of Education college enrollment data, the National Household Survey on Drug Abuse (NHSDA), the CDC National College Health Risk Behavior Survey and the Harvard School of Public Health College Alcohol Survey (CAS). All survey participants were ages 18-24: 6,930 college and 12,394 noncollege respondents in the NHSDA survey; 3,077 college students in the CDC survey; and 12,217 full-time 4-year college students in the CAS. Based on the number and proportion of 18-24 year olds enrolled in college, data on alcohol involvement in injury deaths among 18-24 year olds and survey responses, we calculated the numbers of 18-24 year old alcohol-related injury deaths and other health problems. We estimate that over 1,400 students aged 18-24 and enrolled in 2- and 4-year colleges died in 1998 from alcohol-related unintentional injuries, including motor vehicle crashes. According to surveys conducted in 1999, in the preceding year, over 2 million of the 8 million college students in the United States drove under the influence of alcohol and over 3 million rode with a drinking driver. Over 500,000 full-time 4-year college students were unintentionally injured under the influence of alcohol and over 600,000 were hit or assaulted by another student who had been drinking. There is an urgent need for expanding prevention and treatment programs, to reduce alcohol-related harm among U.S. college students and other young adults.

Objective.: To explore whether people who start drinking at an early age are more likely to have been in physical fights after drinking, independent of respondent history of alcohol dependence and frequency of heavy drinking. Design.: In 1992, the US Census Bureau interviewed, in person, 42 862 randomly selected adults age 18 or older, mean age 44, household response rate 91.9%, and in-person response rate 97.4%. The survey included questions regarding the age respondents started drinking, frequency of heavy drinking, and whether respondents were ever or in the past year in a physical fight after drinking alcohol. Results.: Relative to respondents who did not begin drinking until age 21 or older, those who started drinking before age 17 were 2.9 to 4.1 times more likely ever in their lives, and at least 3 times more likely in the past year, to have been in a fight after drinking. These relationships were found even after controlling for personal history of alcohol dependence, years of drinking, frequency of heavy drinking, smoking, drug use, and other personal characteristics associated with the age respondents started drinking. Conclusions.: An early age of drinking onset was associated with alcohol-related violence not only among persons under age 21 but among adults as well. Physicians need to query adolescent patients about the age they began drinking and counsel them about the increased risks associated with early drinking onset, such as an increased risk of being involved in alcohol-related violence.

Research from JAMA — Age of Drinking Onset and Unintentional Injury Involvement After Drinking — ContextIn 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.ObjectiveTo 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 SettingThe National Longitudinal Alcohol Epidemiology Survey, a cross-sectional survey conducted in 1992 of a representative sample of the US population.ParticipantsA total of 42,862 randomly selected adults (response rate, 90%; mean age, 44 years).Main Outcome MeasuresUnintentional 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).ResultsRelative 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).ConclusionDrinking onset at ages younger than 21 years is associated with having experienced alcohol-related injuries.