Does our legal minimum drinking age modulate risk of first heavy drinking episode soon after drinking onset? Epidemiological evidence for the United States, 2006–2014

Background. State-level 'age 21' drinking laws conform generally with the United States National Minimum Drinking Age Act of 1984 (US), and are thought to protect young people from adverse drinking experiences such as heavy episodic drinking (HED, sometimes called 'binge drinking'). We shed light on this hypothesis while estimating the age-specific risk of transitioning from 1st full drink to 1st HED among 12-to-23-year-old newly incident drinkers, with challenge to a "gender gap" hypothesis and male excess described in HED prevalence reports. Methods. The study population consisted of non-institutionalized civilians in the United States, with nine independently drawn nationally representative samples of more than 40,000 12-to-23-year-olds (2006-2014). Standardized audio computer-assisted self-interviews identified 43,000 newly incident drinkers (all with 1st HED evaluated within 12 months of drinking onset). Estimated age-specific HED risk soon after first full drink is evaluated for males and females. Results. Among 12-to-23-year-old newly incident drinkers, an estimated 20-30% of females and 35-45% of males experienced their 1st HED within 12 months after drinking onset. Before mid-adolescence, there is no male excess in such HED risk. Those who postponed drinking to age 21 are not spared (27% for 'postponer' females; 95% CI [24-30]; 42% for 'postponer' males; 95% CI [38-45]). An estimated 10-18% females and 10-28% males experienced their 1st HED in the same month of their 1st drink; peak HED risk estimates are 18% for 'postponer' females (95% CI [15-21]) and 28% for 'postponer' males (95% CI [24-31]). Conclusions. In the US, one in three young new drinkers transition into HED within 12 months after first drink. Those who postpone the 1st full drink until age 21 are not protected. Furthermore, 'postponers' have substantial risk for very rapid transition to HED. A male excess in this transition to HED is not observed until after age 14.