Age-varying associations between attempts to change weight and suicidal ideation among adolescents in the United States.

PURPOSE: The goal of this study was to inform theory and suicide prevention efforts by examining how the link between attempts to change weight and suicidal ideation varies across adolescence, when it is strongest, and whether there are sex differences. METHODS: Data were from 13,518 youth ages 14-18 years who participated in the 2019 Youth Risk Behavior Survey, a nationally representative study of U.S. high school students. Time-varying effect modeling was used to estimate associations between attempts to change weight and suicidal ideation as continuous functions of age and to test sex differences in these links. RESULTS: The link between attempts to lose weight and suicidal ideation was positive and significant between ages 14.0-17.3 years, with the strongest association at age 15.0 (OR = 2.07). There were no sex differences in this age-varying association. The association between attempts to gain weight and suicidal ideation was positive and age-varying for girls, with the strongest association at age 17.2 years (OR = 2.79). This association was not significant for boys at any age. CONCLUSIONS: Girls and boys who are trying to lose weight and girls who are trying to gain weight may be at elevated risk for suicidal ideation between ages 14 and 18 years. Findings illuminate patterns of association during adolescence and have implications for suicide prevention.

Estimating the Effects of a Complex, Multidimensional Moderator: An Example of Latent Class Moderation to Examine Differential Intervention Effects of Substance Use Services.

Improvements in substance use disorder recovery may be achieved by recognizing that effective interventions do not work equally well for all individuals. Heterogeneity of intervention effects is traditionally examined as a function of a single variable, such as gender or baseline severity. However, responsiveness to an intervention is likely a result of multiple, intersecting factors. Latent class moderation enables the examination of heterogeneity in intervention effects across subgroups characterized by profiles of characteristics. This study analyzed data from adolescents (aged 13 to 18 years old) who needed treatment for cannabis use (n = 14,854) and participated in the Global Appraisal of Individual Needs to evaluate differential effects of substance use services on cannabis use outcomes. We demonstrate an adjusted three-step approach using weights that account for measurement error; sample codes in Mplus and Latent Gold are provided and data are publicly available. Indicators of the latent class moderator comprised six contextual (e.g., recovery environment risk) and individual (e.g., internal mental distress) risk factors. The latent class moderator comprised four subgroups: low risk (21.1%), social risk (21.1%), environmental risk (12.5%), and mixed risk (45.2%). Limited moderation of associations between level of care and any past 90-day cannabis use were observed. In predicting number of cannabis use-days, compared to individuals with low risk, those with environmental risk showed improved outcomes from intensive outpatient care whereas individuals with social risk and mixed risk showed improved outcomes from residential care (all compared to early intervention/outpatient care). Latent class moderation holds potential to elucidate heterogeneity in intervention effectiveness that otherwise may go undetected.

Sensitivity and specificity of information criteria.

Information criteria (ICs) based on penalized likelihood, such as Akaike's information criterion (AIC), the Bayesian information criterion (BIC) and sample-size-adjusted versions of them, are widely used for model selection in health and biological research. However, different criteria sometimes support different models, leading to discussions about which is the most trustworthy. Some researchers and fields of study habitually use one or the other, often without a clearly stated justification. They may not realize that the criteria may disagree. Others try to compare models using multiple criteria but encounter ambiguity when different criteria lead to substantively different answers, leading to questions about which criterion is best. In this paper we present an alternative perspective on these criteria that can help in interpreting their practical implications. Specifically, in some cases the comparison of two models using ICs can be viewed as equivalent to a likelihood ratio test, with the different criteria representing different alpha levels and BIC being a more conservative test than AIC. This perspective may lead to insights about how to interpret the ICs in more complex situations. For example, AIC or BIC could be preferable, depending on the relative importance one assigns to sensitivity versus specificity. Understanding the differences and similarities among the ICs can make it easier to compare their results and to use them to make informed decisions.

Stress and Affect as Daily Risk Factors for Substance Use Patterns: an Application of Latent Class Analysis for Daily Diary Data.

At the population level, use of multiple substances (or "co-use") is prevalent in young adulthood and linked with increased risk for experiencing substance-related harms. Less understood is the heterogeneity of substance use behaviors within individuals and across days, as well as the proximal predictors of these daily use patterns. The present study applied latent class analysis to daily diary data to identify daily substance use patterns and compare day-level class membership based on day-level stress and positive and negative affect among a higher-risk sample of young adult substance users. Participants (n = 152) completed up to 13 daily assessments of stress, affect, and substance use behavior. Among substance use days, five classes of days were identified: cannabis (some alcohol; 43% of days), alcohol-only (26%), vaping (some alcohol, cannabis; 24%), stimulant + alcohol (some cannabis, vaping; 4%), and cigarette-only (3%) days. Days with lower levels of perceived stress were significantly more likely to be alcohol-only Days relative to being days characterized by cigarette use, cannabis use, or multiple drug combinations. Days with higher levels of stress and negative affect were more likely to be cigarette-only days relative to cannabis and vaping days. Study findings document the wide range of substance use and co-use behaviors exhibited among young adults in daily life and highlight the importance of considering risk factors that correspond to days of problematic use patterns.

Flexibly modeling age trends in the prevalence of co-occurring patterns of substance use and mental health disorders using time-varying effects and latent class analysis.

Background: Substance use disorders (SUDs) and mental health disorders may change and co-occur in complex patterns across adult ages, but these processes can be difficult to capture with traditional statistical approaches.Objective: To elucidate disorder prevalence and comorbidities across adult ages by using time-varying effect models (TVEMs), latent class analysis (LCA), and modeling latent class prevalences as complex functions of age.Methods: Data were drawn from participants who are 18-65 years old in the National Epidemiologic Survey on Alcohol and Related Conditions III (n = 30,999; 51% women) and a subsample who reported a past-year post-traumatic stress disorder (PTSD), mood, anxiety, or SUD based on DSM-5 diagnoses (n = 11,279). TVEM and LCA were used to examine age trends and comorbidity patterns across ages.Results: SUD prevalence peaked at age 23 (31%) and decreased thereafter, while mental health disorder prevalence was stable (20%-26% across all ages). The prevalence of five classes of individuals based on specific combinations of mental health and SUDs varied by age: the Alcohol Use Disorder class had the highest prevalence at age 26, whereas the Mood and Anxiety Disorder classes peaked around age 63. Interestingly, the Poly-Disorder class prevalence was greatest at age 18 but decreased sharply across young adulthood; however, the prevalence of the other high comorbidity class, PTSD with Mood or Anxiety Disorder, remained fairly constant across age, peaking at age 44.Conclusions: Multimorbid mental health disorders (excluding SUDs) persist in prevalence across adult ages. LCA, TVEM, and their integration together hold substantial potential to advance addiction research.

The developmental course of the link between weight concerns and cigarette use across adolescence: Differences by gender.

OBJECTIVE: This study aimed to illuminate developmental changes and gender differences in the link between weight concerns and cigarette use across adolescence. Specifically, we examined whether and how the strength of the association between weight concerns and cigarette use changed across adolescence, and whether patterns of association differed between boys and girls. METHOD: Participants were 397 predominately White adolescents ages 11-18 years (50.5% female) from a longitudinal observational study conducted in the United States. RESULTS: Time-varying effect modeling revealed that even after adjusting for BMI, the association between weight concerns and cigarette use was positive and significant for girls from age 11.3 to 15.9, with the strongest association at 12.7 years. For boys, this association was non-significant throughout adolescence. DISCUSSION: Results suggest a sensitive period in early- to mid-adolescence during which girls with weight concerns may be at heightened risk for cigarette use. Findings have implications for the developmental timing of interventions to prevent cigarette use and weight concerns and suggest that tailored interventions for girls may be warranted.

Age-varying associations between physical activity and psychological outcomes among rural cancer survivors.

We examined the prevalence of psychological outcomes (i.e., symptoms of depression and anxiety) by age and age-varying associations between physical activity and psychological outcomes among rural cancer survivors. Participants (N = 219; ages 22-93) completed sociodemographic, psychological, and physical activity questionnaires. Time-varying effect models estimated the prevalence of psychological outcomes and assessed associations between physical activity and psychological outcomes as a flexible function of age. Depression and anxiety symptoms decreased with age among cancer survivors aged 22-40 years and were relatively stable across age among those > 40 years. Positive associations between vigorous physical activity and psychological outcomes in those aged 22-40 years were identified. In those > 70-80 years, there were negative associations between vigorous physical activity and psychological outcomes. Results suggest there is variation across age in the associations between physical activity and psychological outcomes among rural survivors. Future research should further explore these age-varying relationships to identify important intervention targets.

Dynamic Associations of Parent-Adolescent Closeness and Friend Support With Adolescent Depressive Symptoms Across Ages 12-19.

Supportive relationships with parents and friends reduce adolescent risk for depression; however, whether and how the strength of these associations changes across adolescence remains less clear. Age-varying associations of mother-adolescent and father-adolescent closeness and friend support with depressive symptoms were examined across ages 12.5-19.5 using data from the National Longitudinal Study of Adolescent to Adult Health (N = 4,819). Positive relationships with mothers, fathers, and friends were associated with lower depressive symptoms across adolescence, and the associations were generally stable across age. The association between father-adolescent closeness and depressive symptoms was stronger for girls than for boys during mid-adolescence. Mother-adolescent closeness was more strongly negatively associated with depressive symptoms in the context of higher friend support during mid-adolescence.

Age-varying trends in alcohol and cannabis co-occurring use: Implications for prescription drug misuse.

Background: Individuals who engage in alcohol and cannabis co-occurring use are at heightened risk for negative outcomes than individuals who only use alcohol or only use cannabis, but far less is known about implications of alcohol and cannabis co-occurring use for prescription drug misuse (PDM).Objectives: This study aimed to (1) identify whether co-occurring use was linked with greater risk for PDM across ages 18-60 and to determine ages at which this association was strongest, (2) determine whether associations remain after controlling for pain severity, and (3) test for gender differences.Methods: Cross-sectional data were from Wave 1 of the Population Assessment of Tobacco and Health (PATH) study. The analytic sample included 20,120 (50.6%wt men) individuals aged 18-60 reporting past-year alcohol and/or cannabis use.Results: Time-varying effect models indicated that individuals reporting co-occurring use were at increased risk for PDM than individuals reporting single-substance use across all ages, with odds ratios peaking at >3 at age 34. After controlling for pain severity, associations were only slightly weakened. Associations were slightly stronger for men than women from ages 28 to 35.Conclusion: Co-occurring use was linked with heightened risk for PDM compared to individuals who used only one substance; co-occurring use may be important to target for PDM prevention. Identifying factors underlying study associations, beyond pain, and how these factors evolve with age are important avenues for prevention work.

Shifting Age of Peak Binge Drinking Prevalence: Historical Changes in Normative Trajectories Among Young Adults Aged 18 to 30.

BACKGROUND: This study examined the extent to which the developmental pattern of prevalence of binge drinking in the past 2 weeks from ages 18 through 30 has changed across 29 cohorts of U.S. young adults, and whether the changes differed by gender. METHODS: Analyses used national longitudinal data from 58,019 12th-grade students (from graduating high school classes 1976 to 2004) participating in the Monitoring the Future study followed through modal age 30 (with age 29/30 data collected from 1987 to 2016). Weighted time-varying effect modeling was used to model cohort group differences in age-related patterns of binge drinking. RESULTS: The age of peak binge drinking prevalence increased across cohorts (from age 20 in 1976 to 1985 to 22 in 1996 to 2004 for women, and from 21 in 1976 to 1985 to 23 in 1996 to 2004 for men). Historical change in the developmental pattern of binge drinking across all ages of young adulthood differed for men and women. Even after controlling for key covariates, women in the more recent cohort group reported significantly higher binge drinking prevalence than women in earlier cohorts from ages 21 through 30. Men in the more recent cohort group reported higher binge drinking prevalence at ages 25 to 26, but prevalence levels then converged to those seen in earlier cohort groups by age 30. CONCLUSIONS: An older age of peak binge drinking and a decreased rate of decline in the prevalence of binge drinking in later young adulthood among more recent cohorts have resulted in an extension of individual and societal risks associated with binge drinking, particularly for women, across young adulthood. High-risk alcohol use prevention efforts are needed throughout at least the third decade of life.

Dynamic Features of Problematic Drinking: Alcohol Use Disorder Latent Classes Across Ages 18-64.

AIMS: Alcohol use disorders (AUDs) are linked with numerous severe detrimental outcomes. Evidence suggests that there is a typology of individuals with an AUD based on the symptoms they report. Scant research has identified how these groups may vary in prevalence by age, which could highlight aspects of problematic drinking behavior that are particularly salient at different ages. Our study aimed to (a) identify latent classes of drinkers with AUD that differ based on symptoms of AUD and (b) examine prevalences of latent classes by age. SHORT SUMMARY: Our findings advocate for personalized treatment approaches for AUD and highlight the need for carefully considering the role of age in prevention and intervention efforts. METHODS: We used data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III). Current drinkers aged 18-64 who met criteria for a past-year AUD were included (n = 5402). RESULTS: Latent class analysis (LCA) based on 11 AUD criteria revealed 5 classes: 'Alcohol-Induced Injury' (25%), 'Highly Problematic, Low Perceived Life Interference' (21%), 'Adverse Effects Only' (34%), 'Difficulty Cutting Back' (13%) and 'Highly Problematic' (7%). Using time-varying effect modeling (TVEM), each class was found to vary in prevalence across age. The Adverse Effects Only and Highly Problematic, Low Perceived Life Interference classes were particularly prevalent among younger adults, and the Difficulty Cutting Back and Alcohol-Induced Injury classes were more prevalent as age increased. CONCLUSIONS: Findings suggest that experience of AUD is not only heterogeneous in nature but also that the prevalence of these subgroups vary across age.

Understanding stress reports in daily life: a coordinated analysis of factors associated with the frequency of reporting stress.

Although stress is a common experience in everyday life, a clear understanding of how often an individual experiences and reports stress is lacking. Notably, there is little information regarding factors that may influence how frequently stress is reported, including which stress dimension is measured (i.e., stressors-did an event happen, subjective stress-how stressed do you feel, conditional stress-how stressful a stressor was) and the temporal features of that assessment (i.e., time of day, day of study, weekday vs. weekend day). The purpose of the present study was to conduct a coordinated analysis of five independent ecological momentary assessment studies utilizing varied stress reporting dimensions and temporal features. Results indicated that, within days, stress was reported at different frequencies depending on the stress dimension. Stressors were reported on 15-32% of momentary reports made within a day; across days, the frequency ranged from 42 to 76% of days. Depending on the cutoff, subjective stress was reported more frequently ranging about 8-56% of all moments within days, and 40-90% of days. Likewise, conditional stress ranged from just 3% of moments to 22%, and 11-69% of days. For the temporal features, stress was reported more frequently on weekdays (compared to weekend days) and on days earlier in the study (relative to days later in the study); time of day was inconsistently related to stress reports. In sum, stress report frequency depends in part on how stress is assessed. As such, researchers may wish to measure stress in multiple ways and, in the case of subjective and conditional stress with multiple operational definitions, to thoroughly characterize the frequency of stress reporting.

Is Young Adulthood a Critical Period for Suicidal Behavior among Sexual Minorities? Results from a US National Sample.

The developmental timing of suicide-related disparities between heterosexuals and sexual minorities (i.e., lesbian/gay and bisexual (LGB) people) is an understudied area that has critical prevention implications. In addition to developmentally situated experiences that shape risk for suicidality in the general population, sexual minorities also experience unique social stressors (e.g., anti-LGB stigma) that may alter their risk for suicidal behavior at different ages. Using a nationally representative US sample of adults, we assessed age-varying rates of suicidal behavior among heterosexuals and sexual minorities ages 18 to 60 and the age-varying association between anti-LGB discrimination and suicidal behavior. We also tested whether these age-varying prevalences and associations differed for men and women and for sexual minorities who did and did not endorse a sexual minority identity. Results indicate a critical period for suicide behavior risk for sexual minorities during young adulthood, with the highest rates of risk at age 18 followed by a steady decline until the early 40s. Disparities were particularly robust for sexual minorities who identified as lesbian, gay, or bisexual. This pattern was present for both men and women, though sexual minority women in their 30s were more likely to report suicidal behavior than heterosexuals and sexual minority men. Sexual minorities who experienced anti-LGB discrimination were more likely to report suicidal behavior, but the significance of this association was limited to those under 30. The effect of discrimination on suicidal behavior was stronger among young adult sexual minority men, relative to sexual minority women, but was present for a wider age range for sexual minority women (until age 30) relative to sexual minority men (until age 25).

Inverse Propensity Score Weighting with a Latent Class Exposure: Estimating the Causal Effect of Reported Reasons for Alcohol Use on Problem Alcohol Use 16 Years Later.

Latent class analysis (LCA) has proven to be a useful tool for identifying qualitatively different population subgroups who may be at varying levels of risk for negative outcomes. Recent methodological work has improved techniques for linking latent class membership to distal outcomes; however, these techniques do not adjust for potential confounding variables that may provide alternative explanations for observed relations. Inverse propensity score weighting provides a way to account for many confounders simultaneously, thereby strengthening causal inference of the effects of predictors on outcomes. Although propensity score weighting has been adapted to LCA with covariates, there has been limited work adapting it to LCA with distal outcomes. The current study proposes a step-by-step approach for using inverse propensity score weighting together with the "Bolck, Croon, and Hagenaars" approach to LCA with distal outcomes (i.e., the BCH approach), in order to estimate the causal effects of reasons for alcohol use latent class membership during the year after high school (at age 19) on later problem alcohol use (at age 35) with data from the longitudinal sample in the Monitoring the Future study. A supplementary appendix provides evidence for the accuracy of the proposed approach via a small-scale simulation study, as well as sample programming code to conduct the step-by-step approach.

College degree attainment by age of first marijuana use and parental education.

Background: Age of first marijuana use is a key predictor of later educational outcomes, but limited work has identified demographic factors that impact this association across continuous ages of first use. The purpose of this study was threefold: (1) to identify the age-varying prevalence of later college degree attainment as a function of age of first marijuana use; (2) to examine the age-varying association of gender and college degree attainment as a function of age of first use; and (3) to examine the age-varying association of parent education and college degree attainment as a function of age of first use. Methods: Data were from the panel portion of the Monitoring the Future (MTF) study, an ongoing longitudinal study of adolescents and young adults. Those who used marijuana by age 22 were included in analyses. Among these participants (N = 2134), 47.0% were male, 67.5% were white, 53.2% reported having at least one parent with a bachelor's degree or higher, and 44.1% attained a bachelor's degree or higher by age 25/26. Results: Intercept-only and logistic time-varying effect models (TVEMs) modeled prevalences and associations as functions of age of first marijuana use. Prevalence of college degree completion was relatively linear across age of first use; such that college degree attainment increased as age of first use increased. Results indicated that college degree attainment varied across age of first use similarly for men and women. Degree attainment differences existed based on parent education. Parental education and degree attainment were most strongly linked at an age of first use between 16 and 19 years. Conclusions: Findings suggest that age of first marijuana use has an association with academic achievement such that earlier ages of first use are associated with lower academic achievement later in adulthood. Parental education serves as a protective factor against college degree attainment in late adolescence.

Personalized models of physical activity responses to text message micro-interventions: A proof-of-concept application of control systems engineering methods.

OBJECTIVES: The conceptual models underlying physical activity interventions have been based largely on differences between more and less active people. Yet physical activity is a dynamic behavior, and such models are not sensitive to factors that regulate behavior at a momentary level or how people respond to individual attempts at intervening. We demonstrate how a control systems engineering approach can be applied to develop personalized models of behavioral responses to an intensive text message-based intervention. DESIGN & METHOD: To establish proof-of-concept for this approach, 10 adults wore activity monitors for 16 weeks and received five text messages daily at random times. Message content was randomly selected from three types of messages designed to target (1) social-cognitive processes associated with increasing physical activity, (2) social-cognitive processes associated with reducing sedentary behavior, or (3) general facts unrelated to either physical activity or sedentary behavior. A dynamical systems model was estimated for each participant to examine the magnitude and timing of responses to each type of text message. RESULTS: Models revealed heterogeneous responses to different message types that varied between people and between weekdays and weekends. CONCLUSIONS: This proof-of-concept demonstration suggests that parameters from this model can be used to develop personalized algorithms for intervention delivery. More generally, these results demonstrate the potential utility of control systems engineering models for optimizing physical activity interventions.

Sexual Behavior and Heavy Episodic Drinking Across the Transition to Adulthood: Differences by College Attendance.

Despite a growing literature on college students' sexual behaviors, little is known about how sexual behaviors, and their associations with alcohol, differ for college and noncollege attenders, and whether these patterns represent changes during college or an extension of pre-college behaviors. This paper applied time-varying effect models to data from the National Longitudinal Study of Adolescent to Adult Health to examine (1) prevalence of four sexual behaviors from ages 14 to 24 and (2) how their association with frequent heavy episodic drinking varied across these ages for college and noncollege attenders. Nonattenders have higher prevalence of all sexual behaviors than college attenders across most ages; however, the association between heavy episodic drinking and sexual behaviors is stronger for college attenders during ages 18-20.

Drinking Patterns of College- and Non-College-Attending Young Adults: Is High-Intensity Drinking Only a College Phenomenon?

BACKGROUND: Young adults report the heaviest drinking of any age group, and many are at risk for experiencing an alcohol use disorder. Most research investigating young adult drinking has focused on single indicators of use. Using multiple dimensions of consumption, such as federal guidelines for daily/weekly drinking and engagement in drinking at twice the binge threshold ("high-intensity drinking") to characterize drinking behavior could illuminate drinking patterns linked with harms. OBJECTIVES: We used a person-centered approach to examine latent classes of drinkers from a national sample of young adults. Further, we compared classes on college status. METHODS: We used 2012-2013 data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)-III. We included past-year drinkers aged 18-22 years (n = 2213). Latent classes were estimated based on drinking frequency, daily/weekly drinking, frequency of heavy episodic drinking (4+/5+ drinks for women/men), frequency of high-intensity drinking (8+/10+ drinks), and intoxication frequency. RESULTS: Five latent classes were identified: Occasional, Light Drinkers (30%), Regular Drinkers (6%), Infrequent Drinkers with Occasional Binging (10%), Frequent Drinkers with Occasional Binging (22%), and High-Intensity Drinkers (32%). Although membership in the two riskiest classes were more common among college-attenders, odds of being a High-Intensity Drinker relative to the second riskiest class was not significantly different for college- and non-college-attending young adults. Conclusions/Importance: As high-intensity drinking does not appear to be a drinking pattern unique to college-attenders and non-college-attenders are less likely to mature out of heavy drinking patterns, intervention efforts are needed for this at-risk age group.

Time Since First Acting on Same-Sex Attraction and Recreational Drug Use among Men Who Have Sex With Men (MSM): Is There an Effect of "Gay Age"?

BACKGROUND: Men who have sex with men (MSM) have higher rates of substance use compared to men who have sex with women. Among MSM, drug use is linked to higher-risk sexual behavior and acquisition of HIV and other sexually transmitted infections. OBJECTIVES: We hypothesize that time since first acting on one's same sex attraction, or one's "gay age", could be predictive of drug using behavior. METHODS: We examined this question among 176 MSM, aged 18-35, presenting at a public sexual health clinic. Behavioral data were captured using interviewer- and self-administered surveys and clinical data were extracted from medical records. We used modified Poisson regression to examine associations between gay age and recent recreational drug use, and separately, between gay age and recent marijuana use. RESULTS: In total, 43% of participants reported recent marijuana use and 26% of participants reported recent use of other drugs. The associations between gay age and marijuana use and other drug use varied by HIV status. After adjustment for biological age, race, and education, a one-year increase in gay age was associated with significantly increased drug use among HIV-negative men (adjusted prevalence ratio (aPR): 1.08; 95% confidence interval (CI): 1.03-1.14), but we observed no association between gay age and drug use among HIV-positive men (aPR: 0.96, 95% CI: 0.86-1.07). Gay age was not associated with marijuana use in HIV-negative (aPR: 1.00, 95% CI: 0.95-1.04) or HIV-positive (aPR: 1.06, 95% CI: 0.98-1.14) men. CONCLUSIONS: In summary, HIV-negative MSM who had experienced more time since first same-sex experience had significantly increased prevalence of recent drug use.

High-Intensity Drinking Versus Heavy Episodic Drinking: Prevalence Rates and Relative Odds of Alcohol Use Disorder Across Adulthood.

BACKGROUND: Heavy episodic drinking (HED) or consuming 4+/5+ drinks in 1 occasion for women/men is linked consistently with alcohol-related harms. Recent research suggests that many individuals drink at levels more than twice this cutoff (8+/10+ drinks), commonly referred to as "high-intensity drinking." Prevalence rates of high-intensity drinking and its dynamic association with alcohol use disorder (AUD) across all ages, however, remain unknown. The current study used data from a nationally representative sample to document age-varying prevalence rates of HED-only drinking and high-intensity drinking, prevalence rates of AUD for HED-only drinkers and high-intensity drinkers, and relative odds of experiencing an AUD for high-intensity drinkers as compared to HED-only drinkers. METHODS: Data were from the National Epidemiologic Survey on Alcohol and Related Conditions-III. The final analytic sample consisted of past-year drinkers aged 18 to 64 years (n = 22,776). RESULTS: Time-varying effect modeling revealed that high-intensity drinking and HED-only drinking were equally prevalent during young adulthood and prevalence rates of both types of drinking generally became less common with increasing age. At all ages, high-intensity drinkers were at 3 or more times greater odds of meeting criteria for an AUD than HED-only drinkers. The association between high-intensity relative to HED-only drinking was strongest earlier in adulthood with approximately 83% of 18-year-old high-intensity drinkers having AUD relative to 42% of HED-only drinkers. CONCLUSIONS: Future research aiming to identify drinkers most at risk of harms and in need of treatment may benefit from assessing the extent to which an individual exceeds the 8+/10+ threshold of drinking.