Drink and drive? Understanding the dynamics of youth risk-taking.

We exploit a reduction in the minimum legal drinking age (MLDA) in New Zealand from 20 to 18 to study the dynamics of youth risk-taking. Using the universe of road accidents over 15 years and an event history approach, we find no evidence that lowering the drinking age increased alcohol-related accidents among teens. Complementary results of a cohort analysis suggest that reducing the drinking age even led to a short-term decline in risky driving among youths directly affected by the MLDA change but had no longer-run impacts on youth risky driving and drinking behaviors.

Health policy and genetic endowments: Understanding sources of response to Minimum Legal Drinking Age laws.

This paper uses policy-induced variation in legal access to alcohol in the United States to explore interactions between genetic predispositions and health behaviors. It is well known that Minimum Legal Drinking Age (MLDA) laws have discrete impacts on binge drinking behaviors, but less is known about heterogeneity of the effects and the characteristics of individuals most and least affected. Using the Add Health data, this paper explores differential policy effects based on polygenic scores (PGS), which are genome-wide summary measures predicting health outcomes. Specifically, we leverage PGS for alcoholism and for a broader set of risk-taking behaviors to explore heterogeneities in response to the policy and consider mechanisms for the responses. Like previous literature using the Add Health and other datasets, we find main effects of MLDA in increasing recent binge drinking episodes by approximately 5 percentage points. We find MLDA effects are concentrated entirely in individuals with high PGS for alcohol use. We are also able to compare these results with measures of parental alcoholism as a global proxy for family history.

Is changing the minimum legal drinking age an effective policy tool?

In year 1991, regional governments in Spain started a period of implementation of a law that rose the minimum legal drinking age from 16 to 18 years old. To evaluate the effects of this change on the consumption of legal drugs and its related morbidity outcomes, we construct a regional panel dataset on alcohol consumption and hospital entry registers and compare variation in several measures of prevalence between the treatment group (16-18 years old) and the control group (20-22 years old). Our findings show important differences by gender. Our main result regarding overall drinking prevalence shows a reduction of -21.37% for the subsample that includes males and females altogether. This effect on drinking is mainly driven by a reduction of -44.43% in mixed drinks and/or liquors drinking prevalence corresponding to the subsample of males. No causal effects regarding overall smoking prevalence and hospitalizations due to alcohol overdose or motor vehicle traffic accidents were found. To our knowledge, this is the first paper providing evidence on gender-based differences to policies aimed at reducing alcohol consumption. Our results have important policy implications for countries currently considering changes in the minimum legal drinking age.

The Impact of the Minimum Legal Drinking Age on Alcohol-Related Chronic Disease Mortality.

BACKGROUND: The minimum legal drinking age (MLDA) of 21 has been associated with a number of benefits compared to lower MLDAs, including long-term effects, such as reduced risk for alcoholism in adulthood. However, no studies have examined whether MLDA during young adulthood is associated with mortality later in life. We examined whether individuals exposed to permissive MLDA (<21) had higher risk of death from alcohol-related chronic disease compared to those exposed to the 21 MLDA. Because prior work suggests that MLDA affects college students differently, we also conducted conditional analyses based on ever having attended college. METHODS: Data from the 1990 through 2010 U.S. Multiple Cause-of-Death files were combined with data on the living population and analyzed. We included individuals who turned 18 during the years 1967 to 1990, the period during which MLDA varied across states. We examined records on death from several alcohol-related chronic diseases, employing a quasi-experimental approach to control for unobserved state characteristics and stable time trends. RESULTS: Individuals who reported any college attendance did not exhibit significant associations between MLDA and mortality for the causes of death we examined. However, permissive MLDA for those who never attended college was associated with 6% higher odds for death from alcoholic liver disease, 8% higher odds for other liver disease, and 7% higher odds for lip/oral/pharynx cancers (odds ratio [OR] = 1.06, 95% confidence interval [CI] [1.02, 1.10]; OR = 1.08, 95% CI [1.03, 1.13]; OR = 1.07, 95% CI [1.03, 1.12], respectively). CONCLUSIONS: The 21 MLDA likely protects against risk of death from alcohol-related chronic disease across the lifespan, at least for those who did not attend college. This is consistent with other work that shows that the long-term association between MLDA and alcohol-related outcomes is specific to those who did not attend college.

Release from drinking-age restrictions is associated with increases in alcohol-related motor vehicle collisions among young drivers in Canada.

BACKGROUND: Alcohol-related motor vehicle collisions (MVCs) are a key concern in current international debates about the effectiveness of minimum legal drinking age (MLDA) laws, but the majority of this literature is based on natural experiments involving MLDA changes occurring 2-4 decades ago. METHODS: A regression-discontinuity approach was used to estimate the relation between Canadian drinking-age laws and population-based alcohol-related MVCs (n=50,233) among drivers aged 15-23years in Canada. RESULTS: In comparison to male drivers slightly younger than the MLDA, those just older had immediate and abrupt increases in alcohol-related MVCs of 40.6% (95% CI 25.1%-56.6%; P<0.001) in Ontario; 90.2% (95% CI 7.3%-171.2%; P=0.033) in Manitoba; 21.6% (95% CI 8.5%-35.0%; P=0.001) in British Columbia; and 27.3% (95% CI 10.9%-44.5%; P=0.001) in Alberta; but also an unexpected significant decrease in the Northwest Territories of -102.2% (95% CI -120.7%-74.9%; P<0.001). For females, release from MLDA restrictions was associated with increases in alcohol-related MVCs in Ontario [34.2% (95% CI 0.9%-68.0%; P=0.044)] and Alberta [82.2% (95% CI 41.1%-125.1%; P<0.001)]. Nationally, in comparison to male drivers slightly younger than the legislated MLDA, male drivers just older had significant increases immediately following the MLDA in alcohol-related severe MVCs [27.0% (95% CI 12.6%-41.7%, P<0.001)] and alcohol-related fatal MVCs [53.4% (95% CI 2.4%-102.9%, P=0.04)]. CONCLUSIONS: Release from Canadian drinking-age restrictions appears to be associated with immediate increases in alcohol-related fatal and non-fatal MVCs, especially among male drivers.

Breaking The Link Between Legal Access To Alcohol And Motor Vehicle Accidents: Evidence From New South Wales.

A large literature has documented significant public health benefits associated with the minimum legal drinking age in the USA, particularly because of the resulting effects on motor vehicle accidents. These benefits form the primary basis for continued efforts to restrict youth access to alcohol. It is important to keep in mind that policymakers have a wide variety of alcohol-control options available to them, and understanding how these policies may complement or substitute for one another can improve policy making moving forward. Towards this end, we propose that investigating the causal effects of the minimum legal drinking age in New South Wales, Australia, provides a particularly informative case study, because Australian states are among the world leaders in their efforts against drunk driving. Using an age-based regression discontinuity design applied to restricted-use data from several sources, we find no evidence that legal access to alcohol has effects on motor vehicle accidents of any type in New South Wales, despite having large effects on drinking and on hospitalizations due to alcohol abuse. Copyright © 2015 John Wiley & Sons, Ltd.

The Utility of Including the Strengths of Underage Drinking Laws in Determining Their Effect on Outcomes.

BACKGROUND: To control underage drinking in the United States, which has been associated with an estimated 5,000 deaths and 2.6 million injuries or other harm annually, each state has developed a unique set of laws. Previous research examining these laws' effectiveness has frequently focused on the laws' existence without considering variance in sanctions, enforcement, or exemptions. METHODS: We scored 20 minimum legal drinking age 21 (MLDA-21) laws for their strengths and weaknesses based on (i) sanctions for violating the law, (ii) exceptions or exemptions affecting application, and (iii) provisions affecting the law or enforcement. We then replicated a 2009 study of the effects of 6 MLDA-21 laws in 3 different ways (using identical structural equation modeling): Study 1-8 additional years of data, no law strengths; Study 2-years from the original study, added law strengths; Study 3-additional years, law strengths, serving as an update of the 6 laws' effects. RESULTS: In all 3 studies-and the original study-keg registration laws were associated with both an unexpected significant increase (+11%, p < 0.001) in underage drinking-driver ratios and a notable 25% reduction in per capita beer consumption-opposing results that are difficult to explain. In Study 3, possession and purchase laws were associated with a significant decrease in underage drinking-driver fatal crash ratios (-4.9%, p < 0.001; -3.6%, p < 0.001, respectively). Similarly, zero tolerance and use and lose laws were associated with reductions in underage drinking-driver ratios (-2.8%, p < 0.001; -5.3%, p < 0.001, respectively). CONCLUSIONS: Including strengths and weaknesses of underage drinking laws is important when examining their effects on various outcomes as the model fit statistics indicated. We suggest that this will result in more accurate and more reliable estimates of the impact of the laws on various outcome measures.

A pint for a pound? Minimum drinking age laws and birth outcomes.

Minimum legal drinking age (MLDA) laws are known to reduce alcohol consumption among young adults. One additional benefit of higher MLDAs may be that they improve health outcomes among infants born to young mothers. We estimate the impact of MLDAs on infant health in the USA by comparing birth outcomes among 14-20 year old mothers who were exposed to different MLDAs because of when and where they gave birth. Infants born to mothers who were between the ages of 21 and 24 years are included as a control group. We find that low MLDAs are associated with very small birth weight reductions, but have a little relationship with other traditional measures of infant health. We find compelling evidence, however, that a low MLDA increases the probability of a female birth, which suggests that restricting alcohol access to young mothers may reduce fetal deaths.

The effects of alcohol on the consumption of hard drugs: regression discontinuity evidence from the National Longitudinal Study of Youth, 1997.

This paper estimates the effect of alcohol use on consumption of hard drugs using the exogenous decrease in the cost of accessing alcohol that occurs when individuals reach the minimum legal drinking age. By using a regression discontinuity design and the National Longitudinal Study of Youth 1997, I find that all measures of alcohol consumption, even alcohol initiation increase discontinuously at age 21 years. I also find evidence that consumption of hard drugs decreased by 1.5 to 2 percentage points and the probability of initiating the use of hard drugs decreased by 1 percentage point at the age of 21 years, while the intensity of use among users remained unchanged. These estimates are robust to a variety of specifications and also remain robust across different subsamples.

Endorsement of a Personal Responsibility to Adhere to the Minimum Drinking Age Law Predicts Consumption, Risky Behaviors, and Alcohol-Related Harms.

Despite minimum drinking age laws, underage college students engage in high levels of risky drinking and reach peak lifetime levels of alcohol dependence. A group of presidents of universities and colleges has argued that these laws promote disrespect for laws in general, and do not prevent drinking or related negative consequences. However, no study has investigated the policy-relevant question of whether students who endorse a personal responsibility to obey drinking laws, regardless of their opinions about the laws, are less likely to drink or to experience negative consequences. Therefore, we compared endorsers to non-endorsers, controlling for race, gender, and baseline outcomes, at two universities (Ns = 2007 and 2027). Neither sample yielded a majority (49% and 38% endorsement), but for both universities, all 17 outcome measures were significantly associated with endorsement across all types of analyses. Endorsers were less likely to drink, drank less, engaged in less high-risk behavior (e.g., heavy/binge drinking), and experienced fewer harms (e.g., physical injury), even when controlling for covariates. Racial/ethnic minority groups were more likely to endorse, compared to White students. By isolating a small window of time between high school and college that produces large changes in drinking behavior, and controlling for covariates, we can begin to hone in on factors that might explain relations among laws, risky behaviors, and harms. Internalization of a social norm to adhere to drinking laws could offer benefits to students and society, but subsequent research is needed to pin down causation and causal mechanisms.

Underage access to alcohol and its impact on teenage drinking and crime.

Does underage access to alcohol increase teenage drinking and crime? To address this question, I leverage a discontinuity in legal access to alcohol at age 16 in Germany, a country with high consumption levels and a particularly early access regulation. Using detailed survey data and administrative crime records from 2005 to 2015, I detect considerable increases in drinking participation, frequency, and intensity at the legal cutoff along the middle and lower end of the distribution. These increases coincide with discrete jumps in criminal engagement under the influence of alcohol, mostly due to violent and property crimes. My findings suggest that changes in drinking intensity induce these crimes, implying a drinking-crime elasticity of 0.4 at age 16.

Examining the Intended and Unintended Impacts of Raising a Minimum Legal Drinking Age on Primary and Secondary Societal Harm and Violence from a Contextual Policy Perspective: A Scoping Review.

Raising a minimum legal drinking age (MLDA) has generated interest and debate in research and politics, but opposition persists. Up to now, the presentation of impacts focussed on effectiveness (i.e., intended impact); to our knowledge, no literature syntheses focussed on both intended and unintended impacts. A systematic scoping review was conducted in which a search strategy was developed iteratively and literature was obtained from experts in alcohol research and scientific and grey databases. Ninety-one studies were extracted and analysed using formative thematic content analysis. Intended impacts were reported in 119 units of information from the studies (68% positive), forming four paths: implementation, primary and (two) on secondary societal harm and violence. Unintended developments were reported in 43 units of information (30% positive), forming five themes. Only eight studies reported on implementation. Furthermore, a division between primary and secondary paths and the use of a bridging variable (drinking patterns in analyses or methodology) was discovered. These results provide an insight into how well legislation works and can be used to discover or implement new means of curbing underage drinking and alcohol-related violence and harm. They also offer valuable starting points for future research and underline the importance of considering unintended developments.

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

BACKGROUND: There is limited evidence about the effects of United States (US) nation-level policy changes on the incidence of alcohol drinking and tobacco smoking. To investigate the potential primary prevention effects on precocious drug use and to clarify lag-time issues, we estimated incidence rates for specified intervals anticipating and lagging after drug policy enactment. Our hypotheses are (a) reductions in underage drinking or smoking onset and (b) increases of incidence at the legal age (i.e., 21 for drinking and 18 for smoking). METHODS: The study population is 12-23-year-old non-institutionalized US civilian residents. Estimates are from 30 community samples drawn to be nationally representative for the US National Surveys on Drug Use and Health 1979-2015. Estimates were year-by-year annual incidence rates for alcohol drinking and tobacco smoking by 12-23-year-olds, age by age. Meta-regressions estimate age-specific incidence over time. RESULTS: Incidence of underage alcohol drinking declined and followed a trend line that started before 1984 enactment of the National Minimum Drinking Age Act, but increased drinking incidence for 21 year olds was observed approximately 10 years after policy enactment. Eight years after the Synar amendment enactment, evidence of reduced smoking incidence started to emerge. Among 18 year olds, a slight increase in tobacco smoking incidence occurred about 10 years after the Synar amendment. CONCLUSION: Once nation-level policies affecting drug sales to minors are enacted, one might have to wait almost a decade before seeing tangible policy effects on drug use incidence rates.

Assessing the impacts of minimum legal drinking age laws on police-reported violent victimization in Canada from 2009 to 2013.

BACKGROUND/AIM: Given that alcohol-related victimization is highly prevalent among young adults, the current study aimed to assess the potential impacts of Minimum Legal Drinking Age (MLDA) laws on police-reported violent victimization events among young people. DESIGN: A regression-discontinuity (RD) approach was applied to victimization data from the Canadian Uniform Crime Reporting 2 (UCR2) Incident-based survey from 2009-2013. Participants/cases: All police-reported violent victimization events (females: n = 178,566; males: n = 156,803) among youth aged 14-22 years in Canada. MEASUREMENTS: Violent victimization events, primarily consisting of homicide, physical assault, sexual assault, and robbery. RESULTS: In comparison to youth slightly younger than the drinking age, both males and females slightly older than MLDA had significant and immediate increases in police-reported violent victimization events (females: 13.5%, 95% CI: 7.5%-19.5%, p < 0.001; males: 11.6%, 95% CI: 6.6%-16.7%, p < 0.001). Victimizations occurring in the evening rose sharply immediately after the MLDA by 22.8% (95% CI: 9.9%-35.7%, p = 0.001) for females and 19.3% (95% CI: 11.5%-27.2%, p < 0.001) for males. Increases in violent victimization immediately after MLDA were most prominent in bar/restaurant/open-air settings, with victimizations rising sharply by 44.9% (95% CI: 29.5%-60.2%, p < 0.001) among females and 18.3% (95% CI: 7.7%-29.0%, p = 0.001) among males. CONCLUSIONS: Young people gaining minimum legal drinking age incur immediate increases in police-reported violent victimizations, especially those occurring in the evening and at bar/restaurant/open-air settings. Evidence suggests that increasing the MLDA may attenuate patterns of violent victimization in newly restricted age groups.

Approaches for reducing alcohol-impaired driving: Evidence-based legislation, law enforcement strategies, sanctions, and alcohol-control policies.

Reducing impaired driving requires a systematic, consistent, and multifaceted approach. There is strong evidence on the effectiveness of both direct and indirect measures. The strategy that has the most immediate and largest impact has been highly publicized, visible, and frequent impaired-driving enforcement, especially deploying sobriety checkpoints or random breath testing. Lowering legal blood alcohol concentration (BAC) limits for driving to 0.05 g/dL or lower has also had a world-wide impact. Raising the legal drinking age has been successful in the US and other countries in reducing young impaired-driver fatal crashes. Graduated drivers' licensing for youth has also been effective by restricting conditions under which youth can drive. Sanctions that reduce impaired-driving recidivism include special driving-under-the-influence (DUI)/driving-while-intoxicated (DWI) courts, mandatory alcohol ignition interlocks, and consistent alcohol-monitoring programs. Opportunities for further progress include better enforcement of the drinking age and refusing to serve obviously intoxicated patrons. Technology for detecting alcohol impairment and autonomous vehicles will also play an important role in future efforts to eliminate impaired driving.

Legal access to alcohol and criminality.

Previous research has found strong evidence that legal access to alcohol is associated with sizable increases in criminality. We revisit this relationship using the census of judicial records on criminal charges filed in Oregon Courts, the ability to separately track crimes involving firearms, and to track individuals over time. We find that crime increases at age 21, with increases mostly due to assaults that lack premeditation, and alcohol-related nuisance crimes. We find no evident increases in rape or robbery. Among those with no prior criminal records, increases in crime are 50% larger-still larger for the most socially costly crimes of assault and drunk driving.

Effects of a stand-alone web-based electronic screening and brief intervention targeting alcohol use in university students of legal drinking age: A randomized controlled trial.

BACKGROUND: Many intervention efforts targeting student drinking were developed to address US college students, which usually involves underage drinking. It remains unclear, if research evidence from these interventions is generalizable to university and college students of legal drinking age, e.g., in Europe. OBJECTIVE: To evaluate the effectiveness of a translated and adapted version of the eCHECKUP TO GO, applied as stand-alone web-based electronic screening and brief intervention (e-SBI), in German university students at risk for hazardous drinking. METHODS: A fully automated web-based two-arm parallel-group randomized controlled trial was conducted. Participants were randomized to an e-SBI or assessment-only (AO) condition. The current paper analyzed students with baseline AUDIT-C scores ≥3 for women and ≥4 for men (sample at baseline: e-SBI [n=514], AO [n=467]; 3-month follow-up: e-SBI [n=194], AO [n=231]; 6-month follow-up: e-SBI [n=146], AO [n=200]). The primary outcome was prior four weeks' alcohol consumption. Secondary outcomes were frequency of heavy drinking occasions, peak blood alcohol concentration, and number of alcohol-related problems. RESULTS: Mixed linear model analyses revealed significant interaction effects between groups and time points on the primary outcome after 3 and 6months. Compared to students in the AO condition, students in the e-SBI condition reported consuming 4.11 fewer standard drinks during the previous four weeks after 3months, and 4.78 fewer standard drinks after 6months. Mixed results were found on secondary outcomes. CONCLUSIONS: The results indicate that evidence on and knowledge of web-based e-SBIs based on US college student samples is transferable to German university students of legal drinking age. However, knowledge of what motivates students to complete programs under voluntary conditions, although rare, is needed.

The impact of the false ID laws on alcohol consumption among young adults: New results from the NLSY97.

In volume 36 of this journal, using data from the National Longitudinal Study of Youth, 1997 Cohort (NLSY97), Yörük (2014) finds that the false ID laws with scanner provision (FSP laws) significantly reduce underage drinking. In a recent paper, Zheng (2018) argues that analyses based on the NLSY97 data fail falsification exercises and uses data from the Youth Risk Behavior Surveillance System (YRBSS) to estimate the effectiveness of the FSP laws. This paper replies to Zheng (2018) and provides new results from the NLSY97, which show that the FSP laws were effective reducing several indicators of alcohol consumption among minors.

Long-term effects of lowering the alcohol minimum purchasing age on traffic crash injury rates in New Zealand.

INTRODUCTION AND AIMS: In December 1999, New Zealand lowered the alcohol minimum purchasing age from 20 to 18 years. We tested hypotheses that this change was associated with long-term increases in traffic injury attributable to alcohol-impaired driving among 18- to 19-year-olds (target age group) and 15- to 17-year-olds (affected by 'trickle-down'). DESIGN AND METHODS: We undertook a controlled before-and-after comparison of rates of fatal and non-fatal traffic injury to persons of any age attributable to impaired drivers aged 18-19 years and 15-17 years, versus 20- to 21-year-olds. Crash data including assessment of driver alcohol impairment were recorded by New Zealand Police. The pre-change period was 1996-1999. Post-change periods were 2000-2003, 2004-2007 and 2008-2010. Outcomes were population-based and vehicle travel-based rates. RESULTS: Compared with the change in injury rates attributable to alcohol-impaired 20- to 21-year-old male drivers, injuries attributable to 18- to 19-year-old male drivers increased in all post-change periods and significantly so in the second post-change period (incidence rate ratio [IRR] 1.3, 95% confidence interval [CI] 1.1 to 1.5). For 15- to 17-year-old male drivers, rates increased in all post-change periods compared with 20- to 21-year-olds, and more so in the second (IRR 1.2, 95% CI 1.1 to 1.4) and third (IRR 1.2, 95% CI 1.1 to 1.4) periods. There was a short-term relative increase in harm attributable to 18- to 19-year-old female drivers (IRR 1.5; 1.1 to 2.0). Results were similar for vehicle travel-based rates. DISCUSSION AND CONCLUSIONS: Reducing the alcohol minimum purchasing age was followed by long-term increases in the incidence of traffic injury attributable to male 15- to 19-year-old alcohol-impaired drivers. [Kypri K, Davie G, McElduff P, Langley J, Connor J. Long-term effects of lowering the alcohol minimum purchasing age on traffic crash injury rates in New Zealand. Drug Alcohol Rev 2017;36:178-185].

The Impact of Drinking Age Laws on Perpetration of Sexual Assault Crimes in Canada, 2009-2013.

PURPOSE: Sexual-assault crimes, primarily perpetrated by males against female victims, impose a substantial burden on societies worldwide, especially on youth. Given that approximately half of all sexual assaults involve alcohol consumption by the perpetrator or victim, it is reasonable to expect that minimum legal drinking age (MLDA) restrictions might have an effect on sexual-assault patterns. Canadian MLDA laws are 18 years in Quebec, Alberta, and Manitoba (MLDA-18), and 19 years in the rest of the country (MLDA-19). The present study assesses whether MLDA laws might have an impact on sexual-assault crimes. METHODS: A regression-discontinuity design was applied to sexual-assault crime data (n = 12,980 incidents) from the national Uniform Crime Reporting survey 2009-2013, a population-level registry of all police-reported crimes in Canada. Uniform Crime Reporting data does not include an explicit alcohol involvement indicator. RESULTS: Nationally, in comparison to males slightly younger than the MLDA, those just older had significant and immediate increases in sexual-assault perpetration of 31.9% (95% confidence interval: 8.7%-54.5%, p = .007). In MLDA-19 provinces, there was an immediate post-MLDA increase of 56.0% (95% confidence interval: 18.9%-90.8%, p = .004) in sexual-assault crimes by males just older than 19 years, whereas in MLDA-18 provinces no significant effect was found. For females, there was no evidence of MLDA effects on sexual-assault crimes. CONCLUSIONS: Release from Canadian MLDA law restrictions was strongly associated with increases in sexual-assault perpetration by young men. These findings lend support to the potential effectiveness of population-level alcohol control policies for sexual-assault prevention among youth.