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Ralph W. Hingson, ScD; Timothy Heeren, PhD; Amber Jamanka, MPH; Jonathan Howland, PhD

JAMA. 2000;284:1527-1533.

Context  In 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.

Objective  To 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 Setting  The National Longitudinal Alcohol Epidemiology Survey, a cross-sectional survey conducted in 1992 of a representative sample of the US population.

Participants  A total of 42,862 randomly selected adults (response rate, 90%; mean age, 44 years).

Main Outcome Measures  Unintentional 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).

Results  Relative 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).

Conclusion  Drinking onset at ages younger than 21 years is associated with having experienced alcohol-related injuries.

Author Affiliations: Departments of Social and Behavioral Sciences (Drs Hingson and Howland) and Epidemiology and Biostatistics (Dr Heeren), and the Data Coordinating Center (Ms Jamanka), Boston University School of Public Health, Boston, Mass.

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