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
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.