title: The legacy of minimum legal drinking age law changes: long-term effects on suicide and homicide deaths among women.
abstract: BACKGROUND
  Prior to the establishment of the uniform drinking age of 21 in the United States, many states permitted legal purchase of alcohol at younger ages. Lower drinking ages were associated with several adverse outcomes, including elevated rates of suicide and homicide among youth. The objective of this study is to examine whether individuals who were legally permitted to drink prior to age 21 remained at elevated risk in adulthood.
  
  
  METHODS
  Analysis of data from the U.S. Multiple Cause of Death files, 1990 to 2004, combined with data on the living population from the U.S. Census and American Community Survey. The assembled data contained records on over 200,000 suicides and 130,000 homicides for individuals born between 1949 and 1972, the years during which the drinking age was in flux. Logistic regression models were used to evaluate whether adults who were legally permitted to drink prior to age 21 were at elevated risk for death by these causes. A quasi-experimental analytical approach was employed, which incorporated state and birth-year fixed effects to account for unobserved covariates associated with policy exposure.
  
  
  RESULTS
  In the population as a whole, we found no association between minimum drinking age and homicide or suicide. However, significant policy-by-sex interactions were observed for both outcomes, such that women exposed to permissive drinking age laws were at higher risk for both suicide (OR = 1.12, 95% CI: 1.05, 1.18, p = 0.0003) and homicide (OR = 1.15, 95% CI: 1.04, 1.25, p = 0.0028). Effect sizes were stronger for the portion of the cohort born after 1960, whereas no significant effects were observed for women born prior to 1960.
  
  
  CONCLUSIONS
  Lower drinking ages may result in persistent elevated risk for suicide and homicide among women born after 1960. The national drinking age of 21 may be preventing about 600 suicides and 600 homicides annually.
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri 63110, USA. Rick@wustl.edu
authors.forename: Richard A
authors.initials: RA
authors.lastname: Grucza
authors.forename: Pamela R
authors.initials: PR
authors.lastname: Hipp
authors.forename: Karen E
authors.initials: KE
authors.lastname: Norberg
authors.forename: Laura
authors.initials: L
authors.lastname: Rundell
authors.forename: Anastasia
authors.initials: A
authors.lastname: Evanoff
authors.forename: Patricia
authors.initials: P
authors.lastname: Cavazos-Rehg
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Bierut
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D000428:Alcohol Drinking / Q000453:epidemiology / Q000331:legislation & jurisprudence* / Q000401:mortality; D002423:Cause of Death; D019352:Censuses; D003627:Data Interpretation, Statistical; D005260:Female; D006708:Homicide / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D015233:Models, Statistical; D009026:Mortality; D016017:Odds Ratio; D011153:Population; D012044:Regression Analysis; D018570:Risk Assessment; D012959:Socioeconomic Factors; D013405:Suicide / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014930:Women; D055815:Young Adult
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