title: Is 'age at first drink' a useful concept in alcohol research and prevention? We doubt that.
abstract: To address and discuss the weaknesses of age at first drink (AFD) as a concept in alcohol research and prevention.
  
  
  
  Narrative literature review.
  
  
  
  Varying from one sip to the consumption of several full drinks, and sometimes including the specification of particular conditions (e.g. without parental consent), no exact definition and operationalization of AFD was found. Evidence reveals poor test-retest reliability when the same individuals report their AFD two or more times. Theoretical arguments and empirical evidence fail to explain why having one sip or one drink earlier than peers should cause heavier drinking and related problems later in life. Alternative explanations such as self-selection, third variable effects and systematic report bias are not considered in most studies. These shortcomings also make AFD unsuitable as an indicator or marker of underlying problems such as conduct problems and academic failure. Together with unjustified causal inferences, this has led to an over-emphasis on the relevance of postponing AFD as a way to prevent problems later in life.
  
  
  
  We argue in favour of shifting the focus of alcohol research and prevention away from AFD towards a better understanding of the progression from infrequent, low-quantity drinking to more detrimental drinking patterns and the prevention of associated acute and short-term harm.
authors.affiliation: Addiction Switzerland, Research Institute, Lausanne, Switzerland.|Behavioural Science Institute, Radboud University Nijmegen, the Netherlands.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Kuntsche
authors.affiliation: Norwegian Institute for Alcohol and Drug Research, Oslo, Norway.
authors.forename: Ingeborg
authors.initials: I
authors.lastname: Rossow
authors.affiliation: Behavioural Science Institute, Radboud University Nijmegen, the Netherlands.|Trimbos Institute, Utrecht, the Netherlands.
authors.forename: Rutger
authors.initials: R
authors.lastname: Engels
authors.affiliation: Addiction Switzerland, Research Institute, Lausanne, Switzerland.
authors.forename: Sandra
authors.initials: S
authors.lastname: Kuntsche
mesh_terms: D000367:Age Factors; D000428:Alcohol Drinking / Q000517:prevention & control*; D019973:Alcohol-Related Disorders / Q000517:prevention & control*; D006801:Humans; D012106:Research
keywords: Age at first drink; age of onset; causal relationship; marker hypothesis; narrative review; recall bias