Alcohol initiation before age 15 predicts earlier hazardous drinking: A survival analysis of a 7-year prospective longitudinal cohort of Australian adolescents.
Level 3 - non-randomized controlled study
Prospective longitudinal cohort study
PubMed 37926434 · doi:10.1111/add.16376
What was done
A 7-year prospective longitudinal cohort of 2,082 Australian adolescents (tracked from 2012 to 2019, aged 13 to 20 years) was established from two school-based studies (Climate and Preventure, and Climate Schools Combined). Participants completed annual surveys. Researchers conducted interval-censored survival analyses to evaluate the time to the first episode of hazardous drinking—defined as a score of 3 or higher on a proxy Alcohol Use Disorders Identification Test (AUDIT-C)—controlling for age, sex, and mental health symptomatology.
What was found
Participants who had their first full drink at age 12 or younger showed a significantly higher risk of hazardous drinking onset compared with those initiating at age 15 or older (log hazard ratio: 9.3; 95% CI: 7.0–12.0, P < 0.001). Delaying alcohol initiation until age 15 or older compared to ages 13–14 postponed hazardous drinking onset by 1.63 years in males (95% CI: 1.31–1.92, P < 0.001) and 1.50 years in females (95% CI: 1.15–1.81, P < 0.001). This resulted in a median age of onset of hazardous drinking above 19 years for both sexes (males: 19.05 years, 95% CI: 18.74–19.38; females: 19.47 years, 95% CI: 19.19–19.75), whereas initiation at ages 13–14 led to the earliest onset (males: 17.43 years; females: 17.98 years).
Why it matters
This study provides specific temporal estimates showing that delaying first alcohol use until at least age 15 significantly postpones the onset of hazardous drinking in youth, supporting the timing of adolescent alcohol prevention strategies.
Limits
The observational design cannot determine causality, and residual confounding from unmeasured factors such as family history, peer drinking, or socioeconomic status remains possible. Outcomes were based on self-reported survey data and a proxy AUDIT-C measure rather than clinical diagnostic interviews. Findings from Australian school-based cohorts may not generalize to other cultural or legal contexts.
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