Effects of Minimum Drinking Age Laws: Review and Analyses of the Literature
from 1960 to 2000
ALEXANDER C. WAGENAAR, Ph.D., andTRACI L. TOOMEY,
Ph.D. Division of Epidemiology, School of Public Health, University of Minnesota,
1300 South Second Street, Suite 300, Minneapolis, Minnesota 55454-1015
ABSTRACT.Objective: The goal of this article is to review critically
the extant minimum legal drinking age (MLDA) research literature and summarize
the current state of knowledge regarding the effectiveness of this policy. Method:
Comprehensive searches of four databases were conducted to identify empirical
studies of the MLDA published from 1960 to 1999. Three variables were coded
for each study regarding methodological quality: (1) sampling design, (2) study
design and (3) presence or absence of comparison group. Results: We identified
241 empirical analyses of the MLDA. Fifty-six percent of the analyses met our
criteria for high methodological quality. Of the 33 higher quality studies of
MLDA and alcohol consumption, 11 (33%) found an inverse relationship; only 1
found the opposite. Similarly, of the 79 higher quality analyses of MLDA and
traffic crashes, 46 (58%) found a higher MLDA related to decreased traffic crashes;
none found the opposite. Eight of the 23 analyses of other problems found a
higher MLDA associated with reduced problems; none found the opposite. Only
6 of the 64 college-specific studies (9%) were of high quality; none found a
significant relationship between the MLDA and outcome measures. Conclusions:
The preponderance of evidence indicates there is an inverse relationship between
the MLDA and two outcome measures: alcohol consumption and traffic crashes.
The quality of the studies of specific populations such as college students
is poor, preventing any conclusions that the effects of MLDA might differ for
such special populations. (J. Stud. Alcohol, Supplement No. 14: 206-225,
2002)
THE MINIMUM legal drinking age (MLDA) is the most well-studied alcohol control
policy in the United States (Wagenaar and Toomey, 2000). The intention of this
policy is to lower alcohol use and its associated problems among youth. Following
Prohibition, most states established an age-21 MLDA. During the early 1970s,
a trend toward lowering the MLDA to age 18, 19 or 20 began in the United States,
providing many natural experiments. As a result of research evidence indicating
that traffic crashes among youth increased following lowering of the legal age,
a citizens' effort began urging states to raise the MLDA back to age 21. In
1984, the federal government enacted the Uniform Drinking Age Act, which provided
for the withholding of federal highway funds from states that failed to increase
their MLDA (King and Dudar, 1987). By 1988, all states had established an age-21
MLDA. The increase in MLDA across multiple states again provided researchers
with many natural experiments to assess effects of these policy changes on alcohol
consumption and related problems among youth.
Despite this long history, the debate over the MLDA
continues. Part of this debate is whether the age-21 MLDA
is really effective in reducing alcohol-related problems. This
debate is particularly relevant to college campuses because
the majority of students on many campuses are under age
21. Some college administrators argue that the age-21 law
has caused more problems on college campuses, not less
(Lonnstrom, 1985).
To determine the overall effect of the age-21 MLDA on youth, including college-age
students, the existing research literature should be critically reviewed. The
purpose of this review is to summarize all studies available in the peer-reviewed
published literature over the past four decades that evaluated the effects of
public policies establishing a legal minimum age for purchase and/or consumption
of alcoholic beverages. Most studies assessed effects of the MLDA on consumption
and alcohol-related problems among all those under age 21college students
and those not in college. Some MLDA studies specifically assessed effects of
MLDA changes on college students alone. Given the current discussions on college
campuses, we provide a review of the college studies in addition to a summary
of the overall MLDA literature. A second objective of this article is to describe
key issues in public debates regarding MLDA policies.
We obtained all identified published studies on the drinking
age from 1960 to 1999, a total of 132 documents. Comprehensive
searches were conducted of four databases to
identify studies of interest: ETOH (1960-1999 [National
Institute on Alcohol Abuse and Alcoholism's alcohol and
alcohol problems science database]), MEDLINE (1966-1999), Current Contents (1994-1999)
and Social Science
Abstracts (1983-1999). The entire record for each document
was included in the search; thus, any record with any
search term in the title, keywords, subject headings, descriptors
or abstract fields was identified. Search terms used
for each database were as follows (where * is the truncation
indicator to include all forms of the root word):
ETOH: (minimum age OR drinking age OR purchase age OR legal
age OR MDA OR MLDA) OR ([teen* OR adolescen* OR
young OR college* OR youth* OR student* OR underage* OR
minor*] AND [sale* OR enforce* OR deterrence* OR avail* OR
access* OR crackdown OR ID OR identification OR compliance])
MEDLINE and Current Contents: (minimum age OR drinking
age OR purchase age OR legal age OR MLDA) OR ([teen* OR
adolescen* OR young OR college* OR youth OR student* OR
underage* OR minor*] AND [sale* OR enforce* OR deterrence*
OR avail* OR access* OR crackdown OR ID OR identification
OR compliance])
Social Science Abstracts: (minimum age OR drinking age OR
purchase age OR legal age OR MDA OR MLDA)
In addition, two previous literature reviews were used to
identify relevant studies (Wagenaar, 1983a, 1993).
We obtained and reviewed the original document for each study and coded eight
key variables for each study. These variables include the jurisdiction studied
(i.e., state or province), specific outcome measures analyzed (e.g., self-reported
drinking, car crash fatalities) and whether the study was specific to college
student populations. In addition, three key indicators of methodological quality
were coded for each study. The first is sampling design, distinguishing lower
quality nonprobability sampling versus higher quality probability sampling or
census data. The second quality indicator is the research or study design, with
lower quality studies consisting of cross-sectional (one time-point) observations
only versus higher quality studies that used pre-post (one observation before
a policy change and one after), longitudinal (more than 2 but fewer than 20
repeated observations) or time-series (20 or more repeated observations over
time) designs. The third quality indicator is whether some form of comparison
group was used; studies with no comparison groups are of low quality. Finally,
we coded whether the findings were statistically significant. If the results
were significant, we coded the direction of the relationship between legal age
for drinking and a specific outcome measure.
Effects of drinking age on alcohol consumption
We located 48 published studies that assessed the effects
of changes in the legal minimum drinking age on
indicators of alcohol consumption (Table 1). In the 48 studies,
a total of 78 alcohol consumption outcome measures
were analyzed (e.g., sales figures, self-reported drinking).
Of the 78 analyses, 27 (35%) found a statistically significant
inverse relationship between the legal drinking age
and alcohol consumption; that is, as the legal age was lowered,
drinking increased, and as the legal age was raised,
drinking decreased. An additional 8 analyses that found an
inverse relationship did not report significance levels. Of
the 78 analyses, only 5 found a positive relationship between
the legal drinking age and consumption. In short, 45% of all analyses found
that a higher legal drinking age
is associated with reduced alcohol consumption.
Of the 78 analyses of alcohol consumption, 21 were the
weaker cross-sectional designs, and 57 were pre-post, longitudinal
or time-series designs. Of the 21 cross-sectional
analyses, 8 (38%) found a significant inverse relationship
between legal drinking age and alcohol consumption,
whereas only 3 found a significant positive relationship.
An additional 4 analyses found an inverse relationship, and
1 found a positive relationship; however, significance levels
were not reported. Of the 57 longitudinal analyses (i.e.,
which we define as any analyses that included repeated
measures over time), 19 (33%) found a significant inverse
relationship; only 1 longitudinal study found a significant
positive relationship. An additional 4 longitudinal analyses
found an inverse relationship but did not report significance
levels.
Of the 78 analyses of alcohol consumption, 55 (71%)
included a comparison group of some kind. For 3 analyses,
it was not clear whether a comparison group was used (not
avail.). Of the 55 analyses including comparison groups,
23 (42%) found a significant inverse relationship; only 4
found a significant positive relationship. An additional 3
analyses found an inverse relationship, and 1 analysis found
a positive relationship but no significance levels were reported.
Of the 20 analyses that did not include comparison
groups, 4 found a significant inverse relationship between
the legal age and alcohol consumption, and none found a
positive relationship. An additional 4 analyses without comparison
groups found an inverse relationship but did not
report significance levels.
Of the 78 analyses of alcohol consumption, 58 (74%)
included probability samples or a complete census of the
relevant population, and 11 analyses clearly did not use a
probability sample or census. For an additional 9 analyses,
it was unclear whether a probability sample or census was
used. Of the 58 with a probability sample or census, 20
(34%) found a significant inverse relationship between the
legal age and alcohol consumption; only 1 study found a
significant positive relationship. An additional 8 studies
found an inverse relationship but did not report significance
levels, and 26 analyses found no significant relationship.
Of the 11 analyses without a probability sample or census,
2 found a significant inverse relationship, and 3 found a
significant positive relationship. One additional study found
a positive relationship but did not report significance. Of
the 9 analyses for which it was unclear whether a probability
sample or census was used, 5 found a significant inverse
relationship between the legal age and alcohol
consumption; none found a significant positive relationship.
Finally, of the 78 analyses of alcohol consumption, only 24 were specific to
college student populations. Of the 24 college-specific analyses, 3 (13%) found
a significant inverse relationship between the legal age and alcohol consumption,
3 found a significant positive relationship, and 15 found no significant relationship.
One additional study found an inverse relationship with no report on significance
levels. Of the 54 analyses that were not college specific, 24 (44%) found a
significant inverse relationship between the legal age and alcohol consumption.
Only 1 found a significant positive relationship. An additional 7 analyses found
an inverse relationship, and 1 found a positive relationship but did not report
significance levels.
In conclusion, the preponderance of evidence suggests that higher legal drinking
ages reduce alcohol consumption. Of all analyses that reported significant effects,
87% found higher drinking ages associated with lower alcohol consumption. Only
13% found the opposite. The evidence is not entirely consistent: Almost half
(46%) of the analyses found no association between the legal age and indicators
of alcohol consumption. However, focusing on the 33 of the 78 studies of high
methodological quality (i.e., those that include a longitudinal design, comparison
groups and probability sampling or use of a census) reveals that 11 (33%) of
the 33 higher quality studies found a significant inverse relationship between
the legal age and alcohol consumption. Only 1 (3%) found a significant positive
relationship. Only 3 of these studies of higher quality were college specific,
and results were not significant in all 3 studies.
Effects of drinking age on driving after drinking and traffic crashes
We located 57 published studies that assessed the effects of changes in the
legal minimum drinking age on indicators of driving after drinking and traffic
crashes (Table 2). In the 57 studies, a total of 102 crash outcome measures
were analyzed (e.g., fatal crashes, drink-driving crashes, self-reported driving
after drinking). Of the 102 analyses, 52 (51%) found a statistically significant
inverse relationship between the legal drinking age and crashes; that is, as
the legal age was lowered, the number of crashes increased, and as the legal
age was raised, the number of crashes decreased. (From here on, we use
the term crashes to include all traffic-related outcome measures.) An additional
12 analyses that found an inverse relationship did not report significance levels.
Of the 102 analyses, only 2 found a positive relationship between the legal
drinking age and traffic crashes. In short, more than half of all analyses found
that a higher legal drinking age is associated with decreased rates of traffic
crashes.
Of the 102 analyses of traffic crashes, 14 were the weaker
cross-sectional designs, and 88 were longitudinal designs.
Of the 14 cross-sectional analyses, 5 (36%) found a significant
inverse relationship between legal drinking age and
crashes, whereas only 1 found a significant positive relationship.
Of the 88 longitudinal analyses, 47 (53%) found a
significant inverse relationship; none found a significant
positive relationship. An additional 12 found an inverse
relationship, and 1 found a positive relationship but did not
report significance levels.
Of the 102 analyses of traffic crashes, 95 (93%) included
a comparison group of some kind (for 2 analyses it was not
clear whether a comparison group was used). Of the 95
analyses including comparison groups, 50 (53%) found a
significant inverse relationship; only 1 found a significant
positive relationship. An additional 11 analyses found an
inverse relationship but no significance levels were reported.
Of the 5 analyses that did not include comparison groups,
1 found a significant inverse relationship between the legal
age and traffic crashes. One additional analysis without comparison
groups found an inverse relationship, and 1 found a
positive relationship but did not report significance levels.
Of the 102 analyses of traffic crashes, 94 (92%) included
probability samples or a complete census of the relevant
population, and 3 analyses clearly did not use a probability
sample or census. For an additional 5 analyses it was unclear
whether a probability sample or census was used. Of
the 94 with a probability sample or census, 49 (52%) found
a significant inverse relationship between the legal age and
traffic crashes; only 1 study found a significant positive
relationship. An additional 11 studies found an inverse relationship,
and 1 study found a positive relationship but did
not report significance levels; 34 analyses found no significant
relationship. Of the 3 analyses without a probability
sample or census, 2 found a significant inverse relationship,
and none found a significant positive relationship. Of
the 5 analyses for which it was unclear whether a probability
sample or census was used, 1 found a significant inverse
relationship between the legal age and traffic crashes;
none found a significant positive relationship.
Finally, of the 102 analyses of traffic crashes, only 6
were specific to college student populations. Of the 6 college-specific analyses, 2 (33%) found a significant inverse
relationship between the legal age and traffic crashes, 1
found a positive relationship but significance was not reported,
and 3 found no significant relationship. Of the 96
analyses that were not college specific, 50 (52%) found a
significant inverse relationship between the legal age and
traffic crashes; only 1 found a significant positive relationship.
An additional 12 analyses found an inverse relationship
but did not report significance levels.
In conclusion, the preponderance of evidence indicates
that higher legal drinking ages reduce rates of traffic crashes.
Of all analyses that reported significant effects, 98% found
higher drinking ages associated with lower rates of traffic
crashes. Only 2% found the opposite. The evidence, however,
is not entirely consistent: 35% of the analyses found
no association between the legal age and indicators of traffic crashes. However,
focusing on the 79 studies of higher
methodological quality (i.e., those that include a longitudinal
design, comparison groups and probability sampling or
use of a census) reveals that 46 (58%) of these 79 higher
quality studies found a significant inverse relationship between
the legal age and traffic crashes; none found a significant
positive relationship. None of these studies of higher
quality were college specific.
Effects of drinking age on other health and social problem outcomes
We identified 24 published studies that assessed the effects
of changes in the legal minimum drinking age on
indicators of other health and social problem outcomes
(other than traffic crashes), such as suicide, homicide or
vandalism (Table 3). In the 24 studies, 61 outcome measures
were analyzed. Of the 61 analyses, 10 (16%) found a
statistically significant inverse relationship between the legal
drinking age and other outcomes; that is, as the legal
age was lowered, the number of problems increased, and
as the legal age was raised, the number of problems decreased.
Of the 61 analyses, 4 found a positive relationship
between the legal drinking age and other outcomes; an additional
2 analyses that found an inverse relationship and 1
that found a positive relationship did not report significance
levels.
Of the 61 analyses of other health and social problems,
16 were the weaker cross-sectional designs, and 45 were
longitudinal designs. Of the 16 cross-sectional analyses, 1
(6%) found a significant inverse relationship between legal
drinking age and other problems; none found a significant
positive relationship. Of the 45 longitudinal analyses, 9
(20%) found a significant inverse relationship; 3 found a
significant positive relationship.
Of the 61 analyses of other health and social problems,
36 (59%) included a comparison group of some kind (for 4
analyses it was not clear whether a comparison group was
used). Of the 36 analyses including comparison groups, 9
(25%) found a significant inverse relationship; none found a significant positive
relationship. One additional analysis
found a positive relationship but no significance levels were
reported. Of the 25 analyses that did not include comparison
groups, 1 found a significant inverse relationship between
the legal age and other problems, and 3 found a
positive relationship.
Of the 61 analyses of other problems, 47 (77%) included probability samples
or a complete census of the relevant population, 12 analyses clearly did not
use a probability sample or census, and for an additional 2 analyses it was
unclear whether a probability sample or census was used. Of the 47 with a probability
sample or census, 9 (19%) found a significant inverse relationship between the
legal age and other problems; only 2 studies found a significant positive relationship.
An additional 2 studies found an inverse relationship but did not report significance
levels, and 33 analyses found no significant relationship. Of the 12 analyses
without a probability sample or census, 1 found a significant inverse relationship,
and 1 found a significant positive relationship. Of the 2 analyses for which
it was unclear whether a probability sample or census was used, neither found
significant inverse or positive relationships between the legal age and other
problems.
Finally, of the 61 analyses of other health and social
problems, 34 were specific to college student populations.
Of the 34 college-specific analyses, 2 (6%) found a significant
inverse relationship between the legal age and other
health and social problems, and 3 found a significant positive
relationship. Two additional studies found an inverse
relationship with no report on significance levels. Of the
27 analyses that were not college specific, 8 (30%) found a
significant inverse relationship between the legal age and
other problems; none found a significant positive relationship.
One additional analysis found a positive relationship
but did not report significance levels.
In conclusion, although there is clearly some evidence that higher legal drinking
ages reduce rates of other health and social problems, results are not as consistent
as they are for traffic crash outcome indicators. Of all analyses that reported
significant effects, 75% found higher drinking ages associated with lower rates
of problems. Only 25% found the opposite. The evidence, however, is not entirely
consistent: 72% of the analyses found no association between the legal age and
indicators of other problems. However, focusing on the 23 studies of higher
methodological quality (i.e., those that include a longitudinal design, comparison
groups and probability sampling or use of a census) reveals that 8 (35%) of
the 23 higher quality studies found a significant inverse relationship between
the legal age and other problems; none found a significant positive relationship.
Two of those studies of higher quality were college specific; however, results
of both were not significant.
Given the diverse types of outcomes included in this section, we also stratified
the analyses of the higher methodological studies into four groups that were
more homogeneous. Of the 16 analyses of nontraffic injuries (fatal and nonfatal),
4 found a significant inverse relationship between the legal drinking age and
injuries; none found a positive relationship. Of the 10 analyses of "other
crime" (e.g., vandalism, disorderly conduct), 3 found a significant inverse
relationship between the legal drinking age and crime; none found a positive
relationship. Only 1 study that analyzed the relationship between social, academic
and employment problems was of higher methodological quality, and it did not
find any statistically significant results. Similarly, only 3 studies that analyzed
"other problems" (e.g., alcoholism, cirrhosis, general alcohol-related
problems) were of higher quality, and none found significant results.
Mediating Factors
In addition to studies specifically evaluating the effects of minimum drinking
age policies, there is a growing scientific literature on several closely related
factors that can be deemed to mediate the relationship between drinking age
law and outcomes of interest. Such factors include self-reported ease of access
to alcohol and sources of alcohol, purchase success rates by underage-appearing
buyers at bars and liquor stores, use of false age-identification documents,
patterns of enforcement of the drinking age, effects of enforcement "crackdowns"
and use of home delivery as a source of alcohol for youth. We identified 34
published articles on these factors; findings are summarized in Table 4.
Results show that more than half to more than three-quarters of teens surveyed
report that alcohol is easy to obtain. Moreover, explicit tests of the propensity
of alcohol retailers to sell to underage youth in purchase-attempt studies found
44-97% of outlets tested sold to underage youth with no request for age identification.
Such studies show that the beneficial effects of the age-21 policy to date in
terms of reduced drinking and reduced traffic crashes among youth have largely
been achieved with minimal implementation of the law.
Most studies reveal that use of false age identification
documents is only a modest problem. Estimates range from
5% to 21% of teens report using false age identification to
obtain alcohol. One study was an outlier, finding 46% of
undergraduate sociology students on one campus report use
of false age identification (Durkin et al., 1996). Most studies
on use of false age identification to date have not specifically
focused on college students. It is possible that the
accessibility and use of false identification documents is
higher in college environments, but we do not know whether
this is the case based on currently available data.
The limited degree to which age-21 policies have been
implemented is also shown in several enforcement studies.
Such studies have consistently found very low levels of
enforcement of the age-21 policy. Enforcement actions
against those selling or providing alcohol to minors are
particularly rare (Wagenaar and Wolfson, 1994).
Studies of the effects of increased enforcement show it
to be a highly effective means to reduce alcohol sales to
minors. Increased enforcement, specifically compliance
checks on retail alcohol outlets, typically cuts rates of sales
to minors by at least half (Grube, 1997; Lewis et al., 1996;
Preusser et al., 1994).
Finally, a recent study reports that 10% of high school
seniors and 7% of 18- to 20-year olds use the home delivery
services of alcohol retailers to obtain alcoholic beverages
(Fletcher et al., 2000).
In summary, research on mediating factors between the establishment of a legal
age for purchase and consumption of alcohol and actual effects on teen drinking
and alcohol-related problems indicates clear means of further increasing the
effectiveness of this policy. Such means include, most notably, increased rates
of enforcement to prevent alcohol sales to minors. Other means to improve implementation
of the age-21 policy, such as efforts to reduce use of false age identification
and tighter restrictions on home delivery of alcohol, may also help enhance
effectiveness of this law.
Conclusion
Compared with a wide range of other programs and efforts
to reduce drinking among teenagers, increasing the
legal age for purchase and consumption of alcohol to 21
appears to have been the most successful effort to date
(compare studies summarized in Table 1 with studies cited
in reviews of other prevention efforts such as Moskowitz
[1989] and Gorman and Speer [1996]). The magnitude of
effects of the age-21 policy may appear small, particularly
in studies using weak research designs and having low levels
of statistical power. However, even modest effects applied
to the entire population of youth result in very large
societal benefits. For example, the National Highway Traffic
Safety Administration, using an average estimated reduction
in traffic fatalities due to the legal drinking age of
13%, calculates that the age-21 policy prevented 846 deaths
in 1997 and prevented a total of 17,359 deaths since 1975
(National Highway Traffic Safety Administration, 1998).
A large proportion of studies of the MLDA found a statistically significant,
inverse relationship between the MLDA and alcohol consumption and alcohol-related
problems (48% of the higher quality studies). Only a small number of studies
found a statistically significant, positive relationship between the
MLDA and various outcomes (1% of the higher quality studies). A large number
of studies found no statistically significant relationship. In addition to differences
in quality of research design and analyses, several other factors may account
for variability in results across studies, including size of sample and extent
of change in policy. The power to detect a statistically significant effect
is directly influenced by the size of the sample. In some states, the MLDA was
raised only 1 year, from age 20 to age 21; in other states it was raised from
age 18 to 21. Studies of policy changes that affect smaller segments of the
population may be less likely to detect effects simply because of reduced statistical
power when analyzing fewer data. Given potential design and analysis limitations
in any single study, the large proportion of MLDA studies that found a significant
inverse relationship with various outcomes gives strong support for the effectiveness
of the MLDA.
It is difficult to estimate accurately the effects of the
drinking age specifically on college students. Unfortunately,
most studies focusing on college students have been based
on weaker cross-sectional designs or limited nonprobability
samples. Only 9% of the college-specific studies (6 of 64)
used a higher quality research design. Of these higher quality
studies, none found a statistically significant inverse relationship
between the MLDA and consumption or
alcohol-related problems. In addition, of these 6 analyses,
4 included a sample of students at only one university.
Although it is possible that the age-21 policy has been less
effective on college campuses than among the general youth
population, existing research clearly does not suggest that
the age-21 MLDA has increased problems among college
students. However, more studies that use robust research
designs would be needed to assess accurately the effect of
the MLDA specifically on college campuses. In addition,
studies of potential mediating factors on campuses are also
needed. For example, how well are MLDA laws enforced
on college campuses? How easily can underage students
obtain alcohol on and around campus? If one assumes that
the MLDA is less effective on college campuses, perhaps it
is due to lax enforcement and particularly easy access to
alcohol by underage youth in such settings.
Finally, despite progress in recent decades, most youth
continue to have access to alcohol, most drink at least occasionally,
and a substantial fraction regularly become intoxicated.
The social costs from injuries, deaths and damage
associated with underage drinking remain high. The benefits
of the legal drinking age of 21 have occurred with
little or no active enforcement in most areas. Simply by
increasing enforcement levels and deterring adults from selling
or providing alcohol to minors, even more injuries and
deaths related to alcohol use among youth are likely to be
prevented each year.
Policy Issues Related to the Minimum
Legal Drinking Age
Despite an abundance of research demonstrating the effectiveness
of the age-21 MLDA in reducing youth drinking
and alcohol-related problems, three decades after states
first began lowering minimum drinking ages, and two decades
after states were in the midst of raising their legal
drinking ages, a few states are again considering lowering
their legal age limits for drinking. Many issues and arguments
heard decades ago are again occasionally heard (Fell,
1985; Toomey et al., 1996). One difference this time around
is that we have the benefit of hundreds of research studies
summarized in the body of this article. Here we summarize
13 similar issues that are still often raised in policy debates
by those opposed to a legal drinking age of 21 and provide
up-to-date responses that may be useful to college administrators,
public health practitioners and others.
Issue 1
Issue. "Establishing a legal drinking age of 21 is unconstitutional
age discrimination."
Response. This question has been treated in detail in
two court cases. The first case challenged, in federal court,
the constitutionality of Michigan's increase in the drinking
age, one of the early states to raise the legal age back to 21
(Guy, 1978). The court ruled, on the basis of scientific
evidence that linked lower drinking ages to increased traffic
crash involvement among youth, that the drinking-age
discrimination was reasonably related to the state objective
of reducing highway crashes. Thus the higher drinking age
withstood the constitutional challenge on three key legal
issues: (1) drinking alcohol is not a "fundamental" right
guaranteed by the Constitution, (2) age is not inherently a
"suspect" criteria for discrimination (in contrast to race or
ethnicity, for example) and (3) using the drinking age to
prevent highway crashes has a "rational basis" in available
scientific evidence. The court mentioned additional reasons
that a higher drinking age is not unconstitutional. The higher
drinking age does not cause a permanent disability, but is
only a temporary postponement of a specific behavior for
the young person's own protection. Furthermore, states have
broad powers to regulate the distribution and use of beverage
alcohol under the Twenty-first Amendment, which
ended Prohibition. Therefore, the drinking age, like other
alcohol-control regulations, has a "strong presumption of
validity," according to the court.
More recently, the state of Louisiana's age-21 MLDA
was challenged in court on the premise that it violated the
state's constitutional law regarding age discrimination.
Louisiana's State Supreme Court concluded, however, that
"statutes establishing the minimum drinking age at a level
higher than the age of majority are not arbitrary because
they substantially further the appropriate governmental purpose
of improving highway safety, and thus are constitutional"
(Manuel vs State of Louisiana, 1996). In other words,
because the age-21 MLDA was based on empirical evidence
that the law saved lives, the court decided that it was
not an arbitrary law and thus did not violate Louisiana's
constitution.
Issue 2
Issue. "The federal government is exerting too much
power over the states. The federal law encouraging states
to set the legal drinking age at 21, by withholding highway
funds from states that do not do so, is just one example of
this."
Response. Citizens groups in a number of states began
the initial movement to raise the drinking age to 21. Numerous
statewide and national surveys show overwhelming
public support for the drinking age of 21, both in the late
1970s and early 1980s when states were raising the age
(Wagenaar, 1993), and today. The most recent national survey
shows 84% of the U.S. population age 18 and over
oppose lowering the age from 21 to 19 (Wagenaar et al.,
2000). As several states increased the drinking age to 21,
significant reductions in multiple types of injuries (including
deaths related to car crashes) were observed (Jones et
al., 1992; Wagenaar, 1993). However, as some states raised
their drinking age while neighboring states did not, some
young people drove across state lines to get alcohol, increasing
the chance of traffic crashes. Recognizing that having
a uniform drinking age achieves safety, the federal
government strongly encouraged, but did not mandate, the
remaining states to increase their drinking ages to age 21.
Issue 3
Issue. "Europeans teens are allowed to drink from an early age,
yet those countries don't have the alcohol-related problems we do. What we need
are fewer restrictions, not more."
Response. The idea that Europeans do not have alcohol-related problems
is a myth. European youth may be at less risk of traffic crashes because youth
drive less frequently in Europe than in the United States. Compared with the
United States, Europeans have higher legal driving ages, more expensive automobiles
and greater access to public transportation. Looking beyond traffic crashes,
however, European countries have similar or higher rates of other alcohol-related
problems compared with the United States. For example, in 1990, France and Italy
had higher per capita alcohol consumption and higher rates of cirrhosis deaths
than did the United States. Per capita consumption in France and Italy was 12.7
and 8.7 liters of alcohol, respectively, compared with 7.5 in the United States.
Cirrhosis death rates in France and Italy were 26.8 and 17.0 per 100,000, respectively,
whereas the U.S. rate was 11.6 (Edwards et al., 1994). European countries are
now looking to the United States for research and experience regarding the age-21
policy. Europeans are initiating the debate on the most appropriate age for
legal access to alcohol.
Issue 4
Issue. "If I'm old enough to go to war, I should be old
enough to drink."
Response. Many rights have different ages of initiation.
A person can obtain a hunting license at age 12, driver's
license at age 16, vote and serve in the military at 18, serve
in the U.S. House of Representatives at age 25 and in the
U.S. Senate at age 30 and run for President at age 35.
Other rights we regulate include the sale and use of tobacco
and legal consent for sexual intercourse and marriage.
The minimum age of initiation is based on the specific
behavior involved and must take into account the dangers
and benefits of that behavior at a given age (Fell, 1985).
The age-21 policy for alcohol takes into account the fact
that underage drinking is related to numerous serious problems,
including injuries and deaths resulting from car
crashes, suicide, homicide, assault, drowning and recreational
injuries. In fact, the leading cause of death among
teens is car crashes (National Center for Health Statistics,
1994), and alcohol is involved in approximately one-third
of these deaths (National Highway Traffic Safety Administration,
1998).
Issue 5
Issue. "Nineteen- and twenty-year-olds are drinking anyway.
If we legalize it, at least they'll be drinking in a controlled
supervised settings, such as a bar or nightclub, rather
than in cars or at unsupervised parties."
Response. Data show bars and nightclubs are not safe,
controlled locations. Studies have repeatedly shown a majority
of alcohol outlets regularly break the law, for example,
by selling alcohol to minors (Forster et al., 1994,
1995; Preusser and Williams, 1992) or selling to intoxicated
patrons (Toomey et al., 1999). When the legal age is
lower than 21, teens purchase the majority of their alcohol
at liquor stores because it is cheaper than getting it at bars.
They then consume this alcohol in homes, cars or parks.
These areas are very difficult to control (Fell, 1985).
There is also some "trickle-down" effect in that when
youth get alcohol they often give it to even younger teens
(Jones-Webb et al., 1997a). When the legal age is 21, 19-
and 20-year olds can often obtain alcohol from their friends.
When the drinking age was 18 and 19, 17- and even 16-year olds were often able to get alcohol from their friends.
If the drinking age is lower, more alcohol will be available
to younger high school students and perhaps even middle
school students. There will always be some people who
violate laws, but this does not mean we should condone the
illegal behavior by modifying the law. The age-21 policy
has resulted in a reduction in the amount of alcohol consumed
and a substantial decrease in the number of car
crashes involving underage drinkers. These results have occurred
despite the fact that the law is often not strictly
enforced (Wagenaar and Wolfson, 1994, 1995).
Issue 6
Issue. "Lower rates of alcohol-related crashes among 19-
to 20-year olds aren't related to the age-21 policy, but rather
they're related to increased drinking-driving education
efforts, tougher enforcement and tougher drunk-driving
penalties."
Response. After the age-21 MLDA was implemented,
alcohol-involved highway crashes declined immediately (i.e.,
starting the next month) among the 18- to 20-year-old population.
Careful research has shown declines are not due to
enforcement of and tougher penalties for driving while intoxicated,
but are directly a result of the legal drinking age.
Studies have also shown that education alone is not effective
at reducing youth drinking (Clayton et al., 1996;
Ellickson et al., 1993). To achieve long-term reductions in
youth drinking problems, we have to change the environment
by making alcohol less accessible to teens.
Issue 7
Issue. "Making it illegal to drink until 21 just increases
the desire for the 'forbidden fruit.' Then, when teens turn
21, they'll drink even more."
Response. Actually, the opposite is true. Early legal access
to alcohol is associated with higher rates of drinking
as an adult. When the drinking age is 21, those under 21
drink less and continue to drink less through their early
twenties. The lower rates of drinking and the reductions in
injury and death before age 21 are not compensated for
after reaching 21 with rates higher than they would have
been (O'Malley and Wagenaar, 1991).
Issue 8
Issue. "Who will pay for enforcement of these laws?
The age-21 law is too expensive."
Response. We already pay large portions of our tax dollars for problems
resulting from alcohol. For example, in Minnesota, cities use approximately
one-third of their police budgets to deal with alcohol-related problems (Cities
Bulletin, 1989); in the United States, we pay more than $10 billion annually
just for the costs associated with drunk driving (Kenkel, 1993a). Moreover,
drinkers clearly do not pay their own way. They end up generating costs (in
health care costs, legal fees and lost wages) of more than a dollar for every
drink soldcosts we all pay in increased taxes, higher health and auto
insurance premiums and higher costs for goods and services (Miller and Blincoe,
1994). The higher drinking age saves money by resulting in fewer alcohol-related
health problems, fewer alcohol-related injuries and less vandalism.
Issue 9
Issue. "We have other more important problems to deal
with. The truth is, underage drinking is just not a big problem."
Response. Underage drinking is a serious problem. In
1998, 52% of high school seniors in the United States drank
alcohol in the last month, and more than 30% were intoxicated
at least once in the last 2 weeks (Johnston et al.,
1998). And these are the lower numbers under the age-21
policy. Teens would be drinking even more if the legal age
were lowered. A recent national survey indicates that 96%
of the public remains concerned about teen drinking
(Wagenaar et al., 2000). The age-21 law clearly does not
eliminate youth drinking, but it is one important component
of a multifaceted effort to minimize youth drinking
problems.
Issue 10
Issue. "Here come the Prohibitionists."
Response. Those supporting the age-21 policy are not
Prohibitionists. They are not interested in outlawing all alcohol
consumption for adults and are not interested in putting
the alcohol industry out of business. They are interested
in protecting youth and the safety of all citizens in our
communities by supporting implementation and enforcement
of the law that states that it is illegal to sell alcohol to
those under the age of 21. They are interested in protecting
property and reducing the costs spent on health care and
crime. These are goals shared by most of the public, and
research shows that if we can reduce youth access to alcohol,
we can help achieve these goals.
Issue 11
Issue. "We need to punish those teens who are drinking
and creating problems, not enact policies that will affect
the whole community."
Response. This problem requires shared responsibility.
It is adults who create the environments within communities
that provide youth with easy access to alcohol. Adults
own and operate the businesses that sell alcohol to underage
youth. Adults permit advertising and marketing of alcohol
in ways that appeal to teens. Thus it is not appropriate
to blame just the teens for drinking. Surely, teens have a
responsibility not to attempt to purchase or consume alcohol.
But arresting after the fact and labeling as criminals
teens who drink is not the most effective approach. A modest
civil penalty for the teenager caught with alcohol is
appropriate.
More effective in the long term are efforts to reduce the
supply of alcohol to teens to prevent youth drinking and
the resulting tragedies before they happen. This requires
active enforcement of statutes and regulations on those who
sell or provide alcohol to teens, with appropriate penalties
for violations.
Issue 12
Issue. "We drank when we were young and we grew
out of it. It's just a phase that all teens go through."
Response. Unfortunately, many teens will not "grow out
of it." Studies indicate that youth who start drinking before
they are 21 are more likely to drink heavier later in life,
whereas those who do not drink until they are 21 tend to
drink less as adults (Grant and Dawson, 1997). Teens who
drink are also more likely to try other illegal drugs and to
become victims of crime (Kandel et al., 1992). If we accept
that teen drinking is just a normal phase that teens go
through, youth will continue to experience car crashes, other
injuries, early unprotected sex and other common problems
associated with drinking.
Issue 13
Issue. "If teens can't get alcohol, they'll just switch to
other, perhaps even more dangerous, drugs."
Response. Research shows that the opposite is true; teens
who drink and/or smoke are more likely also to use other
drugs (Fell, 1985; Kandel et al., 1992). If we can keep
youth from using alcohol and tobacco, we can actually reduce
the chance that they will try other illegal drugs. Moreover,
when the drinking age was raised to 21, and teen
drinking declined, there was no evidence of a compensatory
increase in other drug use (O'Malley and Wagenaar,
1991).
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Alexander C. Wagenaar may be reached at the above
address or via email at: wagenaar@epi.umn.edu.