21st Birthday Research Articles

Defusing a Paradox to a Hypodox

One way of resolving a paradox is to defuse it to a hypodox. This way is relatively unknown though. The goal of this paper is to explain this way with varied examples. The hypodoxes are themselves a broad class: both the Truth-teller and the 21st birthday of someone born on 29th February can be construed as hypodoxes. The most familiar kind of relation between paradoxes and hypodoxes is exemplified by the relation between the Liar and the Truth-teller. This article concerns a second kind where a paradox is defused to a hypodox by restricting or rejecting some granted principles. The Liar paradox has this second kind of relation to a Liar hypodox, which will be introduced. In some cases, defusing a paradox to a hypodox is only a partial resolution, as the hypodox itself may then need resolving. Even so, such a partial resolution decomposes a complex problem into more easily understood problems. Moreover, I compare the result of defusing a paradox to a hypodox with the results of resolving paradoxes in other ways. I give four examples. The first is mainly pedagogic, concerning a birthday. The second is a lightweight legal case, presenting a parking voucher paradox. The third is a formal system in which a Liar and Liar-like sentences are hypodoxical. The fourth is a philosophical critique of ways of solving Bertrand’s chord paradox.

Is the 21st birthday a turning point for alcohol and cannabis use? A monthly study of young adults.

An important life-course event with respect to alcohol and cannabis use is turning 21 years of age, which may be associated with increases in use of these substances due to celebrations during the month and easier access to them on and following this birthday. We examined the trajectories of alcohol and cannabis use behaviors in the months leading up to, during, and following the 21st birthday month. We also examined whether the use trajectories vary by college status and baseline levels of use. We used data from 203 young adults recruited from the Greater Seattle region who turned 21 during the course of the study. Surveys were administered each month for 24 consecutive months. Measures included the typical number of drinks per week for the past month, the frequency of heavy episodic drinking, the number of cannabis use days, and any simultaneous alcohol and cannabis use. Multilevel spline models were run that estimated linear slopes over time at four intervals: (1) up to 1 month before the 21st birthday month; (2) from 1 month before to the month of the 21st birthday; (3) from the 21st birthday month to 1 month following; and (4) from 1 month following the 21st birthday month through all following months. Alcohol use, generally, and simultaneous alcohol and cannabis use showed sharp increases from the month before the 21st birthday month to the 21st birthday month and decreases following the 21st birthday month. For cannabis use, there were significant increases in the months leading up to the 21st birthday and no other significant changes during other time intervals. Patterns differed by baseline substance use and college status. Findings from the current study have implications for the timing and personalization of prevention and intervention efforts. Event-specific 21st birthday interventions may benefit from incorporating content targeting specific hazardous drinking behaviors in the month prior to the 21st birthday.

The Groebke-Blackburn-Bienaymé reaction in its maturity: innovation and improvements since its 21st birthday (2019-2023).

The Groebke-Blackburn-Bienaymé (GBB) three-component reaction, discovered in 1998, is a very efficient strategy to assemble imidazo[1,2-a]-heterocycles starting from amidines, aldehydes and isocyanides. This review aims to exhaustively describe innovative aspects of this reaction achieved during the last five years, and classifies them into five categories: synthetic methods, building blocks, scaffolds, biological activities and physical properties.

Prevention of Childhood Adversities and Children’s Common Mental Disorders and School Grades

Adversity during childhood can limit children's chances of achieving their optimal developmental and psychological outcomes. Well-designed observational studies might help identify adversities that are most implicated in this, thereby helping to identify potential targets for developing interventions. To compare the association between preventing childhood poverty, parental mental illness and parental separation, and the population rate of offspring common mental disorders (ages 16-21 years) or average school grades (age 16 years). A population-based, longitudinal cohort study using Swedish registries was conducted. A total of 163 529 children born in Sweden between January 1, 1996, and December 31, 1997, were followed up until their 21st birthday. They were linked to registries using Sweden's national personal identification number. Children were linked to birth parents, hospital records, and school data. Parents were linked to registries containing health, income, sociodemographic, and obstetric data. Analyses were conducted between January 10, 2021, and August 26, 2022. Childhood adversities of relative poverty (household disposable income <50% of the median), parental inpatient admission for a mental illness, or parental separation. Adversities were categorized into developmental periods: ages 0 to 3, 4 to 7, 8 to 11, and 12 to 16 years. The main outcomes were children's hospital records with a diagnosis of anxiety or depression between ages 16 and 21 years and school grades at the end of compulsory education (age 16 years). The parametric g-formula modeled population changes in outcomes associated with the counterfactual, hypothetical preventing adversity exposures, accounting for fixed and time-varying confounders. Adjustments were made for parental demographic characteristics, obstetric variables, and socioeconomic data at birth. A total of 163 529 children were included in the cohort (51.2% boys, 51.4% born in 1996). Preventing all adversities was associated with an estimated change in the prevalence of offspring common mental disorders from 10.2% to 7.6% and an improvement in school grades with an SD of 0.149 (95% CI, 0.147-0.149). Preventing parental separation provided for the greatest improvement, with an estimated 2.34% (95% CI, 2.23%-2.42%) fewer children with a common mental disorder and an improvement in school grades by 0.127 SDs (0.125-0.129). Greater improvements were shown by hypothetically targeting adolescents (age 12-16 years) and those whose parents had a mental illness when the child was born. The results of this cohort modeling study suggest that preventing childhood adversity could provide notable improvements in the rates of common mental disorders and school grades. Many children might achieve better life outcomes if resources are properly allocated to the right adversities (parental separation), the right groups (children with parental mental illness), and at the right time (adolescence).

Unindicated Cervical Cancer Screening in Adolescent Females Within a Large Healthcare System in the United States

ABSTRACT The increasingly complicated nature of screening guidelines for cervical cancer includes multiple component tests (cytology, genotyping, and high-risk human papilloma virus [HPV] testing) and evolving recommendations. The aim of this study was assessing single-large-healthcare-system trends over time associated with adolescent females and unindicated cervical cancer screening tests. This repeated cross-sectional study analyzed electronic medical records of provider- and patient-specific variables from the Yale New Haven Health System. Included in the study were all 13- to 20-year-old Yale New Haven Health System patients who underwent screening for cervical cancer via either HPV testing or cytology between January 1, 2012 and December 31, 2018. Age, medical histories, surgical histories, self-reported race and ethnicity, and prescribed medications were all patient-specific variables. Provider-specific variables included clinical practice affiliation, clinical degree, and adolescent patient volume (number of medical visits completed by a patient less than 21 every 6 months). In terms of this study, definition of practice setting was either academic (low-income teaching hospitals) or community-based (private practice setting with primarily insured women). Cytologies were categorized as either unindicated or indicated, based on cervical cancer screening guidelines from 2012 (recorded as unindicated for index specimens collected before the 21st birthday in patients lacking immunocompromised conditions). Should an HPV test be performed, any results other than “atypical squamous cells of undetermined significance” received an unindicated status. The final sample size in the study included 794 women from 118 providers (53% community setting and 47% academic setting). Results from analysis of 900 cervical cancer screenings demonstrated that unindicated tests made up the majority of tests (90%), with 87% of these being unindicated cytology testing only and 14% with unindicated HPV testing as well. Reasons for obtaining unindicated tests as recorded in the original clinical history were lacking, as 62% had no justification listed for testing, and those with reasons failed current guideline compliance. The incidence rate (IR) of adolescent unindicated tests decreased by 33% between 2012 and 2018. Although a significantly lower IR of unindicated screening existed in the academic setting, the rate of decline in the IR of unindicated screening during this period was significantly greater in the community than in the academic setting by 11%. A strength of the study included its ability to calculate IRs in all encounters, including sexually transmitted infection or contraception screenings. Limitations included utilization of hospital system cytology reports for obtaining data, thereby hindering any access to data necessary for validation of screening or surveillance indications from previously performed antecedent cytology. Furthermore, the study failed to collect information regarding another guideline-adherence marker: number of indicated index cervical cancer screenings for patients beginning at 21 years. According to an examination by Becerra-Culqui of women having an encounter at the age of 21 years or beyond, 65% missed opportunities for screening. Finally, the authors were unable to comment on both immunocompromised women and eligible young women who missed indicated screening due to collection of data via pathology reports rather than well-woman examinations. Although unindicated screening for women ages 21 and younger experienced significant reductions, areas for improvement remained. As recent guidelines updates may present greater provider and patient challenges, evidence-based strategies are more important than ever in terms of guideline adherence and dissemination.

Contextual Use of Protective Behavioral Strategies for College Drinking

Background: Alcohol use on college campuses in the United States is a public health concern. Some students engage in protective behavioral strategies (PBS) before, during, or after their alcohol consumption (e.g., designated driver) to try to mitigate negative alcohol-related negative consequences. There is a gap in the literature on the use of different PBS in different situations commonly experienced by students (e.g., game day). The goal of the present study was to determine whether students would use different PBS for different situations, and to determine which PBS they would encourage their peers to use in these same situations. Objectives: A total of 182 undergraduate students were presented with three different hypothetical drinking scenarios (i.e., a friend’s 21st birthday celebration, football game day, and a house party) and asked which PBS they would use (i.e., limit drinking, change their manner of drinking, serious harm reduction strategies) and which they would recommend to their friends. They were also given the option to not drink at all. Results: Overall, students chose different strategies for different situations: they chose to limit their drinking at their friend’s 21st birthday or the game day tailgating event, to alter the manner of their drinking for the game day tailgating event, to reduce the potential of harm at the house party, and to not drink at their friend’s 21st birthday or the house party event. Students’ personal choices matched their recommended choices for their friends. Conclusions: Results may have implications for prevention programs that teach harm reduction strategies such as PBS.

Young adult birthday celebrations as windows of risk for alcohol and cannabis use: 21st birthdays compared to other young adult birthdays.

Alcohol use among college students during 21st birthday celebrations constitutes a well-known example of event-specific drinking when alcohol use is both pervasive and heavy. Less is known about how 21st birthday alcohol use compares to other birthday celebrations during young adulthood, whether similar increases occur for cannabis use on 21st birthdays, and whether the "21st birthday effect" is similar for noncollege young adults. Alcohol and cannabis use during 19th to 25th birthday celebrations were explored among college and noncollege students. Participants were 720 young adults of ages 18 to 23 (M = 21.1, SD = 1.7) at enrollment who completed 24 monthly surveys, and 204 reported on a 21st birthday. Participants resided in a state where cannabis was legal and were asked the month following their birthday whether they engaged in alcohol and cannabis use as part of their birthday celebration. Multilevel models found a 21st birthday effect for alcohol use as individuals consumed over twice as many drinks on their 21st birthday than would have been expected given age trends in birthday drinking, and this effect held for college and noncollege students. A 21st birthday effect for cannabis was not found. 21st birthday celebrations represent a high-risk drinking event for young adults in general, and the current findings suggest event-specific prevention programs targeting all young adults turning 21 are warranted. Unlike alcohol where turning 21 is associated with socially and culturally normative use, a similar 21st birthday effect was not found for cannabis. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

"On a night like this": A mixed-methods approach to understanding high-risk drinking events in college students.

Previous research indicates college students report heavier drinking on certain events (e.g., 21st birthday). While past research has identified heavier drinking events, students' own reports of which events are associated with elevated drinking remains understudied. The current study utilized mixed methods to explore potential high-risk drinking events (HRDE) for college student drinkers and how these events differed from typical drinking and each other. College student drinkers (N=204) reported the number of drinks they consume on nine predetermined events (e.g., Halloween). Students also responded to open-ended questions listing five events during which they had elevated drinking and indicating the amount consumed on each event. Open-ended responses were coded into similar event categories. Descriptive statistics for drinks consumed were calculated for predetermined and coded open-ended events. Chi-square analyses assessed differences in endorsement of open-ended events by birth sex, age group, and Greek membership. Two multilevel count regressions assessed within-person differences in number of drinks consumed between participants' typical drinking occasions and (1) highly endorsed open-ended events and (2) predetermined events. For all open-ended event categories, average number of drinks consumed exceeded heavy episodic drinking thresholds; however, there was substantial variability. Comparing predetermined events to participants' typical drinking indicated elevated drinking on participants' birthdays, New Year's Eve, Halloween, Finals, and Spring Break; significant differences between events also emerged. Comparison of open-ended categories to participants' typical drinking indicated elevated drinking on birthdays, celebrations, parties, and holidays; however, there were no significant differences between open-ended events. Students who drink alcohol report heavier drinking on specific calendar-based events (e.g., Spring Break). However, students also report non-calendar-related events (e.g., non-specific parties) as some of their highest drinking events. More research is needed to understand how intervention and prevention programs can be adapted to target both known calendar-based HRDE, and unknown, idiosyncratic HRDE.

Impact of Home-Based Pediatric Palliative Care on Hospital and Emergency Department Utilization at a Single Institution.

Background: There is limited data on home-based pediatric palliative care (PPC) demographics and utilization outcomes. Objective: Describe who receives home-based PPC and compare emergency department visits, hospital admissions, and hospital days admitted in the one year before and after initiation of home-based PPC. Design: Exploratory retrospective medical chart review. Settings/Subjects: Patients, from birth to their 21st birthday, who received home-based PPC during January 1, 2015 to July 31, 2016 at a single site. Measurements: Demographics and hospital utilization were extracted from the medical chart. Results:N = 154. Comparing one year before and after initiation of home-based PPC, the median number of hospitalizations decreased from 2 to 1 (p < 0.001), and the median total number of hospital days admitted decreased from 16 to 4 days (p < 0.001). Conclusions: Children enrolled in a home-based PPC program experienced a significant decrease in the number of hospital admissions and hospital days admitted.

Emilijos Beniovskytės-Vrublevskienės rankraštinis paveldas

Emilia z Beniowskich Wróblewska (1830–1886) is the mother of the founder of the Wroblewski Library of the Lithuanian Academy of Sciences, Tadeusz Stanisław Wróblewski (1858–1925). She was an educator, a litterata, and the wife of Tadeusz Wróblewski’s father, the homeopathic doctor Eustachy Edward Wróblewski (1826–1908). Owing to the efforts of Wróblewska’s son, her memory is immortalized at the name of the Library of Eustachy and Emilia Wróblewski established in 1912 in Vilnius. Kept in the Manuscripts Department of the Wroblewski Library (F9 and F75), the manuscript legacy of Emilia Wróblewska is of importance for the history of the establishment and activities of the Wroblewski Library, and will take a place of honor in Bibliopolis, the future museum of the Lithuanian book. A total of seven diary notebooks written by Emilia Wróblewska are extant today. Two of them are dedicated to her three children: Tadeusz Stanisław, eldest daughter Maria Wróblewska (1860–1878), and another son, Augustyn Anicety Wróblewski (1866–after 1913). The largest in length (175 entries), longest in time (27 years) and most consistently written diary is devoted to her eldest son Tadeusz. It is as if it were a long conversation with her son, a series of letters to him, continued until the diarist’s death (1886). The diary for the eldest daughter Maria contains 77 entries by her mother. She started writing it when Maria was five years old, but after the girl’s death (1878), the mother did not write anything in this diary for a long time, and only eight years later, in 1886, she put in an only entry for her son Augustyn on the eve of his 21st birthday – the mother used the same notebook as a diary for Augustyn. Of the seven Wróblewski children, only Tadeusz Stanisław and Augustyn lived to a mature age. Kazimierz took his own life at seventeen, Maria died at eighteen, and three other children died in childhood. As to five remaining diaries, Wróblewska wrote them for herself (ad se ipsam). In them, the diarist gives account of her emotional experiences in chronological order. Writing for her is spiritual therapy. This is especially obvious from the diary entitled “Moje myśli” (“My thoughts”), which also shows the diarist’s literary talent. Emilia Wróblewska also expressed herself in other literary works, besides the diaries: she translated her father’s works into Polish, attempted to translate literature for servants and even wrote for them a textbook herself. Her entire manuscript legacy not only testifies to her having been a versatile creator, but also represents an attractive object for Bibliopolis – Emilia Wróblewska is a symbol of a creative, but dramatically-fated woman of the late 19th century. Keywords: diaries; 19th-century Polish-language literature in Lithuania; Wroblewski Library of the Lithuanian Academy of Sciences; Emilia z Beniowskich Wróblewska; Tadeusz Stanisław Wróblewski; Maria Wróblewska; Augustyn Anicety Wróblewski.

Supplemental Material for Young Adult Birthday Celebrations as Windows of Risk for Alcohol and Cannabis Use: 21st Birthdays Compared to Other Young Adult Birthdays

Supplemental Material for Young Adult Birthday Celebrations as Windows of Risk for Alcohol and Cannabis Use: 21st Birthdays Compared to Other Young Adult Birthdays

American Journal of Transplantation: Volume 21, Number 6, June 2021

On the cover: This issue is dedicated to celebrating AJT’s 21st birthday, an important milestone indeed, that motivates us to commemorate the journey thus far and envision the road ahead. In “The AJT Report,” Lara Pullen revisits the genesis—the compelling realization that the dynamic field of transplantation needed a journal owned and controlled by our professional community. Through interviews with presidents of the American Society of Transplantation and the American Society of Transplant Surgeons, she gives us a palpable sense of the negotiations and planning that culminated in publication of AJT’s first issue in May 2001. She also elicits reminiscences from Philip Halloran and Allan Kirk about their decade tenure as the first and second Editors-in-Chief. And finally, my piece, entitled “Happy 21st birthday, AJT! An occasion to celebrate, rededicate, and innovate” aims to capture the next 5 to 10 years. I think we all agree that AJT has come of age. We very much look forward to continuing to serve the global transplantation community by showcasing and communicating the most impactful research in transplantation worldwide and doing so elegantly and efficiently. We want AJT to be emblematic of our field: dynamic, progressive, and innovative. Cover design by Megan Llewellyn, Duke University Section of Surgical Disciplines.

Educational attainment by children with parental alcohol problems in Denmark and Finland.

Background:Adverse childhood experiences have negative outcomes for children, yet previous research suggests the independent effect of parental alcohol problems is inconsistent.Objectives:Our aim was (1) to compare educational attainment among Danish and Finnish youth with parental alcohol problems and (2) to study the associations between parental alcohol problems and children’s educational attainment in these two Nordic welfare states.Data and methods:Administrative longitudinal data on children born in 1991 in Finland (n = 64,696) and Denmark (n = 64,138) and their biological parents. The children were followed until their 21st birthdays. We applied a mediation analysis to investigate how the association between parental alcohol problems and children’s educational attainment is mediated by four indicators for poor socioeconomic family background (low parental education, long-term economic distress, psychiatric disorders, and living in a non-intact family).Results:At age 20 years, Finnish children were more likely to complete their education than their Danish peers. Young adults with parental alcohol problems faced early school leaving more frequently in both countries compared with their peers, but the relative risk was higher in Finland. In both countries, long-term economic distress mediated the highest proportion of the effect of alcohol problems (39% in Denmark and 34% in Finland). Low parental education and psychiatric disorders mediated part of the effect, but not to the same degree as economic distress.Conclusions:Ensuring education for children with parental alcohol problems is a key to improving their long-term outcomes in different life domains. Consequently, healthcare, social work and education sectors should prioritise advancing education among these children in order to prevent their exclusion from education and labour markets, and they should cooperate closely in doing so.

When young soldiers drink: The impact of legal access to alcohol among U.S. Army soldiers

AbstractWe study the impacts of legal access to alcohol on young U.S. Army soldiers. Regression discontinuity estimates reveal that soldiers report a large and significant increase in alcohol consumption after their 21st birthday; however, we precisely estimate that there are no meaningful impacts of legal access on any of the short‐term outcomes we observe, including suicidal tendencies, depression, tobacco use, physical fitness, psychological health, fitness for combat deployment, and job‐related infractions. Novel data on soldier's cognitive ability, psychological health, and family history allow us to explore whether the impacts of legal access vary by risk factors for alcohol abuse. While the increases in alcohol consumption were largest among those who had a family history of mental health problems, had better coping ability, and had higher cognitive ability, these subgroups did not uniformly experience adverse behavioral and physical outcomes upon gaining legal access to alcohol.

Intrapersonal and interpersonal pathways linking 21st birthday celebration beliefs, intentions, and drinking behavior

In the United States, turning 21 often involves heavy drinking and high rates of alcohol-related consequences. Friends are an important source of social influence on young adult drinking, including during 21st birthdays. However, research is needed to investigate the specific pathways through which this interpersonal influence occurs. Data were drawn from a larger intervention study focused on reducing 21st birthday drinking. Using data from 166 celebrant and friend dyads (N = 332 individuals), we prospectively examined relations among each person’s beliefs about 21st birthday celebrations, drinking intentions for the celebrant, and celebrants’ estimated blood alcohol concentration (eBAC) on their 21st birthdays. Path analyses evaluated the impact of celebrant and friend beliefs on their own report of celebrant intentions, each other’s report of celebrant intentions, and celebrant eBAC, as well as the mediating role of each individual’s report of celebrant intentions. Results revealed significant indirect effects of each individual’s beliefs on celebrant eBAC via their own report of celebrant 21st birthday drinking intentions. Friend beliefs also predicted celebrant eBAC via celebrant drinking intentions, beyond the effect of celebrant beliefs. Importantly, celebrant eBAC was as strongly predicted by friend 21st birthday celebration beliefs as they were by their own beliefs. Results highlight multiple pathways through which friends influence 21st birthday drinking and reveal that friend influence is not constrained to the celebration, but begins in advance of the event by shaping celebrants’ drinking intentions. Findings highlight key directions for future work leveraging friends as intervention agents to reduce drinking related to this high-risk event.

NICE Comes of Age

Abstract In April 1999, the British government established a new institute, NICE, to assess the clinical and cost-effectiveness of medicines and devices for use by the National Health Service in England. To mark its 21st birthday, NICE's former chair, Michael D. Rawlins, and former chief executive, Andrew Dillon, reflect on the organisation's contributions – plus a few controversies along the way

Predicting Future Criminal Convictions of Children Under Age 12 Using the Early Assessment Risk Lists

The Early Assessment Risk Lists for Boys (EARL-20B) and Girls (EARL-21G) measure risk for future antisocial behaviour in conduct-disordered children aged 6–11. Their aim is to assist clinicians in targeting these factors so that evidence-based, age-graded responses to antisocial behaviour can be provided to prevent children from entering the criminal justice system. EARL-20B and EARL-21G factors are targeted in the Stop Now And Plan® (SNAP) crime prevention program, which has been proven to be both effective and cost-effective. The present study assessed the long-term predictive power of the EARL-20B for 379 boys and the EARL-21G for 67 girls who received the SNAP program between 1985 and 1999. EARL scores were retrospectively coded from case files by three independent raters who also provided confidence ratings for each case (i.e. high, moderate, low). EARL scores were compared with official criminal conviction records registered between each child’s 12th and 21st birthdays. The EARL-20B total score was a significant predictor of any offence for boys and its predictive power was improved for high-confidence ratings. For females, the EARL-21G total score predicted property offending and administration of justice charges for high-moderate confidence cases only. Specific individual, family and peer factors predicted conviction status at follow-up for boys and girls. The findings from this study provide support for using empirically-derived risk assessment tools such as the EARL-20B and EARL-21G to identify children at high risk for future involvement in crime. Developmental crime prevention programs such as SNAP should focus on children with a subset of risk factors that have strong statistical relationships with conviction status during adolescence and early adulthood.

Positive urgency worsens the impact of normative feedback on 21st birthday drinking

BackgroundThe 21st birthday is associated with more alcohol consumption and negative consequences than any other occasion. The current study investigated how positive urgency, the tendency to act rashly in response to positive emotions, influences 21st birthday drinking and the effectiveness of a single event text message intervention designed to reduce 21st birthday drinking and related negative consequences. MethodsParticipants were 183 undergraduate students (69% female, 86% white) about to turn 21. Participants were randomly assigned to either a text message intervention or control condition. Those in the intervention condition received one text message the day before their 21st birthday that provided personalized normative feedback and one text message on the day of their 21st birthday. Participants reported actual alcohol consumption the day after their 21st birthday celebration. ResultsHierarchical linear regression found that, after controlling for sex, intervention condition, and planned drinking, positive urgency was associated with greater number of drinks (β = .15, p = .031) and drinking problems (β = .25, p = .001). A moderated-mediation model was significant (B = 0.42, CI95 [.10, .76]): At high levels of positive urgency, the intervention condition was associated with drinking more than planned, which significantly mediated the relationship between intervention and alcohol-related consequences; the mediation was not significant at mean or low levels of positive urgency. ConclusionsThese findings are the first to link positive urgency with 21st birthday drinking and to empirically demonstrate that positive urgency negatively impacts the effectiveness of an intervention aimed at reducing alcohol consumption.

ESTIMATING CAUSAL EFFECTS OF ALCOHOL ACCESS AND USE ON A BROAD SET OF RISKY BEHAVIORS: REGRESSION DISCONTINUITY EVIDENCE

A growing body of evidence suggests large increases in criminal behavior and mortality coinciding with a young adult's 21st birthday, when alcohol consumption becomes legal. The policy implications from these findings have focused on the need to reduce drinking among young people, potentially by enforcing stricter alcohol controls. However, mortality and arrests are relatively infrequent outcomes and relatively less is known about the intermediate and more prevalent consequences of legal access to alcohol at age 21. This paper uses the Add Health data combined with a regression discontinuity approach to examine the effects of alcohol access on sexual behavior, drunk driving, violence, and other outcomes. The results suggest relatively large effects that appear concentrated in men. The sample also allows some suggestive policy implications on whether changing the minimum drinking age may reduce these consequences. (JEL I12, I18)

A text message intervention to reduce 21st birthday alcohol consumption: Evaluation of a two-group randomized controlled trial.

Twenty-first birthdays are associated with extreme levels of heavy drinking and alcohol-related harm. Effective preventive interventions that are acceptable to young adults are needed. The current study tested the efficacy of a brief text-message intervention for reducing 21st birthday alcohol involvement designed to correct perceived 21st birthday drinking norms and provide protective behavioral strategies (PBS). We also examined potential moderators and mediators. College students (n = 200) with an upcoming 21st birthday completed a baseline assessment and were randomized to a text-message intervention or an assessment-only control condition. For participants in the intervention group, Message 1 (sent one day before the birthday celebration) focused on personalized normative feedback, and Message 2 (sent day of the birthday celebration) discussed PBS to minimize risk. Primary outcomes were assessed using responses to a follow-up assessment the day after their birthday celebration (93% completion rate). Zero-inflated negative binomial regression analyses did not reveal an overall intervention effect for estimated Blood Alcohol Content (eBAC) or alcohol problems on the 21st birthday celebration. In partial support of our hypothesis, there was an indirect effect of perceived 21st birthday norms on 21st birthday eBAC. The intervention was associated with reduced perceived norms, which was, in turn, related to a lower eBAC. There was a 3-way interaction between drinks per week, anticipated eBAC, and intervention condition for the count portion of actual eBAC such that the intervention reduced eBAC among a high-risk subset of the sample. Future research may benefit from further refining the personalized normative feedback (PNF) component of 21st birthday interventions. (PsycINFO Database Record