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However, this often overlooks the fact that earlier initiation also means a longer drinking history. This paper estimated differences in patterns of alcohol use and harm across adolescence and early adulthood, allowing for the fact that the patterns over time may differ depending on the age at which initiation occurred.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Prospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Australia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>\n                      The Australian Parental Supply of Alcohol Longitudinal Study (APSALS), a cohort of\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091906 adolescents recruited in adolescence (mean age 12.9) from 107 Australian schools and followed up until adulthood (11 annual waves total, 2010\u20132021).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>We defined age of initiation as the age at which alcohol consumption was first reported in the study. Our outcomes were amount of alcohol consumed, monthly heavy episodic drinking, alcohol\u2010related harm and self\u2010reported symptoms of alcohol use disorder in the years following initiation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Those who initiated at age 12 had a lower risk of consumption [risk ratio (RR) 0.01; 95% confidence interval (CI) = 0.01\u20130.02] in the year following initiation (age 13), compared with those who initiated at age 18. Similarly, those who initiated at age 15 had a lower risk of alcohol use disorder in the year after initiation (RR 0.66; 95% CI = 0.52\u20130.83), compared with those who initiated at age 18. However, at age 20, those who initiated at age 12 showed higher consumption (RR 1.57; 95% CI = 1.18\u20132.09), monthly heavy episodic drinking (RR 1.24; 95% CI = 1.02\u20131.51) and alcohol\u2010related harms [incidence\u2010rate ratio (IRR) 1.73; 95% CI = 1.21\u20132.46] than those who initiated at age 18. Similar results were seen for symptoms consistent with DSM\u2010IV alcohol dependence (RR 1.20; 95% CI = 1.05\u20131.38), DSM\u2010IV alcohol abuse (RR 1.54; 95% CI = 1.04\u20132.29) and DSM\u20105 alcohol use disorder (RR 1.36; 95% CI = 1.12\u20131.65). However, there was evidence of ageing out, with risk of heavy episodic drinking and alcohol\u2010related harm peaking around age 20 and then declining, regardless of when initiation occurred.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Later initiation to alcohol appears to be associated with more rapid escalation in drinking and related harm, but lower \u2018peak\u2019 harm than earlier initiation. The findings support the current guidelines recommending adolescents avoid alcohol until adulthood, and reinforce the need for public health intervention targeting both children and parents.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.70183","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T03:56:09Z","timestamp":1760414169000},"page":"44-57","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Does alcohol use and related harm differ based on the age of initiation to alcohol? Results from a prospective cohort study"],"prefix":"10.1111","volume":"121","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2009-7386","authenticated-orcid":false,"given":"Philip J.","family":"Clare","sequence":"first","affiliation":[{"name":"Prevention Research Collaboration The University of Sydney  Sydney New South Wales Australia"},{"name":"National Drug and Alcohol Research Centre University of New South Wales  Randwick New South Wales Australia"},{"name":"Charles Perkins Centre The University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2791-6858","authenticated-orcid":false,"given":"Wing See","family":"Yuen","sequence":"additional","affiliation":[{"name":"National Drug and Alcohol Research Centre University of New South Wales  Randwick New South Wales 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