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Fact Sheets - Age 21 Minimum Legal Drinking Age

Age 21 Minimum Legal Drinking Age

Public Health Problem

  • Excessive alcohol consumption contributes to more than 4,300 deaths among underage youth, that is, persons less than 21 years of age, in the United States each year.1
  • Underage drinking is strongly associated with many health and social problems among youth including alcohol-impaired driving, physical fighting, poor school performance, sexual activity, and smoking.2
  • About 2 in 3 high school students who drink do so to the point of intoxication, that is, they binge drink (defined as having five or more drinks in a row), typically on multiple occasions.2,3
  • Current drinking during the previous month among persons aged 18 to 20 years declined significantly from 59% in 1985 to 40% in 1991, coincident with states’ adopting an age 21 minimum legal drinking age, but increased to 47% by 1999.4
  • The prevalence of current drinking among persons aged 21 to 25 also declined significantly from 70% in 1985 to 56% in 1991, coincident with states’ adopting an age 21 minimum legal drinking age, but then increased to 60% by 1999.4

Relationship between Youth and Adult Drinking

  • Binge drinking by adults is a strong predictor of binge drinking by high school and college students living in the same state.5,6
  • There are approximately 1.5 billion episodes of binge drinking among persons aged 18 years or older in the United States annually, most of which involve adults age 26 years and older.7
  • More than half of all active duty military personnel report binge drinking in the past month, and young adult service members exposed to combat are at significantly greater risk of binge drinking than older service members.8
  • More than 90% of adult binge drinkers are not alcohol dependent.9

Prevention of Underage Drinking

  • The Task Force on Community Preventive Services recommends implementing and maintaining an age 21 minimum legal drinking age (MLDA) based on strong evidence of effectiveness, including a median 16% decline in motor vehicle crashes among underage youth in states that increased the legal drinking age to 21 years.10
  • The Task Force on Community Preventive Services also recommends enhanced enforcement of laws prohibiting the sale of alcohol to minors to reduce such sales.11
  • Age 21 MLDA laws result in lower levels of alcohol consumption among young adults age 21 years and older as well as those less than age 21 years.12
  • States with more stringent alcohol control policies tend to have lower adult and college binge drinking rates.6
  • In addition to the age 21 MLDA, other effective strategies for preventing underage drinking include increasing alcohol excise taxes13 and limiting alcohol outlet density14. Youth exposure to alcohol marketing should also be reduced.15


  1. Centers for Disease Control and Prevention (CDC). Alcohol-Related Disease Impact(ARDI). Atlanta, GA: CDC.
  2. Miller JW, Naimi TS, Brewer RD, Jones SE. Binge drinking and associated health risk behaviors among high school students. Pediatrics 2006;119:76-85.
  3. CDC. Vital signs: binge drinking among high school students and adults—United States, 2009 [PDF-635.55KB] . MMWR 2010;59:1274–9.
  4. Serdula M, Brewer R, Gillespie C, Denny C, Mokdad A. Trends in alcohol use and binge drinking 1985–1999, results of a multistate survey. Am J Prev Med 2004; 26:294–298.
  5. Nelson D, Naimi T, Brewer RD, Nelson H. State alcohol-use estimates among youth and adults, 1993–2005. Am J Prev Med 2009;36:218-224.
  6. Nelson T, Naimi T, Brewer RD, Weschler H. The state sets the rate: the relationship of college binge drinking rates to state binge drinking rates and state alcohol control policies. Am J Pub Heath 2005;95:1–6.
  7. Naimi T, Brewer RD, Mokdad A, Serdula M, Denny C, Marks J. Binge drinking among U.S. adults. JAMA 2003;289:70–5.
  8. Jacobson IG, Ryan MAK, Hooper TI, Smith TC, et al. Alcohol use and alcohol-related problems before and after military combat deployment. JAMA 2008;300:663–675.
  9. Woerle S, Roeber J, Landen MG. Prevalence of alcohol dependence among excessive drinkers in New Mexico. Alc Clin Exp Res 2007;31:293–298.
  10. Shults RA, Elder RW, Sleet DA, et al. Reviews of evidence regarding interventions to reduce alcohol-impaired driving [PDF-2.3MB]. Am J Prev Med 2001;21(4S):66–88.
  11. Elder RW, Lawrence B, Janes G, Brewer RD, Toomey TL, Hingson RW, Naimi TS, Wing SG, Fielding J. Enhanced enforcement of laws prohibiting sale of alcohol to minors: systematic review of effectiveness for reducing sales and underage drinking. Transportation Research E-Circular 2007;Issue E-C123:181-8. Access full text article from the issue, Traffic Safety and Alcohol Regulation: A Symposium [PDF - 4.30MB].
  12. O’Malley PM, Wagenaar AC. Effects of minimum drinking age laws on alcohol use, related behaviors, and traffic crash involvement among American youth: 1976–1987. J Stud Alcohol 1991;52:478–491.
  13. Elder RW, Lawrence B, Ferguson A, Naimi TS, Brewer RD, Chattopadhyay SK, Toomey TL, Fielding JE, Task Force on Community Preventive Services. The effectiveness of tax policy interventions for reducing excessive alcohol consumption and related harms [PDF - 665KB]. Am J Prev Med 2010;38(2):217-29.
  14. Campbell CA, Hahn RA, Elder R, Brewer R, Chattopadhyay S, Fielding J, Naimi TS, Toomey T, Briana Lawrence B, Middleton JC, Task Force on Community Preventive Services. The effectiveness of limiting alcohol outlet density as a means of reducing excessive alcohol consumption and alcohol-related harms[PDF - 445KB]. Am J Prev Med 2009;37(6):556-69.
  15. Bonnie RJ, O’Connell ME, eds. Reducing underage drinking: A collective responsibility. Washington, DC: The National Academies Press; 2004.
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