(PS1-8) Associations of Sex and College Exposure with Alcohol Use and Misuse Milestones

Emerging adults (ages 18-30) report the highest alcohol consumption rates in the U.S., leading to increased risk for negative consequences. The progression of alcohol use and misuse is associated with biopsychosocial factors, such as sex (i.e., male or female) and educational attainment, yet their specific associations with alcohol use and misuse milestone attainment and progression remain unclear. Identifying predictors of alcohol use and misuse progression is crucial for mitigating harm and guiding prevention efforts in this developmental period. The present study examined the relationship of sex and level of education attainment with progression and attainment of alcohol use/misuse milestones (e.g., initiation, first drunk, first drinking 5 or more drinks on an occasion) using a large, nationally representative sample. Secondary data analysis was conducted using the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III; N = 36,309, M_age = 45.63 (SD = 17.53), female = 56%, 53% White, 21% Black, 19% Hispanic). Ordinal logistic regression models indicate males had higher odds of milestone attainments compared to females (OR = 1.60, 95% CI [1.32, 1.95], p < .001). Educational attainment significantly predicted milestone attainment, with lower education levels associated with decreased odds of milestone attainment (OR = 0.75, 95% CI [0.71, 0.08], p < .001). An interaction effect between sex and educational levels showed the decreased odds of milestone attainments associated with lower education attainment were stronger for females than males (p = < .01). Cox models of survival analysis revealed significant sex differences in milestone attainment. Males were likely to reach the first milestone (alcohol initiation) and the second milestone (first time drunk) later than females (HR = 0.82, 95% CI [0.78, 0.86], p = .001), but attained the third milestone (first drinking 5 or more drinks on an occasion) earlier than females (HR = 1.83, 95% CI [1.68, 2.00], p = .001). Higher education levels and full work status (as opposed to part-time and no employment) were associated with delayed milestone attainment across all models (p < .01). Kaplan-Meier survival curves replicated the results from Cox models regarding earlier attainment of milestones 1 and 2 for females, while males progressed to milestone 3 more quickly than females. Overall, differences in findings between ordinal regression models and survival analyses (i.e., Cox regression and Kaplan-Meier curves) likely stem from the models' approaches: ordinal regression ranks individuals based on milestone attainments, while survival analysis accounts for timing of attainment. Together, these findings provide a more comprehensive understanding of the biopsychosocial factors influencing alcohol milestone progression in emerging adulthood and highlight the need for tailored interventions based on milestone attainment, as sex differences in alcohol use/misuse evolve. Higher education attainment and full-time work may offer protective effects against risky drinking.