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Alcohol is the drug of choice among youth.1 The total cost of underage drinking is more than $58 billion annually, including costs from traffic accidents, violent crime, suicide attempts and treatment.2 Half of 12th graders have had at least one drink in the past month. According to the 1998 Monitoring the Future Study, which surveys junior high and high school students, more youth used alcohol in the past month than used all illicit drugs combined.3 Among 8th graders, for example, if the rates of past month use for marijuana, hallucinogens, cocaine, heroin, methamphetamine and barbiturates are added together, the total is lower than the rate of past month alcohol use (13 percent vs. 19 percent). The pattern holds true for older teens as well. Young people are also getting drunk more often than in the past. In 1998, one in three high school seniors reported being drunk in the preceding month, up 13 percent since 1993.4 Among teenagers and young adults, illicit drug use accounts for half as many deaths as alcohol-related traffic accidents alone.5
Many youth begin drinking at early ages, putting themselves at great risk for alcohol problems later in life. Almost one-third of teenagers report having had their first drink (more than a few sips) before their 13th birthday.6 According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), youth who drink before age 15 are four times more likely to develop alcohol dependence than those who begin drinking at age 21.7 For each year's delay in initiation of drinking, the likelihood of later alcohol abuse problems decreases markedly.8
Girls are drinking at earlier ages. According to the National Household Survey on Drug Abuse, in 1995, 31 percent of girls used alcohol for the first time between the ages of 10-14, compared to 7 percent in 1965.9
Youth who drink alcohol participate in other risky behaviors more often than those who abstain. According to the American Academy of Pediatrics, the more youth drink, the more likely they are to drink and drive, or ride in a car where the driver has been drinking.10 In addition, alcohol can impair adolescents' judgments about sex and contraception, placing them at increased risk for HIV infection, other sexually transmitted diseases and unplanned pregnancy. 11
Young drinkers use tobacco and other drugs more often than non-drinkers.12 The 1998 National Household Survey on Drug Abuse found that one in three youth aged 12 to 17 who used alcohol in the preceding month also used illicit drugs, compared to only one in 34 non-drinkers. Rates of illicit drug use continue to increase as the quantity of drinking rises. For example, among youth who binged in the past month (five or more drinks at a time), half also used illicit drugs; among youth who binged at least five times in the past month, two-thirds also used illicit drugs. 13
Teenagers are not well informed about alcohol's effects. Nearly one-third of the teens responding to a 1998 American Academy of Pediatrics survey mistakenly believed that a 12 ounce can of beer contains less alcohol than a standard shot of distilled spirits. In addition, eight in ten teens said there is nothing wrong with underage drinking as long as teens are responsible about the amount they consume. 14
Despite the higher number of accidents and deaths associated with alcohol use, teens perceive alcohol to be less dangerous than other drugs. Almost half of teenagers (48 percent) viewed illicit drugs as the biggest problem facing their generation, while less than 10 percent cited alcohol. 15
Research over the past two decades supports the effectiveness of alcohol, tobacco and other drug prevention programs. In addition, these programs save money. For example, an economic analysis of the Midwestern Prevention Project found that every dollar spent on prevention programs saved $68 per affected family in health and social costs. 16
Project Northland, a prevention model supported by NIAAA, is aimed specifically at teenage alcohol use. The program stresses resistance techniques and decision making for middle school students; well-developed family materials are also included to strengthen relationships and communication. The program has been found to reduce teen drinking (as well as marijuana and tobacco use) and to change students' perceptions that drinking is normal teenage behavior. 17
Project Northland received an "A" in Drug Strategies' Making the Grade: A Guide to School Drug Prevention Programs. The guide assesses the extent to which prevention curricula address key areas and promote the necessary skills that research has shown to be essential for successful programming. The expanded 1999 edition of Making the Grade—which includes both alcohol- and tobacco-specific curricula—rates how well each program:
? helps students recognize internal pressures, like anxiety and stress, and external pressures, like peer attitudes and advertising, that influence them to use alcohol, tobacco and other drugs;
? develops personal, social and refusal skills to resist these pressures;
? teaches that using alcohol, tobacco and other drugs is not the norm among teenagers, even if students think that "everyone is doing it";
? provides developmentally appropriate material and activities, including information about the short-term effects and long-term consequences of alcohol, tobacco and other drugs;
? uses interactive teaching techniques, such as role plays, discussion, brainstorming and cooperative learning;
? covers necessary prevention elements in at least ten sessions a year (with a minimum of three to five booster sessions in two succeeding years);
? actively involves the family and the community;
? includes teacher training and support; and
? contains material that is easy for teachers to implement and culturally relevant for students.
Parental involvement is critical to prevention. The more connected teens feel to their parents and schools, the less likely they are to drink, smoke and use other drugs, according to the 1997 report of the National Longitudinal Study of Adolescent Health. 18 Unfortunately, fewer than one-quarter of parents give their children a no-use message about alcohol. A 1998 Hazelden Foundation survey found that only 23 percent of parents expressly forbid their children to drink before they reach legal age. 19
In addition, parents view drinking as a "lesser evil" compared with other drugs. In a 1997 Robert Wood Johnson Foundation survey, 56 percent of adults cited drugs as the biggest problem facing youth in America today. 20 Despite the serious dangers associated with underage drinking and its widespread prevalence, only 8 percent of respondents mentioned alcohol. 21 The view that underage drinking is not a big problem, or that it is somebody else's problem, may discourage parents from talking with their children. According to the Centers for Disease Control and Prevention (CDC), one-third of high school students have binged on alcohol in the past month; however, in a 1999 Peter Hart Poll, just 3 percent of high school students' parents thought their teen had done so. 22
In a 1999 Peter Hart Poll, one in four parents of 9th-12th graders said they would allow their teens to attend a Millennium New Year's Eve Party where they suspected alcohol would be served. 23
Teenagers know how to get alcohol. Whether they obtain it from friends, siblings, unlocked liquor cabinets or licensed alcohol establishments, nearly 90 percent of 10th graders say alcohol is easy to get. 24 When they first start drinking, most youth get alcohol from home, with or without their parents' permission. 25 As they get older, teens are more likely to get alcohol from friends and siblings over age 21 and at parties. 26
Older teens are also more likely to report buying alcohol from licensed alcohol outlets. 27 Minimum legal drinking age laws, which set the legal drinking age at 21, exist in every state. In addition, it is illegal to sell alcohol to minors. However, many merchants do not comply with these laws. The CDC estimates that at least two-thirds of alcohol outlets sell to underage purchasers without asking for identification. 28
Underage drinkers also purchase alcohol through home delivery services. 29 When alcohol is delivered, underage buyers are often not detected. For example, 10 percent of 12th graders report having successfully purchased alcohol through home delivery. Nonetheless, many states do not monitor home delivery services. An University of Minnesota survey found that agencies within the same states often differ as to whether or not home delivery of alcohol is allowed under state law. 30
Lax enforcement of the minimum legal drinking age laws sends young people a mixed message. 31 Increased law enforcement, including the use of sting operations against alcohol merchants, is an important element of underage drinking prevention which has been shown to be effective. The Denver Police Department's compliance check program, aimed at packaged beer outlets, reported a decrease in sales to underage buyers from nearly 60 percent of attempts at the program's start to 26 percent after two waves of compliance checks. 32 Other alcohol control policies can also help reduce underage drinking. For example, a 1996 study of bars in Minnesota found those with server training programs 33 were 20 percent less likely to sell to minors than bars without such programs. Restricting drinking in public places where youth are known to drink, such as beaches, parks and parking lots, is also effective. 34
In 1998, Congress created a new $25 million program in the Office of Juvenile Justice and Delinquency Prevention. The Combating Underage Drinking Initiative provides at least $360,000 to each state to help stop illegal alcohol sales to minors and create new programs to prevent underage drinking. Some states have made good use of these funds. For example, North Carolina combined the funds with a grant from the Robert Wood Johnson Foundation to expand compliance checks, increase communication between local law enforcement and retailers, develop a media campaign, and reduce alcohol outlet density in targeted communities.
1 . "National Survey Results on Drug Abuse from Monitoring the Future Study." NIDA (December 1998).
2. Costs of Underage Drinking. Bethesda, MD: Pacific Institute for Research and Evaluation, July 1999.
3 . "National Survey Results on Drug Abuse from Monitoring the Future Study." NIDA (December 1998).
4 . "National Survey Results on Drug Abuse from Monitoring the Future Study." NIDA (December 1998).
5 . "Statistics on Alcohol Abuse and Alcoholism: The Impact on America." NIAAA Fact Sheet, January 1999.
6 . Youth Risk Behavior Surveillance Summary, Centers for Disease Control and Prevention, 1997.
7 . Bridget Grant and Deborah Dawson, "Age at Onset of Alcohol Use and Its Association with DSM-IV Alcohol Abuse and Dependence: Results from the National Longitudinal Alcohol Epidemiologic Survey." Journal of Substance Abuse, 9:103-110, 1997.
8 . Bridget Grant and Deborah Dawson, "Age at Onset of Alcohol Use and Its Association with DSM-IV Alcohol Abuse and Dependence: Results from the National Longitudinal Alcohol Epidemiologic Survey." Journal of Substance Abuse, 9:103-110, 1997.
9 . "Substance Abuse Among Women in the U.S." HHS, SAMHSA, OAS, September 1997.
10 . Survey of Teen Alcohol Consumption. Elk Grove, IL: American Academy of Pediatrics, 1998.
11 . L. Strunin and R. Hingson, "Alcohol Use and Risk for HIV Infection." Alcohol Health and Research World, NIAAA, 17(1):35-38, 1993.
12 . "Preliminary Results from the 1998 National Household Survey on Drug Abuse." U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, 1999.
13 . "Preliminary Results from the 1998 National Household Survey on Drug Abuse." U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, 1999.
14 . Survey of Teen Alcohol Consumption. Elk Grove, IL: American Academy of Pediatrics, 1998.
15 . "The National Survey of Teenagers," Washington, DC: Bennett, Petts & Blumenthal, June 1998.
16 . NIDA Notes, 13(5):4, January 1999.
17. Making the Grade: A Guide to School Drug Prevention Programs. Washington, DC: Drug Strategies, 1999.
18 . Michael D. Resnick, Peter S. Bearman, Robert Wm. Blum et al., "Protecting Adolescents from Harm: Findings from the National Longitudinal Study on Adolescent Health." Journal of the American Medical Association, 278(10):823-832, 1997.
19 . Talking to Kids about Alcohol and Drugs. Center City, MN: Hazelden Foundation, 1998.
20 . "Survey: Drugs Dominate Americans' Concerns for Kids: Big Changes from 1986, When Child and Sexual Abuse Registered." Princeton, NJ: Robert Wood Johnson Foundation, November 1997.
21 . "Survey: Drugs Dominate Americans' Concerns for Kids: Big Changes from 1986, When Child and Sexual Abuse Registered." Princeton, NJ: Robert Wood Johnson Foundation, November 1997.
22 . Survey conducted for Drug Strategies by Peter D. Hart Research Associates, Inc., Washington, D.C., October 1999.
23 . Survey conducted for Drug Strategies by Peter D. Hart Research Associates, Inc., Washington, D.C., October 1999.
24 . "National Survey Results on Drug Abuse from Monitoring the Future Study." U.S. Department of Health and Human Services, National Institute on Drug Abuse, December 1996.
25 . Alexander C. Wagenaar, "Minimum Drinking Age and Alcohol Availability to Youth: Issues and Research Needs." Economics and the Prevention of Alcohol-Related Problems. U.S. Department of Health and Human Services, National Institute on Alcohol Abuse and Alcoholism Research Monograph 25:175-200, 1993.
26 . Alexander C. Wagenaar, et al., "Sources of Alcohol for Underage Drinkers." Journal of Studies on Alcohol, 57(3):325-333, 1996.
27 . Alexander C. Wagenaar, et al., "Sources of Alcohol for Underage Drinkers." Journal of Studies on Alcohol, 57(3):325-333, 1996.
28 . Prevention Report, U.S. Department of Health and Human Services, Public Health Service, 13(2), Summer 1998.
29 . Linda A. Fletcher, Traci L. Toomey, Alexander C. Wagenaar and Mark L. Willenbrig, "Home Delivery of Alcohol to Youth and Problem Drinkers." Paper delivered at the American Medical Association, Alcohol Policy Conference, Chicago, 1998.
30 . Linda A. Fletcher, Traci L. Toomey, Alexander C. Wagenaar and Mark L. Willenbrig, "Home Delivery of Alcohol to Youth and Problem Drinkers." Paper delivered at the American Medical Association, Alcohol Policy Conference, Chicago, 1998.
31 . William Dejong and Ralph Hingson, "Strategies to Reduce Driving Under the Influence of Alcohol." Annual Review of Public Health, 19:359-78, 1998.
32 . David F. Preusser et al., "Policing Underage Alcohol Sales." Journal of Safety Research, 25(3):127-133, Fall 1994.
33 . Mark Wolfson, Traci L. Toomey, Jean L. Forster, Alexander C. Wagenaar, Paul G. McGovern and Cheryl L. Perry, "Characteristics, Policies and Practices of Alcohol Outlets and Sales to Underage Persons." Journal of Studies on Alcohol, 57:670-674, 1996.
34 . Rhonda Jones-Webb, Traci L. Toomey, Brian Short, David M. Murray, Alexander Wagenaar and Mark Wolfson, "Relationships among Alcohol Availability, Drinking Location, Alcohol Consumption, and Drinking Problems in Adolescents." Substance Use and Misuse, 32(10):1261-1285, 1997.
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