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The federal Substance Abuse and Mental Health Services Administration (SAMHSA) defines current use of alcohol as at least one drink in the past month; binge use as five or more drinks on the same occasion at least once in the past month; and heavy use as five or more drinks on the same occasion on at least five different days in the past month (SAMHSA, July 1997). According to the most recent National Household Survey on Drug Abuse, about 9.5 million (or 9% of) current drinkers were under age 21 in 1996. Of this under-21 group, 4.4 million were binge drinkers, including 1.9 million heavy drinkers (SAMHSA, July 1997). The average age when 12 to 17 year olds say they first tried alcohol is 12.8 (SAMHSA, March 1997). Alcohol is the most frequently used drug by high school seniors, and its use appears to be increasing along with the use of tobacco and marijuana. In 1998, 52% of high school seniors consumed any alcohol in the last 30 days, compared to 26% who used any illicit drug in the last 30 days (Johnston et al, in preparation). Although it is illegal for virtually all secondary students to purchase alcoholic beverages, 81% of twelfth graders have tried them at least once, along with 70% of tenth graders and 53% of eighth graders. In comparison, 65% of twelfth graders have ever smoked cigarettes, 49% have ever used marijuana, and 9% have ever used cocaine (Johnston et al, 1996a). Approximately 88% of 10th graders and 75% of 8th graders report that it's very easy or fairly easy to get alcohol (Johnston et al, in preparation). Of the estimated 5.4 million junior and high school students who have ever consumed five or more drinks in a row, 39% say they drink alone; 58% drink when they are upset; 30% drink when they are bored; and 37% drink to feel high (OIG, 1991). High school students lack essential knowledge about alcohol and its effects. Nationwide, an estimated 5.6 million junior and senior high school students are unsure of the legal age to purchase alcohol; one third do not understand the intoxicating effects of alcohol; and more than 2.6 million do not know a person can die from an overdose of alcohol. A projected 259,000 students think that wine coolers or beer cannot get you drunk, cannot make you sick, or cannot do as much harm as other beverages (OIG, 1991). Each year, junior and senior high school students drink an estimated 35% of all wine coolers and about 1.1 billion cans of beer (OIG, 1991). Binge/Heavy Drinking Recent national surveys find high rates of binge drinking among high school and college students and college-age young adults. High school students. According to the 1995 Youth Risk Behavior Survey, 39% of twelfth graders and 30% of tenth graders reported that they had consumed five or more drinks of alcohol on at least one occasion during the last 30 days (defined as “episodic heavy drinking”). This figure was 33% for all high school students, 36% for male high school students, and 29% for female high school students (CDC, 1996). According to the Monitoring the Future Study, about 32% of the nation’s twelfth graders, 24% of tenth graders, and 14% of eighth graders reported in 1998 that they had consumed five or more drinks of alcohol on at least one occasion in the last two weeks. In addition, about 33% of twelfth graders, 21% of tenth graders, and 8% of eighth graders reported that they had been drunk during the last 30 days (Johnston et al, in preparation). In the 1997 College Alcohol Study of the Harvard School of Public Health, 43% of college students reported they had engaged in binge drinking. Binge drinking is defined in this study as consuming five or more drinks in a row (males) or four or more drinks in a row (females) during the last two weeks. Male students binged at a higher rate than female students (48% versus 39%). Nearly 71% of the college binge drinkers in the study binged in high school (Wechsler et al, 1998). The 1997 Harvard study also found that 19% of college students were abstainers and 21% were"frequent binge drinkers" (i.e., they had binged three or more times in the last two weeks). Four of five (81%) residents of fraternities or sororities were binge drinkers. (Wechsler et al, 1998). In 1997, compared to 1993, among students who drank alcohol, increases in frequency of drinking, drunkenness, drinking to get drunk, and alcohol-related problems, including drinking and driving were reported. College students involved in athletics have significantly higher levels of alcohol use than non athletes according to data from the Core Alcohol and Drug Survey (1994-1996). Both male and female college athletes were more likely than non athletes to engage in binge drinking (5 or more drinks per setting) in the prior two weeks. Moreover, athletic team leaders were just as likely as other team members to binge drink (male team leaders 64%, team member 61%, non athlete 45%; female team leader 49%, team member 47% and non athlete 31%). Similar relationships were found for the number of drinks consumed per week and experiencing negative consequences of alcohol or other drug use (Leichliter et al., 1998). The Harvard study also found that 19% of college students were “frequent binge drinkers” (i.e., they had binged three or more times in the last two weeks). Of this group, 91% of the female students and 78% of the male students considered themselves to be only moderate or light drinkers (College Alcohol Study, 1995; Wechsler et al, 1994). Young adults of college age. A 1996 survey by the American Medical Association found that 33% of 19 and 20 year olds consume at least four alcoholic beverages on an average night, and 20% have six or more drinks (AMA, 1996). Race, Ethnicity and Gender A greater proportion of white adolescents drink compared to their Hispanic and African-American counterparts. While 44% of whites ages 12 to 17 have ever consumed alcohol, only 38% of Hispanics and 30% of African-Americans ages 12 to 17 have ever used it (SAMHSA, March 1997). Increases in binge drinking between 1993 and 1997 occurred among Asian (21.9% to 24.9%)and African-American (16.5% to 18.3%) students while decreases occurred among White (48.1% to 46.8%) and Hispanic (38.5% to 37.6%) students (Wechsler et al. 1998). In the 12 to 17 year old age group, more males (23%) than females (20%) reported that they had used alcohol in the last 30 days (SAMHSA, March 1997). Though male high school seniors binge drink more frequently than females (37% compared with 23%), this gender gap has been diminishing gradually over the past decade (Johnston et al, 1996a). Availability and Affordability of Alcohol Nearly 90% of tenth graders and 75% of eighth graders think alcohol is either “fairly easy” or “very easy” for them to get. These students ranked alcohol a close second in perceived availability behind cigarettes, followed by marijuana and amphetamines (Johnston et al, 1996a). Almost two thirds (or 6.9 million) of junior and high school students who consume alcohol purchase their own beverages (OIG, 1991). Advertising and Promotion of Alcohol to Young People A recent study of more than 300 World Wide Web sites finds that 25 major alcohol beverage companies are using the Web to advertise and promote their products through a variety of marketing techniques that capitalize on the Web’s strong attraction for young people. Such techniques include sponsorship of music and sports, interactive games and contests, and chat and message boards. Overall, there are now hundreds of Web sites that promote alcohol, drinking, and specific products. Nearly five million youth ages 2 to 17 used the Internet or an on-line service from school or home in 1996, and more than nine million college students use the Internet regularly (CME, 1997a/b/c). Beer and wine companies spent about $525 million on advertising in the first eight months of 1996. Three top beer companies spent $396.7 million on advertising in the first nine months of 1996 – 17% more than during the same period in 1995. Coors increased its ad budget by 31%; Miller, by 26%; and Budweiser, by 5%. The vast majority of beer and wine ads run on network, cable, and local broadcasting outlets (Grant, 1996). Youth see almost as much television alcohol advertising as adults. Youth (ages 12 to 20) saw two beer and ale ads in 2001 for every three seen by an adult, and an estimated 30 percent of youth saw at least 780 alcohol commercials in 2001 (CAMY, 2002). Studies show that with greater exposure to beer advertising, children have higher recall of brands or brand cartoon characters, are more likely to expect to drink as adults, and hold more positive beliefs about the social and ritual uses of beer (Grube & Wallack, 1994; Lieber, n.d.). Content analyses of alcohol advertisements on television show that the ads link drinking with highly valued personal attributes such as sociability, elegance, and physical attractiveness, and with desirable outcomes such as success, relaxation, romance, and adventure (Grube, 1993). Econometric studies to date suggest that either new restrictions on alcohol advertising or more counter-advertising could help reduce levels of alcohol abuse (Saffer, 1996). Economic Costs of Alcohol Use According to a recent estimate, alcohol-involved motor vehicle crashes resulted in $45 billion in economic costs in 1994, representing about 30 percent of all crash costs. (Blincoe, 1997).
Alcohol is the most costly abused substance in the United States, with the total bill to the nation estimated to be $99 billion in 1990 (Rice, 1993). This includes the costs of: By contrast with these national cost estimates, Federal tax revenues from alcoholic beverages totaled just $7.5 billion in 1995, while state and local authorities collected approximately $9.4 billion in alcohol tax revenues in 1995 (CSPI, 1996). The external costs of heavy drinking (i.e., costs that heavy drinkers impose on others) were estimated at $0.48 per ounce of pure ethanol in 1986, while excise and sales taxes on alcohol averaged only $0.23 per ounce of ethanol. On the basis of these results, researchers have suggested that Federal excise taxes be further increased, especially on beer and wine (NIAAA, 1993; Manning et al, 1989). Health and Social Consequences of Underage Alcohol Use
Underage alcohol use contributes to numerous health and social problems (NIAAA, 1997), including: Motor vehicle crashes are the leading cause of death for youth ages 15 to 20 in the United States. In 1996, 2,315 youth crash fatalities were related to alcohol consumed by a driver, pedestrian, or bicyclist – an increase of 5% over the 2,206 alcohol-related crash deaths among this age group in 1995. The 1995 figure represents about 36% of all crash fatalities among youth ages 15 to 20. Among 18, 19, and 20 year olds, the proportion of alcohol-related crash fatalities in 1995 was even higher – about 42% (Samber, 1997; NHTSA, 1997). In a 1993 survey, about 5% of males 18 to 20 years old reported that they had driven after having “too much to drink” at least once in the previous month. This translates into an estimated 8.1 million episodes of alcohol-impaired driving for all of 1993. In the same age group, 1.5% of females reported driving after drinking too much, which translates into an estimated 1.6 million episodes of alcohol-impaired driving (Liu et al, 1997). Among sexually active teens, those who average five or more drinks daily were nearly three times less likely to use condoms, thus placing them at greater risk for HIV infection. Among all teens that drink, 16% use condoms less often after drinking (Hingson et al, 1990). Researchers estimate that alcohol use is involved in one third to two thirds of sexual assault and acquaintance or date rape cases among teens and college students (OIG, 1992). Fetal alcohol syndrome (FAS) results from prenatal exposure to high levels of alcohol consumed by a pregnant woman. FAS refers to a constellation of physical abnormalities (such as certain facial features and reduced size of the newborn) and developmental, behavioral, and cognitive problems. FAS is a completely preventable set of birth defects and the most common known environmental (nongenetic) cause of mental retardation (Stratton et al, 1996). Prevention of FAS requires multiple strategies (NIAAA, 1997), including: -community education programs to increase general awareness of the hazards of drinking during pregnancy -approaches to effectively identify women, including adolescents, whose drinking places them at risk for adverse pregnancy outcomes -interventions aimed at individual women, including adolescents, who are problem drinkers and at greatest risk for having a child who is adversely affected by alcohol Environmental Strategies to Reduce Alcohol-Related Harm There is no single solution to reducing alcohol-related harm among the nation’s young people. What is required is a comprehensive range of strategies that can address the many causes and dimensions of alcohol problems. Such strategies may include: -tighter controls on price and availability -increases in Federal, State, and local taxes -enforcement of the minimum legal drinking age (MLDA) for purchase of alcohol -legislative measures to curb driving while under the influence of alcohol -restrictions on the promotion, marketing, advertising, and illicit sale of alcohol to youth under 21 -more intensive and effective public education and awareness programs -increased access to primary health care for all young people -improved training for primary care physicians about alcohol use and misuse -community-based interventions that are carefully designed and evaluated Price increases on alcoholic beverages may be especially effective at reducing addictive consumption by younger, poorer, and less educated consumers (NIAAA, 1993; Becker et al, 1991). Alcohol beverage prices can be raised by:
-increases in taxes Minimum drinking age laws have saved an estimated 15,667 lives since 1975 (NHTSA, 1997). Although many youth still consume alcohol, they drink less and experience fewer alcohol-related injuries and deaths than they did under lower minimum legal drinking ages (Wagenaar, 1993). Since the early 1980s, legislative initiatives, such as the minimum legal drinking age (MLDA) of 21, administrative license revocation, and lower legal BAC (blood alcohol concentration) limits for youth and adults, have been independently associated with significant declines in alcohol-related traffic deaths (Hingson, 1996). Nations banning the advertising of distilled spirits, compared to nations with no bans, had 16% lower alcohol consumption and 10% fewer motor vehicle fatalities. Countries banning beer and wine ads had 11% lower alcohol consumption and 23% fewer motor vehicle fatalities than those prohibiting only the advertising of spirits (NIAAA, 1993). Comprehensive, multistrategy community interventions can reduce alcohol-related problems (Hingson, 1996). In the Community Trials Project, three experimental communities, relative to three comparison communities, showed: -statistically significant program-related increases in coverage of alcohol issues in local media outlets -a significant reduction in alcohol sales to minors -increased adoption of responsible beverage server policies -a significant (10%) postprogram reduction in the numbers of single-vehicle nighttime crashes per 100,000 population References American Medical Association. Generation X Drinking Habit Survey. March 1996. Becker GS, Grossman M, Murphy KM. Rational addiction and the effect of price on consumption. Am Econ Rev. 1991;81:237-241. Blincoe, LJ. Economic cost of motor vehicle crashes, 1994. NHTSA Technical Report. Washington, DC: National Highway Transportation Safety Administration; 1997. Center for Media Education. 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Alcohol Use and Related Consequences Among Students with Varying Levels of Involvement in College Athletics. J Am Coll Health. 1998;46:257-262. Lieber L. Commercial and Character Slogan Recall by Children Aged 9 to 11 Years: Budweiser Frogs versus Bugs Bunny. Berkeley and San Francisco: Trauma Foundation, Center on Alcohol Advertising; n.d. Liu S, Siegel PZ, Brewer RD, Mokdad AH, Sleet DA, Serdula M. Prevalence of alcohol-impaired driving: Results from a national self-reported survey of health behaviors. JAMA. 1997;277:122-125. Manning WG, Keeler EB, Newhouse JP, Sloss EM, Wasserman J. The taxes of sin: Do smokers and drinkers pay their way? JAMA. 1989;261:1604-1609. National Highway Traffic Safety Administration. 1995 Youth Fatal Crash and Alcohol Facts. Washington, DC: National Center for Statistics and Analysis, Fatality Analysis Reporting System; February 1997. National Institute on Alcohol Abuse and Alcoholism. Eighth Special Report to the U.S. Congress on Alcohol and Health from the Secretary of Health and Human Services. Rockville, MD: National Institutes of Health; September 1993. National Institute on Alcohol Abuse and Alcoholism. Ninth Special Report to the U.S. Congress on Alcohol and Health from the Secretary of Health and Human Services. Rockville, MD: National Institutes of Health; June 1997. Office of Inspector General. Youth and Alcohol: A National Survey. Drinking Habits, Access, Attitudes, and Knowledge. Washington, DC: US Department of Health and Human Services; June 1991. Office of Inspector General. Youth and Alcohol: Dangerous and Deadly Consequences. Washington, DC: US Department of Health and Human Services; April 1992. Rice DP. The economic cost of alcohol abuse and alcohol dependence: 1990. Alcohol Health Res World. 1993;17:10-11. Saffer H. Studying the effects of alcohol advertising on consumption. Alcohol Health Res World. 1996;20:266-272. Samber S. SADD responds to rise in teens killed in alcohol-related crashes. NCADI Reporter. WWW location: http://www.health.org/pressrel/itn/rep/26.htm; July 23, 1997. Stratton K, Howe C, Battaglia F, eds. Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention, and Treatment. Washington, DC: National Academy Press; 1996. Substance Abuse and Mental Health Services Administration. Preliminary Results from the 1996 National Household Survey on Drug Abuse. Rockville, MD: Office of Applied Studies; July 1997. Substance Abuse and Mental Health Services Administration. National Household Survey on Drug Abuse: Main Findings 1995. Rockville, MD: Office of Applied Studies; March 1997. Toomey TL, Rosenfeld C, Wagenaar AC. The minimum legal drinking age: History, effectiveness, and ongoing debate. Alcohol Health Res World. 1996:20:213-218. Wagenaar, AC. Minimum drinking age and alcohol availability to youth: Issues and research needs. In Hilton ME, Bloss G, eds. Economics and the Prevention of Alcohol-Related Problems. Rockville, MD: National Institute on Alcohol Abuse and Alcoholism, Research Monograph No. 25; 1993:175-200. Wechsler H, Davenport A, Dowdall G, Moeykens B, Castillo S. Health and behavioral consequences of binge drinking in college: A national survey of students at 140 campuses. JAMA. 1994;272:1672-1677. Wechsler H, Dowdall, G, Maenner, G, Gledhill-Hoyt, J, Lee, H. Changes in binge drinking and related problems among American college students between 1993 and 1997. J Am Coll Health. 1998;47:57-68. Abbreviations
AHRW Alcohol Health and Research World
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