Underage drinking is widespread throughout the United States. More than 13 million underage youth drink each year. In fact, according to recent research conducted by the Institute of Medicine (IOM), actual drinking patterns in the US suggest that "almost all young people use alcohol before they are 21" (Reducing Underage Drinking: A Collective Responsibility, 2004). The average age of first alcohol use has generally decreased since 1965. This in itself is troubling, because the age of the youth at the onset of drinking strongly predicts the development of alcohol dependence over the course of an individual's lifetime (Reducing Underage Drinking: A Collective Responsibility, 2004).

This early onset of alcohol use has triggered tragic health, social and economic problems for youths and their families: homicide, suicide, traumatic injury, drowning, burns, violent and property crime, high risk sex, fetal alcohol syndrome, alcohol poisoning, and a need for treatment for alcohol abuse and dependence (Understanding Underage Drinking, National Institute on Alcohol Abuse and Alcoholism, 2002).

As a prevention coordinator, it is likely that you are quite well-versed on the topic of alcohol prevention. However, it is also likely that many members of your school community are not as well versed as you. As you address the issue of underage drinking in your schools, it is important to keep in mind that many people have only just begun to understand that underage drinking is not just a matter of kids being kids -- but that underage drinking actually can lead to serious and enduring problems. These problems may include: academic failure, attendance issues, behavioral problems including social and emotional issues, suspension and incarceration, and even school violence (Dwyer, Osher, & Warger, 1998).

By looking at local, state and national data, you can gain a more complete understanding of the education, health, and safety issues, as well as high risk behaviors that are part of growing up in America. As stated earlier, numerous agencies and data collection systems at the state and national levels routinely gather and publicize a wealth of information around underage drinking. It is important for you as a coordinator to review these reports, and present the findings to your Advisory Committee. By doing this, your Advisory Committee can make informed decision about how to address the problem of underage drinking in your school and community. Be sure to keep in mind that some of the data may be a year or more old since it takes time to complete data collection, analysis, and compilation.

Reasons to Review National Data

• National or regional data can give you a broad idea of the scope of a problem beyond your community. For example, if national survey data reveal a marked increase in alcohol use among eighth graders, and state data show this trend as well, then alcohol use among middle school students in your community may also have increased.

• Comparing local data to state or national data can offer a different perspective on the rates of substance use and violence in your community. It can help you ascertain whether the problem in your community is worse, about the same, or less than it is elsewhere.

• Comparing your local data to larger populations can provide you with information that can help you evaluate your efforts. For example, if a city teen alcohol prevention project evaluated its multi-year efforts and no significant changes appeared in alcohol use, and a comparison of city rates to statewide rates revealed that while rates of statewide alcohol use had increased, city rates had remained unchanged. This suggests that the alcohol prevention project might have had a positive effect after all.

• National and state-level data collection instruments can serve as models for your own data collection. You can use these surveys for ideas about how to frame your own survey questions and, if you use the same questions, you can make comparisons between your community and other localities.

Assessing the Problem
There are several national assessment surveys that study trends in underage drinking. This section will give you a brief overview of the three of the most prominent assessments: the Youth Risk Behavior Survey (YRBS), Monitoring the Future (MTF), and the National Survey on Drug Use and Health (NSDUH).

• Youth Risk Behavior Surveillance Survey (YRBSS)
  The Youth Risk Behavior Survey was developed in 1990 to monitor priority health risk behaviors that contribute markedly to the leading causes of death, disability, and social problems among youth. YRBSS includes a national school-based survey conducted by the CDC as well as state and local school-based surveys conducted by education and health agencies. Conclusions in the latest report are based on the responses of 15,214 students in grades 9 through 12. Most of these surveys were conducted in the spring of 2003. Students completed a self-administered questionnaire during a regular class period.

• Monitoring the Future (MTF)
  The Monitoring the Future (MTF) project, begun in 1975, studies changes in the beliefs, attitudes, and behavior of young people in the United States. The current study focuses on youth and tracks drug use trends and related attitudes among America's adolescents. It is conducted annually by the Institute for Social Research at the University of Michigan. MTF surveys a nationally representative sample of students in public and private secondary schools throughout the United States. In 2004, MTF surveyed nearly 50,000 students in 406 secondary schools. Students completed these surveys in a regular class period.

  It is composed of three sub studies:

  • An annual survey of high school seniors;
  • Ongoing panel studies of representative samples from each graduating class since 1976
  • Annual surveys of eighth and tenth graders.
    
    

• National Survey on Drug Use and Health (NSDUH)
  The National Survey on Drug Use and Health provides estimates of trends in drug use. The survey provides yearly national and state level estimates of alcohol, tobacco, illicit drug, and non-medical prescription drug use. Other health-related questions also appear from year to year, including questions about mental health. The design also oversampled youths and young adults, so that each State's sample was approximately equally distributed among three major age groups: 12 to 17 years, 18 to 25 years, and 26 years or older.

  The 2004 NSDUH report has separate chapters that discuss the national findings on eight topics: use of illicit drugs; use of alcohol; use of tobacco products; trends in lifetime use of substances; trends in initiation of substance use; prevention-related issues; substance dependence, abuse, and treatment; and mental health.

Scope of the Problem
Due to differences in data collection, the results of assessment tools vary somewhat, but the trends are clear. Here's what we know:

• According to the NIAAA, alcohol is the drug of choice among youth. "A higher percentage of youth 12-17 use alcohol (28.7%) than use tobacco (11.9%), or illicit drugs (10.6%)" (National Survey on Drug Use and Health, 2004). Equally disturbing is the fact that tobacco and drug use for this age group is declining while alcohol use is staying fairly constant (NSDUH, 2004). Many young people are experiencing the consequences of drinking too much, at too early an age. As a result, underage drinking is now a leading public health problem in this country.

• About half (50.3 percent) of Americans aged 12 or older reported being current drinkers of alcohol in 2004. This translates to an estimated 121 million people and is similar to the 2002 and 2003 estimates (National Survey on Drug Use and Health, 2004).

• More than three-fourths of twelfth graders, two-thirds of tenth graders, and nearly half of eighth graders have drunk alcohol at some point in their lives (Monitoring the Future Study, University of Michigan, 2004).

• 34.3 percent of youths reported they have consumed alcohol in the past year. (Table E.1, SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002). This data has remained constant in the 2004 survey.

• More young people use alcohol than tobacco or other drugs.Young adults aged 18 to 25 continued to have the highest rate of past month cigarette use (39.5 percent). The rate did not change significantly between 2002 and 2004. The rate of cigarette use among youths aged 12 to 17 declined from 13.0 percent in 2002 to 11.9 percent in 2004 (National Survey on Drug Use and Health, 2004).

• In 2004, the rate of current illicit drug use was approximately 8 times higher among youths aged 12 to 17 who smoked cigarettes (47.5 percent) than it was among youths who did not smoke cigarettes (5.6 percent) (National Survey on Drug Use and Health, 2004).

• Illicit drug use also was associated with the level of alcohol use. Among youths aged 12 to 17 who were heavy drinkers (i.e., drank five or more drinks on the same occasion on at least 5 different days in the past 30 days), 65.6 percent also were current illicit drug users, whereas among nondrinkers, the rate was only 5.0 percent (National Survey on Drug Use and Health, 2004).

• 20 percent of eighth graders, 35 percent of tenth graders, and 48 percent of twelfth graders reported binge drinking in the month prior to the 2002 survey. In 2004, use decreased for eighth graders, leveled for tenth graders, and increased some for twelfth graders (Monitoring the Future Study, University of Michigan, 2004).

• Binge drinking is defined as consuming five or more alcoholic beverages in one drinking session. Due to differences in metabolism, this number drops to 4 or more drinks for females (Monitoring the Future Study, University of Michigan, 2004).

• Binge drinking is not perceived as a significant risk by 44 percent of the twelfth graders (Monitoring the Future Study, University of Michigan, 2004).

• In 2004, heavy drinking was reported by 6.9 percent of the population aged 12 or older, or 16.7 million people. These figures are similar to those of 2002 and 2003, when 6.7 and 6.8 percent, respectively, reported heavy drinking (National Survey on Drug Use and Health, 2004).

• 95 percent of twelfth graders say they have ready access to alcohol (Monitoring the Future Study, University of Michigan, 2004).

Underage drinking can result in a range of adverse short- and long-term consequences.

Whether the consequences are acute in the form of a car crash or accumulated over a longer period of time, the underlying cause is the same - alcohol impairs one's decision-making capacity. In Reducing Underage Drinking, the Institute of Medicine reports that "young people who drink are more likely to engage in risk-taking behavior that can lead to illness, injury, and death. And these consequences appear to be more severe for those who start drinking at a young age." Peter M. Monti, professor of medical sciences and director of the Center for Alcohol and Addiction Studies at Brown University, tells us that alcohol can disrupt the adolescent brain's ability to learn life skills that can help one avoid trouble as an adult.

The National Institute of Alcohol Abuse and Alcoholism (NIAAA) has supported research on underage drinking including the effect of alcohol on the brain. You can find the latest information on this topic in NIAAA's journal, Alcohol Research and Health, "The Effects of Alcohol on Physiological Processes and Biological Development." The full text of the article, titled "Alcohol and Development in Youth: A Multidisciplinary Overview" is also available on the NIAAA website.

"We want to send a wake-up call to parents that any use of alcohol for teens involves risk, not just binge drinking or drinking and driving. Alcohol can affect the developing adolescent brain," said Charles Curie, Administrator of Substance Abuse and Mental Health Services Administration (SAMHSA), in a press release announcing a new public service ad campaign focused on underage drinking. "Parents of children and teens must change their attitudes toward teen drinking from acceptance to abstinence, and recognize the importance of talking to their children early and often about alcohol, especially before they've started drinking."

Short-term problems linked to alcohol use include the following:

• Alcohol-related car crashes and other unintentional injuries such as burns, falls, and drowning
  Motor vehicle crashes were the leading cause of death among young persons aged 16 to 20 in 2002. In addition, 19 percent of drivers aged 15 to 20 who were killed in motor vehicle crashes in 2002 had been drinking alcohol (NSDUH, 2002). Each year about 1900 persons under 21 die in motor vehicle crashes that involve underage drinking (NHTSA, 2003). Alcohol is also involved in about 1600 homicides and 300 suicides among persons under age 21 (CDC, 2004; Smith et. al., 1999; Levy, Miller, Cox, 1999; Hingson and Kenkel, 2004).

• Physical problems such as hangovers or illnesses

• Unwanted, unintended, and unprotected sexual activity
  "Significant numbers of young people . . . report engaging in risky sexual behaviors because of alcohol or drugs. More than a third (36%) of sexually active young people 15 to 24 say that drinking or drug use has influenced their decisions about sex — including more than a quarter (29%) of teens 15 to 17 and 37 percent of young adults 18 to 24.

  Twenty-nine percent of sexually active young people 15 to 24 say they have "done more" sexually than they had planned while drinking or using drugs.

  Almost one quarter (23%) sexually active young people 15 to 24 report having had unprotected sex because they were drinking or using drugs — including 12 percent of teens 15 to 17 and twenty-five percent of young adults 18 to 24.

  Because of something they did while drinking or using drugs, 26 percent of sexually active teens 15 to 17 have worried about STDs or pregnancy" (Kaiser Family Foundation survey, 2002).

• Physical and sexual assault

Problems related to the accumulated effects of long-term alcohol use include the following:

• Academic and/or social problems ranging from excessive absences and disciplinary problems to school failure and dropping out of school.
• Memory problems. Alcohol-induced memory impairments, such as "blackouts," are particularly common among young drinkers (Brown 2005).
• Increased risk of suicide and homicide. Alcohol has been reported to be involved in 36 percent of homicides, 12 percent of male suicides, and 8 percent of female suicides involving people under 21 (Bonnie 2004). Homicide is the second leading cause of death for 15- to 24-year-olds (Alcohol Fact Sheet 2004).

Debunking the Myths of Underage Drinking

There are many misconceptions concerning adolescents and alcohol use. These issues confuse not only young people, but their parents and other responsible adults. Following are some of these myths. Click on the link to go to a related fact sheet with the real story about underage drinking.

• Myth: It's only a phase, a rite of passage to adulthood.
  Fact: Early alcohol use is a strong predictor of lifetime alcohol abuse and dependence.

• Myth: Everybody does it.
  Fact: 80 to 90 percent of middle school students don't drink.

• Myth: "Alcohol relaxes me so I can do better in school."
  Fact: Drinking alcohol negatively affects students’ academic performance.

• Myth: Drinking will make me feel better about myself.
  Fact: Alcohol use in adolescence is associated with psychological distress and depression.

• Myth: Drinking helps me form meaningful relationships with people.
  Fact: Underage drinking is linked to an increase in risky sexual behavior.

• Myth: There are no long-term consequences of underage drinking.
  Fact: Individuals who begin drinking before the age of 15 are four times more likely to become alcohol dependent than those who begin drinking at age 20 or older.

• Myth: It doesn't really hurt anyone.
  Fact: Alcohol has disinhibiting effects that increase the likelihood of unsafe activities.

The Youth Risk Behavior Surveillance Survey (YRBSS) has more data about how alcohol influences a variety of health risk behaviors. The information is available online and is readily searchable by state, topic, specific question, gender, survey year, and more.

References for Day 1 Materials:

Bonnie, Richard J., and O'Connell, Mary Ellen. (Eds.) (2004). Reducing Underage Drinking: A Collective Responsibility. Washington: National Research Council, Institute of Medicine, The National Academies Press. Available: http://www.nap.edu/books/0309089352/html/

Centers for Disease Control and Prevention. General Alcohol Information. (2004). Alcohol Fact Sheet -- Measures of Alcohol Consumption and Alcohol–Related Health Effects from Excessive Consumption. Available http://www.cdc.gov/alcohol/factsheets/general_information.htm

Centers for Disease Control and Prevention. HIV/AIDS Prevention. (1994). Facts About: Adolescents and HIV/AIDS. Available: http://www.aegis.com/pubs/Cdc_Fact_Sheets/1993/CDC93118.html.

Centers for Disease Control and Prevention. (2003). YRBSS: Youth Risk Behavior Surveillance System. Available: http://www.cdc.gov/mmwr/PDF/SS/SS5302.pdf

Centers for Disease Control and Prevention. (2003). YRBSS: Youth Online: Comprehensive Results. Available: http://apps.nccd.cdc.gov/yrbss/

Dwyer, K., Osher, D., & Warger, C. (1998). Early warning, timely response: A guide to safe schools. Washington, DC: U.S. Department of Education.

Johnston, L. D., O'Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2005). Monitoring the Future national survey results on drug use, 1975-2004. Volume I: Secondary school students (NIH Publication No. 05-5727). Bethesda, MD: National Institute on Drug Abuse.

The Henry J. Kaiser Family Foundation and The National Center on Addiction and Substance Abuse at Columbia University. (2002). Substance Use and Risky Sexual Behavior: Attitudes and Practices Among Adolescents and Young Adults. Available: http://www.kff.org/youthhivstds/loader.cfm?url=/
commonspot/security/getfile.cfm&PageID=14907

Leadership to Keep Children Alcohol Free. Youth. Available: http://www.alcoholfreechildren.org/en/audiences/youth.cfm

Monti, Peter M. Center for Alcohol and Addiction Studies. (2005). Alcohol's damaging effects on adolescent brain function. Available: http://www.eurekalert.org/pub_releases/2005-02/
ace-ade020705.php

Morgan, Gregory. (2003) What Your Kids Are Not Telling You: The real story on underage drinking. DRIVEN. Available: http://www.madd.org/news/0,1056,7558,00.html

National Association of State Boards of Education. (2000). Fit, Healthy, and Ready to Learn: A School Health Policy Guide. Virginia: National Association of State Boards of Education.

National Center for Statistics & Analysis of the National Highway Traffic Safety Administration. (2003). Traffic safety facts 2002: alcohol. Available: http://www-nrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/
TSF2002/2002alcfacts.pdf

National Institute on Alcohol Abuse and Alcoholism (NIAAA). Alcohol and development in youth — A multidisciplinary overview. Alcohol Research and Health. 28(3): 107-175, 2004/2005.

National Institute on Alcohol Abuse and Alcoholism (NIAAA). (2002). NIAAA Initiative on Underage Drinking. Available: http://www.niaaa.nih.gov/about/underage.htm

National Institute on Alcohol Abuse and Alcoholism (NIAAA). (2003). Underage Drinking: A Major Public Health Challenge. Available: http://www.niaaa.nih.gov/publications/aa59.htm

National Institute on Alcohol Abuse and Alcoholism (NIAAA). (1997). Youth Drinking: Risk Factors and Consequences. Available: http://www.niaaa.nih.gov/publications/aa37.htm

Strunin, L., and Hingson, R. Alcohol, drugs, and adolescent sexual behavior. International Journal of the Addictions 27(2):129-146, 1992.

Substance Abuse and Mental Health Services Administration. Center for Substance Abuse Prevention. (2002) Making the Link factsheets:

Underage Drinking and Academic Performance. Available:
http://www.alcoholfreechildren.org/en/stats/
Fct%20Sht-Acdmc%20Prfrmnc.pdf

Underage Drinking and Mental Health. Available: http://www.alcoholfreechildren.org/en/stats/
Fct%20Sht-Mntl%20Hlth.pdf

Underage Drinking and Risky Behavior. Available: http://www.alcoholfreechildren.org/en/stats/
Fct%20Sht-Rsky%20Bhvr.pdf

U.S. Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. "Start Talking before they start drinking." Press release announcing Public Service Advertising campaign, 2005.

U.S. Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. Report to Congress. (2004). Development of a Plan for Combating Underage Drinking. Available: http://www.alcoholfreechildren.org/en/emplibrary/
ICCPUD_Report_42004.pdf

U.S. Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. (2004). Summary of findings from the 2004 national survey on drug use and health (NSDUH). Rockville, MD: Author. Available: https://nsduhweb.rti.org/