Reducing Underage Drinking A Collective Responsibility (2004) / Chapter Skim
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1 The Epidemiology of Underage Drinking in the United States: An Overview--Robert L. Flewelling, Mallie J. Paschall, and Christopher Ringwalt
1 The Epidemiology of Underage Drinking in the United States: An Overview--Robert L. Flewelling, Mallie J. Paschall, and Christopher Ringwalt
Pages 319-350
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From page 319... ...
The information presented is based primarily on data that are available from large-scale national surveys that have been conducted regularly for many years. It also focuses on what might be considered fairly basic measures and patterns of alcohol use, and breakdowns in these measures according to standard demographic characteristics such as age, gender, and race/ethnicity.
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From page 320... ...
Underage Drinking: Measures and Data Sources Measures of Alcohol Use Since 1988, and as a direct consequence of the passage of the National Minimum Drinking Age Act in 1984, the minimum legal drinking age for every state in the nation has been 21. In this context, the term "underage drinking" refers to alcohol consumption by persons less than 21 years of age, and is the focus of this volume.
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From page 321... ...
and National Household Survey on Drug Abuse (NHSDA) studies respectively, also vary in their specific definitions.
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Measures of Alcohol Abuse and Dependence In addition to measures of drinking per se, such as frequency of use and quantity of alcohol consumed, another important dimension of drinking behavior is whether it causes significant problems for the user or is indicative of physiological dependency. Diagnostic criteria have been developed for assessing symptoms of alcohol dependence and various other problems stemming from alcohol use.
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From page 323... ...
Some concerns have been raised about the validity of survey-based selfreport measures for assessing conditions such as alcohol abuse and dependence, especially among adolescents. For example, very low prevalence rates of certain alcohol abuse and dependence symptoms (e.g., legal problems, withdrawal symptoms)
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From page 324... ...
Thus, DSM-IV criteria may be less reliable and valid indicators of abuse and dependence for youthful drinkers than adult drinkers. Based on these considerations, it is suggested that the data provided in this chapter regarding alcohol abuse and dependence, which are derived from the 2000 NHSDA, be interpreted with caution, as they may not reflect the prevalence rates that would be obtained through clinical diagnoses.
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From page 325... ...
Voluminous summary data for all three surveys, in both graphical and tabular form and including many more ways of breaking down the data than could be included in this chapter, are available from the sponsoring agencies for each of these surveys. A number of other data sources that are national in scope also provide information on drinking behaviors of underage persons (or various subsets thereof)
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From page 326... ...
, the age at which alcohol use becomes legal. Also shown in Figure 1-1 are estimated prevalence rates based on the 2000 NHSDA, by single year of age, for heavy drinking, and for frequent 2As discussed in the previous section, most of the data presented here are derived from the National Household Survey on Drug Abuse (NHSDA)
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From page 327... ...
Heavy drinking is defined here as reporting having five or more drinks on the same occasion in the past 30 days, and frequent heavy drinking as having five or more drinks (on the same occasion) on each of five or more days in the past 30 days.3 The prevalence rates depicted in the figure are provided in tabular form in Table 1-2.
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From page 328... ...
, the ratio of heavy drinkers to all drinkers is already starting to decrease with age, and in general, adults who drink alcohol are much less likely to be heavy drinkers than are drinkers in middle to late adolescence. Another striking pattern evident in Table 1-2 is the relatively low prevalence of frequent drinking (i.e., drinking alcohol on six or more of the past 30 days)
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From page 329... ...
These data are repeated in tabular form, along with prevalence rates for frequent drinking and frequent heavy drinking, in Table 1-4. The figures and table clearly show that the overall age effects described previously remain strong and consistent even when broken out by racial/ ethnic group and gender.
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From page 330... ...
For heavy and frequent drinking, however, meaningfully higher rates in the 21- to 25-year age group, as compared to persons ages 18 to 20, are observed only among males. For frequent heavy drinking, this pattern of higher prevalence rates in young adulthood is seen only for African-Ameri
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From page 331... ...
for any use of beer, wine coolers, wine, and hard liquor in the past 30 days by high 50 45.8 45 40 Female Male 35.9 35 33.0 30 26.3 25 Percent 22.1 21.0 20.0 20 18.3 17.7 15.2 15 10 7.7 6.6 5.2 5 3.94.1 3.0 1.81.6 0 White African- Hispanic White African- Hispanic White African- Hispanic American American American 12-14 Years of Age 15-17 Years of Age 18-20 Years of Age FIGURE 1-3 Prevalence of heavy use of alcohol in the past 30 days, persons aged 12 to 20, by gender, race/ethnicity, and age group, 2000. SOURCE: National Household Survey on Drug Abuse (Analysis of Public Use File Data)
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From page 332... ...
Although males have higher rates of past-month beer and hard liquor use, rates for use of wine coolers and wine are approximately the same for females and males. A fairly similar pattern is seen when heavy drinking within the past two weeks is examined for each of these four beverage types (Figure 1-5)
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From page 333... ...
. 60 Female Male 50 48.3 40 38.2 30.8 30 28.7 Percent 20 17.6 17.4 9.4 10 8.4 7.3 3.5 0 Beer Wine coolers Wine Hard liquor Any alcohol FIGURE 1-5 Prevalence of having five or more drinks of beer, wine coolers, wine, and hard liquor in a row during the past two weeks, high school seniors, by gender.
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From page 334... ...
is much less prevalent than the consumption of beer and wine coolers. By the upper grades, however, prevalence rates for hard liquor consumption are similar to those for beer and wine coolers.
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As discussed earlier in this chapter, these prevalence rates may not reflect the prevalence of clinically detectable cases of alcohol abuse and dependence. Looking across all ages, including ages 21 and older, the highest rate for alcohol abuse occurs among persons who are 19 years old.
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From page 336... ...
The data also show that for the oldest age category, in particular, the relative difference in the prevalence rates for abuse or dependence between African-Americans and whites are considerably smaller than for heavy and frequent heavy drinking. Additional data from persons older than 20 show that this pattern of convergence continues, resulting in similar rates of alcohol abuse and dependence for whites and African-Americans aged 26 and older.
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From page 337... ...
Patterns for this behavior, differentiated by major racial/ethnic groupings, age group, and gender, are shown in Figure 1-8. The patterns are similar to those observed for measures of alcohol abuse or dependence.
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Table 1-6 presents prevalence rates for any alcohol use, heavy use, and abuse or dependence, by each of six sociodemographic variables, for persons ages 12 to 17.
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From page 339... ...
None 26.7 18.2 8.4 1 to 10 27.5 19.5 9.9 11 to 20 33.4 23.4 11.2 More than 20 33.4 25.0 12.3 SOURCE: National Household Survey on Drug Abuse (Analysis of Public Use File Data)
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From page 340... ...
Prevalence rates for alcohol use measures among persons 18 to 20 years old, by selected sociodemographic variables, are displayed in Table 1-7. Among this set of attributes, those that were generally related to higher levels of use, heavy use, and abuse/dependence were
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From page 341... ...
48.0 31.7 12.3 Small MSA 50.9 38.1 14.5 Not in MSA 47.6 34.6 15.3 College student status (excluding persons still in high school) Full time college student 56.5 39.4 15.0 Part time student or not in college 47.4 34.3 14.5 Employment status Full-time 51.9 36.2 14.6 Part-time 50.3 35.1 13.7 Unemployed 51.1 41.3 22.9 Not working and not in labor force 42.5 30.5 10.6 SOURCE: National Household Survey on Drug Abuse (Analysis of Public Use File Data)
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From page 342... ...
Recent Trends in Underage Drinking Examination of recent trends in underage drinking prevalence rates may be useful for helping to anticipate where these rates are headed in upcoming years. Just as important, trend data are valuable for retrospectively reviewing the relative levels of this behavior over time and thus providing a foundation for identifying and/or exploring hypotheses about societal influences on levels of underage drinking.
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From page 343... ...
Studies conducted by SAMHSA to compare prevalence levels in heavy drinking (and other key measures of substance use) found no difference in the prevalence rates for any use or heavy use between 1998 and 1999 for any age group when controlling for differences in methodological features, including interviewer experience of the survey administration (SAMHSA, 2000)
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From page 344... ...
As with Figure 1-9, the rates before and after 1999 are not strictly comparable, with the large apparent increase between 1998 and 1999 being due primarily to methodological changes in the survey administration and imputation procedures rather than to any actual increases in prevalence. Assuming that these changes have enhanced the accuracy of the survey estimates, it appears that the NHSDA-derived prevalence rates of heavy drinking prior to 1999 may have been slightly underestimated.
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SOURCE: National Household Survey on Drug Abuse (Analysis of Public Use File Data)
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From page 346... ...
. 20 who are frequent heavy drinkers, the number of days per year in which they drink heavily has increased substantially (T.K.
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From page 347... ...
Perhaps even more significant, the majority of underage persons who drink alcohol also drink large amounts on at least a monthly basis, and 15 percent of persons ages 16 to 20 report driving a vehicle under the influence of alcohol within the past month. Underage drinking increases steadily with age throughout the range from 12 to 20.
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From page 348... ...
The same is true for underage DUI. The lack of progress in reducing underage drinking in recent years, including heavy drinking and DUI, warrants heightened attention to this issue and a reexamination of current prevention priorities and approaches.
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From page 349... ...
. Age of onset of alcohol use and its association with DSM-IV alcohol abuse and dependence: Results from the National Longitudinal Alcohol Epidemiologic Survey.
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From page 350... ...
. Substance dependence, abuse, and treatment: Findings from the 2000 National Household Survey on Drug Abuse, Appendix C: Measurement of dependence, abuse, treatment, and treatment need.
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