t, . ' 
Depa,rtment of Health and Human Servces 
OFFICE OF 
INSPECTOR GENERAL 
YOUTH AND ALCOHOL: 
DANGEROUS AND DEADLY CONSEQUENCES 
VI' 
Rich"d P. Ku,"crow 
INSPECTOR GENERA 
J(( 
"0 
APRI 199 
d!a  OFFCE OF INSPECTOR GENERA 
The mission of the Offce of Inspector General (OIG), as mandated by Public Law 95-452, as 
amended, is to protect the integrity of the Department of Health and Human Servces' (HHS) 
programs as well as the health and welfare of beneficiaries served by those programs. This 
statutory mission is carried out through a nationwide network of audits , investigations, and 
inspections conducted by three OIG operating components: the Offce of Audit Servce, the 
Offce of Investigations, and the Offce of Evaluation and Inspections. The OIG also informs the 
Secretary of HHS of program, and management problems, and recommends courses to correct 
them. 
OFFCE OF AUDIT SERVICE 
The GIG's Offce of Audit Servce (OAS) provides all auditing servces for HHS, either by 
conducting audits with its own audit resource or by overseeing audit work done by others. 
Audits examine the performance of HHS programs and/or its grantees and contractors in carrng
out their respective responsibilities and are intended to provide independent assessments of HHS 
programs and operations in order to reduce waste, abuse, and mismanagement and to promote 
economy and effciency throughout the Department. 
OFFICE OF INTIGATIONS 
The OIG's Offce of Investigations (01) conducts criminal, civil, and administrative investigations 
of allegations of wrongdoing in HHS programs or to HHS beneficiaries and of unjust enrichment 
by providers. The investigative efforts of 01 lead to criminal convictions, administrative sanctions 
or civil money penalties. The 01 also oversees State Medicaid fraud control units which 
investigate and prosecute fraud and patient abuse in the Medicaid program. 
AN 
OFFCE OF EVALUATION  INSPECTONS 
The OIG's Offce of Evaluation and Inspections (OEI) conducts short-term management and 
program evaluations (called inspections) that focus on issues of concern to the Department, the 
Congress, and the public. The findings and recommendations contained in these inspection 
reports generate rapid, accurate, and up-to-date information on the effciency, vulnerability, and 
effectiveness of departmental programs. 
This report was prepared under the direction of Kaye D. Kidwell, Regional Inspector General 
and Paul A Gottlober, Deputy Regional Inspector General, Offce of Evaluation and Inspections 
Region IX. Participating in this project were: 
Region IX  Headquarers 
Elizabeth Bell  Maruta Zitans 
Brad Rolln  Department of Health and Human Servces 
OFFICE OF 
INSPECTOR GENERAL 
YOUTH AND ALCOHOL: 
DANGEROUS AND DEADLY CONSEQUENCES 
VI' 
Richard P. Kusserow 
INSPECTOR GENERA 
':d! 
92-01 
OEI-0- .................... ................................
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. . . . ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ...   ..  ..  ..  ..  
TABLE OF CONTENTS

. . . . . . . . . . . . . . 1

INODUCTON 
SUMY 
OF REEACH FIINGS

Crie. . 
. . . . . . . . . . . . . . . . . . 2

Victims of Crime

Rape and Sexual Assault. . . . . . . . 
 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Risky Sexual Behavior. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Suicide. . . . . . . . . . . . 
............................... 3

Water-Related Injuries and Drownng. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Campus-Related Problems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

. . . . . . . . . . . . A-
BmuOGRAHY  INTRODUCTION

PURSE 
The purpose of this study was to describe the dangerous and often unrecognized 
consequences of underage drinking. 
BACKGROUN 
As part of her campaign against underage 
drikig, the Surgeon General requested 
that the Offce of Inspector General (OIG) provide information on some of the 
negative consequences of youth alcohol use. This concern mirrors one of the

Department of Health and Human Servces Secretary s goals which is to reduce the 
prevalence of alcohol problems among children and youth. As part of his strategy to 
meet this goal, the Secretary sponsored "Healthy PeoplelHealthy Environments: The 
Secretary s National Conference on Alcohol-Related Injuries" on March 23- , 1992. 
This conference served as a call-to-action and a forum for health professionals to help 
advance the alcohol and injury-related objectives of  Healthv People 2000. This study 
is one in a series conducted by the OIG related to youth and alcohol. A related 
report, "Youth and Alcohol: Drinking and Crie" (OEI-09-92-00260), describes the 
association between alcohol and youth crie. 
Although extensive research exists related to the negative consequences of adult 
alcohol use, few national studies have attempted to assess the relationship between 
underage drinking and rape, sexual assault, suicide, and other harmful incidents. 
Researchers who attempt to link youth alcohol use with injuries and other problems 
face legal and scientifc barriers. For example, one survey found that emergency room 
physicians rarely will administer blood alcohol tests unless an injury was automobile-
related or the test is vital to a patient's treatment. 
Most studies and data related to the negative 
consequences of underage drinkig 
focus on traffic fatalities. For instance, the National Highway Traffc Safety 
Administration reported that 34.8 percent of drivers ages 18 to 20 and 18.9 percent of 
drivers ages 15 to 17 who were involved in fatal automobile crashes in 1989 had 
alcohol in their system. Although few national data concerning other problems exist 
researchers focusing on local populations have uncovered startlng data concerning 
alcohol use among youth who experience serious injuries or unintentional death. 
METHODOLOY 
Using several University of California on-line database servces, we conducted a 
review of medical, legal, psychological, and other social research studies and surveys 
related to the negative consequences of youth alcohol use. We also referred to 
articles and data obtained durig our previous youth and alcohol studies.  SUMMARY OF RESEARCH FINDINGS

The Department of Justice (DOJ) and other researchers at times have attempted to 
determine the extent to which underage driking is associated with criminal activity. 
These researchers have found a strong association between alcohol use and crimes of 
aggression, such as murder and rape. 
According to a DOJ survey, 31.9 percent of youth under 18 in long-term, State-
operated juvenile institutions in 1987 were under the infuence of alcohol at the 
time of the offense.( 46) 
A DOJ ll-city survey 
found that from 4 to 32 percent of male juvenile 
arrestees admitted using alcohol in the 72 hours prior to their arrest. ( 47) 
A 1974 survey of youth under 21 in State adult correctional facilities found that 
approxiately 36.4  6 percent reported drinking at the time of the 
to 38.
offense.(9) 
One researcher reported that almost 50 percent of German juvenile offenders 
surveyed in 1971 were intoxicated when they committed criminal offenses. For 
crimes of aggression--such as murder, robbery, rape, and assault--the rates were 
rather higher. (17) 
VICT 
OF 
Studies of various populations have shown that many victims of violent crime are 
intoxicated at the time of the incident. While this problem is most frequently noted in 
rape victims, victims of other crimes exhibit similar high levels of intoxication. 
, almost 50 percent who said they had 
In a national survey of college students
been victims of crime admitted that they had used drugs or alcohol before the 
crime occurred.(I2) 
A study of homicide victims in Atlanta, Georgia, found that 51 percent had 
blood alcohol levels of . 10 percent or greater.(4) 
One social science researcher observed that minors who drink may provoke 
assailants or otherwse catch the attention of criminals by handling money 
openly, acting vulnerable, or failing to take normal precautions in public.(38) 
. For further information, see the OIG report ''Youth and Alcohol: Drinking and Crime.  , "

RAE AN 
SEXUAL ASAULT 
Researchers estimate that alcohol use is implicated in one- to two-
thirds of sexual 
assault and acquaintance or "date" rape cases among teens and college students. 
In a survey of students at a southwestern university, 55 percent of sexual assault 
perpetrators and 53 percent of sexual assault victims admitted to being under 
the influence of alcohol at the time of the assault.(23) 
According to a school administrator, 100 percent of sexual assault cases at the 
University of Colorado involve alcohol.(I) 
A study of college women nationally found that alcohol use is one of the 
strongest predictors of a college woman s rape.(2) 
A survey of high school students found that 18 percent of females and 
39 percent of males say it is acceptable for a boy to force sex if the girl is 
stoned or drunk.(23) 
RIKY SEXUAL BEHVIOR 
behavior. 
Alcohol use is associated with the early onset of sexual activity and with risky sexual
A study of ninth grade students from four urban high schools showed that the 
best predictor of risky sexual behavior was alcohol and/or drug use.( 40) 
Other studies of adolescents have shown that the use of substances, including 
alcohol and tobacco, are associated with early sexual debut and an inadequate 
use of contraceptives.( 40) 
A 1990 survey of Massachusetts 16- to 19-year-olds found that 49 percent were 
more likely to have sex if they and their partner had been drinkg. In 
addition, 17 percent used condoms less often after dring.( 42) 
The National Longitudinal Survey of Youth found that substance use and 
sexual activity are more closely linked for white youth than they are for 
(I4) 
minority youth.
SUICIDE 
According to one researcher  Suicide among American teenagers is increasing at an 
alarming though underestimated rate." Alcohol acts as a contributing factor in the 
timing and seriousness of youth suicide attempts. Although youth may use alcohol in 
an attempt to reduce stress and pressure, this frequently results in additional self-
destructive behavior.  , one researcher found that drug and 
In a detailed analysis of youth suicide
alcohol abuse is the most common characteristic of youth who attempt suicide. 
Seventy percent of youth suicide attempters were frequent drug and/or alcohol 
, he noted a high incidence of drug and alcohol abuse among 
users. In addition
youth suicide attempters' parents. (ll) 
Based on rising youth suicide rates, three researchers conducted a study on 
10- to 19-year-old suicide victims in Alegheny County (P A). They found " 
striking association. . . between the ingestion of alcohol and the use of firearms 
as a method of suicide." They conclude that "the epidemic increase in the 
suicide rate among youth may be associated with an increase in the prevalence 
of alcohol abuse. (3) 
REIATE INJU AN DROWNG 
WATER-
Although swiming, boating, and diving are popular activities among youth, they can 
be deadly, especially when the participants consume alcohol before or during these 
water activities. According to national data, drowning is the second leading cause of 
injury-related death among adolescents and young adults. One researcher named 
alcohol and/or drug use as the primary factor contributing to adolescent swimming, 
boating, and diving drownings.

Two studies that have attempted to link youth alcohol use and drowng found 
that from 40 to 50 percent of young males who drown used alcohol prior to 
drowning.(33)(5I) 
According to national data, the ratio of young males who drown after boating 
incidents outnumbers females 12 to 1. Alcohol particularly may affect a youth' 
balance, resulting in the boat capsizng or the youth fallng overboard.(33) 
A detailed study of the factors contributing to youth drowning indicated that 
alcohol may severely affect a young swimmer s coordination and judgment. 
beyond their abilty. On a 
Peer pressure may cause youth to attempt to swim 
dare, a youth might experience overconfidence if under the influence of 
alcohol. At the same time, the youth might underestimate the length of swim 
or the water s currents. (33) 
Researchers have documented that 40 to 50 percent of all diving injury victims 
consumed alcoholic beverages. Again, alcohol may impair judgment, resulting 
in a youth underestimating the challenge.(34)  CAMUS-RETE 
PROBLEMS 
A researcher who reviewed studies on college drinking found that missing classes 
missing work, and not studying were the most frequently noted alcohol-related 
problems. Other researchers have linked alcohol use with more serious campus 
problems. 
In a national survey, college administrators estimated that student alcohol use 
leads to 69 percent of damage to residence halls, 34 percent of academic 
problems, and 25 percent of dropouts.(7) 
A Towson State (MD) University study found that alcohol was a factor in 
98 percent of student conduct violation cases.(22)  ,,  ,"" , " , "  ",,  ""   , "  ), 
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