. .
" '
" .
. ..  . "
::-'7'''. 
Departent of Health and Human Servces 
FFICE OF 
INSPECTOR GENERA 
YOUTH AND ALCOHOL: 
A NATIONAL SURVEY 
DO THEY KNOW WHAT THEY' RE DRINKING? 
Richard P. Kusserow 
INSPECfOR GENERA 
JU 
1991 .  ", 
Department of Health and Human Servces 
OFFICE OF 
INSPECTOR GENERAL 
YOUTH AND ALCOHOL: 
A NATIONAL SURVEY 
DO THEY KNOW WHAT THEY' RE DRINKING? 
V1C1. 
Richard P. Kusserow 
INSPECfOR GENERAL 
daa  OEI-09-91-0053  .' .
GEN 
OFFCE OF INSPECfOR 
The mision of tbe Offce of Inpeor General (OIG), as mandated by Public Law 95-452, as 
amended, is to prote tbe integrty of the Departent of Healtb and Human Servce' (HS)
progrms as well as tbe bealtb and welfre of beneficiaries selVed by,thos progrms. Th statutory 
miion is carred out thugb a nationwide netwrk of audilS, investigations, and inpeons 
conducted by thee OJG operatig componenlS: tbe Offce of Audit Servce, tbe Offce of 
Investigations, and the Offce of Evaluation and Inpeons. The OIG also inorm the Seetary of 
HHS of progrm and management problems and remmends cour to correc them. 
OFFCE OF AUDIT SERVICE 
The OIG's Offce of Audit Servce (rOeASu) rpr odes aU auditing servce for HHS, either by

conducting audilS witb ilS own audit  or by oversing audit work done by otbers. AudilS

erxempiee th e performance of HH progrms ancl/or ilS grntee and contractors in carrg out tbeir
responsibilties and are intended to prode independent asmenlS of HH progrms and -

operations in order to reuce wate, abus and mismanagement and to promote ecnomy and 
effciency thrughout tbe Depanment. 
OFFCE OF INTIGATIONS 
The OIG's Offce of Invetigations (01) conduct crminal, civil, and administrative investigations of 
allegations of wrongdoing in HHS progrms or to HHS beneficiaries and of unjust enrchment by 
providers. The investigative effons of 01 lead to crminal 
convictions, administrativ sanctions, or 
overs 
ci money penalties. The OJ als  State Medicaid frud control unilS whicb investigate and
proste frud 
and patient abus in tbe Medicaid progrm. 
AN 
OFFCE OF EVALUATION  INSPECTONS 
The OIG's Offce of Evaluation and Inpecions (OEI) conduct sbon-term management and progrm 
evluations (called inpections) tbat foc on isues of concern to tbe Depanment, tbe Congres, and 
the public. The fidings and recmmendations contained in these inspeion repons generate rapid, 
accrate, and up-to-te inormtion on the effciency, vulnerabilty, and effectivenes of depanmental 
progrms. 
This repon wa prepared under the direcion of Kaye D. Kidwell, Regional Inspeor General, and 
Paul A. Gottlober, Deputy Regional Inspecor General, Offce of Evaluation and Inspecions, Region
IX 
Panicipating in tbis project were: 
Fraci 
Sa 
New York  Chcago 
Brad Rolln, Led Analyst
 Jack Molnar  Thomas Komaniecki 
Elizbeth Bell 
1lm Nee  Pamela May 
Dette  Trce 
Kathy  Rennie  Ann O'Connor

Deborab HalVey 
Jennifer Mallen  Phiadelphia  Dalas 
Brian Pattisn  Donna Milan
 Michelle Adams 
Elaine Sbelub  Nancy Molyneaux  Pamela Smith

Headquarers .  Atlanta 
Wm. Mark Krhat, Mathematical Statistician  Josiab Towel
Barbara Tedesco, Mathematical Statistician 
Maruta Zitans, Program Spealit  EXECUTIVE  SUMMAR Y

PUROSE 
Ths inspection surveyed junior and .senior high school (7th through 12th grade) 
students to determine their knowledge about alcoholic and non-alcoholic beverages. 
BACKGROUN 
In  TR'- pDns .t pll  &..lth &amrn and the adverse.hal cDnsequerues of 
alcohol abuse, Surgeon General Antonia Novello requested that the Offce of 
Inspector General (OIG) survey youth to determe their views and practices 
regarding alcohol use. These concerns mirror one of Department of Health and 
(lS) 
Human Servces  Secretary Louis Sullvan s goals which is to reduce the 
prevalence of alcohol problems among children and youth. The Surgeon General is 
particularly concerned about the similarities in the packaging of aTcoholic and non-
alcoholic beverages and young peoples' inabilty to distinguish between them. 
Wine coolers (1.5 to 6.0 percent alcohol by volume), mixed drink coolers (4.0 percent 
alcohol), and malt beverage coolers (4. 8 percent alcohol) offer consumers 
0 to 4.
alcoholic beverages in a wide range of frity flavors, vibrant colors, and attractive 
packaging. While not new to the 1980s, fruit-flavored fortifed wines became more 
mainstream with the controversial marketing of Cisco (20.0 percent alcohol), which is 
wie 
packaged similai"y to  coolers. The Surgeon General has expressed an ongoing 
concern about Cisco because of its high alcohol content and potential for abuse. 
While containing no alcohol, mineral waters with frit juice or flavor offer a variety 
packaged attractively in bottles that are similar to the ones used for 
of frit flavors 
alcoholic coolers and Cisco. 
We conducted structured intervews with a random national sample of 956 junior and 
senior high school students. This is one of several reports prepared by the OIG 
concerning youth and alcohol. 
FIINGS 
Tho oUl of thee stunt cannt ditiguh akoJwli beverges frm non-alcoJwli 
beverages 
alcoholic. 
Students confuse alcoholic coolers with mineral waters that appear similar in color, 
labeling, and packaging. Also, some alcoholic coolers are not clearly labeled as conJ 
In mot StIte bee an oth malt beverge label do not dicloe alohol 
are consuming. 
Although the alcohol content of beer and other malt beverages vary by State and 
brand, consumers cannot tell by looking at the can or bottle how much alcohol they
alohol conJ of beverges is a myste to 
Th 
Less than one in six students identified the beverage containing the most aJcohol 
when shown a panel of beverages. Students were most liely to select beer and malt 
liquor as having the most alcohol, although Cisco contains two to five times more 
alcohol than either. Even afer being allowed to read the labels on all cas and 
bottles, less than half correctly identified the beverage containing the most alcohol.
Th 
is due to (1) the students' inabilty to understand the labels and (2) the labels 
lack of clarity.  st 
th 
More thn a  of al  do not knw, tht Cico con/in akohol 
popularity. 
Although Cisco is not available in all areas, students have found ways to obtain it. 
Students related stories about Cisco which emphasize not only its danger, but also its
RECOMMATIONS 
Genl  wi  intr,  Fedl 
Sureon  shoul work  beverge  Stile and  offcils to 
Th  an 
imprve th labelig and packagig of akoholi  non-akoholi beverages 
A coordinated effort should ensure that (1) total alcohol content of all beverages-
including beer and malt liquor-is clearly displayed and understandable and 
(2) alcoholic and non-alcoholic beverages are clearly distinguishable. This could be 
accomplished through voluntary industry standards, State legislation, or Federal 
legislation. 
Ge 
agen 
Sureon  shoul conps wri opu
 li and priate  sttuo d eelop,

Th 
promote edatinal  whih woul inease  awaren of 
imve, and  th 
an 
akoholi"beverges  efects

In addition to consulting with other HHS components, the Surgeon General should 
work with the U.S. Departments of Education, Transportation, and Justice, the 
alcoholic beverage industry, and public interest groups to implement this 
recommendation. The educational programs should include (1) teaching students 
about the total alcohol content of different beverages and (2) eliminating myths 
about wine coolers and beer.  ........................................ 
. . . . . .. 
..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  ..  
TABLE OF CONTENTS

EXCU SUMY

INODUCTON . . . 
. . . . . . . . 1 
FIINGS 
Two out of three students cannot 
distinguish aJsoholic

. . . . . . . . . . . . . .. . . . . . . . . . . . . . . 5

beverages from non-alcoholic beverages. . 
In most States, beer and other malt beverage labels

do not disclose alcohol content. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 
. . . 9

The alcohol content of beverages is a mystery to students. . . . . . . . . . . . . . . . . . 9 
More than a third of all students do not know that 
Cisco contains alcohol 
RECO:MATIONS 
APPENIX: Methodology and Beverage Selection  " "
INTRODUCTION
PUROSE 
This inspection surveyed junior and senior high school (7th through 12th grade) 
students to detennine their knowledge about alcoholic and non-alcoholic beverages. 
BACKGROUN 
consequences of 
In response to public health concerns and the adverse health 
alcohol abuse, Surgeon General Antonia Novello requested that the Offce 
Inspector General (OrG) surey youth to determe their views and practices 
regarding alcohol use. These concerns mirror one of Department of Health and 
Human Servces (HHS) Secretary Louis Sullvan s goals which is to reduce the 
prevalence of alcohol problems among children and youth. The Surgeon General is 
particularly concerned about the simlarities in the packaging of alcoholic and non-
alcoholic beverages and young peoples' inabilty to distinguish between them. This is 
one of several report prepared by the OrG relating to youth and alcohol. 
Th  populri of fr-flored aloholi beverges skykete in th 1980s 
During the 1980s, alcoholic beverage companies introduced a variety of new products 
to the market. They offered consumers alcoholic beverages in a wide range of frity 
flavors, vibrant colors, and attractive packaging. Introduced in 1981, wie colers 
0 percent alcohol by volume) are a mixre of wine and frit juice or other 
(1.5 to 6.
flavoring, sometimes carbonated. Wine coolers offer consumers a sweet, fruity 
beverage with little or no alcohol taste. They are available in 12-ounce, screw-top 
bottles which are sold individually or in 4-packs. The most popular brands are 
Bartles & Jaymes and Seagram 
The wie cooler market's explosive growth dudrinrg  its first 6 years prompted the 
liquor and beer industries to introduce mied  colers (4.0 percent alcohol) and 
frit-flavored malt beerage colers (4. 8 percent alcohol)l marketed in single-
0 to 4.
serve bottles. Bacardi Breezer, which looks and tastes much like a wine cooler, is an 
example of a mixed drink cooler. White Mountain Cooler is a malt beverage cooler 
available in flavors such as "Wild Raspberr,  Original Citrs " and "Cranberr 
Splash. 
, frt-
While not new to the 19805 flavored forted wies became more mainstream 
with the controversial marketing of Cisco (20.0 percent alcohol). Fortified wines-
lAicohol  content of malted beerages is commonly measured in alcohol weight, ralber than 
alcohol volume. The malted beverage colers we obselVed contain 3.2 10 4.D percent alcohol by . 
weight.  such as Thunderbird and Night Train--contain more alcohol than regular wines and 
historically have been considered ''wno '' beverages because they are inexpensive and 
available mainly in inner cities. Cisco offers consumers 20 percent alcohol fortified 
wine-4 to 5 times more than regular wine coolers--in popular wine cooler flavors 
such as peach, berr, and orange, marketed in bottles designed similarly to wine 
coolers. Cisco has become more widely available and popular than other fortified 
wie 
wines and now can be found displayed next to  coolers not only in cities, but 
also in suburbs and smaller towns throughout the United States. 
The Suigeon General has expressed an ongoin.g concern about Cisco because of its 
high alcohol content and potential for abuse. Cisco looks similar to wine coolers and 
has been implicated in a number of alcohol-related deaths and cries, especially 
among youth. As a result, Dr. Novello has worked with the Federal Trade 
Commission to require Cisco to change its labelig and bottle shape, so it does not 
resemble a wine cooler. 
While containing no alcohol, miera water with frt juice or flavor also became 
popular during the 1980s. These beverages offer a variety of frit flavors in bottles 
that are very similar to the ones used for alcoholic coolers and Cisco. Brands 
include Sundance Sparkler and Mistic. While these alcoholic and non-alcoholic 
beverages offer a similar sweet, frity flavor and are packaged and sold in 
attractively designed four-packs or single 12-ounce bottles, they are in fact very 
substitutes for soda pop. The coolers offer similar 
different. Mineral waters offer 
flavors with 4 to 6 percent alcohol. Cisco offers the same flavors with 20 percent 
alcohol. 
MEODOLOY 
We randomly selected 8 States, 2 counties per State, 2 schools per county, and 
30 students per school. The States were: California, Colorado, Florida, Ilinois 
Louisiana, New York, Ohio, and Pennsylvania. We completed structured intervews 
with a total of 956 junior and senior high school students. 
We purchased alcoholic and non-alcoholic beverages from stores close to each 
school. During the intervews, we displayed a panel of these beverages and asked 
each student (1) whether each beverage did or did not contain alcohol, (2) which 
contained the most alcohol simply by looking at the bottles, and (3) which contained 
the most alcohol after reading the labels. We included Cisco in all intervews 
regardless of whether it was available in that area. 
The appendix contains a more detailed description of our metliodology and beverage 
selection.  , ;
"", 
Stuents were 
tesed on their 
knwledge of 
dozens of 
siilar
loqldg 
beverages. 
w&i 
Inrerviewers displayed bOl/les and cans and obsered 
stents exmining the beverages.  TI 
YOU TELL  DIFFERENCE? 
CA 
Pitured above are eight 
beverage representig si
dierenr tyes of dr, wi 
alcohol content rangig from 
o to 20 percen wi cooler 
a lit win cooler a mixed 
dr cooler, a malre beverage
coole a fortfi win an a
minal water wi 
juice. The
shope of th botte, color of the 
beverage, and label deign are
siilr. 
Mis 
Black Che, a msinieirall  
WQte wiJ juice, is ver 
to th Bales  Jayes Ligh
Be wie cooler in color 
lael des  FINDINGS
TIE STEN 
TWO OUT OF  CANOT DISTGUISH ALHOLIC 
BEVERAGES FROM NON-ALHOLIC BEVERAGES 
Students confused alcoholic coolers with mineral waters that are similar in color 
some alcoholic coolers are not clearly labeled as . 
labeling, and packaging.  Also, 
alcoholic. Students were most often confused by coolers that do not state clearly on 
the front of their labels what kind of beverages they are. An example is Bacardi 
reezer (page 7). 
Students correctly identifed alcoholic beverages more often when shown clearly 
marked, popular, and well-advertised name-brand alcoholic beverages, especially 
beers and Bartles & Jaymes wie coolers. More than 60 percent of the students did 
not distinguish between alcoholic and non-alcoholic beer-such as Sharp s and 
Doul' s. Although non-alcoholic beer contains less than 0.5 percent alcohol, some 
students assumed these products contained the same amount of alcohol as regular 
beer, because the popular Miler and Anheuser-Busch ' slogans appear directly under 
the product name. 
Younger students were more likely to mistake an alcoholic beverage for a non-
alcoholic one. Seventy-three percent of students ages 15 and younger erred or did 
not know that at least one of the alcoholic beverages contained alcohol. Sixty 
percent of those 16 and older made the same mistake. 
PERCE ANSWEG INCORRCI Y OR "DN' KNOW' 
TO TI QUF0N, "DES TI CONTAI ALHOL?" 
Tropical Passion, Pik Passion, Pule Passion (wine cooler or liquor)  61.3%
Cisco (fortfied wine)  36.
drk 
Bacard Breezer (mied  cooler)  25.5
White Mountain (malted beverage cooler)  18.
Jaymes (wine cooler)

Bartles 
Schlitz (malt liquor)

Michelob (beer)
Miller, Miler Genuine Draft (beer)
Budweiser (beer) 
(malt liquor) 
Colt  45  Students sometimes believed that mineral waters with juice contained alcohol. 
Several brands of mieral water now use foil labels to cover the cap. This gives 
them a,n appearance similar to some alcoholic beverages. Thirt-four percent of all 
students failed to identif mineral waters as non-alcoholic. 
The similar appearance of alcoholic coolers and mineral waters has been used by 
students to fool retail clerks into sellng them alcoholic beverages, according to one 
junior high school teacher. In one area, students place wine coolers into mineral 
water four-pack containers. Because of their similar appearance, the ckrks fail to 
notice that the beverages have been switched. 
On average, students were unable to distinguish between alcoholic and non-alcoholic 
beverages 3 out of 10 times.  .. 
SNASHOT  BACAI 
BREEZER 
SUMY 
The only
obvi 
mentin of 
Bacardi 
Brezer 
coniaming 
the 
flohol  is 
smal  cursive 
Bacardi Rum 
Refesher 
prted nat to 
the rile. The

beige alcohol 
contenr is 
almosr 
inviible 
compared to 
the rest of rhe

label 
Th 
ingredient litig is also 
difcult to read when compared 
to the resr of the label 
. Although Bacardi is a popular

percent of 
bran of rum,  25 
the stents did not know 
thai Bacardi Breezer conrow 
alcohoL The product name 
and the frit collage are

emphasied on the front label.  ,.: ' 
,,, 
SUMY: 
SNAPSHOT  STUENT WERE  BY "PASSION' 
FOOLE 
More thn  61  pecent of all students did not
know that Pik Passion, Tropical Passion, and 
Purple Passin contain alcohoL Consmers can 
ttelhl   thr  Passion beverages contain alcohol by
ingredients, but the front of the label offers 
no help. Nowhee on the bottle does -Passion 
tell th consmer t!crly what 
ki of bevoera.g.e;
il is In fact two ty of Passin ext 
a wine cooler often made wilh "subsrndard 
wie. 
" The othe is a liqor made with 
Everclear, a grain alcohol illegal in many Stmes. 
Alcohol content varies between 5.0 and 
6.0 perent The only way to tell the diference 
between the wine cooler and the liqor is to read

the ingredients.

The 
beverages also are 
available in two litre bottles- 
lik soda pop--with a free

promotional 32-ounce plastic 
bottle attached. 
Anybod could 
pick up 0 
cardboard 
four-pack and 
not know that 
it contain 
alcohoL  IN MOsr SfATE, BEER AN OTI MAT BEVERAGE LAELS 00 NOT 
CONT 
DISCSE ALHOL 
Although the alcohol content of beer and other malt beverages vary by State and 
brand, consumers cannot tell by looking at the can or bottle how much alcohol they 
are consuming. Beers generally contain 4. 8 percent alcohol by volume. 
0 to 4. 
Although malt liquor has more alcohol than beer, it is impossible to tell by the. 
labeling. Malt liquor may contain up to twce as much alcohol (8.0 pei'ceqt) as 
re,glar beer and frit-flavored malt coolers. 
Federal law prohibits beer and other malt liquor beverage companies from disclosing 
alcohol content on labels, but it permits States to require disclosure.2 According to 
one State liquor control offcial, this law was enacted after prohibition to prevent 
alcohol content to attract consumers. 
beer and malt liquor companies from using 
These companies oppose State laws because they would be required to manufacture 
different labels for States that require disclosure. Washington State s Liquor Control 
Board recently passed a rule  , but has 
requirig alcohol content disclosure
encountered "enormous" resistance from microbreweries and foreign manufacturers. 
s virtually impossible to do anything at the State level," said a Washington State 
liquor control offcial, citing industry opposition. 
TH ALHOL CONT OF BEVEGES IS A MYSTRY TO STENT 
Less than one of six students identified the beverage containing the most alcohol 
when shown the panel of beverages. Students were most likely to select beer 
(42. 7 percent of students) and malt liquor (18.2 percent) as having the most alcohol, 
although Cisco (16.0 percent) contains two to five times more alcohol than either. 
Even after being allowed to read the labels on all cans and bottles, less than half 
correctly identifed the beverage containing the most alcohol. This is due to (1) the 
students' inabilty to understand the labels and (2) the labels ' lack of clarity. 
As discussed in the OIG report "Youth and Alcoho): A National SUIVey--Drinking 
Habits, Access, Attitudes, and Knowledge" (OEI-09-91-00652), students do not know 
the relative strengths of diferent alcoholic beverages. Almost 80 percent of the 
students did not know that a shot of liquor has the same amount of alcohol as a can 
of beer. Approximately 55 percent did not know that a glass of wine and a can of 
beer have similar alcohol content. Students were especially unaware of the alcohol 
content of wine coolers, even though coolers are favored almost two to one by 
students who drik alcohol. Some students stated that they or their classmates 
prefer wine coolers over other alcoholic beverages because "they contain less 
alcohol." 
227 use  205(e)  '" 
Some students had diffculty detennining total alcohol content because some
beevxeraagesm do pnotl disepla y itb proemilnenotlyw. Fo.r a n example, see the Bartles & Jaymes
The box on page 13 descdbes students' two ddnks of choice: wie coolers and 
beer. 
SNASHOT  JAYMES 
SUMY: BATL 
hl 
Although stuent recogized Barlles  layes wine cooler, they often  difculty 
deterining how much alcohol these cooler contain One 
reason was the location and sie of 
stpe 
the alcohol content lisg, located on one of the  leading towards the  BJ  crest logo. 
3For a full discuion on student 
beverage preference , se "Youth and Alcohol: A National 
, Acc
SUlVey--Drinking HabilS , Attitudes, and Knowledge," (OEI-0-91-052).  .- 
. .
..  . . .
- .. . .
.... .  ...- 
. .
...-  .... . . -
,;  ..  .. . . . . . ., .. ". .... .  . .
Why were. more tharih lfofthestiidentsimable .to identify the . beverage containing 
the most alCohol even after readilg the labelS? . We observed that: 
niny stent haddifcuitor cOuld not ftalcohol content listed on alcoholic 
beerages; 
beer and lniJtliluir donotdisdbse alCohol content. While some stent knew 
.ihatnult liui:(;(Jntain1n  tllCohol than beer othelO made no disticton 
between ihe two; lfven ilfterdiscoverUg ihat. Cisco contained 20 percent alcohol, 
;:1J  liluor 
4in -22  &tizts belieedtk:lbeer 8nd/onnail 
contaiidmorealcohOl; 
1ith 
.iome  Cdui4iifFOii/l!  ft#N1  despite readingiJ closely; and 
Md; 1idjJfPd&  d;deiiI'1ldhcould not be changed about 
which beerage coriOined ihe most alcohoL. 
TI 
STEN 
TH A  THT 
MORE  DO NOT KNOW  CISCO 
OF  AI 
CONTAIS ALHOL 
alcohol. Even 
Thirt-six percent of the students did not know that Cisco contains 
, less than half of the students knew that Cisco contains the 
after reading the labels
most alcohol of any drik in the panel. In fact, it contains at least two-and-a-half 
times more alcohol than any of the other beverages. 
The warning on new Cisco bottles  This is not a wine cooler " confused some 
students. "I thought 'Ths is not a wine cooler' meant it didn t have alcohol," said 
one student. In other regions of the country, Cisco bottles did not contain this 
warning. 
Although Cisco is not available in all areas, students have found ways to obtain it. 
For example, students in Philadelphia purchase Cisco from "speakeasies" or 
aspelackieso," ihlegaol olpeircatio nbs theat pvroveider satudegntse wisth C.i sco as well as other
Students related stories about Cisco which emphasize not only its danger, but also its
popularity. Among the stories we heard: 
I know a lot of people that blacked out (after drinking-Cisco). 
One girl tasted it, said it tasted like Kool-Aid, and drank it fast.  - ,
..: !-
. -
It's good to buy one for four people. It s strong.  Someties you just have a 
couple of dollars and need to get drunk. 
Some people pass out. . It tastes good. I know a girl who drank two bottles 
and died. It can reaJly get you messed up. 
SUMY:  TAK STENI BY 
SNASHOT  CISCO " SURPRISE' 
the midle)
Although Cisco has changed it labeling, we found the old bonle (pictured here  in 
several a;eas. Whle many stdents were unfamiliar wih Cisco, other 
stil available  in 
descred iJ as the drk of choice for them or their j'nd. "I've seen 10- and ll-year-old 
drk  iJ"  said one stuent. "It make yo wild." WI COIE: A 
BEE 
VS.  COMPARON 
WI  DRI 
OF CHOICE
COOLERS 
Wme cooler are the alcoholic drk of choice for stuents. Most stents knew rhat Bartles 
& laymes Wme Coolers contain alcohol because rhey recognized rhe brand and the words "wine 
cooler " although smal 
are prited clearly on

rhe front of th bottle.
Stuents knew popular

beers, such as
Buweiser, Miller and
Michelob. However
many stuents had no 
ida how much alcohol 
beer contain. As a 
resl  even after 
learing rhat Cisco

contain 20 percent

alcoho  percent of
28 
all stuenrs srl believed

, malt liqor,
rhat beer
and/or non-alcoholic beer conrain more alcohol rhan Cisco. This problem is exacerbated by

popular myths among students rhat beer is "stronger than wine coolers. 
DRI?
mE MOST POTENT 
BEER  RECOMMENDATIONS
GEN 
TH SURGEON  SHOUL WORK WI BEVEGE INUSlY 
OFFCI 
Sf ATE AN FEERA  TO IMROVE TH IAEUNG AN 
PACKGING OF ALHOUC AN NON-ALHOUC BEVERAGES 
A coordinated effort should ensure that (1) total alcohol content of all beverage 
including beer and malt liquor-is clearly displayed and understandable -and 
(2) alcoholic and non-alcoholic beverages are clearly distinguishable. .
, it may be necessary to seek repeal of the Federal law 
In order to accomplish this
prohibiting disclosure of alcohol content on beer containers. Other options would be 
to convice States to enact legislation requirg content disclosure or to seek
voluntary industry standards.
WI 
TH SURGEON GENRA SHOUL CONSULT  PUBUC 
PRIATE AGENCI TO DEVEP, IMROVE AN PROMOTE 
INCRE STENT
EDUCATIONAL PROGRA WICH WOUL 
AWAR  EFCI 
OF ALHOUC BEVEGES AN THm 
Ths recommendation is simar to one that appears in the OIG report entitled 
Youth and Alcohol: A National Surv.ey--Driking Habits, Access, Attitudes, and 
Knowledge." In addition to consulting with other IlS components, the Surgeon 
General should work with the U.S. Departments of Education, Transportation, and 
Justice, the alcoholic beverage industr, and public interest groups to implement this 
recommendation. The educational programs should include (1) teaching students 
about the total alcohol content of diferent beverages and (2) elimnating myths 
about wine coolers and beer.  APPENDIX
MEODOLOGY AN BEVEGE SELECrON 
MEODOLOGY 
Samplig Methodlogy 
The sample for this inspection was drawn in four stages. 
At the first stage, a cluster of eight States out of the nation was selected at random 
without replacement, with probabilty proportionate to size. That is, for this level 
size, dej'ned as the number of schools in each State, was used as the weighting 
factor for the selection of the eight States. The universe of schools was limited to 
secondary schools Gunior high or senior high) and Kindergarteruhrough 12th 
grade
schools. 
The second stage involved selecting a cluster of counties within each of the eight 
States. Two counties were selected from each sampled State for a total of 
16 counties. These counties were also selected with probabilty proportionate to size. 
However, the size for this stage was determined by the number of students in the 
county in grades seven through twelve. 
Once counties were selected, a simple random sample of schools within the county 
was chosen. Two schools per county were sampled for a total of 32 schools. 
The fial stage of sampling was the selection of students in the schools. A sample of 
thrt students per school was desired. However, 42 were initially selected to allow 
for absentees and refusals. The schools were instructed to alphabetize a list of all 
students in grades 7 through 12. Then the total number of students on the list was 
divded by 42 and rounded to the nearest whole number (n). Students were then 
selected by counting every nth one on the list until the entire list was 
exhausted. In 
many cases
, more than the required thirt students were available to participate. 
The schools were instructed to randomly subs ample to obtain a final sample of 30. 
This final sample size was achieved in all but a few schools. However, in no school. 
were less than 27 students intervewed. The total sample for this inspection was 
956 students. 
Weightg Predue 
Since the sample was selected with four different stages and a different set of 
, weighting of the respondents was standardized through a 
probabilties at each stage
five-step process based on sample size and the universe. Although the first two 
stages of selection employed probabilty proportionate to size, the measure of size  difered between the two stages. In the first stage the measure of size was number 
of schools whie the measure of size for the second stage was number of students; 
The thrd and fourth stages involved taking simple random samples of schools and 
then students. To provide a uniform unit of selection so that accurate weights could 
be determned, the number of students, known at each of the four stages, w!!s used 
for purposes of weighting the sample. 
Overall, there were 32 distinct weights used to project to the universe-one for-each 
school. These weights were applied to every student in the school ant!. were 
computed as follows: 
(1)	 In weighting from the students to the school, the population in the school was 
divided by the sample in the school. There were 32 different weighting 
factors for this phase. 
(2)	 The second weighting factor was determined by dividing the number of 
students in the county by the sum of students in the two schools that were 
chosen. There were 16 different weighting factors used in projecting to the 
county level. 
(3)	 , the weight was computed by dividing the number of 
In the third stage
students in the State by the sum of students in the two counties that were 
chosen. There were 8 weighting factors (one for each State) at this stage. 
(4)	 For the final stage, the weight was calculated by taking the number of 
students in the universe and dividing by the number of students in all eight 
States combined, for one weighting factor to project to the universe. 
(5)	 The weight at each of these four stages was multiplied together to obtain the 
32 unique weighting factors. 
Adjustmts to 
Weights 
It was determined, subsequent to data collection, that the 956 students int  rvewed 
were disproportionately distnouted when compared to the estimated national 
population. Using data provided by the Department of Education, we determined 
that the data needed to be reweighted to appropriately reflect this national 
population. The table below shows the distribution of the national population and 
sample with respect to race and grade, including the adjusted weights.  DISTUTON OF POPULTION AN SAMLE
WI 
REPECf TO GRAE

ADJUSTED 
UNWEIGHTD  WEIGHTED 
GRAE  SAMLE  SAMPLE  POPULTION 
21.40%  12.90%  13.03% 
27.10%  12. 10%  12.04%
23% 
232% 
14 711% 
12.70%  21.40%  20.96% 
12.40%  17. 10%  17.20% 
11.50%  13.40%  13.42% 
DISTUTON OF POPULTION AN SAMLE
WI 
REPECf TO RACE 
ADJUSTED 
UNWElGHTD  WEIGHTED 
RACE  SAMPLE  SAMPLE  POPULTION 
WHIT 
58.20%  70.20%  69.35% 
BLACK  29.30%  15.40%  15.36% 
HISPANIC 8.40%  10.50%  10.20% 
INIA

20%  0.40%  1.04% 
ASIA 
3.40%  3.40%  3.43% 
OTHR 
70% 
As can be seen from the above two tables, there is a difference between the 
Unweighted sample and population distributions with respect to 
both race and grade. 
Using a cross tabulation of race and grade, compiled for the population and the 
sample, the adjusted weights were constructed. These adjustments were made based 
on the proportions found in the sample compared with the population. For example 
since whites were under sampled and blacks were over sampled, the responses were 
weighted more heavily for whites and less for blacks. This adjustment brought the 
sample in line with the national population. 
The dierences between the adjusted proportions and the unweighted proportions in 
the sample are mainly due to the following: 
(1)  In general, the sample selected proportionately more 7th and 8th graders than 
are found in the population and (2) The sample selected proportionately more non-white students than are present 
in the national population. 
Strtued Int Quns 
We asked students three questions: 
(1) Imagie you are at a store and you saw thes bottles on a shelf. Plea tell 
me whether you believe each one doe or doe not conta alcoliol. . It is okay 
if you do not know. 
(2) Now at the bottes (not touchig), which of thes, if any, do 
, just 
you th conta 
the most alcohol? 
(3) Now you  touch and read the labels. Whch of thes, if any, do you 
conta  ca 
the most alcohol? 
BEVEGE SELEcnON(cid:1)
Intervewers purchased the survey beverages in the communities where the intervews(cid:1)
were conducted. Cisco was the only exception. Cisco was used in all intervews 
regardless of whether it was available in the community because of the Surgeon 
General's work with the FfC to require Cisco to change its packaging. Interviewers 
were instructed to find beverages in 10- to 
16-ounce containers. Intervewers 
attempted to purchase one of each of the folIowig: 
Mied drink cooler(cid:1)
Wine cooler(cid:1)
Light wie cooler(cid:1)
Mieral water with juice(cid:1)
Non-light beer(cid:1)
Non-alcoholic beer 
Malt liquor(cid:1)
Not all beverages were available in each community. In several communities malt(cid:1)
liquor was available in 40-ounce bottles only.(cid:1)
The intervewers also purchased up to three other alcoholic or non-alcoholic 
beverages at their discretion. Intervewers were instructed to look for additional(cid:1)
beverages that closely resembled others in the panel.(cid:1) BEVEGES USED DURG TH INRVIWS
MID DRI COLE 
NON-ALCOHOLIC BEER 
Berr  Kingsbury 
Bacardi Breezer Calypso 
Lie 
Bacardi Breezer Key  Doul's 
Sharp 
WI 
COLERS  Texas Light Non-Alcoholic 
Bartles & Jaymes Berr  MAT LIQUOR 
Bartles & Jaymes Black Cherr 
Bartles & Jaymes Light Berr  Colt ' 
Bartles & Jaymes Red Sangra  Elephant (Danish) 
Olde English 800 
Pink Passion 
Schlitz 
Purple Passion 
Tropical Passion  CQAI 
Seagram s Wild Berres 
MAT BEVERAGE COOLE  Qub Martini 
FRUI JUCE 
White Mountain Cooler
MI 
wr 
WATE  FRUI JUCE  Everfesh Cranberr-Apple 
Chapelle Pear SODA POP 
La Croix Natural Orange
Mistic Berr
 Faygo Redpop 
Mistic Tropical Passion.

Rll/:llD 
Sundance Sparkler Concord Twit 
Sundance Sparkler Cranberr 
Cisco Berr 
Sundance Sparkler Raspberr 
Walleroo .  Cisco Black Cherr 
Cisco Peach 
BEER  Cisco Regular (Grape) 
Budwei6er
Lowenbrau
Michelob
Miler Genuine Draft
Miler High Life
Regal Select