Department  of  Health  and  Human  Services 
OFFICE  OF 
INSPECTOR  GENERAL 
. 
YOUTH  AND  ALCOHOL: 

A  NATIONAL  SURVEY 

DRINKING  HABITS,  ACCESS,  ATTITUDES,  AND  KNOWLEDGE 

Richard  P.  Kusserow 
INSPECTOR  GENERAL 
OEI-09-91-00652  OFFICE  OF INSPECTOR  GENERAL 
The mission of the Office of Inspector General (OIG),  as mandated by Public Law 95452.  as 
amended, is to protect the integrity of the Department of Health and Human Services (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 Office of Audit  Services,the Office of 
Investigations, and the Office of Evaluation and Inspections.  The OIG  also informs the Secretary of 
HHS of program and management problems and recommends courses to correct them. 
OFFICE  OF AUDIT  SERVICES 
The OIGs Office of Audit  Services (OAS)  provides all auditing services for HHS, either by 
conducting audits with  its own audit resources or by overseeing audit work done by others.  Audits 
examine the performance of HHS programs and/or its grantees and contractors in carrying out their 
respective responsibilities and are intended to provide independent assessmentsof HHS programs and 
operations in order to reduce waste, abuse, and mismanagement and to promote economy and 
efficiency throughout  the Department. 
OFFICE  OF INVESTIGATIONS 
The OIGs Office 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 overseesState Medicaid fraud control  units which investigate and 
prosecute fraud and patient abuse in the Medicaid program. 
OFFICE  OF EVALUATION  AND  INSPECIIONS 
The OIGs Office of Evaluation and Inspections (OEI)  conducts short-term  management and program 
evaluations (called inspections) that focus on issuesof 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 efficiency, vulnerability, and effectivenessof departmental 
programs. 
This report was prepared under the direction  of Kaye D. Kidwell,  Regional Inspector General, and 
Paul A. Gottlober,  Deputy Regional Inspector General, Office of Evaluation and Inspections, Region 
IX.  Participating  in this project were: 
San Francisco  New  York  Chicago 
Deborah Harvey, Project Leader 
 Jack Molnar  Thomas Komaniecki 

Brad Rollin,  Lead Analyst 
 Tim Nee  Pamela May 

Elizabeth Bell 
 Tracey Rennie  Ann  OConnor 

Kathy Dezotte 

Jennifer Mallen 
 Philadelphia  Dallas 
Brian Pattison 
 Donna Millan  Michelle Adams 
Elaine Shelub 
 Nancy Molyneaux  Pamela Smith 
Headquarters  Atlanta 
Wm. Mark  Krushat, Mathematical Statistician  Josiah Townsel 
Barbara Tedesco, Mathematical Statistician 
Maruta  Zitans, Program Specialist  EXECUTIVE  SUMMARY 
PURPOSE 
This  inspection  surveyed junior  and senior  high school  (7th  through  12 grade) 
students  to  determine  how  they  obtain,  view,  and consume  alcohol. 
BACKGROUND 
In  response to  public  health  concerns and the adverse health  consequences of 
alcohol  abuse, Surgeon  General  Antonia  Novello  requested  that  the  Office  of 
Inspector  General  (OIG)  survey youth  to determine  their  views and practices 
regarding  alcohol  use.  These  concerns mirror  one of Department  of  Health  and 
Human  Services (HHS)  Secretary  Louis  Sullivans  goals which  is to  reduce  the 
prevalence  of  alcohol  problems  among  children  and youth.  The  Surgeon  General  is 
particularly  concerned  about  the  drinking,  habits  of youth,  especially  the  nations 
20.7 million  7th  through  12th graders.  This  report  is one in  a series prepared  by the 
OIG  related  to youth  and alcohol.  It  describes survey findings  relating  to youth 
perceptions,  knowledge,  opinions,  and drinking  habits  and is based on structured 
interviews  conducted  with  a random  national  sample  of junior  and senior  high  school 
students. 
FIN-DINGS 
Fij@one  percent of junior  and senior high school studenfi  have had at least one 
drink  within  the past year and 8 milEon  studenr~ drink  weekly. 
Junior  and senior high school students drink  35 percent of all  wine coolers sold in 
the United States and I.1  billion  cans of  beer each year. 
More  than  5 million  students have binge  3 million  within  the last month; 
454,ooO binge at least once a week 
More  than  3 million  studen& drink  alone, more than  4 million  drink  when they 
are upset, and less than  3 million  drink  because they are bored 
Studen& lack  essential knowledge about  alcohol  and its @ec&. 
Nine  million  students get their information  about  alcohol from  unreliable  sources. 
Seven mill&a  students are able to walk  into  a store and buy alcohoL 
Students accept rides from  friend  who have been drinking. 
i  Parents, jiiends,  and alcoholic  beverage advetiements  injknce  students 
b 	
attitdes  about  alcohoL 
RECOMMENDATIONS 
The Surgeon General should  consult with public  and private  agencies to develop, 
b 	
improve, and promote  educational  pmgramr  which  would  increase student 
awareness of alcoholic  beveragesand their @et%. 
The Surgeon General should  collabomte  with  the appropriate public  and private 
b 	
agencies to reduce the appeal of alcoholic  bevemge advert-king to youth. 
The Surgeon Geneml  shouki  emphasize the need for  law  enforcement  and State 
b 	
alcoholic  bevemge control  agencies to prevent youth jium  illegally pudasing 
alcohoL 
ii  TABLE  OF  CONTENTS 
EXECUTIVESUMMARY 
INTRODUCTION  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1 

FINDINGS  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 

Fifty-one  percent  of junior  and senior  high  school students  have had 

at least one drink  within  the past year.  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 

Junior  and senior  high  school students  drink  35 percent  of all wine  coolers 

sold in  the  United  States and  1.1 billion  cans of beer  each year.  . . . . s . . . . . . . . 4 

More  than  5 million  students  have binged;  3 million  within  the  last month; 

454,000 binge  at least once a week.  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 

More  than  3 million  students  drink  alone,  more  than  4 million  drink 

when  they  are upset, and less than  3 million  drink  because they  are bored.  . . . . . 7 

Students  lack  essential knowledge  about  alcohol  and its effects.  . . . . . . .. s . . . . , . 8 

Nine  million  students  get their  information  about  alcohol 

from  unreliable  sources.  . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . e .  10 

Seven million  students  are able to walk  into  a store and buy  alcohol.  . . . . . . . .  11 

Students  accept  rides from  friends  who  have been drinking.  . . . . . . . . . . . . . . .  12 

Parents,  friends,  and alcoholic  beverage advertisements  influence 

students  attitudes  about  alcohol.  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  13 

RECOMMENDATIONS  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  15 

APPENDICES 
Appendix  A:  Methodology  . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . .  A-l 
Appendix  B:  Projected  Universe  by Grade  and Gender  . . . . , . , . . . . . . . . . .  B-l 
Appendix  C:  Selected  Bibliography  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  C-l  INTRODUCTION 
PURPOSE 
This  inspection  surveyed junior  and senior  high  (7th  through  12th grade)  students  to 
determine  how  they  obtain,  view,  and consume alcohol. 
BACKGROUND 
. 
In  response to  public  health  concerns and the adverse health  consequences of 
alcohol  abuse, Surgeon  General  Antonia  Novello  requested  that  the  Office  of 
Inspector  General  (OIG)  survey youth  to determine  their  views and practices 
regarding  alcohol  use.  These  concerns mirror  one of Department  of  Health  and 
Human  Services (HHS)  Secretary  Louis  Sullivans  goals which  is to  reduce  the 
prevalence  of  alcohol  problems  among  children  and youth.  The  Surgeon  General  is 
particularly  concerned  about  the  drinking  habits  of youth,  especially  the  nations 
20.7 million  7th through  12th graders.  This  report  is one in  a series prepared  by the 
OIG  related  to youth  and alcohol.  It  describes survey findings  concerning  youth 
perceptions,  knowledge,  opinions,  and drinking  habits. 
Youth  Consumption  and Beliefs About  Alcohol 
According  to  the  U.S. Department  of Education,  20.7 million  students  attend 
7th through  12th grade.  Previous  national  surveys have disclosed that  most 
adolescents have tried  alcohol  and that  many  drink  frequently.  Among  high  school 
seniors in  the  class of  1990, 89.5 percent  had used alcohol  at least once, and 
32.2 percent  had experienced  a binge  of  5 or more  drinks  in  a row  within  the  past 
2 weeks.  While  recent  surveys of  high  school students indicate  an overall  drop  in 
drug  use, alcohol  use continues  at a high  rate. 
According  to  another  survey, adolescents have started  drinking  at earlier  ages since 
1978.*  Although  youth  begin  using alcohol  at earlier  ages, their  information 
regarding  its contents  and effects may be faulty.  A  recent  survey of  4th,  5th,  and 
6th graders  found  that  only  21 percent  consider  wine  coolers  a drug, while 
50 percent  believe  beer, wine,  and liquor  are drugs.3 
University  of Michigan, Institute  for Social Research, Monitoring  the Future:  A Continuing 
Study of the Lifestyles and Values of Youth,  January 1991. 
National  Clearinghouse on Alcohol  and Drug Issues (NCADI),  Alcohol  and Youth,  NCADI 
Alcohol  Topics Fact Sheet, January 1987, p. 1. 
3National Families in Action,  Wine Coolers Becoming Gateway Drug, Drug Abuse Update, 
no. 28, March  1989, p. 12.  Youth Access to Alcohol 

Youth  obtain  alcohol  from  a variety  of social and commercial  sources.  Although  the 

minimum  age to buy alcohol  in all  States is 21, studies show that  youth  are 

frequently  able  to  obtain  alcohol  with  little  or no problem.  While  youth  frequently 

find  alcohol  at parties  without  parental  supervision  and at friends  homes, they  also 

obtain  alcohol  from  retail  outlets  in a variety  of ways.  Youth  may (1)  have an older 

friend  purchase  alcohol,  (2) buy from  stores that  are known  to sell to  minors,  and/or 

(3)  solicit  a stranger  to  purchase  alcohol. 4  In  some areas, youth  may simply  purchase 

alcohol  without  being  challenged  by the vendor.  According  to  a recent  study, 

underage  males were  able  to buy beer  in 97 of  100 District  of  Columbia  stores.5 

METHODOLOGY 

To  establish  the  universe  of  7th through  12th grade students, we compiled  data on 

all  secondary  (junior  and senior  high  schools), kindergarten  through  8th grade  (K-8), 

and kindergarten  through  12th grade  (K-12)  schools in  the  United  States.  We 

weighted  the  States based upon  the total  number  of  schools.  The  eight  randomly 

selected States were:  California,  Colorado,  Florida,  Illinois,  Louisiana,  New  York, 

Ohio,  and Pennsylvania.  We  obtained  data on all  target  schools in  the  eight  States 

from  the  U.S. Department  of  Education.  After  weighting  each county  in  each State 

by the number  of  students, we randomly  selected two  counties  in  each State.  We 

randomly  selected two  schools from  each county  list, without  weighting,  for  a total 

sample  of  32 schools. 

During  March  and April  1991, we conducted  structured  interviews  with  a random 

national  sample  of 956 students in  the  7th through  12th grades.  We  asked all 

students  about  their  opinions  and knowledge  of  alcohol.  We asked about  the 

personal  experiences  of students who  had drunk  at least one full  alcoholic  beverage 

in  the  past year.  Throughout  this report,  we refer  to  these students  as students  who 

drink.  Of  the  students who  never  drank  alcohol  or  had not  had a drink  during  the 

past year, we asked about  their  perceptions  and observations  of  their  classmates who 

drink.  We refer  to  these students  as non-drinkers.  Appendix  A  contains  a full 

description  of  the  sample  selection  and methodology. 

Friedner D. Wittman, Ph.D., J.W. Grube, and P. Shane, Survey of Alcohol  and Other Drug 
Experiences Among Castro Valley High School Students in 1987 and 1990, September 1, 1990, p. 2. 
%hristine  Russell, Its Easy for Underage Men to Buy Beer in the District,  Washineton Post 
Health, March  19, 1991, p. 5. 
2  FINDINGS 
STATtSTIU  HIGHUGH73:  WHO DRLMLS? 
7TH THROUGH  12TH  GRADE  STUDENTS  NATlONWIDE 
20.7  MILLJON 
1
STUDENTS  WHO BUY  4.4  MILLION  DRINK WHEN  UPSET 
ALCOHOL  IN STORES 
12.7  MlLLlON  DRINK WHEN  BORED
6.9 MILLION 
BINGERS 
HAVE HAD 5 OR MORE DRINKS IN A ROW 
5.4  MILLION  HAVEBINGED AT LEAST  ONCE 
1 3 MILLION  HAVE BINGED  IN THE PAST MONTH 
454,000  BINGE AT LEAST ONCE A WEEK 
FIFTY-ONE  PERCENT  OF JUNIOR  AND  SENIOR  HIGH  SCHOOL  STUDENTS 
HAVEHADATLEASTONEDRINKWlTHIN  THEPASTYEAR. 
According  to  our  survey, 68 percent  of all  students  have drunk  alcohol  at least once, 
and  51.2 percent  (10.6 million)  have had at least one  drink  within  the  past year. 
The  average  student  who  drinks  is 16 years old  and in  the  10th grade.  Of  the 
students  who  drink,  53.8 percent  are male,  and  46.2 percent  are female.  See 
appendix  B for  gender  and school grade breakdowns. 
3 
 We  found  that  students  were  13 years old when  they  took  their  first  drink.  This  is 
close to  other  national  surveys that  report  12.3 years as an average  age.6 
THE  hUJORL?Y  OF STUDENTS  HAVE  THEIR 
FIRST  DRINK  IN  TXEIR  EARLY  TEENS 
NO ANSWER 
1% 
We  found  that  eight  million,  or  38.6 percent  of ail  students,  drink  weekly.  Three 
million  students  reported  that  they  do not  usually  drink  each week. 
JUNIOR  AND  SENIOR  HIGH  SCHOOL  STUDENTS  DRINK  35 PERCENT  OF 
ALLwINEcooLERssoLDINTHEu-NITED  STATES  AND  1.1 BILLION 
CANS  OF  BEER  EACH  YEAR. 
We  asked students  about  four  types of alcoholic  beverages-beer  (including  all  malt 
beverages),  wine  coolers,  wine,  and liquor  (including  mixed  drinks  that  contain 
alcohol  such as rum  or vodka).  Some students  drink  more  than  one type  of 
alcoholic  beverage.  We  project  that: 
9.2 mill.ion  students  have drunk  beer.  Of  this  group,  6 million  drink  between 
b 	
0.12 and 33 beers weekly.  In  some schools, students  mentioned  that  they 
6U.S. Department  of Health  and Human Services,PHS-ADAMHA-OSAP,  Alcohol  Use Lunong 
Children  and Adolescents, Statistical Bulletin,  October-December  1987, p. 2 
4  drink  40-ounce  bottles  of malt  liquor  instead  of  12-ounce cans or bottles  of 
beer. 
c 	 8.9 million  students  have drunk  wine  coolers.  Of  this group,  4 million  drink 
between  0.16 and  12 wine  coolers weekly. 
b 	 6.2 million  students  have drunk  wine.  Of  this group,  1.4 million  drink 
between  0.25 and 24 glasses of wine  weekly. 
b 	 7.2 million  students  have drunk  liquor.  Of  this group,  3.6 million  drink 
between  0.25 and 24 drinks  weekly. 
The  average weekly  consumption  for  each alcoholic  beverage  type  is shown below. 
KHILE  KUVE  COOLERS  ARE  THE  DRINK  OF  CHOICE, 
STUDENlX  DRliX  MORE  BEER 
2.7 
Wine coolers are the students Think  of  choice. 
When  asked about  their  favorite  alcoholic  drink,  42.1 percent  of students  who  drink 
chose wine  coolers.  This  translates  to 4.5 million  students  who  drink  nationally.  In 
addition,  51 percent  of  all  students say that  wine  coolers  are the  favorite  drink 
5 
 among  their  friends  and classmates.  Students  choose wine  coolers  because they taste 
good,  are fruity,  do not  have a strong  taste of alcohol,  and they  think  wine  coolers 
do not  contain  much  alcohol. 
Junior  and senior high school students d&k  35 penxnt  of  all  wine coolers sold in  the 
United States. 
According  to  estimated  sales figures ,  88.8 million  gallons  of wine  coolers were  sold 
in  the  United  States in  1989.  Based on an average consumption  of  6.4 million 
bottles  weekly  (1Zounce  size), we estimate  that  students  drink  31.2 million  gallons  of 
wine  coolers  annually.  By projecting  the  total  volume  of wine  coolers  students 
reported  drinking,  we estimate  that  students drink  35 percent  of  the wine  coolers 
sold in  this country. 
Junior  and senior high school students drink  I.1  bill&  beers each-year. 
Students  drink  less than  2 percent  of the  62 billion  bottles  and cans8 of beer 
consumed  annually  in the  United  States.  While  this  percentage  appears  small,  it  is 
staggering when  one considers that  minors  illegally  consume  more  than  a billion 
beers each year. 
Students  who  chose beer  as their  favorite  alcoholic  beverage  said it  tastes good,  is 
easy to get, is cheap, and does not  get you  drunk  as fast as other  alcoholic 
beverages.  Several students  said that  beer  is always around  or  available  at parties. 
MORE  THAN  5 iILLION  STUDENTS  HAVE  BINGED,  3 MILLION  WITHIN 
THE  LAST  MONTH,  454,000 BINGE  AT  LEAST  ONCE  A  WEEK. 
Researchers  define  a ?binge as drinking  five  or  more  drinks  in  a row.  O.ur 
projections  show that  5.4 million  students have binged  at least once.  Almost 
55 percent  of  these had binged  at least once in  the month  before  the  survey.  For 
this group,  the  number  of binges ranged  from  1 to  20 per  month. 
The  demographics  for  students who  binge  mirror  the  demographics  for  all  students 
who  drink.  Fifty-nine  percent  are male;  41 percent  female.  The  average binger  is a 
16-year-old  male  in  the  10th grade.  He  was 12 years old  when  he took  his first 
drink,  slightly  less than  the  average  13 years for  all  students who  drink.  He 
consumes six drinks  each week. 
The  Wine Institute, Table of Commercially Produced Wine Entering  Distribution  Channels in 
the United  States, by Areas Where Produced, 1985-1989. 
81989 data, State reports compiled by Beer Institute  and U.S. Department  of Commerce, Bureau 
of Census. 
6  There  is a smaller  group  of students who  binge  almost  every week--454,000  students 
average  15 drinks  weekly.  Their  average age is 16.6 years, and they  are in the 
11th grade.  Eighty-seven  percent  are males, and  13 percent  are females. 
BINGERS  DRUKK MORE  BEER  KliWV  OTRTERALCOHOLIC  BEK?ZRAGES 
lo 
8 
6 
4 
2 
0 
BEER  COOLERS  WINE  LIQUOR 
phlks  of choice 
THOSE  WHO BINGED 
IN LAST  MONTH 
II 
WEEKLY  SINGERS 
MORE  THAN  3 MILLION  STUDENTS  DEW-K  ALONE,  MORE  THAN 
~MIILIOND~~~~WSET,ANDLESSTHAN~~ON 
DFUNK  BECAUSE  THEY  ARE  BORED. 
Scientific  research  has shown  that  alcohol  is a fast-acting  drug.  The  early  phases of 
drug  action  tend  to have a positive  effect  on mood  and general  arousal  level.  Many 
students  use alcohol  as a tool  to help  them  cope with  certain  feelings  and situations. 
Of  the  10.6 million  students  who  drink,  (1)  31 percent  drink  alone,  (2)  41 percent 
drink  when  they  are upset because it  makes them  feel  better,  (3)  25 percent  drink 
because they  are bored,  and  (4)  25 percent  drink  to  feel  high. 
7 
 STUDENT  DRINKING  PA7TERNiS  ARE  REASON  FOR  CONCERN 
DRINKING  PA-i-lERNS 
0  1  2  3  4  5 
MILLIONS  OF STUDENTS 
We  compared  these responses to  a smaller  group  of  students who  binge.  We  found 
that  students who  binge  are more  likely  to  drink  alcohol  to relax,  change their  mood, 
or  cope with  emotional  distress.  Of  the  5.4 million  students  who  binge, 
(1)  39 percent  drink  alone,  (2)  58 percent  drink  when  they  are upset,  (3)  30 percent 
drink  when  they  are bored,  and  (4)  37 percent  drink  to feel  high. 
STUDENTS  LACK  ESSENTIAL  KNOWLEDGE  ABOUT  ALCOHOL  AND  ITS 
EFFECTS. 
Nationwide,  5.6 rniilibn  students are umwe  of  the  legal  age to puhase  alcohoL 
The  minimum  age to  purchase  alcohol  in all  States is 21.  Nevertheless,  a projected 
1.6 million  students  do not  even know  such a law  exists.  Many  students  know  about 
the  law,  but  do not  know  the  minimum  age is 21.  Their  guesses ranged  from  14 to 
24 years. 
In  Louisiana,  only  46 percent  of  the  students we interviewed  knew  the  correct 
minimum  age.  The  confusion  among  these students  may be attributed  to the  State 
law which  prohibits  persons under  21 from  purchasing,  possessing, or  consuming 
8 
 alcohol,  yet does not  prohibit  restaurants  and bars from  selling  alcohol  to  persons 
over  18.  Therefore,  someone between  18 and 21 who  drinks  in  a restaurant  has 
committed  a violation,  but  the restaurant  or bartender  has not.  A  State Alcohol 
Beverage  Commission  official  said they are not  prosecuting  the underage  drinker 
because the  law  is superficial.  When  servers realize  this, they  are not  hesitant  to sell 
to those under  21.19 
A  third  of  all  studem  do  not  undemtand  the  intoxikating  fleets  of  alcohoL 
We asked students  about  alcohols  intoxicating  effects  and whether  different 
stimulants  will  counteract  these effects.  More  than  2.6 million  students  do not  know 
a person  can die from  an overdose of  alcohol.  More  than  one-third  of  students 
believe  that  drinking  coffee,  getting  some fresh air,  or  taking  a cold  shower will 
sober you  up. 
In  addition,  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. 
Students  like  wine  coolers  because they  are like  soda--I  dont  consider  them 
alcohol,  and they...dont  get you  drunk. 
Students do  not  know  the  relative  strengths  of  different  alcoholic  beverages. 
Almost  80 percent  of the  students do not  know  that  one shot of whiskey  has the 
same amount  of  alcohol  as a 1Zounce  can of beer.  Similarly,  55 percent  do not 
know  that  a 5-ounce  glass of wine  and a 12-ounce can of beer  have the  same 
amount  of  alcohol.  One  out  of three  students do not  know  that  all wine  coolers 
contain  alcohol. 
The  chart  on the  next page details  student  responses to  our  questions. 
9May 1, 1991, telephone conversation with  a State Alcohol  Beverage Commission official. 
9  STUDENTKNOKLEDGE  VARIES  GREATLY 

ACTUAL  QUESTION 
Mothers  who  drink  alcohol  during  pregnancy  have 
True  98 
a higher  risk of having  babies  with  birth  defects. 
Alcohol  slows  the  activity  of the  brain.  True  96 
A teenager  cannot  become  an alcoholic.  False  96 
Alcohol  improves  coordination  and  reflexes.  False  93 
A person  can  die from  an overdose  of alcohol.  True  87 
Many  wine  coolers  actually  contain  no alcohol.  False  68 
Drinking  coffee,  getting  some  fresh  air, or taking  a 
False  54 
cold  shower  can  help  a person  sober  up  more  quickly. 
One  can  of beer  (12 ounces)  has more  alcohol 
False  45 
than  a glass  of wine  (5 ounces). 
One  shot  of whiskey  (1-l/2  ounces)  has twice 
as much  alcohol  as a can  of beer  (12 ounces). 
NINE  MILLION  STUDENTS  GET THEIR  INFORMATION  ABOUT  ALCOHOL 
FROM  UNRELIABLE  SOURCES. 
More  than  4 million  students  learn  about  alcohol  from  their  friends,  whose 
information  may  or  may not  be accurate.  Similarly,  more  than  5 million  students  say 
that  they  just  picked  up what  they  know  by themselves or  that  nobody  taught  them. 
A  greater  proportion  of students who  drink  than  non-drinkers  learn  about  alcohol 
through  unreliable  sources.  When  asked who  taught  him  about  alcohol,  one  student 
explained,  Nobody.  A  lot  of  teenagers who  drink  it  dont  know  what  it  is. 
Students  also learn  about  alcohol  from  their  parents,  school,  and the  media.  The 
chart  on the  next  page illustrates  students  information  sources. 
10 
 STUDENTS  ALSO  LEARN  ABOUTALKOHOL  FROM  FAMILY, 
SCHOOL,  AND  7X-E iUEDL4 
70 -
59.2 
60 
FAMILY  SCHOOL  MEDIA  FRIENDS/SELF/NOBODY 
Sources  of Information 
NON-DRINKERS  STUDENTS  WHO  DRINK 
n=10,111,637  cl  n=10,616,760 
As  shown  in  the  graph,  non-drinkers  are much  more  likely  to  learn  about  alcohol 
from  their  family  and  school  than  are students who  drink.  Non-drinkers  are also 
slightly  more  likely  to  cite  the  media  as a source of  their  knowledge. 
More  than  a quarter  of  all  students cited  school, a class, teachers,  or  a specific 
school  program  as teaching  them  about  alcohol.  For  example,  a few  students 
mentioned  the  Drug  Abuse  Resistance Education  (D.A.R.E.)  program.  A 
coordinated  effort  between  local  police  and schools, D.A.R.E.  sends uniformed  police 
officers  into  the  schools to  teach 5th- and 6th-grade  students  about  alcohol  and other 
drugs. 
SEVEN  MILLION  STIJ?ENTS  ARE  ABLE  TO  WALK  INTO  A  STORE  AN-D 
BUY  ALCOHOL 
Studen&scan buy alcohol  in stores. 
Almost  two-thirds  or  6.9 million  of  the students who  drink  buy  their  own  beverages. 
Despite  the  minimum  age laws, students as young  as  12 or  13 said they  can buy 
alcoholic  beverages in  a store.  As students get older,  a larger  proportion  buy  alcohol 
11 
 directly.  Students  said, Sometimes  they  [vendors]  do not  even ask your  age, and I 
could  go out  right  now  and buy some. 
Students  may  (1)  use fake  identification,  (2) buy from  stores known  to  sell to young 
people  or  stores with  young  clerks, or  (3) just  go in  and buy  alcohol.  Forty-five 
percent  of  all  students know  someone who  has used a fake  identification  to  buy 
alcohol.  A  small  group,  4.5 percent,  admit  they steal alcohol  from  stores.  Unable  to 
purchase  alcohol  from  stores, students in Philadelphia,  Pennsylvania  use a black 
market  source.  Students  mentioned  that  houses, called  speakeasies, sell alcohol  to 
underage  students, and they offer  some alcoholic  beverages, like  Cisco, which  are not 
available  elsewhere  in  the State. 
Friends, parties, and stores are the main  sourcesfor  alcohoL 
Students  who  drink  usually  obtain  alcohol  from  their  friends.  Their  grade  in school 
influences  where  and how  they get alcohol.  While  88 percent  of  12th graders get 
alcohol  through  friends,  only  49 percent  of  7th graders  do.  The  younger  students 
obtain  alcohol  from  their  parents  with  or without  their  parents  knowledge.  Almost 
three-fourths  of  the  7th graders  obtain  alcohol  from  their  parents,  while  only  a 
quarter  of the  12th graders  do. 
Almost  65 percent  of  all  students--students  who  drink  and non-drinkers  alike--have 
been  to  parties  where  alcohol  is served.  The  number  of  students  attending  parties 
increases with  each grade  level.  More  than  79 percent  of  high  school  students 
(9th  through  12th grade)  have been to  parties  with  alcohol.  When  asked where  they 
obtain  alcohol,  88 percent  of  the students who  drink  mentioned  parties. 
STUDENTS  ACCEPT  RIDES  FROM  FRIENDS  WHO  HAVE  BEEN  DRINKING. 
In  1989, almost  2,800 students between  15 to  19 years old  died  in alcohol-related 
traffic  accidents.  Forty-five  percent  of the  traffic  accidents  among  this  age group  are 
alcohol  related,  yet  students  say it  is not  okay to  drink  and drive.iO 
Even  though  92 percent  of  all  students  in our  survey said a person  should  never 
drink  and drive,  almost  a third  have accepted  a ride  from  a driver  who  had been 
drinking.  This  translates  to  6.8 million  students who  are placing  their  lives in danger. 
Almost  half  of the  students who  drink  have been  a passenger in a car that  a friend 
drove  after  drinking. 
lw.S.  Department  of Transportation,  National  Highway Traffic Safety Administration,  Fatal 
Accident Reporting  &stem:  .1989Annual  Report, Pub. No. DOTHS807693, March  1991. 
12  PARENTS,  FRIENDS,  AND  ALCOHOLIC  BEVERAGE  ALNERTISEMENTS 
INFLUENCE  STUDENTS  ATITIVD  ES ABOUT  ALCOHOL 
Parenrr injluence  students attituks  about  alcohoL 
Almost  two-thirds  of all  students say their  parents  do not  approve  of  underage 
drinking  or would  punish  them  if  they drank.  Some extreme  examples  of punishment 
that  students gave are, I  would  have a grave, I  would  be grounded  until  I was 42, 
and They  would  beat  my behind! 
Many  parents  are more  lenient.  Thirty-five  percent  of  the students who  drink  say 
their  parents  tolerate  their  drinking  under  certain  conditions.  These  conditions 
typically  limit  the  amount,  frequency,  or  location  of  the  students  drinking.  Examples 
include,  They  tell  me not  to go overboard  and not  to get drunk  and I  can have it 
with  my parents.  Almost  15 percent  of the students who  drink  reported  that  their 
parents  trust  them  or  do not  say or  do anything  about  their  drinking. 
Friends injkence  student  by prvviding  both alcohol  and occasions to drink 
Nationwide,  10.1 million  students  drink  with  their  friends.  The  main  reasons students 
gave for  drinking  involve  their  friends: 
Almost  8.7 million  students  drink  to have fun. 
b 
Less than  5.5 million  students, or  half  of  those who  drink,  do so because their 
b 	
friends  drink. 
More  than  6 million  drink  to be social. 
b 
At  one of  the  surveyed schools, the March  cover story from  the  student  newspaper 
discussed student  views on drinking  beer.  The  article  listed  reasons why  beer  is so 
popular,  including  it  makes even the most  shy people  witty  and clever  at parties.* 
Some students  expressed concerns that  the  most  popular  weekend  activity  is drinking. 
One  student  was disappointed  that  several of my friends  cant  be social unless they 
are drunk  (or  so they  say).12 
Advertiiements  for  alcoholic  bevemges influence  students perceptions about  alcohoL 
Thirty-nine  percent  of  all  students named  something  they  like  about  advertisements 
for  alcoholic  beverages.  Their  likes vary widely.  The  most  common  responses were 
D.  Roberts, True Love, or Just an Alcoholic?  Complex Review, March  1991. p. 6. 
12B. Linas, Social Drinking?  Complex Review, March  1991, p. 7. 
13  that  the  advertisements  spotlight  attractive  people  and make  drinking  look  like  fun. 
We  asked students  if  anything  appealed  to them  about  the  advertisements.  Student 
responses included: 
They  are very  convincing.  They  make  it  look  very glamorous. 
b 
The  way they  make  life  look  like  fun. 
b 
t  They  look  exciting  and fun.  The  message is:  It  is all  right  to  drink,  not  that 
. 
it  is bad. 
Some  of  them  are funny,  and some have sexy women. 
b 
They  make  you  look  like  youre  cool  and accepted. 
b 
Girls  in  the  ads are skinny,  and I want  to be like  that. 
b 
t 	 The  slogan The  Right  Beer  Now  makes you  think  Is  now  a good  time  to 
drink? 
Virtually  all  students  have seen advertisements  for  alcoholic  beverages.  To  find  out 
if  students were  able  to  associate a spokesperson,  star, or  symbol  with  a particular 
brand  of beer,  we asked the  students if  Spuds MacKenzie  is the  mascot  for  Coors 
Light  beer.  More  than  half  knew  that  Spuds was not  Coors  mascot.  Because the 
majority  knew  enough  to  correctly  link  the symbol  and the  product,  advertisements 
may be a stronger  influence  on students than  they realize. 
14 
 RECOMMENDATIONS 
THE  SURGEON  GENERAL  SHOULD  CONSULT  WITH  PUBLIC  AND 

PRIVATE  AGENCIES  TO  DEVELOP,  IMPROVE,  AND  PROMOTE 

EDUCATIONAL  PROGRAMS  WHICH  WOULD  INCREASE  STUDENT 

AWARENESS  OF  ALCOHOLIC  BEVERAGES  AND  THEIR  EFFECIS. 

This  recommendation  is similar  to one that  appears  in  the  OIG  report  entitled 

Youth  and Alcohol:  A  National  Survey--Do  They  Know  What  They  Are  Drinking? 

In  addition  to  HHS,  agencies should  include  the  U.S. Departments  of  Education, 

Transportation,  and Justice, the  alcohol  beverage industry,  and public  interest  groups. 

The  Surgeon  General  should  ensure that  alcohol  education  is developed  and 

improved  to  include  practical  information  about  alcohol.  Programs  should  emphasize 

information  about  (1)  different  alcoholic  beverages and their  relative  strengths, 

(2)  how  alcohol  affects  the body,  (3)  how  to  cope with  problems,  and  (4)  laws 

regarding  youth  and alcohol. 

THE  SURGEON  GENERAL  SHOULD  COLLABORATE  WITH  THE 

APPROPRIATE  PUBLIC  AND  PRIVATE  AGENCIES  TO  REDUCE  THE 

APPEAL  OF  ALCOHOLIC  BEVERAGE  ADVERTISING  TO  YOUTH. 

The  Surgeon  General  should  initiate  a collective  effort  to  eliminate  images that 

glamorize  drinking  or  link  drinking  to fun,  recreation,  or sex appeal.  We  found  that 

youth  most  frequently  pay attention  to  this type  of  advertising  which  they  may 

perceive  as making  drinking  socially  acceptable.  The  collective  effort  should  include 

agencies such as the  Bureau  of Alcohol,  Tobacco,  and Firearms,  the  Federal  Trade 

Commission,  the  National  Association  of  Broadcasters,  the American  Association  of 

Advertising  Agencies,  the  alcohol  industry,  and public  interest  groups. 

THE  SURGEON  GENERAL  SHOULD  EMPHASIZE  THE  NEED  FOR  LAW 

ENFORCEMENT  AND  STATE  ALCOHOLIC  BEVERAGE  CONTROL 

AGENCIES  TO  PREVENT  YOUTH  FROM  ILLEGALLY  PURCHASING 

ALCOHOL. 

The  Surgeon  General  should  consult  the  State Alcoholic  Beverage  Control  (ABC) 

agencies to find  ways to better  deter  youth  from  purchasing  alcohol  and vendors 

from  selling  to  minors.  The  OIG  will  provide  the Surgeon  General  with  information 

about  the ABC  agencies and the  State laws and enforcement  in  a subsequent  report 

on youth  and alcohol. 

15 
 APPENDIX  A 
METHODOLOGY 
Four-Stage Sampling  Methodblogy 
At  the first  stage, a cluster  of  eight  States out  of the  nation  was selected at random, 
without  replacement,  with  probability  proportionate  to  size.  That  is, for  this  level, 
size, defined  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 (junior  high  or  senior  high)  and Kindergarten  through  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  probability  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  final  stage of sampling  was the selection  of students  in  the  schools.  A  sample  of 
thirty  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 
divided  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  thirty  students were  available  to  participate. 
The  schools were  instructed  to  randomly  subsample  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  interviewed.  The  total  sample  for  this inspection  was 
956 students. 
Weighting Rocedwe 
. 
Since the  sample  was selected with  four  different  stages and a different  set of 
probabilities  at each stage, weighting  of  the respondents  was standardized  through  a 
five-step  process based on sample  size and the universe.  Although  the  first  two 
stages of  selection  employed  probability  proportionate  to  size, the  measure  of  size 
differed  between  the  two  stages.  In  the first  stage the  measure  of  size was number 
of schools while  the  measure  of  size for  the  second stage was number  of  students. 
The  third  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 
A-l  be determined,  the  number  of students, known  at each of  the four  stages, was used 
for  purposes  of weighting  the  sample. 
Overall,  there  were  32 distinct  weights  used to project  to  the  universe--l  for  each 
school.  These weights  were  applied  to every student  in the  school  and 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) 	 In  the  third  stage, the weight  was computed  by dividing  the  number  of 
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 4 stages was multiplied  together  to  obtain  the 
32 unique  weighting  factors. 
Adju.rtments  to  Wtights 
It  was determined,  subsequent  to data  collection,  that  the  956 students  interviewed 
were  disproportionately  distributed  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  on the  next page shows the  distribution  of  the  national 
population  and sample  with  respect  to race and grade, including  the  adjusted 
weights. 
A-2 
 DISTF2IBUTION  OF  POPULATION  AND  SAMPLE 

WITH  RESPECI- TO  GRADE 

ADJUSTED 
UNWEIGHTED  WEIGHTED 
GRADE  SAMPLE  SAMPLE  POPULATTON 
7  21.40%  12.90%  13.03% 
8  27.10%  12.10%  12.04% 
9  14.70%  23.20%  23.32% 
10  12.70%  21.40%  20.96% 
11  12.40%  17.10%  17.20% 
12  11.50%  13.40%  13.42% 
DISTRIBUTION  OF  POPULATION  AND  SAMPLE 
WITH  RESPECT  TO  RACE 

ADJUSTED 
UNWEIGHTED  WEIGHTED 
RACE  SAMPLE  SAMPLE  POPULATION 
WHITE  58.20%  70.20%  69.35% 
BLACK  29.30%  15.40%  15.36% 
HISPANIC  8.40%  10.50%  10.20% 
INDIAN  0.20%  0.40%  1.04% 
ASIAN  3.40%  3.40%  3.43% 
OTHER  0.70% 
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  differences  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. 
A-3  Disczbon  Guides 
We  asked all  students  one or  two  screening questions: 
(1) 	 EXCLUDING  CHILDHOOD  SIPS THAT  YOU  MIGHT  HAVE  HAD 
FROM  AN  OLDER  PERSONS  DRINK,  HAVE  YOU  EVER  HAD  A 
GLASS  OF  BEER  OR  WINE,  A  WINE  COOLER,  OR  A  DRINK  OF 
LIQUOR? 
(2)  HAVE  YOU  HAD  AT  LEAST  ONE  DRINK  IN  THE  PAST  YEAR? 
Students who  answered  Yes  to both  screening questions  were  asked questions  about 

their  personal  experiences,  knowledge,  and attitudes  about  alcohol.  Students  who 

answered  No  to  either  of  the  screening  questions were  asked about  their 

perceptions  and observations  concerning  classmates who  drink. 

A-4 
 APPENDIX  B 

PROJECIED  UNTVERSE  BY  GRADE  AND  GENDER 
Our  sample  is representative  of the  20.7 million  7th through  12th grade  students  in 
the  United  States.  The  data in  this chart  reflect  a national  projection  of the students 
we  interviewed. 
TOTAL 
1  GRADE 
I 
PERCENT  POPULATION  PERCENT  POPULATION  PERCENT  POPULATION 
7l-H  6.0  1,248,926  7.0  l&5,489  13.0  2,694,415 
8TH  6.4  1,335,556  5.8  1,203,873  123  2,539,429 
9m  10.3  2,139,895  127  2640,591  23.1  4,780,486 
1oTH  10.1  2102594  11.1  2,305,280  21.3  4,407,874 
1lTH  9.9  2,053,192  7.1  I ,475,387  17.0  3,528,579 
12I-H  7.1  1,479,801  6.2  1,289,655  13.4  2,769,456 
NOT STATED  0.0  8,350  0.0  0  0.0  8,358 
TOTAL  50.0  10,368,322  50.0  10,360,275  100.0  20,728,597 
B-l  APPENDIX  C 
SELECTED  BIBLIOGRAPHY 
American  Council  on Alcoholism,  Inc., The  Most  Frequently  Asked  Questions  About 
Teenage  Drinking  and Their  Answers!  June  1990. 
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Bachman,  J.G., and L.D.  Johnston,  The  Monitoring  the  Future  Project:  Designs and 
Procedures,  Occasional  Paper  1,  University  of  Michigan,  Institute  for  Social 
Research, Ann  Arbor,  Michigan,  1978. 
Chassin, L.,  C. Tetzloff,  and M.  Hershey,  Self-Image  and Social-Image  Factors  in 
Adolescent  Alcohol  Use, Journal  of Studies on Alcohol,  v. 46, no.  1, 1985, 
pp.  39-47. 
Cherry,  Linda  et al., Too  Young  to Buy  and Too  Young  to  Sell:  A  Case for 
Raising  the Age  of Alcohol  Sellers, Horizon  Services, Inc.,  1989. 
City  of  Irvine,  California,  Substance Abuse  Task  Force,  Youth  Alcohol  Access 
Project,  Irvine  City  Council,  1990. 
Coate,  D.,  and M.  Grossman,  Effects  of Alcoholic  Beverage  Prices and  Legal 
Drinking  Ages on Youth  Alcohol  Use, Journal  of Law  and Economics,  v. 31, 
1988, pp.  145-171. 
Linas,  B., Social  Drinking  ? Comolex  Review,  March  1991, p. 7. 
Males,  Mike,  Youth  Behavior:  Subcultural  Effect  or  Mirror  of  Adult  Behavior, 
Journal  of  School  Health,  v. 60, 1990, pp.  505-508. 
Malvin,  J.H.,  and J.M.  Moskowitz,  Anonymous  and Identifiable  Self-Reports  of 
Adolescent  Drug  Attitudes,  Intentions  and Use,  Public  Oninion  Quarterly, 
v. 47, 1983, pp.  557-566. 
Mosher,  James F., The  Prohibition  of  Youthful  Drinking:  A  Need  for  Reform, 
Contemnorarv  Drug  Problems,  v. 6; no. 3, 1987, pp. 397-436. 
Moskowitz,  J.M.,  Alcohol  and Drug  Problems  in Schools:  Results  of  a National 
Survey of  School Administrators,   Journal  of Studies  on Alcohol,  v. 49, 1988, 
pp.  299-305. 
C-l  National  Clearinghouse  on Alcohol  and Drug  Issues (NCADI),  Alcohol  and Youth, 
NCADI  Alcohol  Tonics  Fact Sheet, January  1987, p.  1. 
National  Clearinghouse  on Alcohol  and Drug  Issues (NCADI),  Alcohol  Problems 
and Youth,  NCADI  Alcohol  Tonics  Fact Sheet, January  1985, pp.  1-2. 
National  Families  in Action,  Wine  Coolers  Becoming  Gateway  Drug,  Drug  Abuse 
&date,  no. 28, March  1989, p.  12. 
1989 Data,  State Reports  Compiled  by the Beer  Institute  and U.S. Department  of 
Commerce,  Bureau  of  Census. 
Roberts,  D.,  True  Love,  or Just an Alcoholic. 3 Complex  Review,  March  1991, p. 6. 
Russell, Christine,  Its  Easy for  Underage  Men  to  Buy  Beer  in the  District, 
Washington  Post Health,  March  19, 1991, p. 5. 
Saffer, 	 Henry,  and M.  Grossman,  Beer  Taxes, the  Legal  Drinking  Age,  and Youth 
Motor  Vehicle  Fatalities,  Journal  of Legal  Studies, v. 16, 1987, pp.  351-374. 
Skager, Rodney,  et al., Biennial  Statewide  Survev of Drug  and Alcohol  Use Among 
California  Students  in  Grades  7. 9, and  11: Report  to  the Attornev  General, 
Winter  1989-90. 
U.S. Department  of Health  and Human  Services, PHS-ADAMHA-NIAAA,  Seventh 
Special  Report  to  the  U.S. Congress on Alcohol  and Health,  January  1990. 
U.S. Department  of  Health  and Human  Services, PHS-ADAMHA-NIDA,  Facts 
about  Teenagers  and Drug  Abuse,  NIDA  Cansules, no.  17, 1990. 
U.S. Department  of  Health  and Human  Services, PHS-ADAMHA-NIDA,  High 
School  Senior  Drug  Use:  19751989,  NIDA  Caosules, no. 23, 1990. 
U.S. Department  of  Health  and Human  Services, PHS-ADAMHA-NIDA,  Highlights 
of  National  Adolescent  School Health  Survey: Drug  and Alcohol  Use,  NIDA 
Causules, no. 28, 1988. 
U.S. Department  of  Health  and Human  Services, PHS-ADAMHA-NIDA,  Highlights 
of  National  Household  Survey on Drug  Abuse:  Population  Estimates  of 
Lifetime  and Current  Drug  Use,  1990, NIDA  Capsules,  1990. 
U.S. Department  of  Health  and Human  Setices,  PHS-ADAMHA-OSAP,  Alcohol 
Use Among  Children  and Adolescents,  Statistical  Bulletin,  v. 68, no. 4, 
October/December  1987, pp.  2-12. 
c-2  U.S.  Department  of  Health  and  Human  Services, PHS,  Office  of  the  Surgeon 
General,  Surgeon  Generals  Workshon  on Drunk  Driving:  Background 
Papers,  1988. 
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