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 OIG’s 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 OIG’s 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 INSPECI’IONS 

The OIG’s 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 

Deborah Harvey, Project Leader 

Brad Rollin, Lead Analyst 

Elizabeth Bell 

Kathy Dezotte 

Jennifer Mallen 

Brian Pattison 

Elaine Shelub 

Headquarters 

Wm. Mark Krushat, Mathematical Statistician 

Barbara Tedesco, Mathematical Statistician 

Maruta Zitans, Program Specialist 

New York 

Jack Molnar 

Tim Nee 

Tracey Rennie 

Philadelphia 

Donna Millan 

Nancy Molyneaux 

Chicago 

Thomas Komaniecki 

Pamela May 

Ann O’Connor 

Dallas 

Michelle Adams 

Pamela Smith 

Atlanta 

Josiah Townsel 
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 Sullivan’s 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 nation’s 

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 
b Parents, jiiends, and alcoholic beverage advetiements injknce students’ 

attitdes about alcohoL 

RECOMMENDATIONS 

b The Surgeon General should consult with public and private agencies to develop, 

improve, and promote educational pmgramr which would increase student 

awareness of alcoholic beveragesand their @et%. 

b The Surgeon General should collabomte with the appropriate public and private 

agencies to reduce the appeal of alcoholic bevemge advert-king to youth. 

b The Surgeon Geneml shouki emphasize the need for law enforcement and State 

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 Sullivan’s 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 nation’s 

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, “It’s 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 

STUDENTS WHO BUY 14.4 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: 

b 9.2 mill.ion students have drunk beer. Of this group, 6 million drink between 

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 DRli’X 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 alcohol’s 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 don’t consider them 

alcohol,” and “they...don’t 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 

a higher risk of having babies with birth defects. True 98 

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 

cold shower can help a person ‘sober up’ more quickly. False 54 

One can of beer (12 ounces) has more alcohol 

than a glass of wine (5 ounces). False 45 

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 don’t 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?EN’T’S 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 student’s 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: 

b 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 

friends drink. 

b More than 6 million drink to be social. 

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 can’t 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: 

b ‘They are very convincing. They make it look very glamorous.” 

b ‘The way they make life look like fun.” 

t ‘They look exciting and fun. The message is: It is all right to drink, not that . it is bad.” 

b “Some of them are funny, and some have sexy women.” 

b ‘They make you look like you’re cool and accepted.” 

b “Girls in the ads are skinny, and I want to be like that.” 

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 EFFECI’S. 

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 

7 21.40% 12.90% 

8 27.10% 12.10% 

9 14.70% 23.20% 

10 12.70% 21.40% 

11 12.40% 17.10% 

12 11.50% 13.40% 

DISTRIBUTION OF POPULATION AND 

WITH RESPECT TO RACE 

POPULATTON 

13.03% 

12.04% 

23.32% 

20.96% 

17.20% 

13.42% 

SAMPLE 

POPULATION 

69.35% 

15.36% 

10.20% 

1.04% 

3.43% 

RACE 

WHITE 

BLACK 

HISPANIC 

INDIAN 

ASIAN 

OTHER 

As can be seen from 

UNWEIGHTED 

SAMPLE 

58.20% 

29.30% 

8.40% 

0.20% 

3.40% 

0.70% 

ADJUSTED 

WEIGHTED 

SAMPLE 

70.20% 

15.40% 

10.50% 

0.40% 

3.40% 

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 PERSON’S 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 

PROJECI’ED 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 

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 

1 
APPENDIX C 

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Teenage Drinking and Their Answers!” June 1990. . 

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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, “It’s 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 General’s Workshon on Drunk Driving: Background 

Papers, 1988. 

U.S. Department of Transportation, National Highway Traffic Safety Administration, 

Fatal Accident Reoorting Svstem: 1989 Annual Report, 

Pub. No. DOTHS807693, March 1991. 

University of Michigan, Institute for Social Research, “Monitoring the Future: A 

Continuing Study of the Lifestyles and Values of Youth,” February 1990. 

Washington Post, “Dramatic Findings in School Drug Survey,” San Francisco 

Chronicle, February 25, 1991. 

The Wine Institute, Table of Commercially Produced Wine Entering Distribution 

Channels in the United States, by Areas Where Produced, 1985--1989. 

Wittman, Friedner D., 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. 

c-3