. .. . . . . 

::-'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. 

, 

daa 

Richard P. Kusserow 

INSPECfOR GENERAL 

OEI-09-91-0053 
.

.

OFFCE OF INSPECfOR GEN 

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 (OAS) prodes aU auditing servce for HHS, either by


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


exmie the performance of HH progrms ancl/or ilS grntee and contractors in carrg out tbeir€

repe 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 

ci money penalties. The OJ als overs State Medicaid frud control unilS whicb investigate and

proste frud and patient abus in tbe Medicaid progrm. 

OFFCE OF EVALUATION AN 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: 

Sa Fraci 

Brad Rolln, Led Analyst


Elizbeth Bell 

Kathy Dette 

Deborab HalVey 

Jennifer Mallen 

Brian Pattisn 

Elaine Sbelub 

Headquarers . 

New York 

Jack Molnar 

1lm Nee 

Trce Rennie 

Phiadelphia 

Donna Milan


Nancy Molyneaux 

Chcago 

Thomas Komaniecki 

Pamela May 

Ann O'Connor


Dalas 

Michelle Adams 

Pamela Smith


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 

Human Servces (lS) 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 nonalcoholic 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 (4.0 to 4.8 percent alcohol) offer consumers 

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 

packaged similai"y to wie 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 

of frit flavors packaged attractively in bottles that are similar to the ones used for 

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 

Students confuse alcoholic coolers with mineral waters that appear similar in color, 

labeling, and packaging. Also alcoholic. , some alcoholic coolers are not clearly labeled as
In mot StIte bee an oth malt beverge label do not dicloe alohol conJ 

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. 

Th alohol conJ of beverges is a myste to 

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. 

More thn a th of al st do not knw, tht Cico con/in akohol 

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 popularity. , but also its

RECOMMATIONS 

Th Sureon Genl shoul work wi beverge intr, Stile and Fedl offcils to 

imprve th labelig and packagig of akoholi an 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. 

Th Sureon Ge shoul cons wi puli and priate agen to deelop,


imve, and promote edatinal pro
 akoholi"beverges an th efects


whih woul inease stu awaren of 

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


beverages from non-alcoholic beverages. . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . 5


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 

In response to public health concerns and the adverse health consequences of 

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 nonalcoholic 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 

(1.5 to 6.0 percent alcohol by volume) are a mixre of wine and frit juice or other 

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 during its first 6 years prompted the 

liquor and beer industries to introduce mied dr colers (4.0 percent alcohol) and 

frit-flavored malt beerage colers (4.0 to 4.8 percent alcohol)l marketed in singleserve 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. 

While not new to the 19805, frt-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 

wines and now can be found displayed next to wie 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 

different. Mineral waters offer substitutes for soda pop. The coolers offer similar 

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 

siilarloqldg 

beverages. 

, , ;

w&i 

Inrerviewers displayed bOl/les and cans and obsered stents exmining the beverages. 
CA YOU TELL TI DIFFERENCE? 

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 mineral 

WQte wiJ juice, is ver siil to th Bales € Jayes Ligh€

Be wie cooler in color 

lael des 
FINDINGS€

TWO OUT OF TIE STEN CANOT DISTGUISH ALHOLIC 

BEVERAGES FROM NON-ALHOLIC BEVERAGES 

Students confused alcoholic coolers with mineral waters that are similar in color 

labeling, and packaging. Also, some alcoholic coolers are not clearly labeled as . 

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 nonalcoholic 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.€

Bacard Breezer (mied drk cooler) 25.5€

White Mountain (malted beverage cooler) 18.€

Bartles Jaymes (wine cooler)


Schlitz (malt liquor)


Michelob (beer)€

Miller, Miler Genuine Draft (beer)€

Budweiser (beer) 

Colt 45 (malt liquor) 
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 SUMY BACAI BREEZER 

The only

obvi 

mentin of 

Bacardi 

Brezer 

coniaming 

flohol is the 

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


bran of rum, 25 percent of 

the stents did not know 

thai Bacardi Breezer conrow 

alcohoL The product name 

and the frit collage are


emphasied on the front label. 
,,, ,.: 

 

SNAPSHOT SUMY: STUENT WERE FOOLE BY "PASSION' 

More thn 61 pecent of all students did not know that Pik Passion, Tropical Passion, and 

Purple Passin contain alcohoL Consmers can 

tell thr Passion beverages contain alcohol by

th ingredients, but the front of the label offers 

no help. Nowhee on the bottle does -Passion 

tell th consmer t!crly what ki of beverage

il is In fact two ty of Passin ext o..; 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 

DISCSE ALHOL CONT 

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 4.0 to 4. 8 percent alcohol by volume. 

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 

beer and malt liquor companies from using alcohol content to attract consumers. 

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 requirig alcohol content disclosure, but has 

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€

beverages do not display it prominently. For an example, see the Bartles & Jaymes€ example below. 

The box on page 13 descdbes students' two ddnks of choice: wie coolers and 

beer. 

SNASHOT SUMY: BATL JAYMES 

Although stuent recogized Barlles layes wine cooler, they often hl difculty 

deterining how much alcohol these cooler contain One reason was the location and sie of 

the alcohol content lisg, located on one of the stpe leading towards the BJ crest logo. 

3For a full discuion on student beverage preference , se "Youth and Alcohol: A National 

SUlVey--Drinking HabilS, Acc, 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, 

4in -22 ;:1J &tizts belieedtk:lbeer 8nd/onnail liluor 

contaiidmorealcohOl; 

.iome Cdui4iifFOii/l! 1ith ft#N1 despite readingiJ closely; and 

Md; 1idjJfPd& d;deiiI'1ldhcould not be changed about 

which beerage coriOined ihe most alcohoL. 

MORE TH A TI OF AI STEN DO NOT KNOW THT CISCO 

CONTAIS ALHOL 

Thirt-six percent of the students did not know that Cisco contains alcohol. Even 

after reading the labels, less than half of the students knew that Cisco contains the 

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 

speakies," ilegal operations that provide students with Cisco as well as other alcoholic beverages. €

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. 

SNASHOT SUMY: CISCO "TAK STENI BY SURPRISE' 

Although Cisco has changed it labeling, we found the old bonle (pictured here in the midle)€ stil available in several a;eas. Whle many stdents were unfamiliar wih Cisco, other 

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."
BEE VS. WI COIE: A COMPARON 

WI COOLERS DRI OF CHOICE€

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 28 percent of€

all stuenrs srl believed


rhat beer, malt liqor,€

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. 

BEER mE MOST POTENT DRI?€
RECOMMENDATIONS€

TH SURGEON GEN SHOUL WORK WI BEVEGE INUSlY 

Sf ATE AN FEERA OFFCI 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. .€

In order to accomplish this, it may be necessary to seek repeal of the Federal law 

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.€

TH SURGEON GENRA SHOUL CONSULT WI PUBUC 

PRIATE AGENCI TO DEVEP, IMROVE AN PROMOTE 

EDUCATIONAL PROGRA WICH WOUL INCRE STENT AWAR OF ALHOUC BEVEGES AN THm EFCI 

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 

probabilties 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 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)	 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 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


UNWEIGHTD 

GRAE SAMLE 

21.40% 

27. 10% 

14 711% 

12.70% 

12.40% 

11.50% 

ADJUSTED 

WEIGHTED 

SAMPLE POPULTION 

12.90% 13.03% 

12. 10% 12.04%

23% 232% 

21.40% 20.96% 

17. 10% 17.20% 

13.40% 13.42% 

DISTUTON OF POPULTION AN SAMLE WI REPECf TO RACE 

RACE 

WHIT 

BLACK 

HISPANIC

INIA


ASIA 

OTHR 

UNWElGHTD 

SAMPLE 

58.20% 

29.30% 

8.40% 

20% 

3.40% 

70% 

ADJUSTED 

WEIGHTED 

SAMPLE 

70.20% 

15.40% 

10.50% 

0.40% 

3.40% 

POPULTION 

69.35% 

15.36% 

10.20% 

1.04% 

3.43% 

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, just at the bottes (not touchig), which of thes, if any, do 

you th conta the most alcohol? 

(3)€ Now you ca touch and read the labels. Whch of thes, if any, do you 

conta the most alcohol? 

BEVEGE SELEcnON

Intervewers purchased the survey beverages in the communities where the intervews

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

Wine cooler

Light wie cooler

Mieral water with juice

Non-light beer

Non-alcoholic beer 

Malt liquor

Not all beverages were available in each community. In several communities malt

liquor was available in 40-ounce bottles only.

The intervewers also purchased up to three other alcoholic or non-alcoholic 

beverages at their discretion. Intervewers were instructed to look for additional

beverages that closely resembled others in the panel.
BEVEGES USED DURG TH INRVIWS€

MID DRI COLE 

Bacardi Breezer Calypso Berr 

Bacardi Breezer Key Lie 

WI COLERS 

Bartles & Jaymes Berr 

Bartles & Jaymes Black Cherr 

Bartles & Jaymes Light Berr 

Bartles & Jaymes Red Sangra 

Pink Passion 

Purple Passion 

Tropical Passion 

Seagram s Wild Berres 

MAT BEVERAGE COOLE 

White Mountain Cooler

MI WATE wr FRUI JUCE 

Chapelle Pear€

La Croix Natural Orange€

Mistic Berr


Mistic Tropical Passion.


Sundance Sparkler Concord Twit 

Sundance Sparkler Cranberr 

Sundance Sparkler Raspberr 

Walleroo . 

BEER 

Budwei6er€

Lowenbrau€

Michelob€

Miler Genuine Draft€

Miler High Life€

Regal Select€

NON-ALCOHOLIC BEER 

Kingsbury 

Doul's 

Sharp 

Texas Light Non-Alcoholic 

MAT LIQUOR 

Colt ' 

Elephant (Danish) 

Olde English 800 

Schlitz 

CQAI 

Qub Martini 

FRUI JUCE 

Everfesh Cranberr-Apple 

SODA POP 

Faygo Redpop 

Rll/:llD 

Cisco Berr 

Cisco Black Cherr 

Cisco Peach 

Cisco Regular (Grape)