t, . ' 

Depa,rtment of Health and Human Servces 

OFFICE OF 

INSPECTOR GENERAL 

YOUTH AND ALCOHOL: 

DANGEROUS AND DEADLY CONSEQUENCES 

VI' 

Rich"d P. Ku,"crow 

J(( INSPECTOR GENERA "0 

d!a APRI 199 
OFFCE OF INSPECTOR GENERA 

The mission of the Offce of Inspector General (OIG), as mandated by Public Law 95-452, as 

amended, is to protect the integrity of the Department of Health and Human Servces' (HHS) 

programs as well as the health and welfare of beneficiaries served by those programs. This 

statutory mission is carried out through a nationwide network of audits , investigations, and 

inspections conducted by three OIG operating components: the Offce of Audit Servce, the 

Offce of Investigations, and the Offce of Evaluation and Inspections. The OIG also informs the 

Secretary of HHS of program, and management problems, and recommends courses to correct 

them. 

OFFCE OF AUDIT SERVICE 

The GIG's Offce of Audit Servce (OAS) provides all auditing servces for HHS, either by 

conducting audits with its own audit resource or by overseeing audit work done by others. 

Audits examine the performance of HHS programs and/or its grantees and contractors in carrng out their respective responsibilities and are intended to provide independent assessments of HHS 

programs and operations in order to reduce waste, abuse, and mismanagement and to promote 

economy and effciency throughout the Department. 

OFFICE OF INTIGATIONS 

The OIG's Offce of Investigations (01) conducts criminal, civil, and administrative investigations 

of allegations of wrongdoing in HHS programs or to HHS beneficiaries and of unjust enrichment 

by providers. The investigative efforts of 01 lead to criminal convictions, administrative sanctions 

or civil money penalties. The 01 also oversees State Medicaid fraud control units which 

investigate and prosecute fraud and patient abuse in the Medicaid program. 

OFFCE OF EVALUATION AN INSPECTONS 

The OIG's Offce of Evaluation and Inspections (OEI) conducts short-term management and 

program evaluations (called inspections) that focus on issues of concern to the Department, the 

Congress, and the public. The findings and recommendations contained in these inspection 

reports generate rapid, accurate, and up-to-date information on the effciency, vulnerability, and 

effectiveness of departmental programs. 

This report was prepared under the direction of Kaye D. Kidwell, Regional Inspector General 

and Paul A Gottlober, Deputy Regional Inspector General, Offce of Evaluation and Inspections 

Region IX. Participating in this project were: 

Region IX Headquarers 

Elizabeth Bell Maruta Zitans 

Brad Rolln 
Department of Health and Human Servces 

OFFICE OF 

INSPECTOR GENERAL 

YOUTH AND ALCOHOL: 

DANGEROUS AND DEADLY CONSEQUENCES 

VI' 

':d! 

Richard P. Kusserow 

INSPECTOR GENERA 

OEI-0-92-01 
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

........... .........................................

TABLE OF CONTENTS


INODUCTON . . . . . . . . . . . . . . 1


SUMY OF REEACH FIINGS


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


Victims of Crime


Rape and Sexual Assault. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 

Risky Sexual Behavior. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3


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


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


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


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


PURSE 

The purpose of this study was to describe the dangerous and often unrecognized 

consequences of underage drinking. 

BACKGROUN 

As part of her campaign against underage drikig, the Surgeon General requested 

that the Offce of Inspector General (OIG) provide information on some of the 

negative consequences of youth alcohol use. This concern mirrors one of the


Department of Health and Human Servces Secretary s goals which is to reduce the 

prevalence of alcohol problems among children and youth. As part of his strategy to 

meet this goal, the Secretary sponsored "Healthy PeoplelHealthy Environments: The 

Secretary s National Conference on Alcohol-Related Injuries" on March 23- , 1992. 

This conference served as a call-to-action and a forum for health professionals to help 

advance the alcohol and injury-related objectives of Healthv People 2000. This study 

is one in a series conducted by the OIG related to youth and alcohol. A related 

report, "Youth and Alcohol: Drinking and Crie" (OEI-09-92-00260), describes the 

association between alcohol and youth crie. 

Although extensive research exists related to the negative consequences of adult 

alcohol use, few national studies have attempted to assess the relationship between 

underage drinking and rape, sexual assault, suicide, and other harmful incidents. 

Researchers who attempt to link youth alcohol use with injuries and other problems 

face legal and scientifc barriers. For example, one survey found that emergency room 

physicians rarely will administer blood alcohol tests unless an injury was automobilerelated or the test is vital to a patient's treatment. 

Most studies and data related to the negative consequences of underage drinkig 

focus on traffic fatalities. For instance, the National Highway Traffc Safety 

Administration reported that 34.8 percent of drivers ages 18 to 20 and 18.9 percent of 

drivers ages 15 to 17 who were involved in fatal automobile crashes in 1989 had 

alcohol in their system. Although few national data concerning other problems exist 

researchers focusing on local populations have uncovered startlng data concerning 

alcohol use among youth who experience serious injuries or unintentional death. 

METHODOLOY 

Using several University of California on-line database servces, we conducted a 

review of medical, legal, psychological, and other social research studies and surveys 

related to the negative consequences of youth alcohol use. We also referred to 

articles and data obtained durig our previous youth and alcohol studies. 
SUMMARY OF RESEARCH FINDINGS


The Department of Justice (DOJ) and other researchers at times have attempted to 

determine the extent to which underage driking is associated with criminal activity. 

These researchers have found a strong association between alcohol use and crimes of 

aggression, such as murder and rape. 

According to a DOJ survey, 31.9 percent of youth under 18 in long-term, Stateoperated juvenile institutions in 1987 were under the infuence of alcohol at the 

time of the offense.( 46) 

A DOJ ll-city survey found that from 4 to 32 percent of male juvenile 

arrestees admitted using alcohol in the 72 hours prior to their arrest. ( 47) 

A 1974 survey of youth under 21 in State adult correctional facilities found that 

approxiately 36.4 to 38.6 percent reported drinking at the time of the 

offense.(9) 

One researcher reported that almost 50 percent of German juvenile offenders 

surveyed in 1971 were intoxicated when they committed criminal offenses. For 

crimes of aggression--such as murder, robbery, rape, and assault--the rates were 

rather higher. (17) 

VICT OF 

Studies of various populations have shown that many victims of violent crime are 

intoxicated at the time of the incident. While this problem is most frequently noted in 

rape victims, victims of other crimes exhibit similar high levels of intoxication. 

In a national survey of college students, almost 50 percent who said they had 

been victims of crime admitted that they had used drugs or alcohol before the 

crime occurred.(I2) 

A study of homicide victims in Atlanta, Georgia, found that 51 percent had 

blood alcohol levels of . 10 percent or greater.(4) 

One social science researcher observed that minors who drink may provoke 

assailants or otherwse catch the attention of criminals by handling money 

openly, acting vulnerable, or failing to take normal precautions in public.(38) 

. For further information, see the OIG report ''Youth and Alcohol: Drinking and Crime. 
, 

RAE AN SEXUAL ASAULT 

Researchers estimate that alcohol use is implicated in one- to two-thirds of sexual 

assault and acquaintance or "date" rape cases among teens and college students. 

In a survey of students at a southwestern university, 55 percent of sexual assault 

perpetrators and 53 percent of sexual assault victims admitted to being under 

the influence of alcohol at the time of the assault.(23) 

According to a school administrator, 100 percent of sexual assault cases at the 

University of Colorado involve alcohol.(I) 

A study of college women nationally found that alcohol use is one of the 

strongest predictors of a college woman s rape.(2) 

A survey of high school students found that 18 percent of females and 

39 percent of males say it is acceptable for a boy to force sex if the girl is 

stoned or drunk.(23) 

RIKY SEXUAL BEHVIOR 

Alcohol use is associated with the early onset of sexual activity and with risky sexual behavior. 

A study of ninth grade students from four urban high schools showed that the 

best predictor of risky sexual behavior was alcohol and/or drug use.( 40) 

Other studies of adolescents have shown that the use of substances, including 

alcohol and tobacco, are associated with early sexual debut and an inadequate 

use of contraceptives.( 40) 

A 1990 survey of Massachusetts 16- to 19-year-olds found that 49 percent were 

more likely to have sex if they and their partner had been drinkg. In 

addition, 17 percent used condoms less often after dring.( 42) 

The National Longitudinal Survey of Youth found that substance use and 

sexual activity are more closely linked for white youth than they are for 

minority youth.(I4) 

SUICIDE 

According to one researcher Suicide among American teenagers is increasing at an 

alarming though underestimated rate." Alcohol acts as a contributing factor in the 

timing and seriousness of youth suicide attempts. Although youth may use alcohol in 

an attempt to reduce stress and pressure, this frequently results in additional selfdestructive behavior. 
In a detailed analysis of youth suicide, one researcher found that drug and 

alcohol abuse is the most common characteristic of youth who attempt suicide. 

Seventy percent of youth suicide attempters were frequent drug and/or alcohol 

users. In addition, he noted a high incidence of drug and alcohol abuse among 

youth suicide attempters' parents. (ll) 

Based on rising youth suicide rates, three researchers conducted a study on 

10- to 19-year-old suicide victims in Alegheny County (P A). They found " 

striking association. . . between the ingestion of alcohol and the use of firearms 

as a method of suicide." They conclude that "the epidemic increase in the 

suicide rate among youth may be associated with an increase in the prevalence 

of alcohol abuse. (3) 

WATER-REIATE INJU AN DROWNG 

Although swiming, boating, and diving are popular activities among youth, they can 

be deadly, especially when the participants consume alcohol before or during these 

water activities. According to national data, drowning is the second leading cause of 

injury-related death among adolescents and young adults. One researcher named 

alcohol and/or drug use as the primary factor contributing to adolescent swimming, 

boating, and diving drownings.


Two studies that have attempted to link youth alcohol use and drowng found 

that from 40 to 50 percent of young males who drown used alcohol prior to 

drowning.(33)(5I) 

According to national data, the ratio of young males who drown after boating 

incidents outnumbers females 12 to 1. Alcohol particularly may affect a youth' 

balance, resulting in the boat capsizng or the youth fallng overboard.(33) 

A detailed study of the factors contributing to youth drowning indicated that 

alcohol may severely affect a young swimmer s coordination and judgment. 

Peer pressure may cause youth to attempt to swim beyond their abilty. On a 

dare, a youth might experience overconfidence if under the influence of 

alcohol. At the same time, the youth might underestimate the length of swim 

or the water s currents. (33) 

Researchers have documented that 40 to 50 percent of all diving injury victims 

consumed alcoholic beverages. Again, alcohol may impair judgment, resulting 

in a youth underestimating the challenge.(34) 
CAMUS-RETE PROBLEMS 

A researcher who reviewed studies on college drinking found that missing classes 

missing work, and not studying were the most frequently noted alcohol-related 

problems. Other researchers have linked alcohol use with more serious campus 

problems. 

In a national survey, college administrators estimated that student alcohol use 

leads to 69 percent of damage to residence halls, 34 percent of academic 

problems, and 25 percent of dropouts.(7) 

A Towson State (MD) University study found that alcohol was a factor in 

98 percent of student conduct violation cases.(22) 
, 

, , , , , , ), 

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