Really Underage Drinkers: The Epidemiology of Children’s Alcohol Use in the United States

Little attention has been paid to alcohol use by children aged 12 and younger. The present article summarizes findings on the prevalence of alcohol use from US national and statewide surveys of children in grades 6 and younger based on reports located in searches of the literature and the Internet. Four national surveys and seven statewide surveys of children’s alcohol and drug use were located that present rates of lifetime sipping and tasting, lifetime experience of more than a sip, alcohol use in the past year, use in the past month, and use in the past week. Prevalence rates decrease with the level of involvement assessed. Alcohol use increases with age, doubling between grades four and six, with the largest jump in prevalence between grades five and six. At each grade level, boys are more likely to have used alcohol than girls. African-American children are nearly as likely as white and Hispanic children to have used alcohol. Over the past decade or so, the prevalence of both lifetime and current alcohol use has been declining in children. The failure to assess intensity of children’s use hampers evaluation of the level of risk experienced by children. There is a need for ongoing nationwide surveillance of alcohol use in this population and for greater education of parents regarding the dangers of introducing children to alcohol use. Portions of this paper were presented at the Research Society on Alcoholism meetings at Fort Lauderdale, FL in 2003 and published in a symposium summary report (Donovan et al. 2004).     

Attitudes and management of alcohol problems in general practice: descriptive analysis based on findings of a World Health Organization international collaborative survey

AIMS: To determine if general practitioners' (GPs) experience of education on alcohol, support in their working environment for intervening with alcohol problems, and their attitudes have an impact on the number of patients they manage with alcohol problems. METHODS: 1300 GPs from nine countries were surveyed with a postal questionnaire as part of a World Health Organization (WHO) collaborative study. RESULTS: GPs who received more education on alcohol (OR = 1.5; 95% CI, 1.3-1.7), who perceived that they were working in a supportive environment (OR = 1.6; 95% CI, 1.4-1.9), who expressed higher role security in working with alcohol problems (OR = 2.0; 95% CI, 1.5-2.5) and who reported greater therapeutic commitment to working with alcohol problems (OR = 1.4; 95% CI, 1.1-1.7) were more likely to manage patients with alcohol-related harm. CONCLUSION: Both education and support in the working environment need to be provided to enhance the involvement of GPs in the management of alcohol problems.     

Alcohol problems in pregnancy and childhood--where do we go from here?

The awareness of potential damage to the foetus caused by maternaldrinking during pregnancy creates the need for a planned programmeof education for young women of child-bearing age. Preventionof foetal damage might best be achieved by commencing the educationprocess with schoolchildren and adolescents but preconceptionand antenatal clinics must necessarily be ‘foci of attention’.Thought must be directed to the content of the material presentedand efforts made to tailor the information for target groups.A prime need is the proper instruction of all those who willbe involved as educators to ensure a balanced approach. Primary prevention must be the mainstay of our efforts in themanagement of obstetric, neonatal and developmental problemsresulting from alcohol consumption during pregnancy.     

Associations between mother’s level of education and offspring’s smoking and alcohol use in adulthood: a 28-year longitudinal follow-up study

Aims  The aim of this study was to examine the association between changes in mother’s education level during early childrearing years with offspring’s tobacco and alcohol (TA) use in adulthood. It was hypothesised that use of TA is lower among offspring whose mothers improve their level of education compared with offspring for whom mother’s education level does not increase. Subjects and methods  Information on TA use among 1,015 adults (from a national survey in 1998; response rate 72.7%) was linked with information on their mother’s education levels recorded in the National Education Register from 28 to 8 years earlier (mother’s education in 1970 and change in level of education from 1970 to 1990).Results   Multiple logistic regression revealed an inverse association between increase in maternal education level and risk of high alcohol use among female offspring. Higher level of mother’s education measured in 1970 was associated with lower risk of daily smoking and lower risk of moderate and high levels of alcohol use among male and female offspring.Conclusion   Low level of tobacco and alcohol consumption among adult offspring is influenced by mother’s level of education. Research on social inequalities in health behaviour should include more attention to the possible effects of mother’s social mobility during childrearing years.

Education on drugs and alcohol: past disappointments and future challenges

A review is presented of the effectiveness of alcohol and drugeducation. It is concluded that, contrary to popular belief,there is little evidence that such education is ‘effective’in curbing ‘problematic’ or illegal behaviour andthat in some contexts health education may be counterproductive.Psychoactive drug use is influenced by many factors which areunlikely to be countered by health education. Public Healthpromotion campaigns are often directed by political pressuresrather than by epidemiology. It is concluded that in futurehealth education should be conducted with far more awarenessof its practical limitations and possible dangers and that majorpublic initiatives should be objectively evaluated.     

Availability and Acceptance of Health Education Among Socially 'At Risk' Pregnant Women Attending Health Centres in Belfast

This study highlights the large number of pregnant women inBelfast who fall into the ‘at risk’ category basedon socioeconomic factors and suggests a need for greater emphasison health education by professionals in both the fields of healthand education in order to improve the knowledge and change theattitudes and behaviour of pregnant women; this could play animportant part in reducing infant mortality and handicap inour society. The study showed that neither patients nor health care teamssee health education as an integral part of antenatal and postnatalcare and that little impact has been made in encouraging patientsto plan their pregnancies, stop smoking and eat a more balanceddiet.     

DRUG ABUSE AND INTOXICATION IN ALCOHOLICS

The frequency of drug, alcohol and combined alcohol/drug intoxicationin forensic autopsy material is described. Alcoholics had frequentlyabused drugs; the cause of death was drug intoxication in 12%,combined alcohol/drug intoxication in 13%, and alcohol intoxicationonly in 4%. The manner of death was different in the variousgroups as it was almost equally stated as accident, suicideand unascertainable, respectively, with only drugs involved,whereas accidents were the predominant features in the combinedalcohol/drug intoxication among alcoholics. In controls, accidentspredominated on both types of intoxication. The alcoholics seemedto be more ‘deliberately’ choosing suicide withdrugs, while both alcoholics and controls need more informationwith regard to the dangers of mixing alcohol and drugs. Thefrequency of combined alcohol and drug intoxication was muchhigher in alcoholics.     

Concurrent Alcohol Use or Heavier Use of Alcohol and Cigarette Smoking Among Women of Childbearing Age with Accessible Health Care

This study was conducted to provide nationally representative findings on the prevalence and distribution of concurrent alcohol use or heavier use of alcohol and cigarette smoking among women of childbearing age with accessible health care. For the years 2003–2005, a total of 20,912 women 18–44 years of age who participated in the National Health Interview Survey (NHIS) reported that during the study period, there was a place where they would usually go for health care when sick or in need of advice about their health. The prevalence and distribution of concurrent alcohol use or heavier use of alcohol and cigarette smoking reported by such women was calculated. Logistic regression analysis was used to evaluate the “most often visited health care place” among concurrent users who reported having seen or talked to a health care provider during the previous 12 months. Among surveyed women with accessible health care, 12.3% reported concurrent alcohol use and cigarette smoking, and 1.9% reported concurrent heavier use of alcohol and cigarette smoking during the study period. Of women who reported either type of concurrent use, at least 84.4% also indicated having seen or talked to one or more health care providers during the previous 12 months. Such women were more likely than non-concurrent users to indicate that the “most often visited health care place” was a “hospital emergency room or outpatient department or some other place” or a “clinic or health center,” as opposed to an “HMO or doctor’s office.” Concurrent alcohol use or heavier use of alcohol and cigarette smoking among women of childbearing age is an important public health concern in the United States. The findings of this study highlight the importance of screening and behavioral counseling interventions for excessive drinking and cigarette smoking by health care providers in both primary care and emergency department settings.     

VIOLENT CRIME: THE ROLE OF ALCOHOL AND NEW APPROACHES TO THE PREVENTION OF INJURY

Almost all evidence of a link between alcohol consumption andviolence is available only in the form of aggregate data. Thisis unsatisfactory and case-control investigations and studieswhich relate injury severity to blood alcohol levels are needed.In the few closely controlled studies which have been performed,increased risk of injury in assault has been linked with bingeconsumption of more than about 8 units, and above average weeklyconsumption only in those over 25 years. Raising the minimumpurchasing age for alcohol to 21 years, learning to drink responsiblywith parents, especially fathers, and the adoption of temperedglassware are all achievable objectives which would reducedalcohol-related injury. The use of sobriety-checkpoints (breathtesting though not by the police) and other situational preventionprogrammes need to be evaluated in relation to reducing injurysustained in violet crime. Proactive, community policing hasbeen shown to reduce levels of alcohol-related violent crime,in contrast to more reactive, defensive and confrontationalpolicing. The concept of ‘capable guardianship’to establish and maintain social control of young delinquentsneeds to be extended, particularly near known foci of violencesuch as bars and adjacent fast-food outlets and taxi-ranks.     

Substance-abusing urban homeless in the late 1990s: How do they differ from non-substance-abusing homeless persons?

Much of our understanding of substance abuse and homelessness comes from data from the 1980s and may not necessarily reflect issues or trends prevalent during the 1990s. We report data from a two-city, community-based, populations-proportionate sample of 531 randomly selected homeless adults; the study was conducted in 1997 and compared substance-abusing to non-substance-abusing respondents. Most (78.3%) met criteria for substance abuse/dependence and were abusing either cocaine or alcohol and cocaine (68.5%). In the multiple logistic regression model, male gender (odds ratio [OR] 2.94, 95% confidence interval [CI] 1.70–5.09), less than a 12th grade education (OR 1.96, 95% CI 1.11–3.46), bustling or stealing for sustenance (OR 3.14, 95% CI 1.15–8.55), and identifying a need to learn how to manage one’s money (OR 2.41, 95% CI 1.45–3.98) were independently associated with substance abuse/dependence. Drug abuse/dependence and polysubstance use among urban homeless persons became a more prevalent issue in the late 1990s. These individuals have unique needs that will require tailored interventions.     

ALCOHOL HABITS IN SWEDISH WOMEN: OBSERVATIONS FROM THE POPULATION STUDY OF WOMEN IN GOTHENBURG, SWEDEN 1968-1993

In a prospective population study of women in Gothenburg, Sweden,three examinations were conducted with 12-year intervals between1968–1969 and 1992–1993. There were 1462 participantsaged 38–60 years in the baseline study in 1968–1969,with a participation rate of 90.1%. This paper describes longitudinalchanges and secular trends with respect to women's alcohol habits.An alcohol frequency questionnaire was validated at baselineand was re-administered at all examinations. Between 1968–1969and 1980–1981, the proportion of alcohol abstainers decreasedsignificantly both in 38-year-old and 50-year-old women. Womenreporting alcohol intake at least once per week had higher socio-economicstatus and higher education than other women. Serum     

DETERMINING THE EFFECTS OF MEDIA PORTRAYALS OF ALCOHOL: GOING BEYOND SHORT TERM INFLUENCE

The presentation of alcohol by the mass media has been a richsource of research into the potential influence of media messagesupon their audience. This paper reviews the existing literaturein this field. It is noted that research has concentrated onattempts to measure the strength of media ‘effects’,employing techniques which have so far produced few fruitfulresults. The impact of media output on alcohol also has implicationsfor the evaluation of alcohol-related health education campaigns,which utilize newspapers and television as an information sourcefor members of the public. The role of the media in settingthe public and policy agenda is examined as a potentially morefertile source in evaluating media influence. A number of policyand research implications are highlighted.     

Correlates of Sexual Risk Behaviors Among High School Students in Colorado: Analysis and Implications for School-based HIV/AIDS Programs

Objectives of this study are to examine correlates of antecedent sexual risk exposures associated with HIV/AIDS infection among adolescents participating in the 2005 Colorado Youth Behavioral Risk Survey (CYBRS), and to determine gender differences associated with these exposures since previous studies have produced mixed findings. Variables assessing these relationships were drawn from CYBRS, 2005. We used χ² to assess bivariate relationships and multinomial logistic regression to evaluate associations among dependent variables (sexual risk behaviors, age at first sex, and number of sexual partners in the past 3 months) and independent variables (in-school HIV/AIDS education, use of illegal substances, physically forced sex, and alcohol use). We found no significant effect of having received in-school HIV/AIDS education on all outcome measures. Compared with females, males were more likely to initiate sex at a relatively younger age, report unprotected sex with multiple partners, and drink alcohol before sexual intercourse. Among females, using 2 illegal substances increased the odds of early sexual debut by 12 times, while using ≥3 substances increased the same odds to 44-fold. Likewise, binge drinking was also associated with higher odds of having multiple partners. Hispanic ethnicity and physically forced sex variables were consistently associated with high risk sexual behaviors, early sexual initiation, and increased number of sexual partners. Efforts to control the HIV/AIDS epidemic among adolescents may need to focus on targeted interventions aimed at addressing gender- and racial/ethnic-specific risk exposures among this population group, including risk behaviors linked with lifetime physically forced sex. The need to re-examine the role of in-school HIV prevention programs to build adequate competencies among students, parents and community leaders to reduce risk exposures associated with HIV/AIDS infection among youth is emphasized.     

From gender bias to gender awareness in medical education

Gender is an essential determinant of health and illness. Gender awareness in doctors contributes to equity and equality in health and aims towards better health for men and women. Nevertheless, gender has largely been ignored in medicine. First, it is stated that medicine was ‘gender blind’ by not considering gender whenever relevant. Secondly, medicine is said to be ‘male biased’ because the largest body of knowledge on health and illness is about men and their health. Thirdly, gender role ideology negatively influences treatment and health outcomes. Finally, gender inequality has been overlooked as a determinant of health and illness. The uptake of gender issues in medical education brings about specific challenges for several reasons. For instance, the political-ideological connotations of gender issues create resistance especially in traditionalists in medical schools. Secondly, it is necessary to clarify which gender issues must be integrated in which domains. Also, some are interdisciplinary issues and as such more difficult to integrate. Finally, schools need assistance with implementation. The integration of psychosocial issues along with biomedical ones in clinical cases, the dissemination of literature and education material, staff education, and efforts towards structural embedding of gender in curricula are determining factors for successful implementation. Gender equity is not a spontaneous process. Medical education provides specific opportunities that may contribute to transformation for medical schools educate future doctors for future patients in future settings. Consequently, future benefits legitimize the integration of gender as a qualitative investment in medical education.     

MEDICAL EDUCATION ABOUT ALCOHOL: REVIEW OF ITS ROLE AND EFFECTIVENESS

Many reports have described inadequate responses by doctorsto problems associated with alcohol misuse. Low levels of medicalknowledge and inappropriate attitudes continue to be documentedin the alcohol area. However, in recent years, greater emphasishas been placed on the need to improve doctors' skills in relationto alcohol problem detection and intervention. Experientialteaching approaches have been recommended and strategies whichincorporate feedback methods offer considerable promise. Inthe United Kingdom and Canada, there has been no centrally fundedapproach to improve alcohol medical education. In contrast,federally funded initiatives in the United States of Americaand Australia have been associated with impressive increasesin alcohol-related teaching hours and elective opportunities.Despite the substantial effort invested in achieving these curriculumgains, there is a dearth of research demonstrating impacts onmedical behaviours or evaluating the cost-effectiveness of differenteducational strategies. Evidence from trials in smoking cessationtraining indicate that well-designed programmes can alter doctorbehaviours in relation to substance abuse. If the alcohol medicaleducation field is to progress, there is an urgent need forthe development and evaluation of programmes which are betterdesigned and are more informed by theory.     

ALCOHOL CONTROL POLICY IN ISRAEL 1986-1987: RECOGNIZING THE NEED FOR DIVERSE PRIMARY PREVENTION INITIATIVES

The purpose of this paper is to describe the recent integrationof two different preventive models (the ‘Distributionof Consumption Model’ and the ‘Social Science Model’),planned to support each other, in order to reduce per capitaalcohol consumption and curb the rise in alcohol-related problemsin Israel, to shed light on the Israeli laws regulating alcoholuse and on the extent of their enforcement, to illustrate thecauses for their enforcement and to discern some indicationsfor future directions. Although the focus on attitudes and practiceswhich lead to excessive drinking, and the efforts to changethem through education remain the very core of the entire Israelipreventive program, alcohol itself has been considered to bea source of difficulties. The beginning of law-enforcement concerningits availability among youngsters and drivers has emerged, bothas a result of several fatal events and intense pressures ofthe Israeli Alcoholism Prevention and Treatment Services. Thepresent tasks are to reinforce the emerging trends of enforcementconcerning the existing laws, to adopt some new regulationspertaining to alcohol advertising targeted at adolescents, andto continue with the educational messages based on Jewish-Israelinorms.     

Disentangling Adolescent Pathways of Sexual Risk Taking

Using data from the National Longitudinal Survey of Youth, the authors aimed to describe the pathways of risk within sexual risk taking, alcohol use, and delinquency, and then identify how the trajectory of sexual risk is linked to alcohol use and delinquency. Risk trajectories were measured with adolescents aged 15–24 years (N = 1,778). Using Latent Class Growth Analyses (LCGA), models indicated that the majority of adolescents engaged in sexual risk and alcohol use. In joint trajectory analyses, LCGA revealed six risk taking classes: sex and alcohol, moderate risk taking, joint risk taking, moderate alcohol, alcohol risk, and alcohol and delinquency experimentation. Editors’ Strategic Implications: School administrators and curriculum designers should pay attention to the study’s findings with respect to the need for prevention programs to target early adolescents and integrate prevention messages about alcohol use and sexual risk taking.     

PREVENTION OF ALCOHOL ABUSE-RELATED BIRTH EFFECTS -- I. PUBLIC EDUCATION EFFORTS

Maternal alcohol abuse during pregnancy can result in a patternof anomalies in children called ‘fetal alcohol syndrome’(FAS) and more recently, ‘fetal alcohol abuse syndrome(FAAS)’. FAAS as well as individual alcohol-related anomalies,called ‘alcohol abuse-related birth effects’ (AARBEs),are widely considered to be totally preventable, because theystem from a behaviour that is presumably modifiable. However,current strategies to reduce their occurrence are more palliativethan preventive, because their underlying premise, viz, thatraising public awareness of the potential dangers of commonlyused substances such as alcohol is enough to reduce their use,lacks empirical support. Moreover, in some cases they are alsocounter-productive. After considenng the relevant literature,this review contends that ‘universal’ public educationefforts will only be effective in reducing FAAS and AARBEs ifthey focus on the cause of these disorders, which is alcoholabuse rather than the currently open-ended message that anyamount of alcohol consumption during pregnancy constitutes adanger to an unborn child. This argument lays the ground workfor an alternative and more pragmatic strategy set forth inthe following paper for preventing FAAS and AARBEs.     

Alcohol consumption by refuse collection workers: a problem of public health]

A total of 485 workers were interviewed employed by the municipal urban refuse collection corporation of Venice; 87.6% consumed alcoholic beverages, 24.5% of whom exceeded 1 litre of wine per day. Only 9.7% of the interviewees thought that an acceptable alcohol consumption level should not exceed 1 litre, whereas more than 23% thought that 2 or more litres of wine per day was not harmful. The variables associated with a high alcohol consumption in this working community were mainly: level of education and of specific knowledge about alcohol and long-term residence in the historical centre of Venice. The authors discuss the possible factors connected with the type of job which could influence the incentive to drink and the public hygiene actions that could be taken. The need for community medicine programmes is emphasized.     

Physicians' attitudes and beliefs concerning alcohol abuse prevention in adolescents.

BACKGROUND: Primary alcohol abuse-prevention services delivered to adolescents are inadequate, despite the fact that alcohol abuse is a major health problem. Physicians' attitudes and beliefs regarding primary prevention of adolescent alcohol abuse and appropriate onset ages of alcohol use may be useful in understanding why delivery of prevention services is inadequate, but as yet has not been investigated. OBJECTIVES: To examine (1) physicians' attitudes and beliefs regarding alcohol abuse prevention and practice, and (2) correlates of these attitudes and beliefs, including the delivery of primary alcohol abuse-prevention services to adolescents. METHODS: A national, stratified random sample of pediatricians and family practitioners was drawn from the American Medical Association's Masterfile Registry. Inclusion criteria included active medical practice and seeing at least one adolescent per week. The response rate was 63%, resulting in a final sample of 1842 physicians. Participants were queried about their practice, alcohol use, attitudes and beliefs, and delivery of alcohol-related screening and education to adolescents. RESULTS: On average, physicians reported providing alcohol-related screening to 40.3% (standard error [SE]=0.6) and education to 52.0% (SE=0.8) of their adolescent patients. Participants had positive attitudes toward adolescents, believed that prevention was important, and approved of alcohol screening early in adolescence, but did not feel very comfortable about their adolescent alcohol-management skills. Except for ceremonial use, most physicians did not believe in underage drinking. Attitudes and beliefs were significantly related to the delivery of alcohol screening (R(2)=0.34, p < 0.001) and education (R(2)=0.18, p < 0.001). Participants who delivered more screening and education had more positive beliefs in the importance of prevention (beta=0.14 and beta=0.13, respectively; p < 0.001); approved of early alcohol screening (beta=0.29 and beta=0.09, respectively; p < 0.001); and were more comfortable with their alcohol management skills (beta=0.31 and beta=0.28, respectively; p < 0.001). A profile of physicians with positive attitudes and beliefs is presented. CONCLUSIONS: Physician attitudes and beliefs are associated with variations in alcohol screening and education services delivered to adolescents. A better understanding of physicians' attitudes and beliefs can be useful in providing physician education and training aimed at improving primary alcohol-abuse prevention.