Alcohol is the drug of choice among young people in the United States, and alcohol use constitutes one of the principal public health issues for this population. Approximately 5,000 persons under 21 years of age lose their lives each year as a result of underage drinking, and early initiation of alcohol use is associated with increased risk of subsequent alcohol use disorders and increased risk of involvement in violent behaviors, suicide attempts, and a variety of other problematic activities. In response to this issue, this study presents findings from the 2002 to 2006 National Surveys on Drug Use and Health (NSDUHs) on the use of alcohol by persons aged 12 to 20.
NSDUH is an annual survey of the civilian, noninstitutionalized population of the United States aged 12 or older. The survey is sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services and is planned and managed by SAMHSA's Office of Applied Studies (OAS). Data collection is conducted under contract with RTI International, Research Triangle Park, North Carolina.1 Selected key findings from this study are described below.
Prevalence of Underage Drinking Behaviors in 2006
In 2006, more than half (53.9 percent) of persons aged 12 to 20 (20.6 million persons) had used alcohol in their lifetime, almost half (46.1 percent, 17.6 million) had used it in the past year, and more than a quarter (28.3 percent, 10.8 million) had used it in the past month (current use). One in five persons in this age group (19.0 percent, 7.2 million) engaged in binge alcohol use, meaning they had consumed five or more drinks of alcohol on at least one occasion in the past month. This includes 2.4 million (6.2 percent of persons aged 12 to 20) who drank heavily, defined as 5 or more days of binge alcohol use in the past month.
Trends in Underage Current and Binge Drinking>
Between 2002 and 2006, rates of current and binge drinking among those aged 12 to 20 remained stable. Current use among underage persons was 28.8 percent in 2002 and 28.3 percent in 2006, while binge use was 19.3 percent in 2002 and 19.0 percent in 2006.
There were varying trends by age. Among youths aged 12 to 14, there was no change in current or binge alcohol use between 2002 and 2006, but past year use declined from 17.6 to 16.2 percent. Among 15 to 17 year olds, the rates declined from 2002 to 2006 for past year use (from 52.3 to 48.7 percent) and current use (from 28.3 to 26.1 percent), but binge use remained stable. There were no changes for 18 to 20 year olds in any of these alcohol use measures from 2002 to 2006.
Sociodemographic and Geographic Differences in Underage Drinking
Combined data from 2002 to 2006 indicated that rates of current (past month) alcohol use were 7.0 percent for youths aged 12 to 14, 27.5 percent for youths aged 15 to 17, and 51.3 percent for 18 to 20 year olds. Binge alcohol use rates for these age groups were 3.3, 17.8, and 36.3 percent, respectively.
Underage males were more likely than underage females to be current alcohol users (29.4 percent for males, 27.8 percent for females) and binge drinkers (21.6 percent for males, 16.5 percent for females). Among youths aged 12 to 14, the rate of current drinking was higher for females (7.7 percent) than males (6.3 percent), but there was no gender difference in the rate of binge drinking. For those aged 15 to 17, males and females did not differ in the rate of current alcohol use, but binge drinking was higher for males than females (19.0 vs. 16.5 percent). Among those aged 18 to 20, males had higher rates of current and binge drinking than females.
Past month underage alcohol use was higher among non-Hispanic whites (32.6 percent) than Hispanics (25.7 percent), who in turn had a higher rate than blacks (18.8 percent). Underage current drinking rates were 27.2 percent among American Indians or Alaska Natives and 17.1 percent among Asians.
One third (33.9 percent) of persons aged 12 to 20 whose family income was less than $20,000 consumed alcohol in the past month, higher than the rate among those with a family income in any category over $20,000. The rate of current alcohol use among underage persons in the highest income category ($75,000 or more) was 28.6 percent, higher than the rate for those with a family income of $20,000 to $49,999 (26.0 percent) and $50,000 to $74,999 (26.4 percent). A similar pattern was found for binge drinking.
Underage persons who lived in nonmetropolitan areas were more likely than those who lived in metropolitan areas to engage in binge drinking (20.8 percent in nonmetropolitan areas, 18.8 percent in metropolitan areas). The rate of current drinking among underage persons was 29.4 percent among those who lived in nonmetropolitan areas and 28.5 percent among those who lived in metropolitan areas, though this difference was not statistically significant.
Among underage persons who lived in metropolitan areas, the prevalence of current drinking was higher for non-Hispanic whites (33.2 percent) than for Hispanics (25.3 percent). Among those who lived in rural areas, however, Hispanics had a higher prevalence of current drinking (32.4 percent) than whites (28.9 percent).
Rates of current and binge alcohol use among 12 to 20 year olds were higher in the Northeast and Midwest than in the South or West. For example, 21.4 percent of those in the Northeast and 21.8 percent of those in the Midwest engaged in binge drinking compared with 17.3 percent of those in the South and 17.8 percent of those in the West. Among the 10 States with the highest rates of binge drinking, 4 were in the Midwest (Iowa, North Dakota, South Dakota, and Wisconsin), and 4 were in the Northeast (Massachusetts, New Hampshire, Rhode Island, and Vermont).
Alcohol Use Disorders among Persons Aged 12 to 20
Combined data from 2002 to 2006 indicated that an annual average of 9.4 percent of persons aged 12 to 20 (3.5 million persons in that age range) met the diagnostic criteria for an alcohol use disorder (dependence or abuse) in the past year.
Among all persons aged 12 to 20, a higher percentage of males (10.3 percent) than females (8.5 percent) had an alcohol use disorder, though this pattern varied by age group. Among youths aged 12 to 14, a higher percentage of females (2.2 percent) than males (1.6 percent) were classified with an alcohol use disorder. In contrast, among 18 to 20 year olds, a higher percentage of males (19.6 percent) than females (13.4 percent) were classified with an alcohol use disorder.
The rate of past year alcohol use disorder among persons aged 12 to 20 was higher for American Indians or Alaska Natives (14.9 percent) than for whites (10.9 percent), blacks (4.6 percent), Hispanics (8.7 percent), and Asians (4.9 percent). One in eight Native Hawaiians or Other Pacific Islanders (12.7 percent) met the criteria for an alcohol use disorder.
Association of Underage Drinking with Parental Alcohol Use
Rates of current and binge alcohol use among underage persons were higher among persons aged 12 to 20 who lived with a mother or father who had consumed alcohol in the past year compared with those who lived with a mother or father who had not consumed alcohol in the past year. For example, rates of binge drinking among underage persons were 17.6 percent for those whose mother was a past year drinker versus 9.3 percent for those whose mother was not a past year drinker, and 16.5 percent for those whose father was a past year drinker versus 10.2 percent for those whose father was not a past year drinker. Rates of underage binge drinking were also higher among those aged 12 to 20 who lived with a mother (21.3 percent) or father (19.5 percent) who was a binge drinker than among those whose mother (17.5 percent) or father (15.4 percent) was a current drinker but not a binge drinker.
Social Context of Last Alcohol Use
In 2006, 80.9 percent of persons aged 12 to 20 who had consumed alcohol in the past month were with two or more people the last time they drank alcohol, 14.3 percent were with one other person the last time they drank, and 4.9 percent were alone. Underage persons who drank with two or more other people on the last occasion in the past month had more drinks on the last occasion on average (4.9 drinks) than those who drank with one other person (3.1 drinks) or those who drank alone (2.9 drinks).
Among current drinkers, youths aged 12 to 14 were more likely to have been alone (9.0 percent) or with one other person (21.9 percent) the last time they drank compared with youths aged 15 to 17 (5.2 percent alone and 14.6 percent with one other person) or 18 to 20 year olds (4.2 percent alone and 13.2 percent with one other person).
Location of Last Alcohol Use
A majority of underage current drinkers in 2006 reported that when they last used alcohol they were either in someone else's home (53.4 percent) or their own home (30.3 percent).
Drinkers aged 12 to 14 were more likely to have been in their own home the last time they drank (38.8 percent) and less likely to have been in someone else's home (45.0 percent) compared with underage drinkers in older age groups (26.0 and 60.9 percent, respectively, for those aged 15 to 17, and 31.4 and 50.7 percent, respectively, for those aged 18 to 20). Drinkers aged 18 to 20 were more likely than those in younger age groups to have been in a restaurant, bar, or club on their last drinking occasion (12.9 percent for those aged 18 to 20 vs. 4.6 percent for those aged 12 to 14 and 3.7 percent for those aged 15 to 17).
Sources of Alcohol
Among all underage current drinkers, 31.0 percent paid for the alcohol the last time they drank, including 9.3 percent who purchased the alcohol themselves and 21.6 percent who gave money to someone else to purchase it. Underage persons who paid for alcohol themselves consumed more drinks on their last drinking occasion (average of 5.9 drinks) than did those who did not pay for the alcohol themselves (average of 3.9 drinks).
More than one in four underage drinkers (25.8 percent) indicated that on their last drinking occasion they were given alcohol for free by an unrelated person aged 21 or older. One in sixteen (6.4 percent) got the alcohol from a parent or guardian, 8.3 percent got it from another family member aged 21 or older, and 3.9 percent took it from their own home.
Underage persons in older age groups were more likely to have paid for alcohol themselves on their last drinking occasion, with 37.6 percent of 18 to 20 year olds paying for it themselves compared with 23.5 percent of 15 to 17 year olds and 6.6 percent of 12 to 14 year olds. Among underage drinkers, males were more likely to have paid for alcohol themselves on their last drinking occasion (36.7 percent) than were females (24.5 percent).
Underage Drinking and Illicit Drug Use
In 2006, more than one third (35.8 percent) of persons aged 12 to 20 who used alcohol in the past month also had used an illicit drug in the past month, and 16.0 percent of underage drinkers used an illicit drug within 2 hours of using alcohol on their last occasion of alcohol use.
Marijuana was the illicit drug most used by underage drinkers, with nearly one third (30.0 percent) having used marijuana in the past month, and 15.0 percent having used marijuana within 2 hours of their last alcohol use.
1 RTI International is a trade name of Research Triangle Institute.