The epidemiology of underage drinking in the United States: an overview

Flewelling, R.L.; Paschall, M.J.; and Ringwalt, C.

National Research Council and Institute of Medicine, Reducing underage drinking: a collective responsibility, background papers.[CD-ROM], pgs. 319-350 (2004)

Alcohol is by far the most widely used psychoactive substance in the United States. This is true for both adults and adolescents, even though the minimum legal age for drinking is 21 in all states. Underage drinking is a pressing public health and safety concern due to the very high prevalence of this behavior and the correspondingly high costs it exacts, either directly or indirectly, in terms of lost lives, injury and disability, illness, damaged interpersonal relationships, and lost productivity. In addition, early involvement with drinking has been shown to increase the likelihood of alcohol-related problems as an adult (Grant and Dawson, 1997; Hingson, Heeren, Levenson, and Voas, 2002).

The purpose of this chapter is to provide an overview of what is known about the prevalence, patterns, and trends of underage drinking in this country from an epidemiological perspective. The information presented is based primarily on data that are available from large-scale national surveys that have been conducted regularly for many years. It also focuses on what might be considered fairly basic measures and patterns of alcohol use, and breakdowns in these measures according to standard demographic characteristics such as age, gender, and race-ethnicity. These demographic characteristics should not be viewed as the causes of observed differences in alcohol use patterns across subgroups. Rather, they serve as easily-identified markers for subgroups of the population that may share relatively similar experiences, accumulated over the life course, that help to shape alcohol-related attitudes, beliefs, and drinking behaviors.

Creditable information on the scope, demographic patterns, and trends in underage drinking behaviors provides an important empirical foundation in helping justify and prioritize needs for policies and programmatic efforts to address this problem and reduce its negative public health consequences. Rigorous analysis of even more detailed epidemiologic data can also contribute to our understanding of the factors that influence this behavior and help suggest more specific strategies for preventing it. Because the purpose of this chapter is to provide a broad overview of underage drinking patterns and trends, rather than examine etiological factors, it does not include complex analyses that simultaneously involve or control for multiple variables. Research based on such strategies, however, will be cited in a number of the more substantively focused chapters in this volume in order to support particular perspectives on underage drinking and approaches for addressing the problem.